# Association of Women Surgeons Blog > AWS Blog > Generated by All in One SEO Pro v5.0.3, this is an llms-full.txt file, used by LLMs to index the site. ## Posts ### [The Surgeon Everyone Wants to Work With](https://blog.womensurgeons.org/the-surgeon-everyone-wants-to-work-with/) **Published:** October 7, 2026 **Author:** Blog Team **Content:** **Author: Smruti K. Patel, MD FAANS FACS FCNS FAAP** Every surgeon remembers them. The attending whose operating room felt calm even during chaos. The surgeon whose team was fully engaged. The leader whose nurses, residents, anesthesiologists, and colleagues genuinely looked forward to working with them. Their technical skill may have been exceptional but that wasn’t what made them memorable. What set them apart was how they made others feel. In medicine, we spend years developing our technical abilities. We learn anatomy, master procedures, and refine our clinical judgment. Yet, as our careers progress, it becomes increasingly clear that technical excellence alone is not what defines the most effective surgeons. The surgeons who have the greatest impact are often the ones who build trust, inspire confidence, communicate clearly, and create environments where teams can thrive. In other words, they become the surgeons everyone wants to work with. **Technical Excellence Is Expected** Patients deserve technical mastery. Colleagues expect competence. Surgical training is built around developing expertise. But technical skill is the entry ticket, not the differentiator. Every department has technically gifted surgeons. Yet some consistently attract strong teams, exceptional trainees, and loyal collaborators. Why? Because people choose to work with leaders who make them better. The surgeon everyone wants to work with understands that surgery is fundamentally a team sport. No operation succeeds because of one person alone. Every outcome reflects the performance of an entire system of people working together under pressure. **They Make It Safe to Speak Up** One of the most important qualities of an effective surgeon is creating psychological safety. In healthcare, silence can be dangerous. The circulating nurse who notices a discrepancy. The resident who sees something unexpected. The anesthesiologist who has a concern. The junior team member who feels uncertain. The best surgeons create an environment where every member of the team feels comfortable speaking up. They ask questions. They invite input. They listen. Most importantly, they respond respectfully when concerns are raised. Psychological safety is not about being agreeable. It is about creating a culture where patient safety always outweighs hierarchy. The surgeon everyone wants to work with understands that a team willing to speak up is a team that protects patients. **They Stay Calm When Things Go Wrong** Every surgeon eventually encounters crisis. Unexpected bleeding. Difficult anatomy. Equipment failure. A rapidly deteriorating patient. In these moments, leadership becomes particularly visible. Teams take emotional cues from their leader. When the surgeon becomes reactive, frustrated, or overwhelmed, the entire room feels it. Conversely, when the surgeon remains calm, focused, and deliberate, the team gains confidence. One of the most important leadership lessons in surgery is this: **In moments of crisis, the room borrows the emotional stability of the surgeon.** The surgeons everyone wants to work with are not necessarily the ones who never encounter problems. They are the ones who lead effectively when problems arise. **They Respect Everyone in the Room** The operating room contains individuals with different levels of expertise, experiences, and responsibilities. The strongest leaders recognize that respect is not something reserved for peers or superiors. It extends to **everyone.** The scrub technician who anticipates needs. The nurse who catches an error. The resident learning a new skill. The anesthesiologist managing a challenging airway. Respect builds trust. Trust builds communication. Communication improves outcomes. The surgeon everyone wants to work with understands that every member of the team contributes to success. **They Teach While They Lead** Great surgeons do more than perform operations. They develop people. Trainees remember the surgeons who challenged them while preserving their confidence. Teams remember leaders who invested in their growth rather than simply directing tasks. Teaching is not limited to residents. Every interaction in the operating room creates an opportunity to coach, mentor, and elevate those around us. The most influential surgeons leave behind more than a case log, an innovation, or an instrument named after them. They leave behind stronger surgeons, stronger nurses, and stronger teams. **They Understand That Culture Matters** Culture is often described as “how we do things around here.” In surgery, culture influences everything. It determines whether concerns are voiced or ignored. Whether mistakes become learning opportunities or sources of shame. Whether teams feel energized or exhausted. The surgeon everyone wants to work with understands that culture is created one interaction at a time. It is shaped by how we respond under stress. How we communicate during conflict. How we treat people when no one is watching. **Leadership is NOT an occasional act. It is a** **daily** **practice.** **A New Definition of Surgical Excellence** For decades, surgery celebrated technical prowess above all else. Today, our understanding of excellence is evolving. The most effective surgeons are technically outstanding, but they are also emotionally intelligent, collaborative, and self-aware. They command respect without demanding it. They create accountability without creating fear. They lead without diminishing others. Women in surgery have helped challenge the traditional archetype of the surgical leader, demonstrating that empathy, emotional intelligence, collaboration, and psychological safety are not ‘soft’ leadership skills—they are the qualities that make people want to follow you and teams want to work with you. Not by changing the expectations of excellence, but by expanding them. Because at the end of a career, people may not remember every operation you performed, the papers you wrote, or the awards you won. **But they will remember how you made them feel.** They will remember whether they learned from you, trusted you, and grew because of you. And perhaps the highest compliment a surgeon can receive is not that they were the most technically gifted person in the department. It is that they were the surgeon everyone wanted to work with. *This article draws on work by Amy Edmondson on psychological safety, Atul Gawande’s writings on surgical systems and teamwork, TeamSTEPPS patient safety research, and contemporary studies on operating room communication, leadership, and team performance.* ![](https://blog.womensurgeons.org/wp-content/uploads/2026/10/smruti-731x1024.jpg)**Dr. Patel** is a board-certified pediatric neurosurgeon at Cincinnati Children’s Hospital Medical Center and Associate Professor of Neurosurgery at the University of Cincinnati College of Medicine. She serves as the Associate Program Director of the University of Cincinnati Department of Neurosurgery Residency Program and Associate Fellowship Director for Pediatric Neurosurgery. She completed her medical school education at Rutgers, New Jersey Medical School, neurosurgery residency at the University of Cincinnati Medical Center, and her pediatric neurosurgery fellowship at Cincinnati Children’s Hospital Medical Center. Her main clinical interests include pediatric brain tumor and skull base surgery, longitudinal care for patients with spina bifida from in utero to transition to adulthood, and neurosurgical tone management for cerebral palsy and other related disorders. Across her roles as a surgeon, educator, program builder, and mentor, Dr. Patel has sought to model a form of surgical leadership grounded not only in excellence and accountability, but in trust, collaboration, mentorship, and creating teams that people genuinely want to be part of. **Categories:** career development, leadership, women **Tags:** expert, leadership, psychological saftey, surgeon --- ### [Art of the Scalpel: Lessons from French Impressionism to Scientific Innovation](https://blog.womensurgeons.org/art-of-the-scalpel-lessons-from-french-impressionism-to-scientific-innovation/) **Published:** September 10, 2026 **Author:** Blog Team **Content:** By: Tracey Pu M.D. The art of the scalpel extends past the operating room, with its influence on our patients’ lives extending beyond the hours spent underneath the fluorescent lights.. As surgeons, we are entrusted with the honor of healing our patients by our hand, both figuratively and literally. The privilege of saving a life is an art, and surgeons serve as artists in the most complex surgeries ranging from pancreaticoduodenectomies to thoracic aortic dissection repairs. However, in pursuit of scientific perfection, it is often easy for the art of medicine to fall to the wayside. Innovation is often born out of challenges against the status quo, and innovation remains paramount within the dichotomy of art and science. For example, amongst the most recognizable artists in the contemporary world are Claude Monet, Edward Degas, and Pierre-Auguste Renoir. The French Impressionists’ pastel impasto and fluid brushstrokes capturing sunlight dancing on water lilies are often recognized by even our youngest counterparts, with decorations often gracing the halls of pre-kindergarten schools. These free flowing brushstrokes are often acknowledged as the height of artistic achievement, with over 4.9 million visitors annually flocking to the Musée d’Orsay and the Musée De l’Orangerie for the artistic pilgrimage to witness Monet’s Water Lilies bathing in natural light.1 However, at the time of the conception of French Impressionism, the bold tactics emphasizing characterization of light were not widely accepted. In fact, the term “Impressionism” was derived from a derogatory scathing review from art critic, Louis Leroy, for which he wrote that a “wallpaper in its embryonic state is more complete” regarding Monet’s Impression, soleil levant, 1872.2 French Impressionism was, in fact, a direct departure from disillusioned traditional romanticism in art promoted by the Academie des Beaux-Arts, which often drew its premise from academic literature or religious context. Common recurring themes and subject matter of the French Impressionists brought accessibility to the working class, with depictions of everyday life and capturing the ethereal light of landscapes highlighting everyday citizens rather than religious figures with artistic interpretation hinging upon education in biblical folklore. This artistic rebellion challenged the norm of classical art precedence, which had previously made art inaccessible to the working and middle classes. Additionally, French Impressionism hinted at technological reform through the new available brightly colored pigments and depictions of newly minted locomotion. The Industrial Revolution allowed for unprecedented global collaboration, with many French Impressionists drawing inspiration from Japanese motifs. Incorporation of Japanese cultural references can be seen in many pieces, such as the overt representation of Japanese patterns and folklore in La Japonaise by Claude Monet to the subtle use of asymmetry and negative space in L’Abstinthe by Edgar Degas.3 Integration of global influences further increases accessibility to diverse audiences, amplifying the outreach of these paintings for decades to come. A similar parallel can be drawn from these art history lessons to scientific advancement in cancer therapies. With innovation underway, a large gap remains in implementation and research. For example, despite rising cases of pancreatic cancer in the United States in the last decade, overall mortality has stagnated4, suggesting a need for novel therapies and improvement of access of care of our cancer patients. Recent groundbreaking trials in the past year have included pancreatic cancer vaccines5,6 and daraxonrasib, a pan-RAS inhibitor7. However, a pervasive need remains for increasing effective enrollment strategies for modern clinical trials to improve access to these novel therapies, as many marginalized populations are unfortunately systemically excluded in clinical trial accrual.8-12 How do we promote systemic change at a national scale? Implementation remains a considerable challenge in the modern era, both at the local and national level. Proposed mechanisms of sustainable change have included efforts by national societies such as Association of Women Surgeons, American College of Surgeons, Society of Surgical Oncology, and American Society of Clinical Oncology.13-15 Large national accrediting bodies such as the American College of Surgeons Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC) have demonstrated feasibility of employing new standards in cancer care on a national level, leading to deliverance of novel quality improvement initiatives to both academic and community hospitals while simultaneously improving access to guideline-concordant care to marginalized populations. 16,17 Another suggested mechanism of change has been utilizing legislation and incentives at the state level to increase access to cancer care through public health policy, such as targeting deficit areas identified via social determinants of health.18 For example, the State of California has previously passed the California Cancer Care Equity Act (CCEA) which expanded access to NCI comprehensive cancer centers and provided reimbursement of non-clinical expenses including travel, parking, lodging and loss wages.19 In identification of unmet needs for barriers to receipt of cancer care, optimization of distribution of novel therapies can continue to improve via these legislative efforts. Indicators of social determinants of health can serve as a potential framework to identify targets for public health initiatives. Nonetheless, the critical need for innovation and improvement of access to care remains omnipresent. As “artists” in the field of surgery, continuous advancement in research and dissemination of novel therapies to vulnerable populations is paramount. Change may often feel uncomfortable, but we must take a leap of faith to continue progress. Driving incremental change in therapeutics and healthcare delivery may be the first step in creating a more equitable future for our patients. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/09/Dr.-Pu-2-819x1024.jpg) **Dr. Tracey Pu** is currently a general surgery resident at the University of Alabama at Birmingham and an aspiring HPB Surgical Oncologist. Dr. Pu graduated from Wake Forest University with Honors in Biology and Studio Art double major with a Chemistry Minor and completed medical school at Wake Forest School of Medicine. She completed a research fellowship at the National Institutes of Health (NIH)/National Cancer Institute (NCI) in the Surgical Oncology Program (2022-2025), with her research focused on how to leverage patient-derived organoid models to study novel kinase inhibitor therapies at the patient-level for gastroenteropancreatic neuroendocrine tumor liver metastases and the role of NFKB in liver metastasis tumorigenesis. Her research interests additionally include how to leverage health systems and policy for increasing access to cancer treatment and clinical trials. Dr. Pu serves as the RAS-ACS liaison for the Commission on Cancer and is involved in national quality improvement efforts surrounding the BeyondASK initiative, which aimed to increase smoking cessation assistance for all patients with new cancer diagnoses. Outside of the operating room, she enjoys photography, oil painting, and traveling. You can follow her at @TraceyPuMD on X. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/09/Dr.-Pu-Ink-Art-2-744x1024.jpg)References: 1\. Almost 4,915,000 visitors for the Public Establishment of the Musée d’Orsay and the Musée de l’Orangerie in 2025. Accessed 05/22, 2026. <https://presse-orsay-orangerie.epmo-musees.fr/almost-4915000-visitors-for-the-public-establishment-of-the-musee-dorsay-and-the-musee-de-lorangerie-in-2025/?lang=eng> 2\. Everything you need to know about Impressionism: how a group of rebel artists ‘freed painting’. Accessed 05/20, 2026. <https://www.christies.com/en/stories/impressionism-everything-you-need-to-know-f36956dac94a49b6a0f18f253d342cfb> 3\. Luo H. JAPONISM IN FRENCH IMPRESSIONISM: TRADITIONAL AESTHETIC ELEMENTS GAINING A NEW LIFE. Brown Art Review2023. 4\. Tan JY, Yeo YH, Ng WL, et al. Pancreatic cancer mortality trends in the United States: how much have we moved the needle? *Journal of Gastrointestinal Oncology*. 2024;15(4):1789-1795. 5\. Huff AL, Haldar SD, Girgis AA, et al. Mutant KRAS vaccine with dual checkpoint blockade in resected pancreatic cancer: a phase I trial. *Nat Commun*. Feb 10 2026;17(1):1538. doi:10.1038/s41467-026-68324-4 6\. Sethna Z, Guasp P, Reiche C, et al. RNA neoantigen vaccines prime long-lived CD8(+) T cells in pancreatic cancer. *Nature*. Mar 2025;639(8056):1042-1051. doi:10.1038/s41586-024-08508-4 7\. Wolpin BM, Park W, Garrido-Laguna I, et al. Daraxonrasib in Previously Treated Advanced <i>RAS</i>-Mutated Pancreatic Cancer. *New England Journal of Medicine*. 2026;394(18):1790-1802. doi:doi:10.1056/NEJMoa2505783 8\. Pu T, Gustafson A, Luberice K, et al. Underrepresentation of Racial and Ethnic Minorities in Metastatic Colorectal Carcinoma Clinical Trials Within the United States. *Ann Surg*. Feb 1 2026;283(2):316-325. doi:10.1097/sla.0000000000006500 9\. Andrasik MP, Broder GB, Wallace SE, et al. Increasing Black, Indigenous and People of Color participation in clinical trials through community engagement and recruitment goal establishment. *PLOS ONE*. 2021;16(10):e0258858. doi:10.1371/journal.pone.0258858 10\. Elshami M, Hue JJ, Hoehn RS, et al. A nationwide analysis of clinical trial participation for common hepato-pancreato-biliary malignancies demonstrates survival advantages for subsets of trial patients but disparities in and infrequency of enrollment. *HPB*. 2022;24(8):1280-1290. doi:10.1016/j.hpb.2021.12.022 11\. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. *Jama*. Jun 9 2004;291(22):2720-6. doi:10.1001/jama.291.22.2720 12\. Snyder RA, Chang GJ. Insurance Status as a Surrogate for Social Determinants of Health in Cancer Clinical Trials. *JAMA Network Open*. 2020;3(4):e203890-e203890. doi:10.1001/jamanetworkopen.2020.3890 13\. Patel MI, Lopez AM, Blackstock W, et al. Cancer Disparities and Health Equity: A Policy Statement From the American Society of Clinical Oncology. *Journal of Clinical Oncology*. 2020;38(29):3439-3448. doi:10.1200/jco.20.00642 14\. Chiba A, Möller MG, Cannada L, et al. It Takes a Village—Association of Women Surgeons’ Comprehensive Initiative for Healthy Surgical Families for Practicing Surgeons. *JAMA Surgery*. 2025;160(9):1012-1017. doi:10.1001/jamasurg.2025.2473 15\. Cortina CS, Molina G, Witt EE, et al. ASO Education and Training: Taking the Next Step in Surgical Oncology Health Disparities Research: Identifying Root Causes and Targets for Actionable Change. *Ann Surg Oncol*. Jun 2026;33(6):4928-4939. doi:10.1245/s10434-026-19221-z 16\. Chan K, Palis BE, Cotler JH, et al. Association of commission on cancer accreditation with receipt of guideline-concordant care and survival among patients with colon cancer. *World J Surg*. Jan 2025;49(1):34-45. doi:10.1002/wjs.12391 17\. Pu T, Burris JL, Matulewicz RS, et al. National Quality Improvement Initiative to Increase Smoking Cessation Assistance in Commission on Cancer Programs and National Accreditation Program for Breast Centers. *Journal of Clinical Oncology*. 0(0):JCO-25-01815. doi:10.1200/jco-25-01815 18\. Pu T, Gustafson A, Coleman KN, et al. Social Vulnerability Predicts State-Level Racial and Ethnic Disparities in Receipt of Treatment for Early-Onset Colorectal Cancer Patients with Metastatic Disease. SPRINGER ONE NEW YORK PLAZA, SUITE 4600, NEW YORK, NY, UNITED STATES; 2025:S205-S205. 19\. Diaz A, Loehrer A, Pawlik TM. Expanding Access to High-Quality Cancer Care Through Policy—California Cancer Care Equity Act. *JAMA Oncology*. 2024;10(1):27-28. doi:10.1001/jamaoncol.2023.5010 **Categories:** Uncategorized --- ### [Common Is Not Always Normal: An OB/GYN’s Reflection on Women’s Pain and the Silence We Inherit](https://blog.womensurgeons.org/common-is-not-always-normal-an-ob-gyns-reflection-on-womens-pain-and-the-silence-we-inherit/) **Published:** August 27, 2026 **Author:** Blog Team **Content:** **By Busra Ozkaya, MD** There is a sentence many girls hear from the time of their first menstrual period: “This is normal. It is just part of being a woman.” Most of the time, this sentence is spoken with kindness. It is meant to comfort a young girl, to ease her fear, and to remind her that she is not alone, but over time, the same sentence can become something else: a quiet curtain drawn over pain. As an obstetrician-gynecologist, I have learned that the word “normal” must be used carefully. Common is not always normal. Familiar is not always harmless. Pain that changes a girl’s or woman’s life deserves more than reassurance alone. During my OB/GYN training, I met many women who had carried pelvic or menstrual pain for years before giving it a name. Some had missed school, work, family responsibilities, or important moments in their lives because of symptoms they had been taught to tolerate. Others began their stories with an apology: “I know this is probably normal, but…” That apology stayed with me. Why should a woman feel the need to apologize before describing her pain? During my training in Turkey, I saw how culture, family expectations, and quiet endurance could shape the way women described pain. Some patients did not only describe symptoms; they described years of adjusting their lives around those symptoms. They had learned to function through pain before anyone had asked whether that pain deserved closer attention. A heating pad, an analgesic, or comforting words may help some patients, and sometimes they truly do. They should never replace the deeper clinical questions: Is this pain interfering with her life? Is this pattern changing? Has she been heard before? What diagnosis might we be missing because the symptom sounds familiar? This question matters deeply in conditions such as endometriosis, where years of normalized dysmenorrhea can delay recognition, diagnosis, and treatment. Of course, not every painful period means endometriosis. Every patient whose pain interferes with daily life deserves to be heard carefully, evaluated thoughtfully, and taken seriously. Beyond any single diagnosis, this issue reflects a broader pattern in women’s health. Too often, women are praised for tolerating pain before they are supported in understanding it. They are told to be strong before they are asked what they are actually carrying. In clinical practice, the way women speak about pain can be shaped by culture, upbringing, fear, access to care, prior dismissal, family responsibilities, and the exhaustion of not being believed. Some patients describe their symptoms only after years of silence. Others have learned to make their pain sound smaller because they do not want to be perceived as dramatic, difficult, or weak. Silence should never be mistaken for absence of suffering. As obstetrician-gynecologists and surgeons, we are trained to listen carefully. We ask about timing, severity, associated symptoms, patterns, and the effect on daily life. We think about the possibilities behind pain. We try not to miss the important diagnosis hiding beneath a common complaint. That is why listening is not a soft skill. It is a clinical skill. Listening shapes the history we take, the differential diagnosis we build, the referrals we make, the urgency we feel, and the trust we earn. Sometimes, healing begins before a diagnosis is made. Sometimes, it begins when a patient realizes that her pain has been heard without judgment. When I later began rebuilding my professional path in the United States, I found myself listening in a different way. Starting again in a new system made me more attentive to pauses, hesitations, and the small ways people communicate uncertainty. It reminded me that listening is not only about understanding words; sometimes it is about recognizing what a person has been taught not to say. This lesson has become especially meaningful to me as an obstetrician-gynecologist trained in Turkey and continuing my professional journey in the United States. Across different cultures and healthcare systems, I have seen that women may describe pain in different languages, but the need to be believed is universal. Some women speak loudly because they have waited too long. Some speak softly because they have been dismissed before. Some do not yet have the words for what they are carrying. Our responsibility is not to decide how much suffering sounds convincing enough. Our responsibility is to ask better questions before silence becomes part of the disease. For me, this is why women’s health advocacy begins before treatment. It begins in the moment we decide that a woman’s pain does not need to be dramatic, perfectly explained, or long endured before it deserves our attention. As women’s health advocates, we have an opportunity to help change this message. We can remind girls and women that pain should not be dismissed simply because it is familiar. We can create clinical spaces where patients do not feel the need to apologize for their symptoms. We can listen earlier, validate more carefully, and remember that compassion is not separate from clinical care. Common is not always normal. Pain should not have to become unbearable before it is taken seriously. A voice should not have to become louder before it is heard. No woman’s pain should have to become silence before it matters. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/08/Dr.-Bursa.png)**Busra Ozkaya, MD**, is an obstetrician-gynecologist trained in Turkey who is continuing her clinical and academic journey in the United States. Her interests include women’s health, gynecologic surgery, patient-centered care, and global collaboration. Through clinical work, research, and advocacy, she is committed to advancing compassionate, evidence-based care that begins with listening. **Categories:** advocacy, gender differences, Underrepresented in medicine, women **Tags:** womeninmedicine --- ### [Before I am a Surgeon: Choosing Womanhood Without Leaving Surgery Behind.](https://blog.womensurgeons.org/before-i-am-a-surgeon-choosing-womanhood-without-leaving-surgery-behind/) **Published:** August 5, 2026 **Author:** Blog Team **Content:** By: Daniela H. Rodriguez Manrique “Since you want to become a wife and have kids,” he said, “are you sure you want to do surgery?” I smiled politely, but I cannot recall what I said next. The only thing I remember is the question lingering in my mind after I left the operating room. “Do I want to be a woman, or do I want to be a surgeon?” Prior to this moment, I had not imagined that these two identities could be mutually exclusive. For the first time, I had doubts about becoming a surgeon, and as a medical student, I questioned if pursuing surgery meant I had to sacrifice the woman I wanted to become. Many women in surgery have encountered some version of this question. Sometimes, the question is asked out loud. Other times, it is implied. As I think of a future surgical residency, I have wondered about its compatibility with marriage, pregnancy, and motherhood. I have found myself searching for the “perfect” time to be a wife or a mother, as if these had to wait until surgery allowed them. As time passed, I began to wonder if the question itself was faulty. Should we be asked to choose between being a surgeon and a mother, a wife, a daughter? I believe the real issue lies in why women are asked to divide their identities when pursuing surgery. Before I am a surgeon, I am a woman. I am also a daughter, a sister, a friend, and a woman with relationships and values that extend beyond the operating room. Surgery will be one of the things I will do as a woman, but it will never become the only thing I am. The various identities that a woman holds are not in competition with the surgical world. Instead, women bring experiences, perspectives, and ways of connecting with patients that deepen the profession. Thus, the hardest question I have faced as a medical student interested in surgery is not if I am capable of becoming a surgeon, but if I am willing to give up on being a woman to become a surgeon. I have learned that the best surgeons are not the ones who forsake their humanity to be in the operating room. They are the ones that prefer to take their humanity with them into the sterile field. If I were to be asked again if I want to be a woman or a surgeon, I now know my answer. I choose to be both. Because one day, I hope to look back and realize that I did not become less of a woman to become a surgeon. Instead, I deeply wish to see that I became a better surgeon because I never stopped being a woman. My desire is for the future generation of women to not have to question their commitment to surgery because they want to be mothers, partners, or simply women outside of the hospital. I hope they can be confident that there is room for who they are – a surgeon and a woman. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/08/HeadShot_AWS_DRM-847x1024.png)**Daniela H. Rodriguez Manrique** is a fourth-year medical student at Ross University School of Medicine with a strong interest in General Surgery. Born and raised in Villa Clara, Cuba, she is passionate about global surgery, mentorship, and advancing opportunities for women in surgery. Throughout medical school, she has remained actively involved in student leadership and community outreach, including serving as the Journal Club Coordinator for her school’s Surgery Medical Student Interest Group. She hopes to pursue a career in academic surgery where she can combine clinical care, education, and advocacy. Outside of medicine, Daniela enjoys spending time with her family, serving in her church community, and discovering new local restaurants and cuisines. **Categories:** family life, gender differences, parenting, women **Tags:** genderdifferences, womeninsurgery, WomenSurgeons --- ### [Mentorship Governs Your Relationship with Research](https://blog.womensurgeons.org/mentorship-governs-your-relationship-with-research/) **Published:** July 30, 2026 **Author:** Blog Team **Content:** By: Ambreen Deol What decides whether you fall in love with research or avoid it altogether as your career takes shape? Your capabilities and academic rigor? Partly. But the real governing factor, especially when you’re starting out, is mentorship. During my nearly six years of medical school in India, I got almost zero exposure to research. We crammed theory, regurgitated it onto exam papers, and rotated through wards. Research wasn’t part of the curriculum, and no one really talked about it. When reading through a textbook, questions would pop into my head. *Has anyone tried this? What if we did it this way? How do we know how this works?* I’d just sit with the question, because I didn’t know I could simply look something up. I had no clue what PubMed was. In most Indian medical colleges, the focus is overwhelmingly clinical, not academic. ## **The advice that wasn’t actionable** When I started leaning toward research, I was grasping at straws. I had ideas but no means to execute them. No institutional support, no infrastructure, no mentorship, no role models. The people I reached out to for guidance would say, “Just start with a case report. Read the literature, you’ll catch the drift.” I couldn’t make heads or tails of scientific papers at that point. And as a med student, every case looks unique, because you’ve barely seen any. I’d badger my mentors on every rotation, “Do you see this often? Is this rare? Can we do a case report on this?*”* The answer to the last one was almost always no. Attending countless workshops on research methodology, I learned the same thing over and over: PICO question, methods, study design. “It’s really simple,” they’d say. None of them taught you how to actually *do* anything. There was no Research 101 for someone who didn’t know where to start. I almost got pulled into one of those 12-week courses promising you’d be able to churn out a manuscript a month. Coming from a lower middle class family, I couldn’t afford to enroll, thankfully. ## **So I did it myself** Eventually, I took it into my own hands. I had noticed how my own family made certain medical decisions, while the patients I saw during clinical rotations, mostly from rural backgrounds, navigated the same system completely differently. I built a health literacy questionnaire, ran a cross-sectional study across my state, and presented it at a national conference. It was the first work I had ever done, and a solo one. Reviewers kept asking, “Who’s your guide? Who’s the PI?” I’d say, “I am.” I hadn’t realized a senior author or guide was supposed to exist. Looking around at the other posters, I saw that everyone else had a guide. I had been doing it on my own without knowing any better. There I met another med student in the same boat, also aspiring to be a surgeon. We collaborated on a study about the factors influencing female medical students to pursue a career in surgery. That paper was presented at ACS 2024 and published in *The American Surgeon*. It was my first publication and my first real step into the research world. The results were good, and we had somehow figured it out on our own. Encouraged, I came up with another idea: an interventional study on whether intermittent fasting could reduce HbA1c in patients with diabetes. I posted my proposal on an online platform that funds independent research ideas, and secured an $8,000 grant on the condition that I actually start the study. I reached out to multiple faculty at my institution. None of them could help, because the work required infrastructure and experience the system here simply didn’t provide. The grant evaporated. My ideas were too ambitious for the system that contained me. ## **The mockery and exhaustion** Next, I came up with a question that wouldn’t cost money. *At what age do surgeons retire? Do they retire at all?* I built a validated questionnaire, this time recruiting a professor from community medicine to act as my PI for support, and I walked the survey personally to every surgeon at my institute. Multiple surgeons assumed I was hired by some resident to help with their research, because there was no way a med student could have a research question and run her own study. Most trainees in my country who do research only do it because their residency curriculum requires them to write a thesis. There is no separate research track for med students, or even for residents who actually want one. The infrastructure simply isn’t there. By that point, I was done. The dead ends, the gatekeeping, the mockery had all but worn me out. As a female IMG drawn to surgery from a med school where not a single faculty surgeon was female, where the lack of female role models was,[ by my own study’s findings](https://journals.sagepub.com/doi/10.1177/00031348251337153), a documented deterrent for women considering the specialty, I wanted to bypass research entirely. I felt completely lost. I stopped looking. The thing that used to excite me now exhausted me. ## **The dinner I wasn’t invited to** During a thoracic surgery elective in the U.S., I heard about a Women in Surgery dinner. It was for trainees and attendings, and med students weren’t invited. I went anyway. I wanted, more than anything, to be in a room with female surgeons. I sat next to a surgeon’s husband, who introduced me to his wife. We talked for 45 minutes, and I shared my story with her. She told me she had more research work than she could keep up with, and that she needed help. Fast forward a year. I’m working with her. This mentor is the best thing that has happened to me professionally. Until last year, I was dreading the prospect of doing research just to qualify for residency. Now I can’t get enough of it. There’s so much to learn, and the experience is empowering. Most of all, I love the teamwork: the brainstorming, the collaboration, the ideas none of us could have built alone. There is something beautiful about devising work that can affect lives at scale. I am also, finally, learning how to read a scientific paper. Every workshop I had ever attended told me to “read the literature.” None of them taught me how. You don’t know what you don’t know. You know what you want, but you have no idea how to get it. You need someone to show you. ## **What I’d tell anyone starting out** Research can’t be forced. But what you can do is lay the conditions for it. Take every opportunity, even the smallest ones, be it a dinner, a casual event, or a conference. If you weren’t invited, go anyway. As a woman in surgery, especially as an IMG, you have to advocate for yourself relentlessly, because nobody else is going to do it for you. Some of this is luck of the draw, but I genuinely believe you make the conditions that attract that luck. I would not be here if I hadn’t turned over every stone I could find. The mentor I have now feels almost like a reward for refusing to stop looking. So here’s my advice if you’re faced with similar barriers: Don’t start with case reports. Don’t start with courses that charge you thousands of dollars. **Start with the right mentor.** That is the first step and the thing that matters the most. Everything else will fall into place. Finding someone who supports your goals and does everything they can to set you up for success is partly luck, but you can build the conditions for that luck. Luck arrives through surface area, and here are a few specific items you can act on today to increase surface area for that yourself, for free: - **Find the names before you find the person.** Search PubMed for the question you care about, filter to the last five years, and look at the last author on the papers that interest you. Their institutional email is almost always on the paper itself or a Google search away on the faculty page. - **Aim for people that are relatively approachable.** Residents and fellows are more likely to answer emails than attendings, and they are the ones who bring you into their attending’s project. Reach out to the administrative assistants and coordinators who can connect you to the people above them. - **Be the collaborator people want a second time.** Reliability is something that’s incredibly valuable in the academic space. Answer emails within a day. Deliver what you said you’d deliver, on the date you said it. Say when you’re stuck instead of going quiet. - **Control what you can control**, take every opportunity until the right person walks into the room (or until you walk into the right room). Whether you come to love research or hate it has almost nothing to do with research itself. It depends entirely on who is standing next to you when you do it. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/07/Abreem-683x1024.jpg)**Ambreen Deol**, MBBS, is a Surgical Oncology Research Fellow at the University of Alabama at Birmingham. Her work focuses on improving preoperative communication and aligning patient expectations with the realities of postoperative recovery for patients undergoing high-risk abdominal cancer surgery. She earned her medical degree in India and is an advocate for international medical graduates, devoted to building accessible mentorship pathways for those coming up behind her. She is also committed to medical education and currently serves as an author for *First Aid for the USMLE Step 1* and a content writer for High-Yield Topics by ScholarRx. She hopes to become a surgeon-scientist who makes a meaningful difference in the world. **Categories:** mentorship, research **Tags:** mentorship, research, womeninsurgery --- ### [Financial Planning Considerations for Surgical Trainees: Webinar Highlights](https://blog.womensurgeons.org/financial-planning-considerations-for-surgical-trainees-webinar-highlights/) **Published:** July 2, 2026 **Author:** Blog Team **Content:** *Authors: Camila R. Guetter, MD MPH\*; Rachel E. Mooney, MD\*; Alizeh Abbas, MD; Kylie Dickerson, MD* *\*Indicates co-first authors.* This blog summarizes key advice and resources from the AWS Webinar on Financial Planning, held on April 9th, 2026, and co-hosted by the Resident & Fellow and the Medical Student Committees. You can find the recording for this webinar [here](https://www.womensurgeons.org/index.php?option=com_content&view=article&id=64:webinar-library&catid=20:site-content&Itemid=162 "here"). ***Building Good Habits and Budgeting as a Medical Student or Resident*** From college to medical school to residency, each stage of training brings a new financial reality requiring different strategies and habits. Medical students often carry loan balances that only grow, while residents navigate, in many cases, their first paycheck and the challenge of dividing income between fixed expenses, personal wants, and savings. One of the most powerful habits trainees can build is automating their finances. Setting up automatic transfers to savings, loan payments, and retirement contributions eliminates guesswork and protects against overspending. A simple framework: cover fixed essentials first (rent, utilities, minimum loan payments), build a short-term emergency fund, contribute to retirement (even if modestly), and if finances allow, begin setting aside funds for broader investments. Of course, not everyone will be able to follow this framework right away; student loans, family obligations, or unexpected hardships can make saving or automating contributions feel out of reach, and that’s okay. Progress looks different for everyone, and even small steps forward count. Financial wellness during training is a marathon, not a sprint. The goal is balance; building a solid financial foundation while still allowing time to recharge and enjoy life outside of training. ***Student Loans*** For many residents, student loans are one of the largest financial stressors during training. Understanding repayment strategy early can help maximize flexibility and support long-term financial goals. *Income-Driven* *Repayment* *(IDR):* Most residents pursuing federal loan forgiveness should enroll in an IDR plan, which bases payments on a resident’s income, keeping payments relatively low during training. Filing taxes as an MS4 is important, as it can significantly lower the first year of payments. Those planning to pursue Public Service Loan Forgiveness (PSLF) must be enrolled in either the standard 10-year repayment plan or an income-based repayment program to qualify. Residency is often “the cheapest time” to accumulate qualifying PSLF payments, as these lower monthly payments still count toward forgiveness. PSLF: This is one of the most valuable options for residents planning careers in academic medicine or nonprofit institutions. Remaining federal balances may be forgiven after 120 qualifying monthly payments while working full-time for a nonprofit or government employer. For those pursuing PSLF, making extra loan payments is counterproductive, as this only reduces the amount eligible for tax-free forgiveness later. *When to Refinance: Refinancing can lower interest rates but permanently eliminates access to PSLF and federal protections. Refinancing may be worth considering for trainees planning to enter private practice, who do not anticipate qualifying for PSLF, or who can secure significantly lower interest rates. When transitioning into residency, trainees should consider enrolling in an IDR plan immediately after graduation, confirming whether their residency institution qualifies for PSLF, and certifying employment annually. Ultimately, the right repayment strategy depends on each trainee’s career path, debt burden, and long-term financial priorities. ***Retirement and General Investments*** Once you become a resident, it can feel counterintuitive to contribute to retirement while already carrying a significant loan debt on a resident’s salary, but starting early matters more than starting big. Trainees with access to a 401(k) or 403(b) account should try to contribute at least enough to capture any employer match (if your program offers one); that is an immediate return that no other strategy can beat. A Roth IRA is also something to consider during residency, as your lower tax bracket makes it an ideal time to invest for tax-free growth later. Beyond retirement accounts, broader investing is also worth considering once the right foundations are in place. Investing during residency may feel out of reach, but even small, consistent contributions can have a meaningful long-term impact. Before doing so, trainees should ensure a basic emergency fund exists and that high-interest debt is being managed. Once those foundations are set, index funds are a widely recommended starting point, offering broad market exposure without requiring active management. A financial advisor can help tailor an investment strategy to individual goals and risk tolerance. ***Financial Planning for the Growing Physician Family*** Short-term considerations and goals for trainees with partners, children, or other dependents include maintaining an emergency fund with approximately 2-3 months’ worth of savings and using high-yield savings accounts (average 4% interest rates) to build wealth for money that will be needed within 2-3 years. Having a small safety net helps avoid the high interest rates associated with credit card debt, and high-yield savings accounts are low-risk and offer a superior return on investment compared to traditional savings accounts. If family members rely on your income and would suffer financially from your demise, it is important to consider getting life insurance. Life insurance provides compensation to dependents in the event of death, and term life insurance typically provides a better cost-benefit ratio compared to permanent life insurance for trainees. For trainees pursuing PSLF who are married, there might be some consideration to file taxes independently rather than jointly; however, the benefits of a lower monthly payment are not significantly different, and simplicity may be favored. Trainees with children may feel pressured to start saving for future expenses such as college education using a 529 account; however, the first priority in general should be funding retirement accounts, including 401 (k), which are far more flexible and will provide more savings in the long run (though individual situations may vary). ***Final Takeaways*** Financial wellness during training is built gradually, through small, consistent habits rather than perfect decisions. The strategies discussed throughout this article, from loan repayment and budgeting to retirement and investing, are meant to serve as a starting framework, not definitive financial advice. Every trainee’s financial situation is unique, and consulting with a qualified financial advisor or planner before making major financial decisions is strongly encouraged. Many hospitals and training programs offer access to financial planning services at reduced or no cost, so trainees are encouraged to check with their institution to see what may be available to them. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/07/Camila-Guetter.jpeg)**Camila Guetter, MD, MPH,** is a General Surgery Resident at Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA. She is currently completing her professional development years as a research fellow in vascular surgery outcomes at BIDMC, while pursuing a PhD in Clinical Epidemiology at the Harvard T.H. Chan School of Public Health. Her research interests lie at the intersection of vascular surgery and epidemiology, with a particular focus on leveraging modern epidemiological methods and causal inference frameworks to answer clinical questions in vascular surgery. She served as the Chair of the AWS Resident and Fellow Committee in 2025-2026. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/07/Rachel-Mooney.jpg)**Rachel Mooney, MD,** is a recent graduate of the University of Kentucky College of Medicine. She will be starting her Preliminary General Surgery Residency at the University of North Carolina-Chapel Hill this year. She served as the chair of the AWS National Medical Student Committee Journal Club in 2025-2026. **Categories:** medical students, residency, resources **Tags:** financialplanning, medicalstudent, resident --- ### [Structural Inclusion in Surgery: Above Visibility, Beyond Pride](https://blog.womensurgeons.org/structural-inclusion-in-surgery-above-visibility-beyond-pride/) **Published:** June 30, 2026 **Author:** Blog Team **Content:** *David S. Shapiro, MD, MPH, CPHQ, MEd, FACS, FCCM* *Chair, Connecticut Committee on Trauma; Chair, ACS Stop the Bleed Program Chair* *This is a special edition blog post presented in partnership with the Association of Out Surgeons & Allies (AOSA) in celebration of Pride Month.* Being a gay surgeon during Pride Month is no different than any other month. Surrounded by chaos is the ordinary, and let’s face it: the first “pride” was just as chaotic. It was a well-intentioned riot. When inclusivity is treated as a seasonal calendar event, it becomes a cliché. True inclusion isn’t a mini-celebration or a morning email observing Pride, Juneteenth, or Eid al-Fitr just to make leadership feel compliant. It must be a permanent, structural component integrated into governance, workforce strategy, and daily culture; and this is not just in your hospitals, but in your departments, sections, and partnerships. At our local American College of Surgeons (ACS) Chapter, groups like Association of Out Surgeons and Allies (AOSA), Association of Women Surgeons (AWS), the Latino Surgical Society (LSS), and the Society of Black Academic Surgeons (SBAS) each have an enduring seat at our table because they need to be there. Without this structural integration, compliance is merely symbolic.We must look to metrics like the Human Rights Campaign’s Healthcare Equality Index (HEI) to evaluate and promote truly equitable care and workplaces year-round, but this organization requires an application for hospitals or health systems, not individual departments or individual people. We all know the possibility of deviation from centralized standards while fringe efforts resist change. **The Operational Imperative of a Workforce Crisis** The United States is entering a period of profound surgical workforce instability. National projections warn that retirements, the existing residency cap, fellowship specialization drain, and geographic maldistribution each combine with rising clinical demand to result in a critical shortage of surgeons. We cannot rely on traditional pipelines alone. To sustain capacity, the field must intentionally attract, retain, and promote talent from historically underrepresented groups including LGBT2SQI+ clinicians. Currently, the profession is forfeiting much of this talent. Scoping reviews show that LGBTQ+ surgeons remain markedly underrepresented and essentially absent from leadership. Research on transgender and gender-diverse trainees highlights systemic barriers, lack of mentorship, and institutional cultures that fail to support identity safety and result in attrition rates higher than peers. Surgery loses potential applicants when environments signal that only certain identities are welcome, but it loses even more when it fails to actively cultivate safety. Failing to create inclusive environments directly undermines our ability to maintain adequate staffing. Recruiting LGBTQ+ surgeons is not a symbolic gesture; diverse teams improve problem-solving, enhance patient trust, and enlarge the overall talent pool at the exact moment the pipeline is contracting. If you don’t lead or participate in this work actively, it doesn’t mean you’re homophobic, transphobic, or otherwise being intentionally exclusive; but this said, you may indeed be complicit in your silence. **Stigma, Operational Risk, and “Being Enough”** As surgeons, we are the ultimate experts on the concept of risk: we operate on every component of the human form to correct disease, mend injuries, and affirm identities. This is our every day; why then does the profession often ignore the needs of particular segments of its own workforce? Many of us have asked ourselves the same fear-driven question I once did: *“If I become a leader, they’ll invite my family, see I’m a man with a partner/husband, and what will happen to my career?” “If I am promoted to the chair, they’ll have a dinner in my honor; will my spouse be welcome? Will they feel welcome?”* If you are asking this of yourself, stop. You are beyond enough. You survived university, medical school, and a grueling surgical residency while carrying the hidden cognitive burden of feeling uninvited. You also survived the 80s, 90s, 00s, and beyond to become who you are with some reasonable comfort and affirmed identity. Studies across surgical specialties including Hauch et al. in general surgery, Pang et al. in vascular surgery, and Dimant et al. on transgender physicians, demonstrate that LGBTQ+ clinicians experience higher rates of concealment, underrepresentation stress, and institutional exclusion. These are not abstract social issues, they are real operational risks. A workforce cannot remain stable if parts of it are forced to navigate additional emotional burdens simply to participate. As a mentor once told me: *don’t get out of trouble, stay out of trouble.* When I became the Chair of Surgery and then the Chief Medical Officer in a large, urban, Level-I trauma center, I could hide, but I didn’t feel it was right. I made sure the >95% Caucasian male representation in those who reported to me was remedied by looking at my community, my staff, and my options. Moving that 95% to having representation from women, gay, multiple ethnicities, and a trans member of my team wasn’t because I sought them out. I worked to create a safe space. I represented openness and transparency of inclusion, and a variety of diverse people applied because they wanted to be part of it. I’m not saying this to toot my own horn. All of this didn’t happen overnight, it took a long time. It also took conviction and intentionality. No matter how much I felt alone embarking on this work, and though it was not my intention, even I felt more supported as a result. In my own written work on *being a scarecrow*, the phenomenon of being present, symbolically useful, yet structurally excluded is underrecognized. I argue that visibility without authority creates a paradox. LGBTQ+ surgeons are often invited to be visible, but *not* to shape the systems that determine if that visibility is safe, sustainable, or meaningful. This is about governance, not identity politics. Representation without influence is just being a scarecrow. Instead, become a beacon, a light to draw others in so that they can survive from your warmth and support. Initially they may simply follow, but this light helps to grow new, strong, intentional leaders who can become beacons of their own. Silence in surgical culture is frequently misinterpreted as neutrality. Do not be silent. In reality, silence is a professional adaptation to environments where speaking out about identity is penalized or labeled as a distraction, or even as unprofessional. We are pushed away from talking about families in interviews, tempting but verboten. Since concealment correlates directly with burnout and attrition, requiring silence as a condition for belonging strips the institution and the individuals of cognitive bandwidth and psychological safety. **Inclusion as a Continuous Executive Function** Writing this post suggests that inclusion is still viewed as an initiative rather than infrastructure. If a topic is only discussed when prompted by the calendar, it is not embedded in society or in an institution’s operating system. Nevertheless, inclusion at this key time of year is beyond appreciated. Effective inclusion requires: - Leadership integration at all levels into the core strategic agenda. - Continuous attention, not episodic celebration (think, “Am I being inclusive?” at every step.) - Policy alignment, replacing symbolic gestures. - Leadership accountability, rather than committee-level delegation. The American College of Surgeons was the *only* organization to reply to my inquiry about this topic a few years ago, and welcomed the Association of Out Surgeons and Allies, into their *Surgeon Well-Being Coalition*. Advocacy for LGBTQIA2S+ inclusion is not only a personal project; but it *is* professional stewardship. A surgical workforce that reflects its trainees and patients is fundamentally more resilient and higher-performing. The future of surgery depends on building environments where all surgeons can contribute fully without navigating structural barriers. Inclusion and belonging are foundational to the survival and integrity of the surgical workforce. Fly that flag year round…it represents those folks who look for it. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/06/Screenshot-2026-05-01-115258.png) **David S. Shapiro**, MD, MHCM, FACS, FCCM, is a trauma/critical care surgeon and Associate Professor of Surgery at both University of Connecticut and the Frank H. Netter School of Medicine at Quinnipiac University. He serves as the Program Area Chair for the American College of Surgeons Stop the Bleed Program, and the Connecticut Chair of the Committee on Trauma. He works clinically as a surgeon with Hartford Healthcare and has been a Chief Medical Officer, Chief Quality Officer, and Chair of Surgery during his career starting in 2008. He is a founding member of the Association of Out Surgeons and Allies, and advocates for those underrepresented, recognized or not. Dr. Shapiro conducts research on violence and injury prevention, hemorrhage management, and focuses on the continuum of trauma care along the chain of survival. David has board certification in Surgery, Critical Care, and Hospice & Palliative Care, and works as an ATLS and ATOM instructor. He has published on a multitude of topics including the book, After the ICU, describing the support of critical illness survivors. **Categories:** advocacy, diversity and inclusion **Tags:** AOSA, AWS, history, Pride --- ### [Dual Identity](https://blog.womensurgeons.org/dual-identity/) **Published:** June 24, 2026 **Author:** Blog Team **Content:** By Keerat Bains *This is a special edition blog post presented in partnership with the Association of Out Surgeons & Allies (AOSA) in celebration of Pride Month.* In qualitative research, [reflexivity and positionality statements](https://pubmed.ncbi.nlm.nih.gov/24979285/) allow for the authors to constantly reflect on their own biases and how they influence the research. My [statement](https://pubmed.ncbi.nlm.nih.gov/37927292/) reads a little something like this: “KB is a cis-gendered, pansexual, first-generation South Asian woman who is an incoming general surgery resident. They are informed by a background in health equity, sexual health education, gender affirming care and street medicine.” At face value, I look like any other femme, heterosexual individual, especially in the hospital. I am even married to a cis, heterosexual man. However, if someone took the time to look more closely, they’d see my rainbow caduceus pin and my “she/they” pin on my white coat; they’d notice my pronouns permeating in every space where my name entered (after noticing the mother tongue that named me doesn’t translate well to English). Reflexivity provides a frame of reference, meeting people where they are at. One of the many things I love about surgery is the ability to be seen without name, face, or perceived gender. To a certain extent, everyone looks the same under a surgical gown, sterile gloves and a mask. Where the uniformity ends is the skill of the surgeon wielding surgical instruments. I appreciate the ability to be anonymous yet seen in the spaces where it counts; this duality is a privilege, allowing me to be seen as both a professional and relatable to patients. While doing my trauma surgery rotation at a safety net hospital, I felt touched when female patients felt comfortable letting only me do their wound dressings after a lifetime of being trafficked or when patients in custody shared information about their crimes in confidence. It felt powerful to have the agency to let these individuals know that I was there solely to take care of them and my responsibility was to them. I could both see and feel patients become more comfortable when they saw my tattoos and piercings, some even matched theirs. There is power in community, solidarity, and representation. I hope to always create safe spaces for patients in my community, allowing the most marginalized access to surgical care they need and deserve. This Pride month it would be apt to remember that[ Black trans women are some of the most medically marginalized patient populations](https://preprint.press.jhu.edu/pchp/sites/default/files/PCHP-OR_ThompsonHale.pdf), yet have been crucial to the[ inception of pride itself](https://www.britannica.com/topic/gay-rights-movement). We must do better to provide equitable care to all patients regardless of their intersectional identities. One key aspect of this is provider congruence. When patients are taken care of by[ others who look like them](https://pubs.aeaweb.org/doi/pdfplus/10.1257/aer.20181446) or[ who have had shared experiences](https://www.pnas.org/doi/10.1073/pnas.1800097115), it leads to better patient outcomes. As we know well (and a personal favorite of mine), female surgeons have[ better post-operative outcomes than their male counterparts](https://jamanetwork.com/journals/jamasurgery/fullarticle/2786671). It is easier to build trust when there is a baseline level of shared understanding and empathy. This is similar to a positionality and reflexivity statement. Everyone may have different perspectives but when we acknowledge who we are at a core level and our biases, we are one step closer to interconnectedness. Humanity is what leads to better patient outcomes, always. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/06/Dr.-Bains.jpg)**Keerat Bains, MD PGY-1** (she/they) is an incoming general surgery intern at The Valley Health System in Las Vegas, NV. She recently graduated from Michigan State University College of Human Medicine in May, 2026. Her future interests include trauma surgery, reconstructive surgery, and gender affirming care surgery. She enjoys powerlifting and relief printmaking in her free time. **Categories:** diversity and inclusion, reflection --- ### [Reflecting on Pride](https://blog.womensurgeons.org/reflecting-on-pride/) **Published:** June 18, 2026 **Author:** Blog Team **Content:** By: Monica Patten, MD PGY3 *This is a special edition blog post presented in partnership with the Association of Out Surgeons & Allies (AOSA) in celebration of Pride Month.* Happy Pride Month to all who celebrate. Pride is rightfully named. As defined by Oxford 9, “pride” is a consciousness of one’s own dignity and self-respect. This definition helps remind us why June brings such joy, visibility, and community for so many of us. As a member of the community and a surgical trainee, I have felt nothing but acceptance for who I am throughout my training. I know this is certainly not the experience all LGBTQ+ trainees share, but I am deeply grateful for the warmth of this community and our allies, and for the ways that medicine continues to work towards inclusion. But, to truly reflect on what Pride means this month, we can’t celebrate without recognizing the fear that so much of the LGBTQ+ community is facing. Pride has always coexisted with oppression, and unfortunately this year is no exception. The political climate of the past eighteen months has brought a wave of legislative and administrative changes with real clinical consequences for LGBTQ+ patients and providers alike. Over 600 anti-LGBTQ+ bills were introduced across the United States in 2025 alone.1 The rollback of Section 1557 nondiscrimination protections has removed explicit federal safeguards for LGBTQ+ patients in Medicaid coverage and insurance benefit decisions.2 At least 26 states have enacted bans on gender-affirming care, treatment that the AMA, WHO, the American Society of Plastic Surgeons, and numerous other major medical organizations recognize as the evidence-based standard of care for gender dysphoria.1 Approximately 38% of transgender youth between the ages of 13 and 17 now live in states where this care is illegal.3 Some states with active bans have documented as high as a 72% increase in suicide attempt rates among transgender youth.4 These policies are impacting our patients medical care and health in significant ways. Research funding has also been negatively affected in many ways. After taking office in January 2025, an executive order declaring the recognition of only two genders and halting government-led DEI initiatives was signed by President Trump. The fallout included the cancellation of 669 NIH-funded grants, totaling over $800 million, nearly 50% of these were related to LGBTQ+ health.5 This included a large-scale oncologic study examining how to better collect sexual orientation and gender identity data in order to address disparities in cancer care settings.5 But this wasn’t just a funding freeze. Scientists working for the CDC were subsequently directed to retract or pause submission of publications containing terms like “transgender”, “LGBT”, “gender”, and even “pregnant people”.6 Many can understand the feeling that none of this makes sense in order to take the best care of patients. The downstream effects will reach our training programs: medical students and residents are not going to feel *more* empowered to engage with gender identity in clinical conversations or research when they aren’t sure what the professional impacts may be. We are shaping a generation of surgeons in a climate of institutional silence about the very patients they will serve. Just as importantly, for LGBTQ+ surgeons and trainees, these federal-level changes compound what was already a difficult environment. A study published in JAMA Surgery in 2022 found that 59.2% of LGBTQ+ surgical residents reported experiencing discrimination, 47.5% experienced harassment, and 74.8% reported bullying.7 Furthermore, LGBTQ+ surgical trainees were twice as likely to consider leaving their residency programs.7 The current political climate does not make navigating our personal or professional lives any easier, and unfortunately, particularly for an older generation of LGBTQ+ individuals, this is not a new experience. Many of us know that pride celebrations exist as a result of the fight against oppression. On June 28, 1969, police raided the Stonewall Inn, a gay bar in New York City’s Greenwich Village, as they had done to countless LGBTQ+ establishments before. This time, the patrons, many of them transgender women of color and drag queens, the community’s most vulnerable and most visible, fought back. The uprising lasted six days and became, as the Library of Congress describes it, a moment that “fundamentally changed the nature of LGBTQ+ activism in the United States.”8 The first Pride March was held exactly one year later on its anniversary. What we now celebrate in June was born directly from that resistance. Neither that history nor the present policy landscape can diminish the joy of this month. If anything, they deepen it. The people who protested at Stonewall Inn were not fighting for the right to have a parade, they were fighting for the right to exist without fear. The fact that so many of us can celebrate openly today is a testament to their courage, and the fact that the fight is not finished requires us to harness that same courage today. We must continue to fight oppression, whether it shows up in our research, our ability to care for our patients, or the environment we create for our students and residents during this time. To my LGBTQ+ colleagues and trainees: you are seen, and your presence in medicine and surgery matters. To our allies, thank you; for the rainbow pin, for using the right pronouns, for the space you hold. This June, we must remember that the joy of Pride month and the work needed to improve the house of medicine, continue together. Happy Pride. 🏳️‍🌈 ![](https://blog.womensurgeons.org/wp-content/uploads/2026/06/Match-Background-While-Keeping-Person-Size-819x1024.png)**Monica Patten, MD**, is a PGY-3 general surgery resident at Western Michigan University Homer Stryker M.D. School of Medicine. She is a graduate of the University of Colorado, Boulder and received her undergraduate degree in integrative physiology. She completed her medical education at the University of Colorado School of Medicine before matching into general surgery residency. In addition to the pursuit of a career in trauma surgery and critical care, Monica is passionate about engaging in policy and advocacy work in order to improve the health of her community and the patients she serves. References 1. American College of Physicians. Attacks on Gender-Affirming and Transgender Health Care. Accessed June 16, 2026. https://www.acponline.org/advocacy/state-health-policy/attacks-on-gender-affirming-and-transgender-health-care 2. 42 U.S.C. §18116 (2020). 3. Human Rights Campaign. Map: Attacks on Gender Affirming Care by State. Accessed June 16, 2026. https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map 4. San Francisco Community Health Center. The American Crisis in Gender-Affirming Care Access – Policy Brief, 2025. Accessed June 16, 2026. https://www.sfcommunityhealth.org/gamc-policy-brief-2025 5. ASCO Post. How the Elimination of Federal Gender-Related Grants and DEI Programs Is Impacting LGBTQ+ Health Research. June 10, 2025. Accessed June 16, 2026. https://ascopost.com/issues/june-10-2025/how-the-elimination-of-federal-gender-related-grants-and-dei-programs-is-impacting-lgbtqplus-health-research/ 6. Clark J, Abbasi K. Medical journal editors must resist CDC order and anti-gender ideology. *BMJ*. 2025;388:r253. doi:10.1136/bmj.r253 7. Heiderscheit EA, Schlick CJR, Ellis RJ, et al. Experiences of LGBTQ+ Residents in US General Surgery Training Programs. *JAMA Surg*. 2022;157(1):23-32. doi:10.1001/jamasurg.2021.5246 8. Library of Congress. Today in History – June 28: The Stonewall Uprising. Accessed June 16, 2026. https://www.loc.gov/item/today-in-history/june-28/ 9. Oxford University Press. Pride. In: *Oxford English Dictionary*. Published 2026. Accessed June 16, 2026. https://www.oed.com/dictionary/pride\_n1 **Categories:** awareness, diversity and inclusion --- ### [Emily Blackwell Did More Than Just Operate Against the Odds, She Built a Legacy of Inclusion](https://blog.womensurgeons.org/emily-blackwell-did-more-than-just-operate-against-the-odds-she-built-a-legacy-of-inclusion/) **Published:** June 11, 2026 **Author:** Blog Team **Content:** By: Aeryn Kangas-Dick, MD *This is a special edition blog post presented in partnership with the Association of Out Surgeons & Allies (AOSA) in celebration of Pride Month.* In 1854, a pioneer in surgery, Emily Blackwell was the second woman in the United States to receive an MD degree at what is now Case Western Reserve University.. She practiced surgery in lower Manhattan where, along with fellow surgeon Marie Zakrzewska, and her sister Elizabeth Blackwell, she was instrumental in founding a women’s hospital, the New York Infirmary for Women and Children. The hospital added a medical school, which trained 364 women surgeons before closing in 1899. Dr. Blackwell first met Elizabeth Cushier when she was a student at the medical school. The pair lived together for the rest of their lives, and they raised a daughter together. Dr. Blackwell was instrumental in advocating for state funding for the hospital, which expanded to serve 7000 patients a year. The hospital survives today as New York-Presbyterian Lower Manhattan Hospital. Marie Zakrzewska first came to the United States after emigrating from Poland, where she had studied as a midwife at the Royal Charite Hospital in Berlin. Her persistence and performance in school impressed her professor, Dr. Joseph Schmidt to such a degree that she was appointed Chief midwife after her graduation in 1851. Unfortunately, there was significant opposition from her colleagues as no woman had ever held this position. After Dr. Schmidt died, she was dismissed after only six months. Seeking better opportunities, Dr. Zakrewska emigrated to the United States, where she met Elizabeth Blackwell who eventually helped her to successfully enroll at Case Western, which at the time was one of the only medical schools in the US that would grant medical degrees to women. After graduation, she began work in New York City where she practiced surgery as well as both obstetrics and gynecology, initially in a private group with the Blackwells. The trio was profoundly affected by the lack of access to medical care amongst the city’s poor women. Their collaboration led to the foundation of the New York Infirmary, as a way to not only provide care to patients but to educate the next generation of women surgeons and physicians. After her work with the Blackwells, she traveled to Boston where she became a professor of Obstetrics and Gynecology at the New England Female Medical College. While initially she found Boston to be more friendly to the idea of a woman surgeon, she resigned from the hospital in 1861 after the founder of the school insisted that female physicians be referred to as “doctress.” In response to the rampant misogyny of the time she founded the New England Hospital for Women and Children in July, 1862, as an institution where women physicians could practice medicine, and established the first nursing school in the United States. She met her partner, Julia Sprague during her time in Boston, where the pair lived together for forty years. While many contemporary historians characterize their relationship as platonic, letters from Dr. Zakrzewska to her friend Caroline Severance suggested a romantic relationship. The lives and work of Emily Blackwell and her sister Elizabeth Blackwell, Marie Zakrzewska, Elizabeth Cushier, and Julia Sprague remind us that the history of surgery has never been separate from the history of gender, sexuality, power, and belonging. These women were giants who built hospitals, medical schools, and training pathways at a time when the profession actively attempted to exclude them and question their legitimacy as surgeons and educators. Their stories remind us to recognize that LGBTQIA+ people, including women, nonbinary people, transgender people, and gender-nonconforming people, have always been present in medicine, even when history has obscured or softened that truth. The barriers they faced were about access to education and to operating rooms but also about the right to live openly, to love, to lead, and to be recognized as fully human within this profession. As we celebrate Pride, we honor not only visibility, but also generations of physicians, surgeons, nurses, and trainees whose courage created spaces for others to follow. Organizations such as the Association of Women Surgeons (AWS) and the Association of Out Surgeons and Allies (AOSA) play a crucial role in continuing this work by advocating for equity, amplifying historically marginalized voices, and creating safer professional communities for anyone whose identities have been excluded from traditional narratives of surgical excellence. Pride is both a celebration and a call to action. We must remember history honestly so that we can continue to protect people who are still facing discrimination and build a surgical culture where everyone can belong and lead. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/06/Untitled-design-23-819x1024.png)Aeryn Kangas-Dick, MD, is a surgical oncologist at the West Michigan Cancer Center and assistant professor of surgery at the Homer Stryker MD School of Medicine at Western Michigan University where she also serves as associate clerkship director for the surgical core rotation. She completed a General Surgery residency at Maimonides Medical Center in Brooklyn, NY, and fellowship in Complex General Surgical Oncology at Roswell Park Comprehensive Cancer Center in Buffalo, NY. She specializes in esophageal, gastric, and pancreatic cancers, and is passionate about her research into both cancer outcomes and creating inclusive learning environments for general surgical trainees. She is a proud member of both AWS and AOSA. Outside of the operating room, she enjoys spending time with her partner and their dog and cat. She is a long time rugby player and stays active with her local club team. **Categories:** awareness, diversity and inclusion, women **Tags:** AOSA, OutSurgeons, Pride, womeninsurgery --- ### [Learning to Lead Before I Felt Ready: A Medical Student’s Perspective ](https://blog.womensurgeons.org/learning-to-lead-before-i-felt-ready-a-medical-students-perspective/) **Published:** June 3, 2026 **Author:** Blog Team **Content:** By: Valentina Montoya Franco, MS4 I didn’t step into leadership because I felt ready. If anything, I thought I needed more experience, more confidence, more proof that I belonged. That moment never really came, so I had no choice but to start anyway. My leadership journey didn’t begin in big roles. It started as a social media coordinator for student organizations during my basic science years. Later, I became Vice President of my school’s Latino Medical Student Association (LMSA) chapter, and later President of our Association of Women Surgeons (AWS) chapter. That was the role that changed my perspective on myself as a leader. I was surrounded by an incredible group of women, many of them Latinas like me, who supported, challenged, and inspired me daily. Together, we built something and because I was the President, I began to see my leadership qualities. When I transitioned into clinical rotations, I noticed something that was missing. Outside of clinical hours, there weren’t many opportunities for students to expand their skills or form connections with physicians. Because I was interested in a career in surgery, it felt like this was holding me and other students back. I remembered how intimidating it was to step into procedural spaces without practice or guidance, and I wanted to help fix this for students after me. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/06/image-7.png)![Medical professional in blue scrubs and a hairnet sits at a DaVinci robotic surgery console, smiling.](https://blog.womensurgeons.org/wp-content/uploads/2026/06/image-6.png)![Female medical student in blue scrubs and a surgical cap stands beside a life-sized medical mannequin on a table in a training room with medical supplies nearby.](https://blog.womensurgeons.org/wp-content/uploads/2026/06/image-5.png) This was when I stepped into a new role as the student site representative for both the surgery and anesthesia interest groups at my hospital. At first, I had no idea where to start. I didn’t know who to reach out to or how to make things happen. For many months I sent emails, followed up on emails, went in circles, and felt like I wasn’t getting anywhere. There were moments when I questioned whether anything I was doing was working. But I kept going. Eventually, I found the right mentors who were willing to teach, support, and help to open doors for me. With their guidance, I began organizing hands-on labs for students. What started as an idea turned into real opportunities. Since then, I’ve helped lead over six labs. These labs create spaces where students can practice, ask questions, and feel more confident. It hasn’t been easy. It’s been a full rollercoaster. But it was worth it. What fulfills me most about the things I have done is knowing that I can help create opportunities I once wished I had. I am also still learning along with everyone else. I’m still a medical student, and I’m still figuring things out, but now I’m building something meaningful at the same time. I’m currently working on expanding these opportunities even further by creating more labs, helping students find observerships, and organizing events that connect pre-clinical students with students doing their clerkships in order to make that transition a little less overwhelming. Those experiences were incredibly meaningful to me. I remember being surprised when many of the physicians in my groups for LAS26 realized I was the only medical student there. Several of them asked me what made me decide to attend. The truth is, I didn’t have a perfect answer. I just knew that I cared about leadership and advocacy, and I wanted to learn. I wanted to understand how physicians can advocate for their patients beyond the hospital walls and how I could better contribute in the future. My mindset was simple: if I don’t know enough about something, then I should go learn and ask questions. ![Selfie of a smiling woman standing on Capitol steps with the dome in the background, daytime light behind her.](https://blog.womensurgeons.org/wp-content/uploads/2026/06/image-3.png)![Professional woman in a black blazer and white shirt stands on a marble staircase, smiling, with a conference badge on a blue lanyard and a black tote bag reachable at her side.](https://blog.womensurgeons.org/wp-content/uploads/2026/06/image-4.png) What I didn’t expect was how welcomed and encouraged I would feel. Being surrounded by physicians who dedicate their time to advocating for healthcare, education, and patient access was inspiring. It opened my eyes to the fact that leadership doesn’t always happen in a classroom, a clinic, or an operating room. Sometimes it happens in meetings, conversations, and difficult discussions where people are working to create change. Looking back, these have been some of the most meaningful experiences of my medical school journey. I truly wish more students had the opportunity to be exposed to advocacy early in their training. It taught me that you don’t need to be an expert to get involved. You just need to care enough to show up, listen, learn, and be willing to take part in the conversation. Leadership has stopped feeling like something I needed to be “ready” for. It has become something I practice every day. I still have moments of doubt, but they no longer hold me back the way they used to. This is because I have learned one important thing: you don’t have to feel ready to lead, you just have to be willing to take the first step. When you do this, you also have to trust that as you move forward you will grow into the leader you want to be. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/06/image.png) **Valentina Montoya Franco** is a fourth-year medical student at Ross University School of Medicine completing her clinical training in Maryland with a strong interest in surgery. Born and raised in Viterbo, Colombia, she has remained actively involved in student leadership and advocacy throughout medical school. During her basic science years, she served as Vice President of the Latino Medical Student Association chapter at her school and later as President of the Association of Women Surgeons chapter. She is passionate about leadership and advocacy and attended LAS26 for ACS and the SALUD Summit 2026 for LMSA this year in DC, experiences she describes as both meaningful and professionally transformative. She currently serves as Vice President of the Surgery Medical Specialty Interest Group and as the student surgery and anesthesia site leader for students from her school during clinical rotations. Her experiences in the operating room, student leadership, and community outreach have strengthened her passion for patient care, teamwork, mentorship, and surgical education. Outside of medicine, she enjoys spending time with family and friends, traveling, being outdoors, horseback riding and cooking which helps keep her grounded and recharged through the demands of medical training. **Categories:** Uncategorized --- ### [We Plant Surgical Flowers When We Choose Joy and Mentorship in Challenging Times](https://blog.womensurgeons.org/we-plant-surgical-flowers-when-we-choose-joy-and-mentorship-in-challenging-times/) **Published:** February 25, 2026 **Author:** Blog Team **Content:** **Author: Dr. Christine Castater** *This is a special edition blog post presented in partnership with the Society of Black Academic Surgeons in celebration of Black History Month.* It is both easy and reflexive to wake up in the morning by focusing on the weight of the socio-political climate pressing down on us. The news cycle moves fast. The commentary is loud. Social media is everywhere. The divisions feel deep. As surgeons and trainees, we are not immune to all of this because we live in it, we train in it, and we lead in it. I want to offer a different viewpoint. What if, instead of orienting ourselves around what feels broken, we orient ourselves around what is extraordinary? We are living and working in a time when technology makes it possible to share knowledge instantly across continents. We can increasingly use artificial intelligence (AI) to guide learning, workup, and education. We can learn from mentors and educators we may never meet in person. On the flip side, we can inspire trainees who don’t live close by and who look to us for both technical guidance and courage. All of these things are not just ordinary, they are remarkable. To exist as a surgeon or trainee today is to stand after a long line of people who pushed this field forward in environments that were not built for them and, most of the time, tried to push them out. Each of us benefits from someone who held a door open, shared a resource, offered a word of encouragement, or modeled what we thought was impossible as possible. In moments when the climate around us feels discouraging, we are tempted to focus on barriers such as glass ceilings, structural biases, and systemic constraints that may persist. These things are not imaginary, so they deserve both attention and advocacy. But if this is the only way we view both our daily work and the world around us, we are narrowing our field of vision and limiting our ability to shine. Instead, we should remember to view our world as full of mentorship, momentum, and promise. When I wake up each day with a plan to do the best I can and to spread as much joy as I can, my perspective shifts. I look for opportunities to teach instead of tallying slights. I look for moments to uplift instead of rehearsing frustrations. I ask myself who I can help in even the smallest way – in every minute and in every way. Mentorship does not have to be formal to be powerful. It can be the five extra minutes you spend reviewing a knot-tying technique. It can be a thoughtful email to a medical student who doubts whether they belong in surgery. It can be transparency about your own missteps and how you did or did not recover. It can be introducing a trainee to someone who might become their next mentor, collaborator, or sponsor. When we focus on moving things forward, even incrementally, our impact continues to grow. A mentored student becomes a mentoring resident. A supported junior faculty member becomes a leader who sponsors others. Culture shifts not only through overarching policy but through repeated acts of generosity, kindness, and belief. There is a metaphor I like to refer to: planting a garden means planting flowers in a world that seems determined not to let them grow. Surgery can feel like hard, infertile ground. It is full of long hours, and high-risk scenarios surrounded by a culture that has historically demanded resilience without providing support. But even in difficult soil, flowers can grow when someone is willing to water them. Planting flowers can look like many things. It might look like celebrating a colleague’s publication publicly and enthusiastically. It might look like advocating for equitable speaking and research opportunities. It might look like checking in on a trainee who has been unusually quiet or seems to be struggling. It might look like bringing warmth, smiles, and compassion into spaces that default to the opposite. The point is not to ignore reality. The point is to refuse to let cynicism be the dominant force that shapes our professional identities. Imagine if each of us committed to a daily practice where we committed to: 1\) one deliberate act of mentorship 2\) one deliberate act of joy 3\) one deliberate act of advocacy 4\) one deliberate act of gratitude 5\) and one deliberate act of growth. Imagine the ripple effect we could have across training programs, departments, institutions, and the community. The cumulative result would be far greater than any one headline or political moment. We may not control the climate of the world around us, but we absolutely control how we show up in it and how we contribute to it. If I wake each day with a plan to do the best I can in this world by spreading the most joy that I can, I am choosing to plant flowers. Some will bloom quickly. Others will take time. Some may not grow or may never be visible to me at all. But the act of planting still matters. In choosing mentorship over resentment, generosity over scarcity, and momentum over paralysis, we help create a surgical community that not only survives difficult seasons but blooms in spite of them. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/Dr.-Castater-833x1024.jpg)**Dr. Christine Castater** is a “non-traditional” student who decided to pursue medicine after being a victim of violence. She finished her BA, MD and MBA all at the University of Connecticut, Surgery Residency at UCSF East Bay, and Trauma Critical Care Fellowship at Emory University/Grady Hospital. She is Vice Chair of Access, Engagement, and Justice, Assistant Professor of Surgery, Assistant Clerkship Director, and Trauma Surgery site director all at Morehouse School of Medicine and a trauma and critical care surgeon at Grady Memorial Hospital. Her research interests include trauma informed care, violence prevention, healthcare disparities, diversity and inclusion, and post-traumatic stress disorder among other things. **Categories:** advocacy, mentorship, self-care **Tags:** advocacy, Gratitude, growth, joy, mentorship, womeninsurgery --- ### [The Art of Seeing Differently: Surgery Through Dr. Patricia Bath’s Lens](https://blog.womensurgeons.org/the-art-of-seeing-differently-surgery-through-dr-patricia-baths-lens/) **Published:** February 25, 2026 **Author:** Blog Team **Content:** **By: Julia Vasquez-Gonzalez and Dieynabou Diallo** *This is a special edition blog post presented in partnership with the Society of Black Academic Surgeons in celebration of Black History Month.* Throughout everyone’s individual medical training, we are often guided to find mentors, to read, and to seek purpose. Nowadays we are taught: *“if they can do it, so can you”.* But can we transport to a time, not so long ago, when that was just a dream? In the 1940s in Harlem, New York, amid war, music, and hope, Louis Armstrong’s Jazz tunes played. In one of these specific homes in Harlem, Dr. Patricia Bath’s parents reminded her to *“never settle for less than your best”*, and so she didn’t. From an early age, Dr. Bath showed an interest in science and service. Inspired by Dr. Albert Schweitzer’s medical work in the Congo and shaped by her upbringing, she pursued medicine in a system that offered few examples of people who looked like her. As an African American woman pursuing medicine, she only had one option – to be excellent. At just 16 years old, she earned a scholarship from the National Science Foundation to develop research on cancer, nutrition, and stress. This was just the beginning of her remarkable career. She graduated with honors from Howard University College of Medicine in 1968. That same year, following the assassination of Dr. Martin Luther King Jr., Dr. Bath translated inspiration into action. She coordinated and led Howard University medical students to provide care for participants in the Poor People’s Campaign at Resurrection City. This effort was later recognized in the *Journal of the National Medical Association.* Dr. Bath returned to New York to complete her internship at Harlem Hospital Center, which had recently affiliated with Columbia University College of Physicians and Surgeons. There, she identified a striking disparity: Harlem Hospital served a significantly higher proportion of blind patients compared to Columbia’s Eye Clinic, yet had no ophthalmologists on staff. Awarded a one year fellowship from Columbia University, she conducted epidemiological research on visual impairment in Harlem. This work became the foundation of what she later termed “Community Ophthalmology.” Her advocacy and perseverance led Columbia faculty to begin performing free eye surgeries at Harlem Hospital, and in 1969, Dr. Bath assisted in the hospital’s first eye surgery. In 1973, she became the first African American to complete an ophthalmology residency at New York University. A year later, she completed a second fellowship at Columbia focusing on corneal transplantation and keratoprosthesis. By 1975, she became the first African American female faculty member at UCLA’s Jules Stein Eye Institute. Despite all of her achievements, she faced discrimination. In an interview she recalled *“I was offered an office in the basement next to the lab animals, which I refused. I didn’t say it was racist or it was sexist. I said it was inappropriate and succeeded in getting acceptable office space.”* By 1977 she founded and became the first president of the American Institute for the Prevention of Blindness, and in 1983, she became chair of the Ophthalmology Residency Training Program at UCLA, the first Black woman in the country to hold such a role. Among her many contributions, Dr. Bath’s invention of the Cataract Laserphaco Probe revolutionized cataract surgery. Her innovation offered a painless and effective solution to what previously, often resulted in irreversible blindness. She recalls that *“When I talked to people about it, they said it couldn’t be done.”* She never listened to those who told her she could not succeed, and her legacy lives on because this invention is used worldwide today. As the world of surgery continues to evolve, many women still find themselves asking, “Will I fit in?” That question is understandable, but Dr. Bath’s story reminds us we were never meant to change ourselves to belong. Instead of manufacturing a new personality to succeed in a field dominated by people unlike her, Dr. Patricia Bath refined the strengths she already had and used them with intention. Women are often described with attributes such as empathy, patience, multitasking, adaptability, attention to detail, and perseverance. In the world of surgery these words translate to attention to patient care, diversity of skill, problem-solving, technical precision, and resilience. The surprising question is not whether we can do this, but rather can we recognize our values early enough to continue our journey? Dr. Bath recalled in an interview: “Sexism, racism, and relative poverty were the obstacles which I faced as a young girl growing up in Harlem. There were no women physicians I knew of and surgery was a male-dominated profession; no high schools existed in Harlem, a predominantly black community; additionally, blacks were excluded from numerous medical schools and medical societies; and, my family did not possess the funds to send me to medical school.” Her legacy of excellence demonstrates that you can be technically brilliant and morally driven. To translate the attributes we already carry to transform medicine. To look at the world we live in with a vision to challenge the status quo. A vision to serve. A vision to inspire. Dr. Patricia Bath didn’t just restore sight, she established a vision for future generations. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/Julia.jpg)**Julia Vasquez-Gonzalez** is a fourth-year medical student at Morehouse School of Medicine, originally from Palmira, Colombia. She immigrated to Miami in her youth and remains deeply connected to her roots. She completed her bachelor’s degree in health sciences at the University of Florida in 2020. Following graduation, she became a certified nursing assistant during the COVID-19 pandemic to serve her South Florida community. She aspires to become a comprehensive and compassionate general surgeon, exemplifying the values of discipline, humility, and service her family taught her. During medical school, she has led several organizations, including serving as President of the Cardiology Interest Group, President of the Alpha Omega Alpha Honor Society, and Vice President of the Morehouse School of Medicine chapter of the Association of Women Surgeons. She continues to mentor students through different organizations and tutors other medical students emphasizing the importance of understanding medicine. In her spare time, she enjoys traveling, attending concerts, reading history books, and completing puzzles. Julia is passionate about patient advocacy, health equity, and mentorship, and she views surgery as the perfect field through which to continue advancing these values. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/Dieynabou-Diallo.png)**Dieynabou Diallo** was born in the Bronx, New York, and raised in Atlanta, Georgia. She is a fourth-year medical student at Morehouse School of Medicine and a proud first-generation Guinean American. She earned her Bachelor of Science in Biology from Georgia State University and completed her Master of Science in Medical Sciences at Morehouse School of Medicine prior to medical school. During medical school, Dieynabou has held several leadership roles, including Vice President of the MD Class of 2026, Co-President of the MD Council, and Co-Founder and Co-President of the Morehouse School of Medicine chapter of the Association of Women Surgeons. She is passionate about creating supportive spaces for women in surgery and fostering community within medicine. In her free time, she enjoys spending time with her family, working out, and binge-watching her favorite TV shows. Dieynabou plans to pursue training in General Surgery, with a career grounded in serving the underserved, leadership, mentorship, and surgical excellence. **Categories:** diversity and inclusion, leadership, Underrepresented in medicine, women **Tags:** Black History Month, Diversity, inclusion, womeninsurgery --- ### [From Barbers to Surgeon-Scientists and Beyond: Creation of the Modern Surgeon](https://blog.womensurgeons.org/from-barbers-to-surgeon-scientists-and-beyond-creation-of-the-modern-surgeon/) **Published:** May 14, 2026 **Author:** Blog Team **Content:** **By Connie Shao** *This is a special edition blog post presented in partnership with the Society of Asian Academic Surgeons in celebration of Asian American and Pacific Islander Heritage Month.* Surgery did not begin as a science. Early practitioners were barbers, monks, and battlefield medics operating without anesthesia, sterility, or formal training. In ancient Mesopotamia, surgeons drained abscesses and set fractures, blending technical skill with spiritual ritual. As outlined in the Code of Hammurabi written in 1754 BCE, this was all under the threat of severe punishment for failure\[1\]. By medieval Europe, surgery had been pushed even further from the practice of medicine as we know it today: physicians avoided it, while barber-surgeons, who trained through apprenticeships rather than universities, became the true procedural experts\[2,3\]. Paradoxically, these “lower-status” surgeons had more practical knowledge than academically trained physicians. That gap began to close during the Renaissance, when figures like Ambroise Paré and Andreas Vesalius challenged dogma with observation, often at great personal and professional risk. These pioneers operated in an environment where innovation meant experimenting on patients without consent, without oversight, and without a systematic way to evaluate outcomes \[4,5\]. Innovation was often the result of crisis, including military conflict and resource scarcity. John of Arderne encouraged surgeons to trust their own experience over authority, foreshadowing the scientific method centuries before its formalization \[6\]. **Their willingness to trust their own observations over received authority laid the groundwork for evidence-based surgery.** However, innovation came at a cost. For much of history, surgery advanced through trial and error on patients, without consent or systematic evaluation. This unregulated progress produced breakthroughs, as well as harmful practices that spread unchecked \[7,8\]. In 1889, William Stewart Halsted (1852–1922) established the first formal surgical residency program at Johns Hopkins, transforming surgical training from a disorganized apprenticeship into a structured residency system that integrated clinical practice with laboratory research. His vision was that surgeons should not merely be technicians but should understand the fundamental biology of surgical disease and contribute to scientific advancement. In the 20th century, ethical concerns slowly emerged, from early attempts at informed consent to scandals that culminated in modern oversight frameworks like the Belmont Report and institutional review boards \[9–11\]. Professional organizations such as the American College of Surgeons and the Association for Academic Surgery formalized training, ethics, and research, transforming surgery into a disciplined field grounded in evidence \[12–14\]. The rise of evidence-based medicine and multicenter trials brought rigor to surgical innovation, replacing anecdote with data. More recently, the IDEAL framework (Idea, Development, Exploration, Assessment, Long-term Study) has provided a structured pathway for evaluating new procedures. Its central principle is simple: “no surgical innovation without evaluation” \[15–17\]. This model drove major advances across fields spanning from transplantation to quality improvement systems. Linking bedside observations to research questions allowed for a streamlined and regulated process from observation to innovation \[18,19\]. However, the founders of surgery operated in a world that no longer exists. Their lives were singular in focus: they lived in hospitals, built their identities entirely around their work, and often relied on invisible personal support systems that allowed them to devote nearly every waking hour to surgery. That model, while historically productive, was never broadly accessible, nor was it sustainable or equitable. Today’s surgical workforce is more diverse, more human, and more complex. Women are no longer peripheral to surgery; they are central to it, now comprising nearly half of surgical trainees and contributing not only to workforce expansion but to measurable improvements in care \[20\]. Studies show women surgeons demonstrate greater guideline adherence, more patient-centered communication, and, in some analyses, improved outcomes and lower costs \[21\]. At the same time, cultural expectations have shifted: male surgeons are more engaged in family life and surgeons broadly are no longer willing or able to sustain the total personal sacrifice that defined earlier generations. Yet, the system has not kept pace. Attrition among women surgeons is not a failure of individual resilience but of institutional design, driven primarily by poor work-life integration (71%) and discrimination (50%), with nearly all reported discrimination being gender-based \[22\]. Evidence shows that structured support, including paid parental leave, lactation resources, childcare access, and cultures that normalize their use, improve retention and workforce sustainability \[23\]. Association of Women Surgeons and American College of Surgeons now advocate for comprehensive family support policies, recognizing that sustainable change requires both institutional policies and cultural shifts enabling their use. Workforce diversity is not just a matter of equity; it is essential to access. International medical graduates (IMGs) now make up approximately 20% of the general surgery workforce and disproportionately serve rural and underserved communities \[24\]. Visa-sponsored physicians are significantly more likely to practice in high-need areas, making them critical to maintaining access where U.S.-trained surgeons are scarce \[25\]. H-1B visa-sponsored surgeons are more than twice as prevalent in rural compared to urban counties and more than 4 times as prevalent in the most versus least impoverished counties \[24\].This is particularly urgent given projected shortages of 15–21% in general surgery and stark geographic disparities, with rural workforce adequacy expected to fall to nearly 40% of need in coming decades \[26\]. However, the engine of academic surgery that trains future surgeons and drives innovation is under pressure. The expectation of surgeons to perform basic science research alongside their clinical duties was established by the Hunterian Laboratory of Experimental Medicine at Johns Hopkins in 1905 \[27\]. Now, clinical productivity demands, corporatization, and funding disparities have eroded protected time for research and teaching \[28\]. Surgeon-scientists represent less than 2% of all NIH investigators despite surgical diseases comprising 28-30% of the global disease burden, with a growing gap in funding compared to PhD investigators \[29\]. An approximately 40% cut to the 2026 NIH budget has been proposed, with more than $1.5 trillion in cuts outlined through 2034 \[30\]. 2,291 active research grants were terminated in early 2025, withdrawing $2.45 billion in funding \[31\]. 694 grants totaling $1.81 billion were terminated between February and April 2025 across 210 institutions \[32\]. Early-career investigators and women were disproportionately affected by grant terminations: women’s projects were smaller on average, had larger shares of unspent funds, and were more concentrated in training and transition awards \[31\]. This is not a trivial loss: academic surgeons not only generate innovation but also train the majority of the surgical workforce, amplifying their impact across generations \[33\]. What role does the academic surgeon play today? Evidence supports team-based science, where surgeons collaborate with PhD investigators and research infrastructure to maintain productivity and relevance \[34\]. The training multiplier effect is real but does not require research-active faculty. While academic surgeons train the next generation, community-based residency programs also produce competent surgeons who achieve equivalent clinical outcomes \[35\]. The argument that research-active faculty are essential for training is not supported by outcome data. Equally important is the intentional protection of time – for research, for education, and for life outside the hospital. Without it, the workforce will continue to wither, slowing progress, and costing society significantly as surgeons complete training only to experience attrition afterwards. Across the workforce, almost 3/4 of surgeons report burnout \[36\], with 26% of surgeons under the age of 60 considering leaving surgery within the next 2 years, citing overall stress (79%), work time demands (77%), and personal time requirements (73%) \[37\]. Nearly 1 in 3 Americans (approximately 100 million) lack access to quality surgical care, with an estimated annual cost of $1 billion in preventable healthcare spending \[38\]. Non-metropolitan areas are projected to have only 42.2% workforce adequacy by 2037 compared to 113% in metropolitan areas \[39\]. Almost 2 in 3 rural general surgeons will be reaching retirement age in the next decade\[40\]. GME positions have been expanded through the Consolidated Appropriations Acts of 2021, 2023, and 2024, adding 1,200 positions in high-need areas \[41\]. Proposed legislation would add 2,000 GME positions per year specifically in rural locations and health professional shortage areas, though this has stalled in Congress since 2023. Exposure to rural training can help alleviate geographic maldistribution, with even a 4-week rotation in rural areas almost doubled the probability of working in rural areas \[41\]. Diversification of the healthcare system is similarly beneficial, with female and underrepresented students more likely to express intent to practice in underserved areas \[42\]. While surgery was originally forged through centuries of innovation, modern surgery is plagued by the ability to apply the standard of care across the population. The diversification of the field of surgery has allowed for improved outcomes and greater access for our rural patients. However, shortages persist and are expected to worsen. Residency positions must expand across both academic and community training institutions. Institutions must adapt to the administrative burden on surgeons today, institutionalizing protective measures to reduce attrition. Diversification of the workforce is often controversial, though data shows the crucial role it plays in caring for underserved populations. The surgical workforce crisis represents one of the most pressing challenges facing American healthcare. Without coordinated action across training, retention, financial, and policy domains, the gap between surgical need and surgical capacity will continue to widen, with the most vulnerable populations bearing the greatest burden. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/05/shao.jpg)**Dr. Connie Shao** is a Colon and Rectal Surgery fellow at Ochsner Health and incoming faculty at Corewell Health (Michigan State University, Ferguson Clinic) in Grand Rapids, Michigan. Originally from Michigan, she completed general surgery residency at the University of Alabama at Birmingham, where she spent two dedicated research years supported by an American College of Surgeons award and an institutional T32 training grant. Her research is focused on colorectal cancer disparities, rural access to care, and the role of telehealth in perioperative management. She is engaged in national efforts through the American College of Surgeons, including work on defining quality metrics in telehealth. She has also been an active member of the Society of Asian Academic Surgeons since 2021 and highly recommends coming to the annual meeting in September. You can follow her @shao\_connie on X. References \[1\] White AJ, Herbeck J, Scurlock JA, Mayberry J. Ancient surgeons: A characterization of Mesopotamian surgical practices. The American Journal of Surgery 2022;224:790–3. https://doi.org/10.1016/J.AMJSURG.2022.03.047. \[2\] Hernigou P, Hernigou J, Scarlat M. Medieval surgery (eleventh–thirteenth century): barber surgeons and warfare surgeons in France. International Orthopaedics 2021 45:7 2021;45:1891–8. https://doi.org/10.1007/S00264-021-05043-Z. \[3\] Bagwell CE, Haller JA. “Respectful image”: Revenge of the Barber surgeon. Ann Surg 2005;241:872–8. https://doi.org/10.1097/01.SLA.0000165185.88634.D0. \[4\] Park MT, Mignucci-Jiménez G, Houlihan LM, Preul MC, Park MT, Mignucci-Jiménez G, et al. Management of injuries on the 16th-century battlefield: Ambroise Paré’s contributions to neurosurgery and functional recovery. Neurosurg Focus 2022;53:E2. https://doi.org/10.3171/2022.6.FOCUS21710. \[5\] On TJ, Xu Y, Tangsrivimol JA, Yangi K, Park MT, Prestigiacomo CJ, et al. Revolution in Surgical Anatomy During the 16th Century: The Neglected Encounters Between Andreas Vesalius and Ambroise Paré. World Neurosurg 2025;196:123810. https://doi.org/10.1016/J.WNEU.2025.123810. \[6\] Pearn J. Master John of Arderne (1307-1380): A founder of modern surgery. 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The seven attributes of the academic surgeon: critical aspects of the archetype and contributions to the surgical community. Elsevier 2017;214:165–79. https://doi.org/10.1016/J.AMJSURG.2017.02.003. \[20\] Kurapati SS, Moeckel C, Stegman MM, Yaghy A, Genao I, Shukla AG. A Flattened Curve: National Trends of Women Physicians and Residents in Surgery Over the Last Decade. J Surg Res 2024;303:506–12. https://doi.org/10.1016/J.JSS.2024.09.058. \[21\] Saka N, Watanabe J. Women surgeons: Are they Better?: Narrative review. European Journal of Surgical Oncology 2026;52:110421. https://doi.org/10.1016/J.EJSO.2025.110421. \[22\] Bass E, Butterfield R, Bush R, Harris L, Shaw P, Brown K, et al. Reasons for Women Surgeon Attrition From the US Workforce. Journal of Surgical Research 2026;319:30–9. https://doi.org/10.1016/J.JSS.2026.01.003. \[23\] Johnson HM, Torres MB, Möller MG, Cannada L, Nosanov LB, Riner AN, et al. Association of Women Surgeons’ Comprehensive Initiative for Healthy Surgical Families During Residency and Fellowship Training. JAMA Surg 2023;158:310–5. https://doi.org/10.1001/JAMASURG.2022.6334. \[24\] Liu M, Patel VR, Ramesh T, Wadhera RK, Tsai TC. Surgeons Sponsored for H-1B Visas in the US. JAMA Surg 2026. https://doi.org/10.1001/JAMASURG.2026.0484. \[25\] Midha M, Doiphode A, Duffy E. Characterization of the International-Born Health Care Workforce in Rural US Communities. JAMA Intern Med 2026;186:486–8. https://doi.org/10.1001/JAMAINTERNMED.2025.7633. \[26\] Oslock WM, Satiani B, Way DP, Tamer RM, Maurer J, Hawley JD, et al. A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands. The American Journal of Surgery 2022;223:28–35. https://doi.org/10.1016/J.AMJSURG.2021.07.033. \[27\] Ro K, Cameron JL, Yeh MW. The Hunterian Laboratory of Experimental Medicine. Ann Surg 2011;253:1042–8. https://doi.org/10.1097/SLA.0B013E31821598C9. \[28\] Foley BL, Sheridan EM, Dougherty CE, Are C, Mammen J, Santamaria-Barria JA. The Landscape of U.S. Academic Surgery Departments in the Corporate Medicine Era: Federal and Industry Funding, Academic Output, and Corporate Medicine Revenue Analysis. Journal of Surgical Research 2025;315:950–8. https://doi.org/10.1016/J.JSS.2025.10.013. \[29\] Nguyen M, Gonzalez L, Newman A, Cannon A, Zarebski SA, Chaudhry SI, et al. Rates of National Institutes of Health Funding for Surgeon-Scientists, 1995-2020. JAMA Surg 2023;158:756–64. https://doi.org/10.1001/JAMASURG.2023.1571. \[30\] Jalali MS, Hasgul Z. Potential Trade-Offs of Proposed Cuts to the US National Institutes of Health. JAMA Health Forum 2025;6:e252228–e252228. https://doi.org/10.1001/JAMAHEALTHFORUM.2025.2228. \[31\] Oliveira DFM, Huang Q, Woodruff TK, Uzzi B. How the 2025 NIH grant terminations varied by researchers’ demographic groups. Proc Natl Acad Sci U S A 2026;123. https://doi.org/10.1073/PNAS.2527755123. \[32\] Liu M, Kadakia KT, Patel VR, Krumholz HM. Characterization of Research Grant Terminations at the National Institutes of Health. JAMA 2025;334:534–6. https://doi.org/10.1001/JAMA.2025.7707. \[33\] Sullivan MC, Sue G, Bucholz E, Yeo H, Bell RH, Roman SA, et al. Effect of program type on the training experiences of 248 university, community, and US military-based general surgery residencies. J Am Coll Surg 2012;214:53–60. https://doi.org/10.1016/J.JAMCOLLSURG.2011.09.021. \[34\] Bell T, Valsangkar N, Joshi M, … JM-A of, 2017 undefined. The role of PhD faculty in advancing research in departments of surgery. JournalsLwwComTM Bell, N Valsangkar, M Joshi, J Mayo, C Blanton, TA Zimmers, L Torbeck, LG KoniarisAnnals of Surgery, 2017•journalsLwwCom n.d. \[35\] Sellers MM, Keele LJ, Sharoky CE, Wirtalla C, Bailey EA, Kelz RR. Association of Surgical Practice Patterns and Clinical Outcomes With Surgeon Training in University- or Nonuniversity-Based Residency Program. JAMA Surg 2018;153:418–25. https://doi.org/10.1001/JAMASURG.2017.5449. \[36\] Keller DS, Narula N, Schwarz E, Mellinger JD, Feldman LS, Dort J, et al. A cross sectional survey on burnout and career satisfaction in surgeons: a joint work from the SAGES quality, outcomes, and safety and reimaging the practice of surgery burnout task forces. Surg Endosc 2024;38:4776–87. https://doi.org/10.1007/S00464-024-11123-Z. \[37\] Mahoney ST, Strassle PD, Schroen AT, Agans RP, Turner PL, Meyer AA, et al. Survey of the US Surgeon Workforce: Practice Characteristics, Job Satisfaction, and Reasons for Leaving Surgery. J Am Coll Surg 2020;230:283-293.e1. https://doi.org/10.1016/J.JAMCOLLSURG.2019.12.003. \[38\] Johnson SM, Miller-Hammond K. The State of Surgical Care Access in America: Current Challenges, Disparities, and Emerging Solutions. Am Surg 2025;91:925–7. https://doi.org/10.1177/00031348251331283. \[39\] Silvestre J, Seeger S, Reitman CA. Geographic disparities in the supply and adequacy of the general surgeon workforce across the United States: Projections to 2037. Am J Surg 2026;253. https://doi.org/10.1016/J.AMJSURG.2025.116685. \[40\] Petty EG, Luke RD, Soult AP, Balio CP. Supply, Distribution, and Aging of the General Surgeon Workforce by Rurality and Over Time: A National Observational Study. Ann Surg 2025. https://doi.org/10.1097/SLA.0000000000006758. \[41\] Walensky RP, McCann NC. Challenges to the Future of a Robust Physician Workforce in the United States. New England Journal of Medicine 2025;392:286–95. https://doi.org/10.1056/NEJMSR2412784;PAGE:STRING:GATEWAY;SUBPAGE:STRING:METEREDCONTENT. \[42\] Nguyen M, Cerasani M, Dinka LA, Rodriguez JA, Omoruan M, Acosta E, et al. Association of Demographic Factors and Medical School Experiences With Students’ Intention to Pursue a Surgical Specialty and Practice in Underserved Areas. JAMA Surg 2021;156:e214898–e214898. https://doi.org/10.1001/JAMASURG.2021.4898. **Categories:** awareness, professionalism, training **Tags:** historyofsurgery, womeninmedicine, womeninsurgery --- ### [Authority Doesn’t Have One Accent](https://blog.womensurgeons.org/authority-doesnt-have-one-accent/) **Published:** May 20, 2026 **Author:** Blog Team **Content:** **By Linda Ding, MD, FACS** *This is a special edition blog post presented in partnership with the Society of Asian Academic Surgeons in celebration of Asian American and Pacific Islander Heritage Month.* “The ED paged,” the circulator announced. “They have an admission for you.” I step away from the operating table and come to the phone. A familiar voice on the line starts describing a 74-year-old patient with end-stage renal disease and perforated diverticulitis. “Okay, sure, I can take the patient,” I said. “But you’re holding back a ‘by the way,’ aren’t you?” “Well, actually,” the emergency physician replied, “the INR is 7.” “Ooof. There it is,” I laughed. “I knew you were trying to pull one over on me.” A colleague once joked that they were surprised I did not get written up more often. The comment was meant lightly, but it lingered with me. How narrow is our cultural script for professionalism? Why do we expect authority to sound a certain way? My communication style has always been direct, humor-laced, and occasionally sarcastic. I now practice in the Pacific Northwest, where indirect and non-confrontational communication is often the dominant culture. Sarcasm is often interpreted as hostility. At the same time, trauma surgery frequently requires what I think of as “surgeon voice”: a tone designed to create focus, decisiveness, and authority in high-stakes moments. Over time, I have realized that the same communication style is not always interpreted equally. A sharp directive from one surgeon may be perceived as confidence; from another, abrasiveness. Gender, race, environment, and cultural expectations all shape how authority is interpreted. As an Asian-American woman surgeon, I often find myself consciously softening directness with humor. This kind of code-switching is not inherently bad. Adaptability can make teams function better. Humor can diffuse tension, build rapport, and make leadership feel more approachable. I do not expect to eradicate unconscious bias, but I can modulate my communication while still leading the room effectively. What I have become less willing to do over time, however, is erase personality in pursuit of professionalism. For many Asian-American professionals, there can be subtle pressure to fit a narrow model of competence: agreeable but not passive, confident but not intimidating, assertive but never abrasive. Yet one of the strengths of representation is that it expands the acceptable range of who we are allowed to be. I thought about this recently when my son met Seattle Mariners ace pitcher Bryan Woo. There are still remarkably few Asian-American starting pitchers in Major League Baseball, and even fewer of Chinese-American descent. Woo has reflected that he did not initially think of himself as an Asian-American role model. Later, he recognized how meaningful it would have been to see someone who looked like him playing professional baseball when he was younger. My son is only in the rookie division of Little League and still rotates through all the positions. But after getting Woo’s autograph, he looked at me and said, “Maybe I can be a pitcher like Woo.” That moment stayed with me because representation expands possibility. Not every Asian-American surgeon, athlete, or leader will look or sound the same. The goal is not to erase difference in pursuit of professionalism, but to widen our understanding of what leadership can look and sound like. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/05/Headshot.png) **Dr. Linda Ding** is a Trauma and Acute Care surgeon in Everett, Washington. When not consumed by the extra-curricular activities of her two children, she enjoys running, skiing, watching the Mariners, and making fun scrub caps. **Categories:** diversity and inclusion, reflection **Tags:** AAPIMonth, diversirt, Diversity, inclusion --- ### [Self-Advocacy as a Trainee: The Grace to Grow](https://blog.womensurgeons.org/self-advocacy-as-a-trainee-the-grace-to-grow/) **Published:** April 29, 2026 **Author:** Blog Team **Content:** **Author: Rosmi Thomas, DO** As a child, I grew up in a chaotic household, but it brought me resilience and a strong sense of self. In my youngest years, we lived in an extended family home, and my older cousin was one of my first role models. Despite the 15-year age difference, she took me under her wing and provided insight on self-respect that few young people are fortunate enough to grasp. She was the first person to open my eyes to the concept of advocating for myself, and she taught me the power behind asking for what you deserve. Her genuine ability to remind you that you are deeply loved, and her persuasive charm, taught me the first and most important lesson of self-advocacy: you must know your worth. As an osteopathic medical student, I was advised on the advantages and limitations of pursuing a surgical residency. As a curious first year student, I wanted to learn more about the process so I attended a club panel of fourth year medical students who successfully matched into surgical specialties. Afterwards, I approached a kind, knowledgeable fourth year student for guidance. Amazingly, she would later serve as one of my chiefs in residency. At the time, I peppered her with questions about her path to surgery. She emphasized that we have different resources as osteopathic medical students, so it is necessary to advocate for yourself. After a plethora of questions about every aspect of her career choice including how to navigate and secure a research position, she ended our conversation with “you should email them, what’s the worst that can happen? They say no?”. This statement shifted my perspective, and was a powerful reminder of the principles my cousin originally exemplified. It is interesting to think that a simple email would be a form of self-advocacy, but it became that for me. Her words taught me another valuable lesson: even when self-doubt and imposter syndrome attempt to creep in, it is important to knock on the door anyway. As I progressed through surgical residency, I continued to advocate for myself and this allowed me to gain opportunities that I once only imagined. I began to understand the important aspects of advocacy as a trainee. In training, it is not solely about asking despite the doubt; it is also being able to receive the right help. Merriam-Webster defines advocacy as “one who defends or maintains a cause or proposal”. It is true that as a trainee you are defending yourself and your capabilities, however, I believe something integral is missing from this definition. Advocacy as a trainee is not a one-dimensional feeling of simply hoping for the door to open. It is most importantly about understanding that you deserve to be at the door, the gift of having someone open it for you, and the willingness to receive the gift on the other side. This three-dimensional nature of self-advocacy; asking, deserving, and accepting the work ahead has reinforced previous lessons while also giving me the space to embrace and grow my current and evolving strengths. This lesson remains evolving: you are worthy of knocking on the door, you are worthy of the hard work on the other side, and you are worthy of receiving the gifts awaiting you. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/04/Headshot-Rosmi.jpg)**Rosmi Thomas** is a PGY4 General Surgery Resident at the Philadelphia College of Osteopathic Medicine who is currently completing a Research Fellowship at Fox Chase Cancer Center. She completed her Bachelors in Arts in Cell Biology and Neuroscience at Rutgers University, Masters in Biomedical Studies at Drexel University, and her medical degree at Philadelphia College of Osteopathic Medicine. She has been involved with AWS through the Surgical Mentorship Program, Coaching Program, and as a member of the Resident and Fellow Committee and Clinical Practice Committee. **Categories:** awareness, diversity and inclusion, residency, self-care, Underrepresented in medicine **Tags:** inclusion, residency, self-advocacy, womeninsurgery --- ### [Bridges & Breakthroughs: International Medical Graduate’s (IMG’s) Preclinical Research Experience](https://blog.womensurgeons.org/bridges-breakthroughs-international-medical-graduates-imgss-preclinical-research-experience/) **Published:** April 16, 2026 **Author:** Blog Team **Content:** **Author:** Shivani Chaudhary (M.B.B.S, M.S General Surgery) Today, I want to share a deeply personal journey of resilience and perseverance which happened during my 2.5 years of preclinical neuro-oncology research. My research years began after I had already completed three grueling years of general surgery residency training, followed by a year of service at a community health center as part of my commitment to the Indian government. The excitement of landing a funded research position in a field I was passionate about was palpable, but I had no idea what challenges lay ahead. The first three months were a whirlwind of emotions that ranged from exciting yet intimidating. I was thrust into the entirely new realm of glioblastoma research, where I had to master unfamiliar techniques and learn a completely new scientific language. I even had to confront my deep-seated fear of handling mice. There were days when self-doubt crept in, making me question whether I had made the right choice. Was I moving forward? Where would this path lead? Transitioning from operating on humans to working with mice felt like a step back. There was no instant gratification in my work, no immediate patient interaction to provide a sense of purpose. The complexity of new vocabulary, procedures, and analytical tools mirrored my experience as a first-year resident, where everything felt overwhelming. I struggled to stay engaged during lab meetings, often understanding only fragments of the data being presented. I tried to build technical competence while staying motivated. I found myself frequently trying to compare this unfamiliar path to the structure and familiarity of the clinical training I had left behind. As a woman in surgery and an international medical graduate, this uncertainty carried an additional, often unspoken weight. Stepping away from a traditional clinical trajectory made me question not only my decisions but also how they might be perceived by others. In spaces where I was often one of the few, I felt a constant pressure to prove that I belonged both in the lab and in the surgical field I hoped to return to. Fast forward two years, I am now so grateful that I didn’t give up. Despite the challenges and failures, I pushed through, fueled by my devotion to neurosurgery, commitment to excellence, and belief in the potential of my work. Over time, I transformed from someone hesitant in the lab to someone who can now confidently perform complex experiments and think critically about the scientific questions. What once felt unfamiliar gradually became part of my skill set. Every challenge tested my resolve. I have learned that meaningful work and expertise in a niche area, whether in the operating room or the laboratory, requires patience, humility, and persistence. Even when progress is slow and feels invisible, it still has significance. With the support of the right mentors and with relentless and concerted effort, I have slowly found my footing in glioblastoma and immunotherapy research. Today, my determination is shaped not just by ambition, but by perspective. This journey taught me that resilience is more than enduring hardship. It is the willingness to continue showing up, even when progress feels slow and uncertain. For those navigating unconventional paths, especially women in surgery, I hope this serves as a reminder: your trajectory does not have to be linear to be meaningful. And for anyone who belongs to any other marginalized group as well, like I did as an IMG, this reminder is even more poignant. I’ll leave you with a thought that has stayed with me throughout this journey: consistent effort, even in uncertain moments, has a way of shaping outcomes over time. I once measured progress by immediate results; now, I measure it by my ability to bounce back and then to keep moving forward. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/04/Shivani-Chaudhary-headshot--793x1024.jpg)**Shivani Chaudhary** is an international medical graduate from India. She completed her medical degree and a residency in General Surgery at M.S. University, Baroda, India. She is currently in her third year as a Research Scholar in the Department of Neurosurgery at the University of Minnesota. Her work focuses on advancing understanding of novel iNK-based immunotherapies and HSV-based oncolytic virotherapy for glioblastoma. Shivani is passionate about combining clinical skills with translational research experience to become an Academic Neurosurgeon-Scientist, to develop improved treatments for patients with brain tumors. Outside of work, she enjoys hiking, caring for her plants, practicing Kathak (Indian classical dance), listening to audiobooks, and spending quality time with loved ones. **Categories:** global surgery, practice, reflection, research **Tags:** global, reflection, research, womeninsurgery --- ### [How One Question Led Me to Surgical Research: A Guide for Women in Medicine](https://blog.womensurgeons.org/how-one-question-led-me-to-surgical-research-a-guide-for-women-in-medicine/) **Published:** April 22, 2026 **Author:** Blog Team **Content:** **Author: Hala AlDabbous** For many medical students, research can feel like an intimidating, distant world, something reserved for residents or those with connections. I used to think the same. What I’ve learned, however, is that research is not a privilege, it is a skill, and like any skill in medicine, it can be learned, practiced, and developed over time. My journey into research didn’t begin with confidence. It began with curiosity. The turning point came during the recent surge in the use of GLP-1 receptor agonists in Kuwait. As these medications became increasingly popular, I found myself drawn not to their well known benefits, but to their less discussed clinical effects. I began to wonder what kinds of patients we might start seeing as a result, and whether there were patterns we had yet to fully understand. That curiosity made the topic feel real and relevant, something unfolding in front of us rather than confined to textbooks. At the time, I knew a physician who was already working in this area. Reaching out to express my interest felt like a small step, but it turned out to be the most important one. That conversation led to an opportunity to join an ongoing research project exploring the relationship between GLP-1 therapy and anorectal disease. What stood out to me was that I was not starting from scratch, I was stepping into an active research environment, learning how questions are shaped, how data is interpreted, and how clinical observations are translated into meaningful work, alongside researchers with experience and multiple publications. This experience eventually led to presenting our findings at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting in May 2025. In that moment, I realized that research was not distant or exclusive. It was already happening around me, accessible through curiosity, initiative, and the willingness to ask questions. What changed most was not just my involvement in research, but how I understood it. Research does not begin with statistical software or publications, it begins with noticing something in clinical practice and asking why. That shift in perspective made research feel less like a requirement and more like a natural extension of clinical thinking. For students interested in surgery, especially women who may feel excluded from research spaces, the first step is often simpler than it seems. Starting small is both practical and effective. Case reports, audits, and retrospective studies are valuable entry points that build both confidence and skill. They allow you to understand the fundamentals of research without becoming overwhelmed, and they create a foundation for more complex projects later on. Mentorship plays a critical role in this journey. A supportive mentor can guide your thinking, refine your approach, and open doors to opportunities you may not have found on your own. Reaching out, expressing genuine interest, and being willing to learn can make a significant difference. Often, the hardest part is simply taking that first step. Consistency matters more than intensity. Progress in research does not require large blocks of uninterrupted time, it happens through small, regular efforts. Reading articles, writing sections, and reviewing data gradually build into meaningful outcomes. Along the way, setbacks such as rejected abstracts or manuscripts are inevitable, but they are part of the process rather than a reflection of your ability. Research is no longer optional in modern surgery, it is essential. More importantly, it is empowering. It allows you to question, to contribute, and to grow into a more thoughtful clinician. Your first publication is not the final goal, it is simply proof that you belong in a space you may have once thought was out of reach. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/04/Hala-blog.jpg)Bio: Hala AlDabbous is a medical student at Kuwait University. She completed her Bachelor of Medical Science in 2025 and is currently pursuing her MD, with a strong interest in surgical research. She is actively involved in clinical research, with experience in cross-sectional studies and retrospective analyses. Hala is passionate about developing her academic and clinical skills, with the goal of pursuing a successful career while remaining actively engaged in research and medical education. Outside of medicine, she enjoys fitness, art and painting, and creative projects, including developing educational content and writing. **Categories:** career development, global surgery, medical students, research, training **Tags:** medicalstudents, reflection, research, womeninsurgery --- ### [Trusting Your Own Hands: Lessons from the OR](https://blog.womensurgeons.org/trusting-your-own-hands-lessons-from-the-or/) **Published:** April 8, 2026 **Author:** Blog Team **Content:** **By: Dr. Wissam Benhami, MD, General surgeon** **Affiliations:** Université des Sciences de la Santé (Youcef El Khatib) – Algiers, Algeria and Clinique Rahmouni Djilali (formerly Les Orangers), Chikh El Bachir El Ibrahimi, El Mouradia, Algiers Every surgeon faces moments when they feel like even though their hands know the truth, doubt pushes them to look outward for guidance. I often remember this playing out in two operations linked by the same thread. My hesitation was replaced by reassurance from someone who had not lived through the case from the beginning. The first case was an emergency colectomy in an unstable patient. The resection was complete, and the question was a familiar one. Should I restore continuity or divert the patient? The tissues were distressed and the patient’s physiology was fragile. My colleague also hesitated. It was not ignorance in either of us. Instead, it was the quiet calculations surgeons make when risk feels more dangerous than it should. A surgeon from the neighbouring theatre stepped in, glanced at the field, and said, “It looks good. You can do an anastomosis.” The comment was light and felt almost casual and yet it miraculously shifted the balance. We completed the anastomosis but with unfortunate consequences- a leak. The patient survived, but only after sepsis, reinterventions, and a prolonged recovery. The second case involved a patient with Crohn’s disease. The bowel was inflamed and although perfusion was not perfect, bowel viability did not seem to be compromised. A stoma had been planned but once again, a colleague entered and questioned this decision. “Why do a stoma? This will do fine.” This reassurance again tipped the scale. We performed another anastomosis which was complicated by another leak. These cases are not examples of incompetence or arrogance. They expose something subtler: the authority we assign to the “fresh set of eyes.” Surgeons are trained to call for help. It is rightly framed as a safeguard against overconfidence. Many complications have been avoided because someone spoke up. But we rarely examine the opposite risk of external reassurance overriding well-founded hesitation and sound decision making. A surgeon entering mid-case sees a snapshot. The operating team has lived through the entire film — the difficult dissection, marginal perfusion, creeping instability, accumulating fatigue. Context is embodied knowledge. It includes tactile feedback, tension in the tissues, and a sense of when conditions are borderline. These things are all difficult to articulate but play a central role in judgment. Objectivity from outside does not automatically mean deeper insight. It simply means objective distance. This distance can create clarity, but it can also create oversimplification. Confidence delivered from the doorway may feel authoritative precisely because it is unburdened by immersion.The problem is not the act of seeking advice, it is mistaking perspective for decision. When reassurance arrives at the moment of vulnerability, it can subtly convert hesitation into compliance. I still believe in teamwork. I still ask for help. But, I have learned to recognise that my hesitation is not weakness, it is data. When something feels marginal, that feeling often reflects accumulated information that is invisible to a late observer. Help should inform judgment, not replace it. A colleague’s opinion is valuable, but responsibility remains with the surgeon who has lived through the case minute by minute, from beginning to end.The question is not whether we should call for help, but how we can integrate advice without surrendering the quiet knowledge formed by our own hands. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/04/Dr.-Benhami-1.png)**Wissam Benhami**, MD, is a general surgeon recently graduated from Université d’Alger, currently working at Clinique Les Orangers, an oncologic surgery clinic in Algiers. She dreams of specializing one day in hepato-biliary and pancreatic surgery. In her free time, Wissam enjoys working out, practicing Pilates, reading romance novels or self-development books, playing with her cat Olivia, and cooking indulgent meals for her husband, her love language. **Categories:** practice, reflection, women **Tags:** generalsurgery, reflection, womeninsurgery --- ### [Cold Tech, Warm Heart: How AI makes Private Practice More Personal ](https://blog.womensurgeons.org/cold-tech-warm-heart-how-ai-makes-private-practice-more-personal/) **Published:** April 2, 2026 **Author:** Blog Team **Content:** **By: Dr. Erin King-Mullins** In the current world of medicine where burnout is on the tip of everyone’s tongue, I’d like to make another case for artificial, or augmented, intelligence. With having to care for patients in a manner driven toward documentation for insurance reimbursement, let’s discuss how template life has been normalized. How many times have you met with your EMR system team to discuss how to make as many templates as possible to improve efficiency and decrease charting time? While it may tick off a few minutes of charting time and checks off necessary boxes… at the end of the day, if you go back and actually read the notes, can you differentiate between the patients? Have you gotten to the point in medicine where you rely so much on the template that you really don’t listen to key information your patient may be sharing with you? Every hemorrhoid patient has the same complaint, or do they? Subtle differences in reported symptoms and timing of those symptoms can increase or lower your suspicion that something more sinister may be the root cause. Using AI based software allows you to really listen to your patient. You can make direct eye contact and you can listen to what they’re saying and see what they aren’t saying. Sure, there’s a “third-party in the room” which you must disclose to the patient and obtain consent to use, but ultimately, they are telling a story that you need to capture. You can really practice the art of medicine by becoming more visually and physically engaged with the patient since you can reliably trust that what the patient is saying is being accurately documented. If there are other family members in the room, you can more accurately gauge that relationship and determine if they should be excused for the physical examination or to be able to ask more probing questions. Now, of course you have to train your AI resource on your notetaking preferences and documentation style. However, in a world where everyone already feels like a just number, this truly is a great resource to aid the restoration of the doctor-patient relationship. On future visits you can refer back to those detailed and personalized notes. Maybe a grandchild was on the way, or an important trip. In any case, being able to engage in a patient-centered manner instills trust in the relationship that can’t be accounted for with check-boxes. Below are several resources for AI scribe software. I have no conflicts of interest or financial disclosures. FreedAI, Heidi, MedQuill, Doximity, Dax Copilot ![](https://blog.womensurgeons.org/wp-content/uploads/2026/04/Dr.-King-Mullins.png) **Erin King-Mullins, FACS, FASCRS** Colorectal Surgeon Founder and CEO [Colorectal Wellness Center](http://www.colowellness.com/) [Tushy Touch Up](http://tushytouchup.com/) Dr. Erin King-Mullins is a double board-certified general and colorectal surgeon. She transitioned to private practice in 2022 by founding Colorectal Wellness Center after serving as Faculty/Research Director for an Atlanta-based colorectal fellowship program. She has a husband with whom she shares an amazing, blended family. The kids keep them pretty busy, but their favorite times are spent on warm sunny beaches. **Categories:** practice, professionalism, Technology **Tags:** AI, patientcare, womeninsurgery --- ### [How to Improve Your Healthcare Profile Picture: Small Visual Details That Increase Patient Trust and Strengthen Your Business](https://blog.womensurgeons.org/how-to-improve-your-healthcare-profile-picture-small-visual-details-that-increase-patient-trust-and-strengthen-your-business/) **Published:** March 26, 2026 **Author:** Blog Team **Content:** **Camellia Russell MBA, DPM (c)** *In a world where patients choose providers online before ever walking through the door, your profile photo does more work than you think.* Your healthcare business’s profile picture is an asset. Patients now choose their care providers how they choose everything else online: looking at ratings and reviews, reading comments, and yes…scrutinizing your photos before deciding who they’ll trust. These decisions are often made in seconds. Will a patient tap to book your next available appointment or swipe away? Here’s what the research says: Patients want providers who look warm, competent, and approachable. They tend to avoid providers who look cold and serious. One study published in JMIR mHealth and uHealth found that perceived warmth and approachability were two of the biggest drivers when patients choose providers online.¹ Another study from BMC Medical Informatics and Decision Making discovered that facial expression and photo quality impact trustworthiness before readers even look at credentials.² And this study on first clinical impressions found that patients make judgments about their doctors in milliseconds based mainly on eye contact and a slight smile.³ In this case, those judgments can impact booking rates, satisfaction, retention, and referrals. **How a Better Photo Drives Results** Great provider photos help your business in four tangible ways: - Increase your appointments: Friendly photos lead to higher click-through rates in directories and telehealth apps, leading to more scheduled visits. - Gain an advantage: On a grid of provider photos, yours will stand out before potential patients ever scroll down to read your bio. - Build your referral brand: High-quality photos that are uniform create familiarity; this is critical for referral-driven practices such as family medicine, pediatrics, and mental health. - Improve patient retention: When patients like you before they even meet you in person, they’re more likely to stick with you long-term. **Seven Adjustments That Make a Difference** 1\. Wear your best smile. Projects warmth and competence simultaneously. 2\. Look at the camera. Eye contact creates a perception of authenticity. 3\. Relax your eyes and raise your brows. This helps you avoid looking like a “scary doctor.” 4\. Eliminate harsh lighting. Lighting that is too bright casts you in an unprofessional light. 5\. Eliminate cluttered backgrounds. Solid white, grey, or soft blue will keep the focus on you. 6\. Dress the part. Depending on your specialty, wear your white coat, scrubs, or something polished. 7\. Sit or stand up straight but remain relaxed. **The Bottom Line** Your profile picture informs whether patients believe you’re competent, which provider they select, and if they return. Between providers, that first impressions can mean the difference between more patients, patient loyalty, and a trusted brand. The three words your image should communicate: *I’m competent. I care. Trust me.* **References:** ¹ Shan et al., JMIR mHealth 2019 ² Huang et al., BMC Med Inform 2022 ³ Slepian et al., Annu Rev Clin Psychol 2014 ![](https://blog.womensurgeons.org/wp-content/uploads/2026/03/Camilla.png)Camellia Russell, MBA engages in clinical training, research, and student leadership. She holds a Master of Business Administration from Eastern University and a B.A. in Psychology from UCLA, combining her medical education with a strong background in business strategy, healthcare communication, and patient engagement. Camellia has presented research at national podiatric conferences, contributed to multiple medical publications, and served in leadership roles within APMSA and ACFAS. Her work reflects a commitment to advancing patient- centered care, health communication, and the intersection of medicine and business. **Categories:** awareness, professionalism **Tags:** healthcarephoto, womeninsurgery --- ### [Crafting Your Residency Professional Development (Research) Years](https://blog.womensurgeons.org/crafting-your-residency-professional-development-research-years/) **Published:** March 18, 2026 **Author:** Blog Team **Content:** **Authors:** **Paulina M. Gutkin, MD1, Nensi M. Ruzgar, MD, MHS2** 1Stanford University, Stanford, CA 2Beth Israel Deaconess Medical Center Many academic general surgical residency programs offer 1-2 years of protected, non-clinical time as an opportunity to pursue research interests, advanced degrees, or select fellowships. This typically takes place after 2-3 years of clinical training. Deciding how to best approach this time requires thoughtful consideration of several key questions. **What is my end goal?** There are numerous career paths in surgery, and each may warrant a different approach to protected time. *It is okay to not have a fully defined career path yet.* Rather than focusing on details, it may be helpful to frame these years as an opportunity to establish a strong foundation and develop a specific skillset or area of expertise. If considering fellowship, early reflection on subspecialty interests is valuable. Data from NRMP 2025 Match1 highlight varying competitiveness among surgical subspecialties, emphasizing the importance of aligning one’s efforts with future application goals. Exploring clinical interests early and seeking guidance from faculty/senior residents can provide critical insight. Long-term goals such as preferred geographic location or practice model—academic, private, or community-based—should also be considered. **Identify potential mentors** Mentorship plays a central role in career development.2 It is beneficial to cultivate relationships with multiple mentors who provide guidance in distinct areas such as research, career planning, technical training, and personal growth. Networks like the [AWS Resident and Fellow Society](https://www.womensurgeons.org/residents---fellows) could also introduce perspectives and opportunities far beyond your local community. Research conferences or grand rounds lectures are also fruitful avenues to connect with new colleagues. Inquire from senior residents on their experiences with specific faculty: Did they successfully publish, do they receive funding support to attend conferences, does the faculty member help them network or have capacity to meaningfully commit to an additional trainee? **Is research right for me?** The traditional model of full-time basic science research has evolved. Consider if your goals align with developing your skills in basic science, clinical or translational research, health services, education development, global health, or beyond. Some programs afford flexibility to pursue opportunities at other institutions; communicate early with your program leadership about your plans. *Grants* You can’t live for free. While some programs provide internal funding, others require residents to secure external support. Potential avenues for grant applications include through the NIH, T32 awards, and society grants. Grant application deadlines are often 6 months to a year in advance; be cognizant of timelines. Furthermore, some programs require pre-approval before submitting external grants. *A Note on Productivity* Ultimately, the goal is to craft a cohesive narrative that supports future fellowship or faculty applications. For those pursuing academic careers, publication quantity, quality, and authorship position may carry significant weight. Consider balancing long-term projects (which often include basic-science, clinical trials) and shorter term projects (retrospective reviews, case reports) that align with your interests. Joining a collaborative research group can also provide opportunities to contribute to lab members’ current projects. Given the relatively short research timelines available to surgical trainees, realistic expectations are important, as the publication review process can be lengthy. It is important to wrap up your manuscripts before re-entering clinical years. **Utility of an additional degree or fellowship** Pursuing an advanced degree may be a good option. Think critically on whether additional formal education would meaningfully develop your career. Discuss with your institution or lab if they have means to fund a degree. Additionally, surgical trainees are eligible to pursue certain fellowships after PGY3 year. Examples include critical care, burn, palliative care, and select medical specialty fellowships. **Personal livelihood** Don’t lose sight of the fact that these years provide opportunities to re-engage with the “regular world”. Embellish your personal life, if desired. Maybe you finally have time to strengthen your relationships or travel more. You are dedicating your life to this rigorous but gratifying career; take advantage of this time in training, the opportunities are endless. **References** 1\. Results and Data: Specialties Matching Service, 2025 Appointment Year. NRMP. February 13, 2025. Accessed January 27, 2026. https://www.nrmp.org/match-data/2025/02/results-and-data-specialties-matching-service-2025-appointment-year/ 2\. Chopra V, Arora VM, Saint S. Will You Be My Mentor?—Four Archetypes to Help Mentees Succeed in Academic Medicine. *JAMA Intern Med*. 2018;178(2):175. doi:10.1001/jamainternmed.2017.6537 ![](https://blog.womensurgeons.org/wp-content/uploads/2026/03/Paulina.png)**Paulina Gutkin** is a general surgery PGY-2 at Stanford University. She went to medical school at Medical College of WIsconsin, and obtained her Bachelor of Science at Bucknell University. She is currently preparing to enter her Professional Development years and plans to work with Dr. Brendan Visser and Dr. Kyle Loh exploring biomarkers associated with pancreaticoduodenectomy. She has been actively involved in AWS and currently serves as a Liaison on the AWS Resident and Fellows Committee. As a medical student, she served on the AWS National Medical Student Committee as Chief of Chapter Development and as Regional Representative for the Midwest Great Plains Region. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/03/Ruzgar-732x1024.jpg)**Nensi Ruzgar** is a general surgery resident at Beth Israel Deaconess Medical Center and is currently completing the second year of her professional development period as a post-doctoral fellow at Dana-Farber Cancer Institute, working on using liquid biopsy to profile pediatric liver and kidney tumors. She is the Vice Chair for the AWS Resident and Fellows Committee, and serves as a Candidate representative on the AAS Basic and Translational Science Committee. **Categories:** mentorship, professionalism, research, residency **Tags:** professionaldevelopment, research, residency --- ### [A (Probably Too Realistic) Week in My Life as a Medical Student](https://blog.womensurgeons.org/a-probably-too-realistic-week-in-my-life-as-a-medical-student/) **Published:** March 11, 2026 **Author:** Blog Team **Content:** **Author: Tessa Paul** Hi!! I’m Tessa, a second-year medical student at LSU Health Shreveport. I originally picked this week because I was heading to the [Women in Surgery Career Symposium](https://women-in-surgery.com/) in Florida. I expected a calm start to a new class block before traveling. A productive, balanced, slightly aesthetic week in my life. That plan didn’t last long. A sudden freeze caused an unexpected schedule change. Add travel stress and burnout I didn’t want to admit, and what I thought would be calm quickly became chaotic (how my weeks normally go). So instead of a curated version of med school, this is one of the real weeks. ### Sunday: The Reset Day That Wasn’t *Supposed to be:* reset day *Reality:* emergency renal exam prep My renal exam got moved from Friday to Monday, and my reset day became survival mode. I woke up at 10:00 am (no weekend alarms ever), did emails and Anki while finishing Heated Rivalry (priorities), called my MawMaw. I then spent the rest of the day cycling between practice questions, *First Aid*, then Anki – all while trying to mentally keep it together. I made dinner, folded laundry I’d been avoiding, and ended the night doing Anki in bed (would not recommend). If I’m being honest, I struggled. Burnout is real. I didn’t feel as prepared as I wanted to be, and focusing took more effort than usual. Sometimes showing up doesn’t look like peak productivity. Sometimes it’s just doing what you can with what you have. And that counts. ### Monday: Exam Day My day started at 2:44 am when construction woke me up. By 5:39 am I was in my favorite study room on campus, running on fumes. Anki, First Aid, and my first Uncrustable of the day carried me to my 11:00 am exam. At 12:31 pm, it was over. Immediately, my stress was knocked down 4 notches. I picked up prescriptions, crocheted instead of being productive, felt guilty about it, then ran errands to compensate. Built a desk. Bedrotted. Got dinner with friends. Played pool. Post-exam evenings mimic getting your nervous system back into normal rhythm. ### Tuesday: Sick Day I was sick. I stayed in bed. Not every day in med school is productive. I needed the reset. ### Wednesday: Regaining Momentum I slept in intentionally. Recovery was the priority. I went to school, checked on our bake sale, watched Sketchy, went to class, attended an IDEAS Day meeting, which is basically a giant science fair for kids in the Shreveport-Bossier community. Then I went home to unpack and repack my bag (removed suture supplies TSA would absolutely confiscate). I did laundry, accidentally vacuumed my entire house, and ended the night with Boards videos and Anki. Momentum was fragile, but it was coming back. ### Thursday: Travel Day Chaos I woke up at 3:30 am, got stuck behind a stopped train, studied at school, worked the AWS “Charm & Chill” event at the Mental Health Fair on campus, partially skipped class to avoid missing my flight, and made it to the airport. I did compliance modules and drank an ice cold Dr. Pepper at the gate. After delays, I landed in Tampa at midnight and finally fell asleep at 2:00 am. Traveling as a medical student means bringing your responsibilities with you. ### Friday & Saturday: Women in Surgery Career Symposium This is why I came. I attended workshops on mentorship, mental health, research, leadership, imposter syndrome, and building a career in surgery. I met mentors, watched poster presentations, and spent time surrounded by women who built the careers I dream about. Friday evening, I walked on the beach and realized this is what I’m working toward. Saturday, I attended more workshops and met a pre-med student interviewing at LSU Health Shreveport. Talking to her felt surreal. Not long ago, I was her. Now I’m the one giving reassurance. ### Final Thoughts This week wasn’t perfect. I was burnt out, sick, sleep-deprived, and overwhelmed. But I still showed up. I took my exam, supported my organization, traveled halfway across the country, met mentors, and helped someone earlier in their journey. Medical school isn’t aesthetic study sessions and perfectly organized schedules. It’s messy. It’s exhausting. It’s meaningful. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/03/unnamed.jpg)**Tessa Paul** is a second-year medical student at LSU Health Shreveport School of Medicine. She is passionate about breast surgical oncology and women-focused surgical specialties. She founded and currently leads the emerging Association of Women Surgeons chapter at LSUHS and is actively involved in IDEAS Day, AMWA, Pars for Peds, Medical Students for Choice, and the Vascular Surgery Interest Group. Her academic interests include breast cancer care, surgical education, and translational oncology research, including work on exosomal miRNAs as diagnostic biomarkers for hepatocellular carcinoma. In her free time, she enjoys crocheting, hiking and running, traveling, and spending time with her cat, Sabrina. **Categories:** career development, medical students, training **Tags:** medicalstudent, womeninsurgery --- ### [Surgery Begins Long Before the Incision](https://blog.womensurgeons.org/surgery-begins-long-before-the-incision/) **Published:** March 4, 2026 **Author:** Blog Team **Content:** **By: Srinithya Gillipelli** During my Fulbright-Fogarty Fellowship, I spent a year in Peru studying global surgery and health policy, much of it alongside community health workers (CHWs). I arrived expecting to focus on operating rooms, surgical volume, and workforce shortages. Yet the most enduring lesson came from outside the hospital walls– for many patients, surgery does not begin in the OR. The surgical cascade begins at home, among beliefs and barriers that affect communities in many resource-limited settings. In resource-limited settings, the distance between a patient and an operating table is rarely just geographic. It is shaped by trust, cost, timing, information, and fear. In Cameroon, nearly one in five patients presenting with a surgically treatable condition in one study ultimately declined surgery, most often because of financial and social constraints rather than medical contraindications.¹ A technically skilled surgeon and a well-equipped operating room mean little if a patient cannot move from diagnosis to decision, or from decision to arrival. Global surgery often measures access through surgeon density, infrastructure, and travel time.² These indicators matter, but I learned that there are many more factors to investigate in order to capture how patients experience care. Even when hospitals are reachable, patients may delay for months or years. Qualitative work across multiple low- and middle-income countries has shown that fragmented perioperative pathways, limited human resources, and direct and indirect costs–even within nominally “free” systems–shape whether patients proceed with surgery.³ In Peru, I met families who lived within reach of tertiary hospitals, yet waited until conditions became emergencies. Some did not recognize surgical disease as treatable. Others feared the health system based on prior experiences. Many could not absorb the indirect or hidden costs of transportation, lodging, or lost wages. In the operating room, we rarely consider the barriers that preceded that moment. CHWs operate precisely in that space. They are often described as extensions of the health system, but in practice, they serve as trusted translators between institutions and communities. They help patients interpret symptoms, understand diagnoses, and anticipate what care will require. A growing body of literature highlights how CHWs strengthen linkage to operative care and support post-operative follow-up by navigating social and structural barriers.⁴ In Peru, I watched CHWs explain surgical plans in familiar language, help families plan for travel, and encourage return visits. They changed surgical trajectories without ever holding a scalpel. Patients also conceptualize surgical disease differently than clinicians. In rural Ethiopia, communities distinguish between “problems you can live with” and true emergencies, often delaying care until function or survival is threatened.⁵ From the patient perspective, surgery is not a discrete event but a process marked by uncertainty. Outcomes are shaped by diagnosis, referral, transport, counseling, and follow-up as much as by technical execution. When these systems fail, surgeons inherit advanced diseases and preventable complications. When they function well, surgery becomes safer and more equitable. If we aim to improve surgical outcomes globally, including within rural areas of the United States, our focus must extend beyond infrastructure. The Lancet Commission on Global Surgery emphasized that timely access requires not only proximity, but the ability to actually receive care when needed.² Meeting that goal requires integrating surgery into community-based systems and valuing the workforce that bridges patients and hospitals. It also requires training surgeons to recognize surgery as both a technical and social intervention. After a year in Peru, I left with deeper respect for the unseen work that makes surgery possible. The scalpel matters, but so does the pathway that leads a patient to it. Surgery begins long before the incision, and our systems should reflect that truth. **Citations** 1. Lerman, B. J., Alsan, M., Chia, N. J., Brown, J. A., & Wren, S. M. (2017). Beyond Infrastructure: Understanding Why Patients Decline Surgery in the Developing World: An Observational Study in Cameroon. Annals of surgery, 266(6), 975–980.<https://doi.org/10.1097/SLA.0000000000002002> 2. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X 3. Bedwell, G. J., Dias, P., Hahnle, L., Anaeli, A., Baker, T., Beane, A., Biccard, B. M., Bulamba, F., Delgado-Ramirez, M. B., Dullewe, N. P., Echeverri-Mallarino, V., Haniffa, R., Hewitt-Smith, A., Hoyos, A. S., Mboya, E. A., Nanimambi, J., Pearse, R., Pratheepan, A. P., Sunguya, B., Tolppa, T., … Stephens, T. J. (2022). Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study. Anesthesia and analgesia, 135(6), 1217–1232.<https://doi.org/10.1213/ANE.0000000000006113> 4. Li, H. W., Scanlon, M. L., Kisilu, N., & Litzelman, D. K. (2021). The role of community health workers in the surgical cascade: a scoping review. Human resources for health, 19(1), 122.<https://doi.org/10.1186/s12960-021-00659-z> 5. Negussie H, Getachew M, Deneke A, Tadesse A, Abdella A, Prince M, Leather A, Hanlon C, Willott C, Mayston R. “Problems you can live with” versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery. BMC Health Serv Res. 2024 Feb 16;24(1):214. doi: 10.1186/s12913-024-10620-0. PMID: 38365723; PMCID: PMC10874059. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/03/Blog-Author.jpg)Srinithya (Nithya) Gillipelli is a fourth-year medical student at Baylor College of Medicine. During medical school, she completed a Paul Farmer Global Surgery Research Fellowship at Harvard Medical School’s Program in Global Surgery and Social Change, as well as a Fulbright-Fogarty Fellowship in Peru focused on surgical systems strengthening and community-based care. She is interested in global reconstructive surgery, cleft care access, financial burden of surgical disease, and surgical workforce development. **Categories:** global surgery **Tags:** womeninsurgery --- ### [Understanding the Misunderstood: A Hidden Burden in Black Communities](https://blog.womensurgeons.org/understanding-the-misunderstood-a-hidden-burden-in-black-communities/) **Published:** February 23, 2026 **Author:** Blog Team **Content:** **Written By: Melissa Rony MSc, Mentor: Evan Garfain, MD** *This article is not intended to be used as medical advice. Views of the author do not reflect the views of the institution.* I was inspired to write this article by the experience of a close friend whose Hidradenitis Suppurativa (HS) was misdiagnosed for many years and whose symptoms were repeatedly dismissed by healthcare providers, allowing her condition to worsen before she received answers. I am writing in the hope that more patients will become aware of HS, recognize early symptoms, and feel empowered to seek care while helping to debunk harmful myths about the condition. Equally important, I hope this encourages clinicians to keep HS in their differential diagnosis, especially when caring for patients of color who are disproportionately affected yet often underdiagnosed. Ultimately, greater awareness can help drive more research, resources, and comprehensive approaches to understanding and treating HS, moving us closer to more equitable care for all patients. **What is HS?** **Hidradenitis Suppurativa (HS)**, also referred to as acne inversa, is a chronic inflammatory condition that causes painfully debilitating persistent lumps, boils and abscess on the skin. It mainly affects the areas that skin rubs together like the armpits, groin, buttock, and under the breast. HS occurs when hair follicles become clogged with keratin, sweat, and bacteria, leading to inflammation and infection. Over time, these pus-filled abscesses can rupture, leaving behind painful, open sores and forming tunnel-like lesions under the skin that can lead to significant scarring. The pathophysiology of HS isn’t well understood, but it is believed to involve a complex interplay of genetics, hormones, lifestyle habits (such as smoking and poor diet), and excess body fat. In the US alone, HS affects millions. Black patients are disproportionately impacted, with Black patients having a 2.8 times higher risk of presenting with severe HS compared to White patients (1). It is estimated that for every 100,000 Black people, about 300 have HS (2). However, that is likely an underestimate given that many people with HS are either misdiagnosed or remain undiagnosed (3,4). ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/HS-1.png) ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/HS-2.png) **HS Diagnosis and Management** So why is HS often missed or misdiagnosed? Unfortunately, the answer echoes many longstanding **inequities in healthcare**: a combination of barriers to accessing care, systematic and structural bias, and lack of HS awareness (5-8). Many patients, particularly in underserved communities, struggle to access a multidisciplinary healthcare team equipped to properly diagnose and manage HS. Comprehensive care and management of HS involves a team of primary care providers, dermatologists, and surgeons, often including both general and plastic surgeons. For far too many, especially those in underserved or low-resource communities, seeking specialized care can involve waiting months for an appointment and traveling long distances to see a provider. Additionally, medical training has historically relied on images of skin conditions in lighter skin tones, contributing to misidentification of HS in Black and deeply pigmented patients, especially during the early stages when it may resemble common acne (5, 9-10). Skin of Color Society has a list of [Dermatology textbooks](https://www.google.com/url?q=https://skinofcolorsociety.org/resources/soc-dermatology-textbooks&sa=D&source=docs&ust=1771869882406511&usg=AOvVaw3Tdivx0V7NB3eX20FFbyTj "recommended Dermatology textbooks") they recommend. Early diagnosis is critical. Not only does it enable timely treatment, but it also plays a key role in effective pain management and preventing disease progression. In its initial stages, HS may present subtly; with light burning, itching, or increased sweating in skin-fold areas before visible lesions appear. While it is not always the case, HS lesions typically appear symmetrically, affecting both sides of the body. For one reason or another **many patients delay seeking care**, believing the symptoms aren’t serious or are related to hygiene, which is a harmful health myth. Another myth is that HS is a contagious disease. These misconceptions can create shame, social stigma, and self-blame. **Disparities in Care and Representation** Despite the clear racial disparities in HS prevalence, Black communities remain underrepresented in HS research, clinical trials, and treatment development. Fewer than 6% of practicing physicians in the U.S. are Black, and less than 3% are specialists. This may be one of many contributing factors to why inclusivity in HS representation and understanding among deeply pigmented skin may be limited. The lack of Black physicians limits access to culturally competent care and diverse research perspectives. Medical research and treatment studies often underrepresent the very populations most affected by the disease, and these disparities further limit the generalizability of existing findings and delay the development of truly equitable care. When the populations most affected by a disease are left out of the science used to understand and treat it, we all lose. Better representation in research is essential to develop equitable, effective, and accessible care. **Looking Ahead** Hidradenitis Suppurativa is more than a skin condition, it is a **public health equity issue**. For too long, it has gone unrecognized, undiagnosed, and undertreated, especially in the Black community. Breaking the cycle starts with raising awareness, improving medical education, increasing access to culturally competent care, and prioritizing diversity in research. Every skin deserves to be seen, every voice deserves to be heard, and every patient deserves access to the care they need. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/image.jpeg)Melissa Rony is a 2nd medical student at Albert Einstein College of Medicine with a strong interest in surgery and health equity. She earned her Bachelor of Science in Psychology and a Master of Science in Nutrition before beginning her medical training. Melissa is deeply committed to advancing women’s health, global health, and equitable access to care. Prior to medical school, she worked in population health research and served as a doula, advocating for reproductive justice among Haitian immigrants and refugees in New York City. During medical school, she has contributed to global health initiatives focused on sustainable wound care techniques in resource-limited settings and health equity research with the Montefiore-Einstein Department of Surgery. She currently serves as President of the Association of Women Surgeons (AWS) Einstein chapter. As a Haitian-American and a nontraditional student, Melissa’s experiences continue to shape her commitment to health justice and community-centered care. **References:** 1\. Ulschmid C, Serrano L, Wu R, Roth GM, Sokumbi O. African American race is a risk factor for severe hidradenitis suppurativa. *Int J Dermatol*. 2023;62(5):657-663. doi:10.1111/ijd.16428 2\. Garg A, Kirby JS, Lavian J, Lin G, Strunk A. Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States. JAMA Dermatol. 2017;153(8):760–764. doi:10.1001/jamadermatol.2017.0201 3\. Garg A, Wertenteil S, Baltz R, Strunk A, Finelt N. Prevalence Estimates for Hidradenitis Suppurativa among Children and Adolescents in the United States: A Gender- and Age-Adjusted Population Analysis. *J Invest Dermatol*. 2018;138(10):2152-2156. doi:10.1016/j.jid.2018.04.001 4\. Kirby J, Kim K, Zivkovic M, et al. Uncovering the burden of hidradenitis suppurativa misdiagnosis and underdiagnosis: a machine learning approach. *Front Med Technol*. 2024;6:1200400. Published 2024 Mar 25. doi:10.3389/fmedt.2024.1200400 5\. Sabat R, Alavi A, Wolk K, et al. Hidradenitis suppurativa. *Lancet*. 2025;405(10476):420-438. doi:10.1016/S0140-6736(24)02475-9 6\. Wang CX, Buss JL, Keller M, Anadkat MJ. Factors Associated With Dermatologic Follow-up vs Emergency Department Return in Patients With Hidradenitis Suppurativa After an Initial Emergency Department Visit. JAMA Dermatol. 2022;158(12):1378–1386. doi:10.1001/jamadermatol.2022.4610 7\. Knecht-Gurwin K, Gurwin A, Łyko M, et al. An Assessment of Clinician Knowledge of Hidradenitis Suppurativa: Insights from a Multidisciplinary Survey Study. *J Clin Med*. 2025;14(9):3171. Published 2025 May 3. doi:10.3390/jcm14093171 8\. Garg A, Naik HB, Kirby JS. A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. *Am J Med*. 2023;136(1):42-53. doi:10.1016/j.amjmed.2022.09.025 9\. Zouboulis CC, Goyal M, Byrd AS. Hidradenitis suppurativa in skin of colour. *Exp Dermatol*. 2021;30 Suppl 1:27-30. doi:10.1111/exd.14341 10\. Jenkins T, Isaac J, Edwards A, Okoye GA. Hidradenitis Suppurativa. *Dermatol Clin*. 2023;41(3):471-479. doi:10.1016/j.det.2023.02.001 **Categories:** advocacy, awareness, diversity and inclusion, diversity and inclusion, Underrepresented in medicine **Tags:** diversity and inclusion, womeninsurgery --- ### [Flapping My Wings Across Borders: A Surgeon’s Journey of Resilience](https://blog.womensurgeons.org/flapping-my-wings-across-borders-a-surgeons-journey-of-resilience/) **Published:** February 13, 2026 **Author:** Blog Team **Excerpt:** Every migration is a form of rebirth and a gentle reminder that courage begins the moment we choose to step into the unknown. When I left my home in Turkey to begin a new chapter in the United States, I carried not just a suitcase but a heart full of determination and dreams that refused to be grounded — dreams strong enough to flap their wings. **Content:** **By: Busra Ozkaya, MD** Every migration is a form of rebirth and a gentle reminder that courage begins the moment we choose to step into the unknown. When I left my home in Turkey to begin a new chapter in the United States, I carried not just a suitcase but a heart full of determination and dreams that refused to be grounded — dreams strong enough to flap their wings. I was born and raised in Cappadocia, a region where strength and patience are part of the landscape itself. The people there taught me that true resilience is quiet, steady, and often unseen. My journey into obstetrics and gynecology began with a deep sense of purpose: empowering women means nurturing the foundation of society. Each delivery and each patient encounter reminded me that medicine is not only about healing the body, but also about listening patiently, showing compassion, and restoring hope. After completing my obstetrics and gynecology residency in Turkey, I made one of the most difficult decisions of my life: to start over in a new country, far from everything familiar. I knew the path ahead would be filled with uncertainty. Still, the desire to grow beyond borders and to see how women’s health was practiced in another part of the world outweighed my fear. Leaving behind everything I had accomplished and the comfort of my old world felt like shedding an old layer of certainty. Yet, with each unfamiliar day, I discovered a new part of myself — one that was flexible, humble, and fiercely determined. In the United States, my journey began again from the ground up. I joined various clinics as a clinical volunteer assistant and participated in academic projects as a volunteer research fellow, where I learned the rhythm of a new healthcare system and the subtle art of communication in another language. There were moments of silence where I once had words, and moments of reflection where I once had confidence. Yet through these pauses, I discovered the quiet power of observation: listening deeply can sometimes teach more than speaking ever could. Over time, I came to realize that medicine truly speaks a universal language. Compassion needs no translation. The connection between doctor and patient transcends geography and culture. Above all, these experiences taught me that being a physician is not defined by where you practice, but by how you touch lives. There were times when doubt whispered louder than hope, when progress felt painfully slow, and the weight of starting over felt heavy. Yet each time, I reminded myself that even small steps forward are still progress and remembered why I began this journey. Resilience, I’ve learned, is not about never falling; it’s about rising every single time with a heart that still believes. Today, as I continue to grow within the U.S. healthcare system, I carry both the roots of my earlier training in Turkey and the experiences I have gained in America as essential parts of who I am. They do not compete with each other; they complete each other. They are two wings on the same journey, one shaped by tradition and the other by transformation. I am still on my way, learning and growing every day. Yet through the lessons carved by my own journey, I’ve come to believe that every woman surgeon carries within her the strength to rise. The path may be uncertain, the skies may seem distant, but they open to those who keep believing. Every challenge, every small victory, adds lift to our wings, and in that flight, we begin to see who we are becoming. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/Dr.-Bursa.png)**Busra Ozkaya, MD**, is an obstetrician-gynecologist originally trained in Turkey and currently gaining clinical and research experience in the United States. Her interests include women’s health, surgical innovation, and global collaboration in medicine. She is passionate about resilience, empathy, and empowering women through patient-centered care. **Categories:** diversity and inclusion, global surgery **Tags:** AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Does Gender Bias Still Exist in Surgical Residency](https://blog.womensurgeons.org/does-gender-bias-still-exist-in-surgical-residency/) **Published:** February 4, 2026 **Author:** Blog Team **Content:** **By: Dr Swathy Elangovan, M.S General Surgery** It’s 2026, a time where the world is AI driven. Advancements and innovation drive people to more effective living. But it is a known fact that Surgeons can never be replaced by AI. Thus the course of surgical training remains crucial in saving the lives of patients. Both females and males residents have to be competently trained and given equal operating chances so that when they become an attending in the future, they would have the confidence to treat patients individually. The scalpel doesn’t know whether the operating surgeon is a female or a male .Then why the discrimination. One thing hasn’t changed. The treatment against women in the field of medicine, specifically surgery, where buttering, flattery and fawning take an upper hand over sheer hard work, truthfulness and raw talent. You might be the best female out there in the course of training, but if you are not in good hands it’s just like a rusted Porsche in the hands of a person who doesn’t know how to drive. If you are submissive, you are labelled good, but if you speak out you are opinionated and arrogant. Survival of the fittest is misinterpreted as yielding to workplace maltreatment, being catcalled, being grabbed of operating chances and labelling you as an ordinary one. It’s sad to realize that with no big daddy, lavish hereditament, first generation female surgeons literally have to burn themselves to acquire spotlight, in their field of training. It takes a great deal of courage to stand up for oneself when you haven’t done anything wrong, but only are true to your profession. There has been a situation during my residency where I had to voice out against an attending who wasn’t professional. Initially there was chaos, but ultimately everyone had accepted the truth. The peculiarity of the surgical field is that, if you don’t get trained under the supervision of an attending with good skills, your learning phase is gone. True talent doesn’t boast i.e some residents are very good at observing their attending operating. When given the chance they intricately exhibit the knots etc. True talent is humble. True talent is kind but strong. True talent is knowledgeable. True talent tries to learn everyday. True talent doesn’t show off True talent is calm, not chaotic. True talent loves the subject. True talent is respectful. Sometimes, your profession and workplace might not recognize and nurture you to the best of your ability. Never-mind. Keep working hard, all your struggles will reap the fruit one day. How long will they try to suppress us? Just like the calm before a storm, stay grounded as always until you make your biggest comeback. A true Surgeon is one who wants to make an impact in the lives of others, which includes his patients, subordinates, seniors and the public. On the contrary, in the contemporary world you are graded based on the number of cases you have operated, the sum in your bank account, not mindful of the struggles of your subordinates The struggles which the female surgical residents face today, will be the lighting path to others who wish to pursue the field of surgery in the future. Surveys have shown that male residents tend to have more OR chances than their female counterparts who equally work their assess off. Everything is temporary. Knowledge ,character and discipline will take you places than all these unworthy favoritism and politics. Study hard. Train hard. All the best. Let we all reap the fruits of labour. The sun will rise again!! ![](https://blog.womensurgeons.org/wp-content/uploads/2026/02/Elangovan.Swathy-edited.png)**Dr. Swathy Elangovan, M.S General Surgery** Hi, I am a General Surgeon from Chennai, Tamilnadu, India. I am a voracious reader. I love writing. Writing gives me peace. It helps me connect with other fellow surgeons who have high aspirations and dreams as mine. I have published many articles in medical and surgical journals. I have authored a poetry book called “Cocktail – Poems for your soul” which is available on Amazon. I wish to inspire women of the world to be fiercely independent, knowledgeable, healthy, wealthy. **Categories:** diversity and inclusion, gender differences, reflection, Underrepresented in medicine **Tags:** #genderequality, AWSBlog, womeninsurgery --- ### [Speaking up from the Global South](https://blog.womensurgeons.org/speaking-up-from-the-global-south-how-young-women-in-neurosurgery-can-influence-global-health-conversations/) **Published:** January 28, 2026 **Author:** Blog Team **Content:** **By Dr. Prarthana Subedi** ## How Young Women in Neurosurgery Can Influence Global Health Conversations Ever since I was a child, I’ve found myself in situations where I quietly questioned my place. These doubts didn’t come from lack of preparation or effort, but from something more deeply seated– an invisible weight carried by the labels that define me–*A woman*, *A medical student from Nepal, A single child raised by a single mother.* These identities shaped how I saw myself, long before I stepped into an operating theater with interest or attended a scientific conference. During my second year of medical school, I worked relentlessly, but for me, the baggage was heavier. When I was selected to serve on the organizing committee for a “Women in Neurosurgery” conference, it felt like the door to my dreams had cracked open. Meeting women from Romania, the United States, Peru, and Spain gave me something textbooks never could: **perspective.** We spoke about training disparities, access to mentorship, and how ambitions are shaped differently by where we come from. That was my first tangible experience of the training gaps often described in academic literature, the difference between global neurosurgery discussions and what is lived by students and surgeons in resource-limited settings. One quiet Sunday afternoon, I came across “*The Art of Storytelling*” by John Walsh. Reading it , I realized how much of medicine, and especially surgery, is rooted in human stories. We publish, we present, and we quantify, **but we rarely pause to humanize.** I understood that storytelling isn’t just an art: it’s a responsibility. ***So I spoke*** I started writing and documenting my experiences as a Nepali woman in medicine. I founded a [podcast](https://www.youtube.com/@behindwhitecoats3934) where we discussed topics often considered “uncomfortable” in our context: periods and ward rounds, LGBTQ+ Health, and the unspoken pressures of medical school. Slowly, I aligned these conversations with my growing passion for neurosurgery and global surgery. I learned: ***every experience is different, every experience is valid, and every experience is inherently human.*** If you never tell your story, no one will know it; if you never ask, the answer will always be no. In 2021, I had the privilege to speak at the UNESCO ASPNet (Associated Schools Network) event, sharing insights on neurosurgical education and global access for young learners like myself. It was humbling to stand as a representative of Nepal, a Himalayan country with big dreams, and talk about how inclusive education can spark opportunities in fields like neurosurgery that often feel out of reach in low-resource nations. The experience affirmed my belief that young voices do belong in global health conversations, not as future leaders, but as present contributors. Building on that belief, I helped initiate “Sisterhood in Scrubs, “an alliance to create open platforms for women in surgery to share stories, experiences, and practical learning via Global Surgery Simulation Network As per my survey, 34% of medical students in my country hadn’t seen a female surgeon – a saddening reality . ![](https://blog.womensurgeons.org/wp-content/uploads/2026/01/Laparoscopy-team-3.jpg) I also initiated a grassroots laparoscopic training program for high school students interested in surgery. The idea was simple: create bridges where none exist. Baseline surgery shouldn’t be a privilege for those with connections or geography on their side; it should be a possibility for anyone with passion, precision, and persistence. Through these experiences, I’ve come to realize that leadership in medicine doesn’t always look like a title or a post but sometimes it’s about ***starting small conversations that ripple outward.*** Whether it’s helping a high school student understand what surgery truly means or ensuring a rural medical student’s perspective is heard in a global forum, influence can begin anywhere. As I continue my journey, still deciding on a training, still learning, I carry an unshakable hope for Nepal***: a future where neurosurgery and surgical education reach beyond cities***, where global health truly listens to voices from the Global South, *and* ***where young women in medicine are defined not by labels, but by their empathy, courage, and stories***. For global surgery to be truly global, it must be shaped by those **who live its realities**. Young women in neurosurgery bring more than diversity: they bring lived insight, compassion, and perseverance. Speaking up is not about visibility; it’s about redefining excellence through empathy and action. The path forward lies in ***our courage to create, connect, and converse – across borders, genders, and generation*s**. Because every time a young woman from the Global South speaks up, she doesn’t just represent herself; she helps reshape the global surgical system. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/01/Custom-Instagram-Resize-Photos-1.png)***Dr. Prarthana Subedi*** *is a medical doctor from Nepal and an aspiring neurosurgeon passionate about global equity, surgical education, and women’s leadership in medicine. She advocates for inclusive, story-driven approaches to global surgery and has spoken on international platforms, including UNESCO ASPNet, about neurosurgical education and youth empowerment. She is actively involved in grassroots initiatives, including early exposure surgical training programs for high school students, and is currently working with the Oxford University Clinical Research Unit in Nepal.* **Categories:** diversity and inclusion, global surgery **Tags:** global action, sisterhood, womeninmedicine, womeninsurgery --- ### [SBAS - Sunday Series: Finding joy in the little things](https://blog.womensurgeons.org/finding-joy-in-the-little-things/) **Published:** February 21, 2025 **Author:** Blog Team **Content:** **by Dr. Crystal Johnson-Mann** Most would agree that achieving the idyllic dream of self-care can be challenging at baseline, let alone when trying to incorporate it into a demanding surgeon schedule. The activities that fulfill one’s idea of self-care are highly variable, depending on who you ask. For some, it is a relaxing day at the spa; for others, it may be quiet and solitude in one’s “happy” place. In the current climate, self-care is of the utmost importance. But how exactly does one achieve it? This is much easier said than done, as one would presume. I’m an academic surgeon, wife, mother to 2 little boys, and a former D-I college athlete. I have repeatedly said at the start of each new year since becoming a mom almost 6 years ago that I would make a special attempt to really lean into devoting time periodically for me…to preserve my sanity and refill my cup so that I can continue to be there for all of the people (and patients) that need me. Have I achieved this? Not really if I am being honest, or at least not as I had initially envisioned. Work (or life) has altered any plans previously made time and time again. As this occurred, I became more frustrated about my inability to make it work out as planned. You may know the saying, “If you want to make God laugh, tell Him your plans.” In this state of frustration, I realized I need to stop putting such rigid goals about this into place, and look for other things in my everyday life that refill my cup. For example, my kids. I mentioned I was a former college athlete but didn’t mention that I also married a former college athlete. Our oldest son is five (almost six if you ask him) and is bright, energetic, amazingly empathetic, and dare I say it – a natural athlete. We have been watching him since he was about 2 years old, running around the house, deftly contorting his little body to miss furniture and other objects, while running at full speed. He has come into his own with sports over the years, and now at almost 6, he can’t wait to go practice routes after a flag football game or work on his dribbling and lay up skills after basketball games. I have affectionately (or not) been given the title of “Coach Mom” by my husband because I literally cannot help but yell and scream encouragement (and reminders) during his games. This has been the highlight of my week this academic year – getting to watch him develop a love of sports on his own. I have watched him take some pretty hard falls and collide with other players, yet get right back up on his own accord and hustle down the court/field. I admit – it sparks a ton of joy in my little heart to see this as sports have been a formative part of my life for as long as I can remember. There were so many invaluable lessons about teamwork, working towards a goal, managing interpersonal relations with others, overcoming adversity, conflict resolution, mental toughness, etc. that are hard to teach in other environments. Our new thing this academic year has also been going on “mommy and son” dates to UF sporting events – his joy during these moments together brings me such happiness. But as I mentioned, I have two sons. My youngest son is 2.5 years old and keeps me on my toes. Everything I thought I knew about kids disappeared with him when he turned one and became a full-fledged toddler! He is smart, funny, kind, and determined. He knows what he wants, goes after it, and notably stands up for himself. He loves making music and playing pretend. His favorite pretend activities involve running around the house on a light saber declaring that he is Harry Potter (since we don’t have a broom for him), and reciting various spell incantations with pretend wands. He is also quite fond of our pet cat (they are besties), and is his big brother’s biggest fan. His big brother is also a huge fan of his little brother, and I love how much they love each other. By being themselves, they instantly lift my spirits when I come home after a hard day or a long week at work. It doesn’t get any better than this, and time spent with them is the best self-care I could ask for. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/02/Johnson-Mann_Crystal-300x200.jpg)I am a clinical assistant professor in the department of surgery at the University of Florida, specializing in bariatric/foregut surgery. My educational background is mainly in South Carolina, where I grew up, attending the University of South Carolina for my undergraduate years and the Medical University of South Carolina for medical school. I stayed in Charleston at MUSC for my general surgery training before relocating to Charlottesville and the University of Virginia for fellowship training. My clinical and research interests are centered on my clinical practice and investigating equity in health care access, delivery, and outcomes. When not caring for patients or teaching, I enjoy traveling and spending time with my family. **Categories:** awareness, career development, current events, diversity and inclusion, family life, health, parenting, practice, professionalism, reflection, self-care, URiM, women **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Second Acts: Embracing Surgery as a Career Changer](https://blog.womensurgeons.org/second-acts-embracing-surgery-as-a-career-changer/) **Published:** January 21, 2026 **Author:** Blog Team **Content:** **By: Vaisny Balamurali** Starting medical school as a “mature” student, after navigating a successful career in healthcare strategy, was both humbling and unsettling. Rather than confidence, my prior experience fueled imposter syndrome and a sense that I needed to justify my presence. Walking away from a stable career with growth opportunities was not a decision I made lightly- I was advised against taking that leap. I knew this type of career change was extremely laborious and challenging but nonetheless my desire to provide direct patient care in a clinical setting was unwavering . The skepticism became most pronounced during my clerkship years, especially when I shared my interest in pursuing a surgical career. Some words of “wisdom” I received along the way: “Are you sure? What if you change your mind again? Surgery will cost you everything, and it might not be worth it!” During moments of exhaustion, I allowed those voices to creep in. I questioned whether my sacrifices would be worth it in the end. However, the most fulfilling and defining moments of my training thus far have come from surgical rotations. Notably, I recall participating in a sigmoidectomy & colovesical fistulotomy case, during post-op follow the patient expressed an emotional thank you as they were so happy to no longer have feculent matter in their urine. There is something grounding about being present at pivotal moments in a patient’s life, where decisive hands-on intervention can immediately improve their lives. I came to understand that while residency is challenging across all specialties, passion fundamentally helps to overcome those challenges and change the experience. When you care deeply, long days become opportunities rather than a laundry list of to-dos. Choosing a career in surgery was not an escape from my previous work, but a deliberate commitment to a career I found rewarding *despite* its rigorous demands. Although I was initially hesitant to share my non-traditional path, those experiences are what made me a stronger student. They helped me navigate team dynamics with ease and contribute meaningfully without overstepping. The operating room felt surprisingly familiar. It mirrored the conference rooms in which we presented healthcare strategies to executives. As a young analyst, these rooms were daunting. They demanded precision, preparation, and accountability. Surgeons, like executives, are meticulous not because they are unapproachable but because the cost of error is high. Understanding this parallel reframed the OR for me; it was no longer as daunting. We shared one goal– to positively impact patient outcomes. My role wasn’t to know everything, but to show up prepared, reliable, and genuinely curious. Once I embraced my role as a learner, my confidence and effectiveness grew. A healthcare executive previously told me, half the battle in attracting boardroom buy-in is *confidence,* and the other half was easy: “show up prepared”. This stood true for the OR as well. When you show up prepared, engaged, and certain of your interest in surgery, people invest in you! They want to teach and mentor you. My mentors didn’t just teach me technical skills; they supported my goal of combining my two worlds together and guided me through opportunities I didn’t know existed. Choosing surgery as my second act was not a rejection of my past, but rather an extension of it. I arrived at surgery with intention, resilience, and clarity-there is no doubt that this is exactly where I belong. So, I say to my peers pondering a career change that it’s never too late and just let your passion guide you! ![](https://blog.womensurgeons.org/wp-content/uploads/2026/01/Vasiny.png)**Vaisny Balamurali** is a 4th year medical student at Ross University School of Medicine. She has a deep interest in General Surgery, motivated by the ability to provide patient care that combines hands-on intervention with immediate impact alongside patient advocacy in high acuity settings. Her non-traditional journey to becoming a physician was driven by her desire to leverage frontline experience as a clinician to advocate for improved & equitable healthcare access and improved patient care outcomes. **Categories:** career development, training, Uncategorized **Tags:** careerchange, medicalschool, womeninsurgery --- ### [Issues faced by the female surgical trainees in developing countries](https://blog.womensurgeons.org/issues-faced-by-the-female-surgical-trainees-in-developing-countries/) **Published:** January 15, 2026 **Author:** Blog Team **Content:** By Dr. Eshana Samaranayake Across South Asia, women are still a small minority in surgical training programmes, and that imbalance shapes daily experiences in ways that are easy to miss from the outside. **‘‘Surgery is for men’’** I have wanted to become a surgeon since high school, but when I prepared for the entrance exam I heard frequent warnings from family, friends, and colleagues. Much of it was well-meant, yet it rested on an assumption: surgery is too demanding for women to balance with personal life, especially where women are expected to carry most household responsibilities. Those expectations sometimes made me doubt myself, not because I lacked interest or motivation, but because I wondered how I would fit into a role society does not always picture for women. I feel fortunate to have been selected for surgical training, and I am now in my third year of general surgery residency. Despite the challenges, I remain grateful to be here and certain this is the right path for me. **‘‘Women may not be as suited to surgery’’** In some cultures, women are assumed to be less physically strong or less assertive than men. Women may also be expected to be quiet, while surgical training often rewards confidence, decisiveness, and visibility. Because of these assumptions, I sometimes feel I must work harder to be seen as capable. Like every trainee, I have days in the operating room when I do well and days when I learn through mistakes. But when expectations are filtered through gender, ordinary setbacks can feel heavier. Over time, these moments have strengthened my resilience and helped me grow, both technically and personally. **Mentorship and a sense of belonging** In my batch of thirty surgical trainees, only three are women. There are times I feel quite alone in the operating theatre, especially when I am surrounded by men and when there are few women seniors to look to for guidance. Bias is not always obvious, and it may not always be intentional, but it can show up in small ways – who is encouraged, who is trusted early, and who receives reassurance when struggling. For a trainee, those small differences can matter. Senior women surgeons in my country are limited, and finding mentorship from someone who understands these experiences can be difficult. At the same time, I have been encouraged by the support I have received from certain teachers and colleagues, and I have also had younger women trainees reach out to me for advice – something that reminds me how important it is to support one another. **Way forward** Change becomes easier when more women are visible in surgical teams, leadership roles, and patient care. Alongside increasing representation, training programmes can help by building intentional mentorship, ensuring fair access to learning opportunities, and creating workplace cultures that value work-life balance for everyone – not only women. Most importantly, young girls everywhere should be able to imagine themselves as surgeons without feeling they must defend their ambition. With supportive training environments and continued progress within both the surgical community and society, more women will be able to enter surgery, thrive, and mentor the next generation with confidence and pride. ![](https://blog.womensurgeons.org/wp-content/uploads/2026/01/image-1.jpeg)**Eshana Samaranayake, MBBS, MRCS, PhD** Is a General Surgical Resident with a passion for teaching medical students. My research interests focus on advancing surgical practices in resource limited settings and improving patient care in developing countries. Outside of my surgical career I enjoy netball and rugby, and I enjoy spending quality time with my family and friends. **Categories:** advocacy, awareness, diversity and inclusion, diversity and inclusion, education, gender differences, global surgery, mentorship, residency, training, Underrepresented in medicine, URiM, women **Tags:** AWSBlog, residency, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Empathy in Medical Training: Lessons from Illness](https://blog.womensurgeons.org/empathy-in-medical-training-lessons-from-illness/) **Published:** January 7, 2026 **Author:** Blog Team **Content:** By Maria Jimena Barroso Alverde When I was little, I honestly believed I had a sixth sense. I’d get this knot in my stomach, or a rush in my chest, and I was convinced something big was about to happen. I didn’t know the word for it back then, anxiety, but it has shaped the way I experience the world. It has made me sensitive, alert, and made me always pay attention to the things few people seem to notice. I didn’t know then, but those sensations were my very first lessons in empathy. Years later, during medical school, life gave me the lesson I never asked for but somehow needed. At 22, I was diagnosed with thyroid cancer. One moment I was learning to use an ultrasound; the next, I was staring at an image that changed my entire life. Suddenly, I wasn’t the student standing confidently beside the bed, I was the one lying in it. I remember everything: the silence, the heaviness in the room, the way everyone searched for the “right” words, while I sat there trying to process that a part of my body had betrayed me. Before that diagnosis, I remember the frustration of not being believed. The months of being told I was “just anxious,” “just tired,” “just stressed because you study medicine.” They reduced my symptoms to personality traits. They dismissed what I felt. Nothing teaches you empathy faster than being dismissed. Cancer didn’t only take my thyroid. It also stripped away the emotional distance most students unknowingly carry. I learned what it feels like to hand your fear to a doctor and hope they don’t drop it. I learned how terrifying it is to hear medical terms directed at you. I learned how even well-intentioned reassurance can feel empty when it isn’t accompanied by genuine presence. The hardest part was something I didn’t expect; I spent more time trying to protect the feelings of others than my own. I downplayed my diagnosis. I smiled when I wanted to cry. I said “I’m fine” so people around me wouldn’t fall apart. That experience taught me my most important lesson– empathy isn’t about being strong for others. It’s about being honest, with yourself and with them. After years, when the world finally became quiet enough for me to hear myself, I realized how long I had lived without true peace. Not because I was physically sick, but because anxiety had been my shadow long before cancer arrived. I spent years shaking at night, feeling things I couldn’t name, drowning in my own thoughts. Living without peace teaches you empathy in a completely different way. When you’ve spent years in internal chaos, you recognize it instantly in someone else, in the way they breathe, the way they avoid eye contact, the way their voice shakes even when their words don’t. That’s why I listen differently now. That’s why I believe patients when they say, “I just feel something is wrong,” and that’s why I refuse to rush moments that need softness. My illness didn’t make me weaker. It made me aware. It made me human. It turned the little girl with the “sixth sense” into someone who finally understands what that feeling really was: a deep, instinctive empathy for anyone who has ever been scared, unheard, or hurting silently. Those are the lessons I carry with me every time I walk into a patient’s room, and the ones I’ll continue to take with me into my future career as an OBGYN doctor. ![Maria Jimena Barroso Alverde headshot](https://blog.womensurgeons.org/wp-content/uploads/2026/01/image.jpeg)I am **Maria Jimena Barroso Alverde**, a final-year medical student and aspiring OBGYN with a strong interest in global health and improving healthcare access for underserved communities. I have trained across Mexico, Houston, and Boston, with research and clinical experience at institutions that have strengthened my commitment to health equity and patient-centered care. I hope to build a career that blends clinical practice with meaningful global health work. Outside of medicine, I enjoy dancing, a hobby I’ve had since childhood, and I value spending quality time with my family and friends, who keep me grounded and motivated. Instagram: jimenabarrosoal\_ **Categories:** awareness, career development, health, medical students, reflection, self-care **Tags:** AWSBlog, ILookLikeASurgeon, womeninsurgery, WomenSurgeons --- ### [Yes, I Want to Be a Surgeon and No, I Don’t Need to Be Talked Out of It](https://blog.womensurgeons.org/yes-i-want-to-be-a-surgeon-and-no-i-dont-need-to-be-talked-out-of-it/) **Published:** December 26, 2025 **Author:** Blog Team **Content:** **By Lilah Kahloon** Halfway through my third year of medical school, I began feeling the urge to lie whenever someone asked me what specialty I was considering. Going into rotations, I never fell prey to the urge some students have to say they are interested in whatever specialty they are on. When I walked into my first day of internal medicine and was asked what I wanted to do, I was honest. I was eager to learn about everything the internists had to teach me but I was interested in being a surgeon, and I didn’t see a reason to hide that. However, I quickly realized that there was often subtext to the reactions people had when I used the words “general surgery”. Sometimes there were looks of discomfort: the questioner scrunching up their nose as if there was a freshly opened box of blue cheese close by. Other times there were looks of pity: the questioner furrowing their brow and wondering if this poor girl actually knew what it meant to be a surgeon. These reactions came from those outside of my rotations, as well–family friends I ran into at coffee shops, strangers I met at events, and even my mom (in her defense, it must be jarring for a dermatologist’s daughter to tell her she wants to be a general surgeon). Versions of “I could never do it” got thrown around often, and I would nod, saying that I understood it was not for everyone. I began feeling like to everyone who wasn’t a surgeon, choosing surgery was synonymous with choosing self-suffering. Of course, I am choosing to highlight the bad. I had support from those outside of surgery, but the truth is, it was rare. The moments of support without some kind of “but” (“but surgery has a terrible lifestyle” or “but you should only do surgery if you hate everything else”) did not come by often. I wondered if it was because I’m a woman. For some people, it was. I sat through a few lectures about what it takes to have a family when you choose surgery. For others, my gender had nothing to do with it. Regardless of the reasoning, I became infuriated by all of it at a certain point. I realized, however, that none of these people were trying to infuriate me. They probably all meant well, with genuine concern that I might not know what I was getting myself into. I was internalizing their words too much, letting them shake me. I had mentally prepared for most of the challenges medical school would bring, but I hadn’t prepared for these moments of self-defense. Now, officially a general surgery applicant, I can say that arguably the biggest strength I have gained in the past two years has been resolve. I feel resolved in my ability to become a *happy* surgeon. Not the mean, over-worked, or unsatisfied one that some people might be scared of me becoming. For me, being happy means truly loving what I do. My resolve has come from learning to hold on tightly to the joy I feel when envisioning my future career in surgery and loosening my grip on the opinions of others. So to anyone wondering: yes, I want to be a surgeon and no, I don’t need to be talked out of it. ![Lilah Kahloon Headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/12/image-3.jpeg)**Lilah Kahloon** is a fourth-year medical student at the University of Louisville School of Medicine. She is currently applying to General Surgery residency for the 2025-2026 Match cycle. Her interests include global health and surgical education. **Categories:** medical students, reflection, training **Tags:** AWS, AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Scrubbed in for the ABSITE: Webinar Highlights](https://blog.womensurgeons.org/scrubbed-in-for-the-absite-webinar-highlights/) **Published:** December 17, 2025 **Author:** Blog Team **Content:** **Authors: Natalia Correa MD, Alizeh Abbas MD, Camila R. Guetter MD MPH, Nensi Ruzgar MD** This blog summarizes key advice, tools, and resources discussed in the AWS Resident & Fellow Committee webinar “Scrubbed for the ABSITE”. ### **What is the ABSITE?** The [American Board of Surgery In-Training Examination (ABSITE)](https://www.absurgery.org/get-certified/for-programs/in-training-exams/#elementor-toc__heading-anchor-1) is an annual test taken by all general surgery residents across the United States. It is a four-hour, computer-based exam of approximately 250 multiple-choice questions spanning the breadth of general surgery. ### **Recent change to ABSITE Score Reports** Historically, ABSITE scores were reported percentiles; however, recently, the ABSITE has shifted to reporting only raw scores, expressed as the percentage of questions answered correctly. This change encourages emphasis on personal improvement rather than comparison and competition. While this may decrease anxiety around small fluctuations, longitudinal performance still matters. Programs expect residents to maintain or improve their score percentage over time and programs set certain thresholds for moonlighting privileges. ### **Top resources used for ABSITE preparation** Residents widely rely on question banks (Q-banks) as the foundation of ABSITE studying. Frequently recommended options include: - **SCORE** and **TrueLearn**: Q-banks with high-yield surgical content, detailed explanations, and performance analytics to identify weak areas. Most residents prefer mixed-topic blocks, supplemented by targeted practice when a deficiency becomes clear. - **ABSITE Quest**: Another popular tool offering high-yield rapid review. ABSITE Quest also provides a two-day bootcamp with live or recorded videos for later access. For content review beyond Q-banks, residents highlighted: - **Fiser’s *The ABSITE Review***: a concise text covering must-know concepts. - **Behind the Knife ABSITE review podcasts**: ideal for commutes or downtime. - **SCORE/ABSITE Companion Book**: an efficient reference aligned with exam style and content. Some residents also use the **Anki Yellow Deck**, a spaced-repetition flashcard resource useful for daily review. However, because some cards contain outdated or incorrect content, users should verify information against reputable sources. **How to fit studying into the busy residency schedule** Time constraints make routine, flexible studying essential. Short, frequent sessions are generally more effective and sustainable than long study blocks. Strategies include: - **Completing questions in small windows of downtime** (e.g., waiting for cases, during breaks). - **Using portable tools**—apps for Q-banks, Anki, or podcasts during commutes. - **Setting weekly, not daily goals**, to account for clinical unpredictability and reduce stress. Residents also emphasize the importance of **full-length practice tests**. Even one full practice exam every few weeks can improve focus, endurance, pacing, and self-assessment. ### **Day-of-Exam Tips** Residents recommended simple but important steps for success on exam day: - Get a **good night’s sleep** the night before, if possible. - Bring **snacks and water**, even if programs provide food. - Use the **45-minute break between the test’s two sections** to recharge—eat, relax, and reset mentally before continuing. ### **Final Takeaways** The ABSITE can feel intimidating, especially when taking it for the first time. However, familiarizing yourself with the test format, selecting a few reliable resources, and developing a consistent and flexible study routine can make preparation manageable. Every resident learns differently, so a period of trial and error may be necessary to find the best tools and schedule for you. Start preparing early—ideally throughout the year—and aim to start studying regularly by November. Most importantly, give yourself grace during demanding rotations; progress matters more than perfection. You got this! For those interested in hearing the full discussion, the recorded webinar is available in the [AWS online webinar library](https://womensurg.memberclicks.net/resident-fellows-library?servId=20057). Watch your AWS email newsletter and social media for future educational programs! **Lead Author Bio:** Natalia Correa, PGY-3 at the University of Miami Holy Cross General Surgery Residency Program, was born and raised in Miami and proudly embraces her Colombian heritage. Her involvement with AWS began during medical school at Florida State University through the AWS Medical Student Committee. She has since served on the Resident and Fellow Committee and the Conference Planning Committee, contributing to nationwide trainee programming and conference development. Outside of clinical work, she mentors medical and premedical students and participates in outreach supporting the professional growth of future surgeons. She plans to pursue a career in plastic and reconstructive surgery, with interests in surgical education, mentorship, diversity within the field, and improving disparities in access to plastic and reconstructive care. ![Dr. Correa headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/12/image-2-1024x1024.jpeg)*About the Webinar: In November 2025, the Association of Women Surgeons (AWS) Resident and Fellow Committee hosted a webinar introducing the American Board of Surgery In-Training Examination (ABSITE) for first-time test takers. The session explored tips and strategies for preparing for and taking the ABSITE, shared from the perspectives of three general surgery residents: Dr. Jennifer E. Geller (PGY-2, Thomas Jefferson University), Dr. Natalia Correa (PGY-3, University of Miami Holy Cross), and Dr. Clementine Foucher (PGY-4, University of Arizona Tucson). The discussion was moderated by AWS Resident and Fellow Committee Chair Dr. Alizeh Abbas and was attended by residents nationwide.* **Categories:** awareness, education, Fellows, residency, resources, training **Tags:** AWS, AWSBlog, ILookLikeASurgeon, womeninsurgery, WomenSurgeons --- ### [What Surgeons Can Learn from Greek Myth: A More Effective Mentorship Model](https://blog.womensurgeons.org/what-surgeons-can-learn-from-greek-myth-a-more-effective-mentorship-model/) **Published:** December 11, 2025 **Author:** Blog Team **Content:** *by Taylor Corsi, MD; Elise Presser, MD* In Homer’s *The Odyssey*, Athena – protectress and goddess of wisdom, practical reason, handicraft, and war strategy – disguises herself as Mentor, a counselor who guides Telemachus in his journey to find his father and restore the kingdom of Ithaca. This story has framed the modern conception of mentorship as an intergenerational relationship between mentor and mentee that benefits the mentee’s growth and accomplishment of stated goals. While the importance of mentorship is clear in the story, the perception of how mentorship is best achieved is worth reinvestigating. Upon closer inspection of our beloved Greek myth, Athena’s wisdom was provided not merely from her form as Mentor. Importantly, Athena also disguised herself as a shepherd and the daughter of a ship captain. While many scholars have classically attributed Telemachus’ success to Mentor’s guidance alone, Athena advises a diverse network of figures who contribute to his successful resolution. Athena’s guidance for the story’s characters *came in many forms, from many sources.* In this way, Homer models for us that the successful mentorship model is not linear but instead webbed. The field of surgery could benefit from this webbed model, particularly for women surgeons. We know that women surgeons value and benefit from mentorship in career development, work-life balance, academic productivity, and academic advancement. While we agree that mentorship is vital in achieving not only gender parity but equity in surgical fields, relying upon a singular, linear mentor-mentee relationship is not always realistic. Many women surgeons lack immediate access to same-gender mentorship. How might we best tackle this? Furthermore, in situations where access to mentors is available but limited, how do we preserve this precious resource, meet the needs of mentees, and avoid undue burden on our mentors? Below is a brief outline for how we might reimagine our path forward. *Where immediate access can exist, take advantage of it.* In the long term, gender parity in surgical specialties overall, and at individual institutions, will improve access. However, in the interim, spaces that bring together women surgeons can create access for mentorship relationships to grow. Go to regional conferences, join your institution’s women in surgery group, and of course, seek out women surgeons at other local institutions. While we work towards ubiquitous access to same-gender mentorship, creating opportunities for ourselves is necessary. As residents, we have found that access can be created in virtual and social media spaces. These virtual spaces are easily accessible, often free, and provide the opportunity to initiate relationships with residents and faculty at institutions across the country that can be developed into a network with time. *Multigenerational webs are better than intergenerational lines: reach forward, reach back, reach across.* The phrase “it takes a village” applies to more than just child rearing. It takes countless hours, interactions, and individuals to forge a surgeon; shouldn’t the same apply to mentorship? Institutional mentorship programming often assigns dyadic relationships, a parent-child model. But the capacity for emotional labor is scarce and variable, creating limits for this traditional mentorship model. We envision mentorship as a web of faculty, leadership, peers, and trainees. Across this web, our efforts, attention, and needs can be shared – a village in which one might rest and rely upon for nurturance and guidance, and in which you provide it in turn. Investing in this connection to your peers, your juniors, and other mentors is exponentially beneficial. Residents are uniquely positioned to model this method. As residents, we are both mentors and mentees, learning how to connect ourselves and each other to the people and resources we need. For example, while we help medical students navigate their early surgical experience or organize intern bootcamps, we are also learning how to more efficiently sew anastomoses and utilize our institution’s family planning options from our chiefs. Residency also provides built-in access to responsibility sharing – when one resident is on a stretch of 24-hour calls and unable to provide extra support to a junior, they rely on the accessibility of their peers. Learning when to give, take, and share support authentically develops a foundation for the mentorship web we hope to establish. *Impart wisdom to other characters who may contribute to “restoring the kingdom.”* Like Athena, we can impart wisdom to other characters who may play a role in our greater mission. We should emphasize to our male colleagues the impact they may have in establishing connections between women surgeons. It is particularly useful to ask male surgical leaders to model this behavior for all junior faculty, residents, and medical students. Multidisciplinary “women in surgery” events at our institution are generously and notably funded by male and female faculty alike. This creates and reflects our mentorship culture. Building a network is labor-intensive; encouraging the sharing of labor not just amongst our female colleagues, but our male allies can minimize burnout, facilitate awareness of the challenges women surgeons face, and build solution-focused coalitions to address them. *Like Athena, a mentor appears in many forms.* The best mentors are shape shifters. What we need on a trauma rotation might not be what we need during professional development years. What we need as chief residents may not be what we need as junior faculty. Our favorite mentors have been open-minded, accessible, and willing to reassess goals and renegotiate the balance of autonomy and guidance. Furthermore, the most successful mentors connect us to others who can meet a different set of needs at different stages of life. Whether restoring the kingdom of Ithaca or creating systems of personal and professional support for women in surgery, integrating some or all of the techniques mentioned here may be a good place to start. The webbed model we introduced allows for and encourages shapeshifting and shared responsibility to guide individuals as they develop and change. Drs. **Taylor Corsi** and **Elise Presser** are general surgery residents at Yale School of Medicine. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/12/image.png)Taylor Corsi, MD ![](https://blog.womensurgeons.org/wp-content/uploads/2025/12/image-1.jpeg)Elise Presser, MD **Categories:** awareness, career development, mentorship, residency, Underrepresented in medicine, URiM, women **Tags:** AWSBlog, ILookLikeASurgeon, residency, womeninsurgery, WomenSurgeons --- ### [Stereotypes of physical appearance for women in medicine](https://blog.womensurgeons.org/stereotypes-of-physical-appearance-for-women-in-medicine/) **Published:** December 4, 2025 **Author:** Blog Team **Content:** By Olivia Charles, MS4 “Do you play basketball?” “What are you doing here?? You should be modeling!” “You’re wasting your height.” If I had a penny for every time someone said one of those lines to me during my journey through medical school, I could probably pay off my student loans entirely. I was always slightly taller than my peers since I was a kid, but I really had my growth spurt in high school. Being 6’ as a woman tends to attract a lot of attention–attention that for me was unwanted for a long time, particularly during my time in medical school. There has not been a single day where someone hasn’t asked me how tall I am, if I played sports, or what I’m doing in a hospital when I should be on a runway. While coming from a sincere place, these “compliments” always felt backhanded to me. Of course I always give them a little smile, say thank you, and carry on, but to go through years of rigorous academic and clinical training just for someone to question you based on your physical appearance kind of stings a little. My dream has always been to be a surgeon. I never questioned myself in that regard, and worked hard, just as countless other women have, in order to one day reach that goal. I didn’t fully appreciate how my appearance would have an apparent role in that journey. While it should not determine what career path you choose in life, as women, we are often unfortunately judged based on our appearance, and I often find myself thinking “Would they have said the same thing to a man?” I never like the answer. Reflection over the years taught me that the most important thing is to remain confident and true to yourself. People are going to keep making their comments, and I am going to keep smiling through it. At the end of the day, I know I’m where I’m meant to be. No matter what you look like, your life is what you make of it. So here I am, a future 6’ women surgeon, and no, I never played basketball. ![Olivia Charles headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/12/image.jpeg)**Olivia Charles** is a 4th year medical student at St. George’s University School of Medicine, and is pursuing a career in General Surgery. Being Haitian, her passion is to serve underserved communities with an emphasis on global health and expanding access to surgical care in developing countries such as Haiti. **Categories:** awareness, gender differences, medical students, reflection, URiM **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [A Common Silence: Perspectives on Pregnancy Loss During General Surgery Residency](https://blog.womensurgeons.org/a-common-silence-perspectives-on-pregnancy-loss-during-general-surgery-residency/) **Published:** November 26, 2025 **Author:** Blog Team **Content:** by Cleo Siderides, MD and Caitlin J. Cain-Trivette, MD Pregnancy loss is a painfully common experience among surgical trainees, yet our institutions remain poorly equipped to respond with support and compassion. Surgical trainees are more than twice as likely to experience pregnancy loss than the general population,1 yet no formal safeguards exist to protect trainees enduring these sentinel events. Cleo’s first pregnancy ended in a missed miscarriage at 9 weeks, followed by six weeks of medical and surgical management amidst the relentless pace of residency. *The day after I took medication to induce a miscarriage I was on a 24-hour trauma call, bleeding through my scrubs to the point that I tied a jacket around my waist between cases. I emphatically stated that no, I did not feel like I needed to step away from work. I saw the hardship as a way to prove my grit and worth as a resident, emulating stories I’d heard of the heroics of female surgeons who had worked through similar circumstances, putting surgery above all else. I was silent, alone, and unmoored. Only after my second loss would I understand the scars left behind and the hurt that came with neglecting my wellbeing in the name of preserving my reputation. Seeking some sense of catharsis, I told my story to anyone in the residency who would listen and found comfort in shared experience–faculty and peers alike reflected the healing that can be found in collective hardship.* Caitlin’s first pregnancy ended in a missed miscarriage requiring medical management early in her research years when she was simultaneously completing a clinical fellowship. *The emotional and physical distress of miscarriage was compounded by anxiety about privacy and my new clinical responsibilities. I hesitated to ask for formal leave, unsure how to navigate disclosure. Despite these fears, I found myself surrounded by colleagues and mentors who quietly offered understanding and flexibility, allowing me to cope without forcing me to share more than I was ready to. Although my institution lacked formal policies, I was deeply appreciative of the informal professional support that softened that difficult period, all while realizing this is not the norm. When a subsequent complicated pregnancy led to my month-long hospitalization and three months spent with my child in the NICU, this network continued to make a profound difference—reminding me how important compassionate, responsive support is, and how much more accessible and formalized support should be for every trainee, particularly for pregnancy loss.* Our stories are not anomalous; they are the endured reality for far too many surgical trainees and evidence that we must do better. We developed a pregnancy loss policy at our institution and published a call to action for other general surgery residency programs to establish policies supporting residents through pregnancy loss.2 Our continued research seeks to bring every surgeon’s experience and priorities forward, transforming individual struggle into collective advocacy at the institutional and national level. By emphasizing what is broken and demanding better we can forge a culture that honors both our profession and our humanity. References 1\. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 2\. Siderides C, Cain-Trivette CJ, Garrett KA. Addressing Pregnancy Loss in Surgical Residency—A Call for Policy Protection. JAMA Surg. Published online January 22, 2025. doi:10.1001/jamasurg.2024.6045 ![Dr. Siderides](https://blog.womensurgeons.org/wp-content/uploads/2025/11/Screenshot-2025-11-26-111802.png)**Cleo Siderides, MD** is a second-year research fellow in the Trauma Surgery and Surgical Critical Care Department at NewYork Presbyterian/Weill Cornell Medicine. Her research focuses on health disparities in trauma outcomes and residency program education and improvement. In addition, she is also pursuing a Master’s in Public Health in Epidemiology and Biostatistics. Her hope is to become a trauma surgeon dedicated to caring for underserved communities and to be actively involved in health policy. She is a mother to a one-year-old daughter Elliot and is passionate about changing our training culture to support and empower residents pursuing parenthood. ![Dr. Cain-Trivette](https://blog.womensurgeons.org/wp-content/uploads/2025/11/Screenshot-2025-11-26-111810.png)**Caitlin J. Cain-Trivette, MD** is a second-year Pediatric ECMO Fellow at NewYork-Presbyterian Morgan Stanley Children’s Hospital and an aspiring pediatric surgeon dedicated to improving outcomes for critically ill infants and the systems that care for them. Her work centers on pediatric critical care, ECMO, and the creation of supportive policies for surgical trainees—particularly around pregnancy loss, parental leave, and trainee wellbeing. A mother and humanities-informed clinician, she believes in the power of narrative to drive institutional change. Twitter: @joelle\_caitlin **Categories:** advocacy, awareness, diversity and inclusion, family life, health, residency, training, women **Tags:** ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Bridging the Gap: Female Surgeons in Malawi and the Power of Representation](https://blog.womensurgeons.org/bridging-the-gap-female-surgeons-in-malawi-and-the-power-of-representation/) **Published:** November 19, 2025 **Author:** Blog Team **Content:** By Dr. Sharon Cheryl Bonya Female surgical trainees face structural and cultural barriers that extend far beyond the operating room. They are not just training to master technical skills, they are also navigating expectations, isolation, and leadership in spaces where their presence still surprises many. In Malawi and across much of Sub-Saharan Africa (SSA), female surgeons face a double burden: under-representation within the surgical workforce and the cultural headwinds that make leadership, mentorship, and progression more difficult. Despite recent gains in training capacity in East, Central and Southern Africa, women surgeons remain a minority with implications for patient trust, communication, and equitable access to surgical care. According to the NHS workforce data, women make up about 17% of general surgery consultants in the United Kingdom. In the United States, women account for roughly 22.6% of general surgeons, based on figures from the Association of American Medical Colleges (AAMC). These numbers show a clear pattern that even in high-resource settings, women remain under-represented in the field of surgery. According to recent workforce reports by the College of Surgeons of East, Central and Southern Africa (COSECSA), women make up only about 10% of surgeons in the region. Some countries in SSA, including Malawi, show a promising increase of women surgeons and have among the highest proportions of women specialists in the region, but the absolute numbers remain low. When I started my General Surgery residency with the Pan African Academy of Christian Surgeons (PAACS) and the College of Surgeons of East, Central and Southern Africa (COSECSA), there was one senior female trainee ahead of me. Her presence mattered. She was living proof that a woman could thrive in surgery as a leader. She navigated her way under pressure, modeled authority in theatre, and emanated strength in a system that often overlooks women. When she completed residency, I became the only female resident in my program. Surely, that moment came with pride but also with the weight of representation. As a senior resident, it meant taking on leadership in ward rounds and theatre, and delegating tasks while carrying the invisible responsibility of representing what female leadership in surgery can look like. Being the sole woman in the room often means being both hyper-visible and unseen, expected to excel, to prove, and to endure. Cultural expectations still question women’s place in surgical leadership. Fewer women in senior positions means fewer role models and shared experiences. For many patients in Malawi, particularly women, gender dynamics also shape care-seeking behavior. According to studies on gender concordance in healthcare conducted globally, cultural expectations, stigma, and financial limitations can discourage women from seeking surgical care. This aligns with evidence highlighted by the Association of Women Surgeons (AWS) that representation improves both patient trust and health-seeking behaviors. In this context, the presence of female surgeons becomes transformative, building trust, comfort, and safety for female patients who may otherwise hesitate to seek care. Representation is powerful. When a woman leads in surgery, patients often feel more comfortable and more willing to open up. Conversations that might have remained silent become possible. And when surgical teams are diverse, communication deepens, collaboration strengthens, and the culture of care improves. These challenges have shaped how I lead and take care of patients. I’ve learned to advocate, to mentor, and to build spaces where others can feel seen. When a young medical student sees a woman confidently leading in the operating room, her imagination expands. She begins to picture herself in spaces she once thought were unreachable. For female surgical trainees, the journey is not only about learning to operate, it’s about navigating barriers that question their very place in the operating room. The experience of being one of the few women in surgery is both isolating and deeply significant. As a woman in surgery, I know I hold a unique and powerful position where surgical leadership is shared and where mentorship, leadership, and research opportunities are in place to help women enter and thrive in surgery. I’m not just operating on bodies, I’m opening doors. Representation is not a luxury. It is, however, a catalyst for trust, access, and change. ![Dr. Bonya headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/11/image-1-706x1024.jpeg)Author Bio: Dr. Sharon Cheryl Bonya is a General Surgery Resident with the Pan African Academy of Christian Surgeons and the College of Surgeons of East, Central and Southern Africa, training at Malamulo Adventist Hospital, Malawi. She is passionate about surgical equity, mentorship, and advancing women’s leadership in global surgery. Links to citations that were requested: For the NHS data: [https://www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/statistics/?utm\_source=chatgpt.com](https://www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/statistics/?utm_source=chatgpt.com) Article: Newman TH, et al. BMJ Open 2022;12:e055516. doi:10.1136/bmjopen-2021-055516 For the AAMC data: [https://rwjms.rutgers.edu/magazine/winter-2025/women-surgery-increasing-numbers-influence#:~:text=Nearly%20a%20quarter%20(22.6%20percent,MD%2C%20professor%20and%20James%20W.](https://rwjms.rutgers.edu/magazine/winter-2025/women-surgery-increasing-numbers-influence#:~:text=Nearly%20a%20quarter%20%2822.6%20percent,MD%2C%20professor%20and%20James%20W.) **Categories:** awareness, diversity and inclusion, diversity and inclusion, education, global surgery, residency, Underrepresented in medicine, URiM, women **Tags:** residency, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Show Up for Yourself: A Message to Women Surgeons Living with Disability](https://blog.womensurgeons.org/show-up-for-yourself-a-message-to-women-surgeons-living-with-disability/) **Published:** November 12, 2025 **Author:** Blog Team **Content:** By Dr. Elizabeth Perazza Imagine ringing in the New Year, celebrating 25 years as a successful surgeon. You place a ruby-studded tiara on your head, proud to be 55 years old, 30 pounds lighter, and stepping into your power as Queen Bee—the new sheriff in town. Among over 100 surgeons, OR nurses, and technicians, you stand tall as the next Chief of Surgery. Then, six months later, everything changes. You begin to feel as though you’re slipping away—paralyzed, bedridden, and mentally foggy. You’re dizzy even while lying down. A tingling sensation creeps from your mouth to your toes. Your eyes hurt to open, and you feel exhausted just from breathing. You’re disoriented whether your eyes are open or closed. You undergo a spinal tap, waiting anxiously for results. Then the diagnosis comes: Multiple Sclerosis. Positive oligoclonal bands confirm it. That day, I became another name on the list of those eligible for disability under Social Security. I felt disabled—not just physically, but emotionally and spiritually. As a wife, mother, neighbor, surgeon, and colleague, I was shaken. But my neurologist—my guardian angel on this earth—looked me in the eye and said, “Elizabeth, please don’t worry. I know everything will be okay. We’re going to get through this.” We began high-dose steroids at home. Miraculously, I experienced no adverse effects. That weekend, I attended Sunday Mass. Though I couldn’t walk straight enough to receive the Eucharist, I was able to kneel before my Lord and Savior. That moment marked the beginning of my recovery. The path has been tortuous, but filled with grace. I’ve been lifted by the kindness of others—my husband, my primary angel, transformed our home. He bought only organic food, replaced Teflon cookware with stainless steel, and swapped plastic containers for glass. My clinics transitioned to virtual care. I continued supporting my patients remotely discussing results, planning treatments, and referring surgical cases to trusted colleagues. Thankfully, I work in a group practice as a full-time employee. Two months after starting steroids, I returned to the OR, performing low-risk outpatient procedures. My stamina was fragile, but my commitment was unwavering. Eventually, I had to consider the risks and benefits of requesting reasonable accommodation. My immune system is suppressed due to disease-modulating medications, and I live with daily pain and fatigue from this neuromuscular condition. But I showed up. Not just for my patients—but for myself. For every woman surgeon who wonders if she can keep going. You can. You are not alone. Your story doesn’t end with a diagnosis—it begins with resilience. **Dr. Elizabeth Perazza** ![Dr. Perazza headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/11/image-768x1024.jpeg) **Categories:** advocacy, awareness, diversity and inclusion, diversity and inclusion, health, reflection, self-care, Underrepresented in medicine **Tags:** AWSBlog, ILookLikeASurgeon, womeninsurgery, WomenSurgeons --- ### [I am Superwoman, I can do it all, but should I?](https://blog.womensurgeons.org/i-am-superwoman-i-can-do-it-all-but-should-i/) **Published:** November 6, 2025 **Author:** Blog Team **Content:** By Dr. Ashley Toussaint Since I was young, I’ve been called a “workhorse.” I’m the one people rely on to get things done, to do more, be more. If something needs to be handled, I’m your woman. That mentality has pushed me through life, and it has served me well. I was a Division 1 athlete in college, then went to medical school, and now, I’m a general surgery resident. That same mentality has carried me through my residency, too. I’ve had two kids while in residency and am currently expecting my third. I delivered both of my children the same day I worked at 40+ weeks pregnant, 18 months apart. I managed to breastfeed and pump for both of my daughters for over a year each. It wasn’t always easy, pumping while rounding on patients, operating, even driving to work. There were days when I did laparoscopic and robotic surgery with my breast pump on because I couldn’t find the time to step away. I was determined to be “Superwoman,” to do it all without asking for help or inconveniencing anyone. There’s one moment that sticks out in my mind. I was pumping when a cardiac arrest was called on one of my patients. I had to rush in and run a code, all while wearing my pumps. It was chaotic, but in that moment, I felt invincible. I thought to myself, *I’m saving a life, pumping for my girls, and building my surgical career.* I was doing it all, and it felt empowering. But then, a thought crept in: *Should I be doing all of this?* Sure, I could handle it at that moment, but should I be pushing myself to such extremes all the time? Nursing and pumping, at least, are temporary. The mentalities I’ve built around pushing myself, always doing more, are long-lasting. And I wondered, is this sustainable? In my career, there’s always more to do, more publications to chase, more advancements, more fellowships. There’s always a next step. But when does it end? When do I say, *enough is enough. I am happy and fulfilled right where I am?* I’ve always been taught to keep striving, to keep reaching for the next milestone. I’ll be happy when I’m a fellow. I’ll be happy when I become an attending. But will I? Is it the idea of constantly striving to achieve that fulfills me? Or is it the chase itself that becomes my definition of success? Somewhere along the way, I’ve forgotten how to appreciate the here and now. We’ve all been taught to chase something bigger, better, more. But how do we know when enough truly is enough? Maybe it’s not about being Superwoman. Maybe it’s about recognizing when to step back, breathe, and accept that we are enough, just as we are, in this moment. And, maybe, that’s the true superpower. ![Dr. Toussaint Headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/11/image.png)Dr. Ashley Ostler Toussaint is a General Surgery resident at Robert Wood Johnson University Hospital in New Brunswick, NJ, with an expected graduation date of 2027. She earned her Doctorate of Osteopathy from Rocky Vista University College of Osteopathic Medicine and a Bachelor of Science from Southern Utah University. Throughout her medical journey, Dr. Toussaint has maintained a strong commitment to both her academic and professional growth while balancing the demands of family life as a wife and mother of two, soon to be three. In addition to her clinical and research achievements, Dr. Toussaint is a passionate advocate for resident wellness and has been actively involved in initiatives to enhance mental health support in surgical residency programs. She has launched wellness programs such as the Nadi Shuddhi and Isha Kriya pilot group within her department and serves on various leadership committees at Rutgers. Her dedication to both her professional and personal life has earned her multiple accolades, including the Rutgers Health GME Professionalism Award and residency ombudsmen. **Categories:** awareness, family life, reflection, residency, self-care **Tags:** AWSBlog, ILookLikeASurgeon, residency, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [How the Joy of Volunteering Molds the Student Doctor](https://blog.womensurgeons.org/how-the-joy-of-volunteering-molds-the-student-doctor/) **Published:** October 29, 2025 **Author:** Blog Team **Content:** By Isabelle Casado Christmastime came around—I must have been about 8-years-old. My father had been collecting toys throughout the year. I remember watching him, month after month, quietly putting aside a little something here and a little something there. You can only imagine my excitement as an 8-year-old who thought she hit the ultimate gift lotto. Except—something better was soon about to happen. One evening, my father sat me down and said, ‘’Today, I am Santa’s helper. We’re going to an orphanage to deliver these gifts.” A few days before Christmas, we arrived at the orphanage. I remember seeing so many children around my age. We played, we danced, and we opened presents together. It wasn’t until years later that I truly understood the gift my father gave me that day: the joy of volunteering. Every year afterward, we volunteered together—at children’s hospitals, veteran centers, orphanages, and in various efforts to bring cheer to our community during the holiday season. Through his actions, my father taught me that volunteering isn’t just a kind gesture; it’s a way of life. He showed me what it meant to show up for others, and how those moments—though small—could leave a lasting impact. His life experiences shaped his commitment to serving the community, and in turn, inspired me to do the same. I genuinely don’t believe I would have envisioned myself as a doctor in training had it not been for those lessons. The seeds of empathy, compassion, and service were planted long before I ever stepped into a hospital. One particular experience stands out during my time in medical school. I volunteered with young patients with Type 1/Type 2 Diabetes Mellitus. I had some knowledge of the condition through a family member, but my perspective was that of an adult managing diabetes. Interacting with these young patients revealed an entirely different narrative—one of resilience, innocence, and adaptability. During one visit, a mother sat down beside me and began sharing her daughter’s story. She spoke of the initial shock and the emotional toll the diagnosis took. Her daughter became withdrawn, hesitant to leave the safety of her home. But over time—and with the support of the community and volunteers—this young girl began not only to adapt but to thrive. She eventually became a volunteer herself, helping other children navigate their new realities. Her transformation reminded me how powerful even the smallest acts of kindness can be. From experiences like these, I’ve come to realize that it’s the seemingly little moments—the conversations, the laughter, the shared humanity—that shape you into a better student doctor. Volunteering teaches you more than medical facts; it teaches you to listen with empathy, to approach others with compassion, and to lead with humility. As we journey forward in our training to become the best physicians we can be, I encourage every student doctor to embrace the community. You might be surprised at how much it gives back to you. Volunteering doesn’t just help others—it molds you, strengthens you, and prepares you for the incredible responsibility of caring for others in their most vulnerable and joyful moments. ![Isabelle Casado photo](https://blog.womensurgeons.org/wp-content/uploads/2025/10/image-1-795x1024.jpeg)BIO: Isabelle is a medical student, passionate about serving her community and making positive impacts. She has experience volunteering across diverse patient populations, including individuals with diabetes, recovering stroke patients and veterans in hospital settings. Isabelle was among the first taking part in a peer-mentorship program at her alma mater to support incoming freshman students entering STEM fields, fostering collaboration and academic success. **Categories:** awareness, leadership, medical students, reflection, training **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Cutting Through Grief: How Surgery Helped Me Reclaim My Strength](https://blog.womensurgeons.org/cutting-through-grief-how-surgery-helped-me-reclaim-my-strength/) **Published:** October 22, 2025 **Author:** Blog Team **Content:** By Meaghan Bethea The first time I stepped into the operating room after my husband died, I wasn’t sure I could do it. Everything felt too raw. Too loud. Too precise for a mind muddied by grief. The sterile light above the surgical table illuminated more than just anatomy; it revealed the parts of me I had been trying to keep buried. Heartbreak. Fear. Uncertainty. I was scrubbed in, masked up, holding retractors with steady hands, but inside, I was anything but that. In the summer of 2023, I had just completed medical sciences, passed Step 1, and was preparing to start clinical rotations. At home, my husband and I had found a rhythm. He managed the household so I could pursue my dream with full focus. We were building a life together with our son. Then, suddenly and without warning, two weeks before third year, he died. I became a widow overnight. A solo mother. A medical student staring down the start of core rotations with a child depending on me and a heart still learning how to beat again. I took time off. Not to quit, but to survive. To learn how to breathe again in a world that no longer made sense. When I returned to rotations, I was not the same student. I was still grieving and still rebuilding, but I knew I had to keep going for myself and for my son. I was terrified of my core surgery rotation. Surgery didn’t just test my physical stamina; it pushed the limits of my emotional endurance. Yet, somehow, it gave me something I had not felt in a long time, a sense of control. In a world that felt chaotic and cruel, the structure of surgery was a refuge. There are steps. There is purpose. There is focus. In the OR, I didn’t have time to fall apart. I had to be present. I had to anticipate. I had to keep my hands steady, even when my heart wasn’t. And somehow, that steadiness began to grow inside me. The grief didn’t disappear, but the operating room helped me carry it. I found mentors who taught with both precision and compassion. Attendings, who didn’t ask me to hide my story, but instead helped me reshape it into grit, discipline, and empathy. Every case became a reason to keep going. Every post-op note, every suture, every first-assist moment reminded me that I was still here. Still capable. Still becoming. As women in surgery, we’re often taught to be invulnerable. To perform without pause. To push through quietly. But I’ve learned that the strongest surgeons aren’t the ones who’ve never struggled. They are the ones who know what it means to suffer, and still show up with grace. Grief has sharpened my empathy, motherhood has taught me sacrifice, and surgery has given me a place to reclaim my power. I don’t have to choose between being a widow, a mother, and a future surgeon. I am all of those things, and that’s exactly what will make me better at each one. ![Dr. Bethea headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/10/image-851x1024.png)Meaghan Bethea is a fourth-year medical student at Ross University School of Medicine with a passion for procedural skills and maintaining presence under pressure. As a solo mother and widow, she draws strength from the challenges that have shaped her journey through medical school and channels that resilience into her work. Beyond medicine, Meaghan finds healing and joy in creative pursuits, including writing, fine-line drawing, and raising monarch butterflies with her son. She hopes to use her voice to inspire others navigating grief, parenthood, and the pursuit of medicine. **Categories:** awareness, family life, parenting, reflection, self-care, URiM, women **Tags:** AWSBlog, grief, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Navigating the Transition from Residency to Fellowship](https://blog.womensurgeons.org/navigating-the-transition-from-residency-to-fellowship/) **Published:** October 15, 2025 **Author:** Blog Team **Content:** By Brienne Ryan You think one would be used to this by now. As medical professionals, we transition frequently into new environments, new roles with new responsibilities. It is the dogma of medical training that we gain graduated autonomy with each step we advance and the closer to attendingship we become. So, what makes fellowship different and why do some struggle? If you are one of the hundreds of fellows in the early months of fellowship who find yourself uneasy about your performance, uncertain about your decision, or just plain overwhelmed with your new position, please know that you are not alone. Struggling during fellowship is commonplace and these might be a few reasons why. Fellowship is an entirely different beast from residency. First and foremost, it is a much smaller cohort of peers. When I graduated from surgical residency, a friend and prior senior co-resident said something that I, initially, found strange. He said “Let me know if you need anything, fellowship can be really lonely”. That statement did not resonate with me at the time, and I did not quite understand what he meant. I had come from a surgical residency that was small by residency standards, but still had a group of 15-17 co-residents. This group became a family with whom you could commiserate about the annoying consults, grab a quick bite to eat between cases, and hang out with on off hours. A special bond is formed during those grueling and tiresome years of residency, where sleep is elusive and burnout is common. And then fellowship comes along and you may become a cohort of two, or quite possibly, only one. Residency afforded a built-in support system of like-minded individuals who were going through the same daily trials and tribulations, who could truly understand the experience, and help navigate the difficulties of residency life. For most fellows, this daily support system suddenly vanishes, and you might find yourself struggling to acclimate to this new reality. One of the second biggest changes may be the method of education. As a resident, faculty and administration recognize that most medical students graduate with limited knowledge and practical experience in their specialty of choice and thus, there is usually a plethora of structured academic time. Maybe you had a group conference, or dedicated lectures to assist with the fountain of knowledge that was expected to be learned. Furthermore, especially with a surgical specialty, residency allots five to seven years to absorb and truly learn the knowledge that is required for board certification. Fellowships, especially those without a co-integrated residency, may lack that level of structure for education and the expectation for learning key material may be more independent or clinically focused. For some, this may be a relief. Not having to sit through another lecture made by a resident who was likely tired and delirious while making it – sounds great! Others may miss that component of their education where there was dedicated time to ask questions, learn about a specific topic, or generally learn the fundamentals. The expertise (or lack thereof) with which a resident enters their respective fellowship differs significantly. For some, there may be a steep learning curve as you enter your specialty of choice. Maybe you spent only one or two months of your residency in that specific specialty. No matter what, it can feel overwhelming, as you once again start at a new hospital, in a new role with a new curriculum to learn. Furthermore, the timeline is significantly condensed, usually with fellowship lasting between one and three years. Lastly, the light at the end of the tunnel is there, but just out of reach. For any medical trainee, the process is arduous. For surgeons, fellowship represents the 8th or 9th year of training. It can feel frustrating to start at square one at a new institution, where attendings may be attempting to fine-tune your skills when you simultaneously feel like you are ready to spring the proverbial training coup. There is a long list of what can make fellowship particularly hard – maybe you didn’t match at your number one program, maybe you are in a new part of the country, or maybe you are struggling to acclimate to a new learning style or attending preferences. Whatever is making this transition difficult, here are some tips to help: First and foremost, speak up for yourself. If you are struggling or having issues, express them to your program director or chair. Most of the time, these are things that they may have dealt with before and can help you overcome the obstacles. Give yourself grace, even if you feel like no one else will. As mentioned, we all enter fellowship with a different degree of specialty knowledge and experience. If you are putting in the effort in cases, reading, and attempting to establish a strong knowledge base, no one can fault you. The key thing to remember is that your fellowship wants you to succeed. It is in their and their hospital’s best interest to produce the best fellow they possibly can – for patient care, for reputation, for all the reasons that are both selfish and altruistic. Therefore, it is in their best interest to help you with the problems that arise. Secondly, use your support system. You may have left residency but remember that your prior co-residents are likely also experiencing these ebbs and flows. Lastly, keep the end goal in mind. Within a few months (maybe more), you will be entering the world as a full-fledged attending. The next few months to years represent the last chances to hone your skills under the guidance of someone else. It can be easy to let the negatives overwhelm the positives and focus on what you feel is going wrong rather than right. But what truly matters is the type of surgeon you want to be when you leave fellowship – that is the only prize you should be working towards. Everything else is noise. If you take anything from this article, please remember that no one is alone in this process. There are hundred of physicians who die by suicide every year – an epidemic that is being addressed by changes to surgical training and the healthcare system overall, albeit slowly and with great turbulence. Be your own advocate. Do not struggle alone, because you are not alone in this. A cursory google search of “struggling in fellowship” will show you innumerable examples of people who are in your boat. Wherever you are, whatever specialty, and with whatever time you have left – remember that the timeline is finite. Just as you have done with each step prior (and we all know there have been many), you will overcome this hurdle – and for the majority, this will be the final summit! Attendingship is waiting on the other side. ![Dr. Ryan headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/10/image.jpeg)Brienne Ryan is a current vascular surgery fellow at the University of Missouri. She has been a member of the Association of Women Surgeons since 2015, and has a strong interest in residency education and wellness initiatives. Her professional interests include limb salvage and endovascular treatment of peripheral arterial disease. In her spare time, she enjoys spending time with her husband and two dogs. **Categories:** career development, Fellows, residency, training, URiM, women **Tags:** AWS, AWSBlog, ILookLikeASurgeon, residency, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Finding My Flow: My Pursuit of Vascular Surgery in a Country Without Dedicated Vascular Surgery Training](https://blog.womensurgeons.org/finding-my-flow-my-pursuit-of-vascular-surgery-in-a-country-without-dedicated-vascular-surgery-training/) **Published:** October 9, 2025 **Author:** Blog Team **Content:** By Dr. Swechha Bhatt My love for vascular surgery began in the very first year of medical school, when I studied hemodynamics. The intricate balance of pressure, flow, and resistance fascinated me, and somehow it all made sense. I carried this love with me into my clinical years, where the subject transformed from textbook diagrams into real patients and real problems. In clinics, every vascular case felt like a puzzle waiting to be solved. I often describe vascular surgery as “plumbing: it’s pipes, and you connect pipes.” Yet behind that simple analogy, I began to see the enormous gaps in access and awareness that patients in my country face. Patients with peripheral arterial disease (PAD) would walk into our hospital with critically cold limbs, many at the point of requiring an amputation. I often wondered how different their lives could have been if they had recognized claudication earlier, or if someone had explained the difference between a muscle spasm and intermittent claudication. Dialysis patients routinely traveled for hours to reach us, but when they finally did, their first access was rarely an arteriovenous fistula. Instead, they ended up with temporary catheters that carried higher risks of infection and complications. I learned that there are only three surgeons in all of Nepal trained to operate on aortic diseases, and only about ten vascular surgeons nationwide, I felt a mix of frustration and determination not a single one of them is female. How sad is that? Despite the enormous need, aspiring surgeons face a nearly impossible pathway. At present, anyone wanting to pursue vascular surgery must complete three years of general surgery and another three years of cardiothoracic and vascular surgery training. The result? They end up stretched across specialties, expected to be general, cardiac, thoracic, and vascular surgeons all at once. It is no surprise that many choose not to pursue this track at all. In contrast, countries like Germany, the UK, and the US have long established dedicated vascular training because the specialty itself is so vast. They recognized that an integrated pathway was the only way to truly train competent vascular surgeons. In Nepal, however, the specialty continues to lose its charm. Most of the few vascular surgeons who train here eventually have to leave through brain drain, seeking opportunities abroad that our system cannot yet offer. Those who remain face an uphill battle against limited resources, lack of structured training, and poor recognition of the specialty’s importance. Still, I believe there is hope. Across low- and middle-income countries, subspecialty fellowships are beginning to emerge. They represent a realistic and promising path to strengthen the surgical workforce, especially in areas like vascular surgery where the need is undeniable. As a junior doctor, I don’t know exactly what my own training journey will look like. But I do know this: I want to dedicate myself fully to vascular surgery. I want to become good at it, not by being everything at once, but by being truly specialized. My hope is that Nepal will one day establish a dedicated fellowship in vascular surgery, so that I, and many others like me can find our flow. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/10/Bhatt-1.jpg)**Dr. Swechha Bhatt** is a House Officer in Nepal with a strong interest in trauma and vascular surgery. Training in a low- and middle-income country, she has witnessed firsthand the real-world gaps in surgical care, which has fueled her passion for global surgery. A dedicated advocate for women in surgery, she works to challenge unconscious bias through surveys, campaigns, and mentorship. She has pioneered cost-effective simulation-based training models and led multiple workshops to expand access to hands-on education in resource-limited settings. Guided by her belief in “growing together,” she aspires to become a vascular surgeon and a global surgeon, committed to strengthening equitable and sustainable surgical systems worldwide **Categories:** awareness, career development, diversity and inclusion, global surgery, residency, training, Underrepresented in medicine, URiM **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [The Six Percent Club](https://blog.womensurgeons.org/the-six-percent-club/) **Published:** September 30, 2025 **Author:** Blog Team **Content:** By Dr. Susana Vargas Pinto *This is a special edition blog post presented in partnership with the* [*Latino Surgical Society*](https://www.latinosurgicalsociety.org/) *in celebration of Hispanic Heritage Month.* For 57 years, Latino heritage has been officially recognized in the United States. What began as a week-long celebration in 1968 under President Lyndon B. Johnson was expanded to a month-long observance by President Ronald Reagan in 1988. Hispanic Heritage Month offers an opportunity to honor the significant role the Latino community has played in shaping and strengthening our nation. Although the terms “Latino” and “Hispanic” are often used interchangeably, they have distinct meanings. “Hispanic” typically refers to people with a connection to Spain or the Spanish language, while “Latino” encompasses individuals of Latin American or Caribbean descent, regardless of their proficiency in Spanish. The term also creates space for diverse ethnic and ancestral backgrounds, including those of European descent, to be acknowledged within the Latino identity. Latinos have made remarkable contributions across various fields, including sports, arts, literature, academia, and national defense. In medicine—especially within surgery, where Latinos remain underrepresented—we continue to make an indelible impact. Despite being a minority in the surgical field, Latino surgeons have helped shape the trajectory of modern medicine in the U.S. and beyond. As skilled practitioners and community advocates, we not only advance surgical care but also work to reduce healthcare disparities that disproportionately affect Latino populations. According to the 2020 U.S. Census, 25.7% (18.8 million) of children in the United States are of Hispanic origin, up from 23.1% (17.1 million) in 2010 \[1\]. Yet Latinos account for only about 6% of practicing physicians, with an even smaller percentage represented in surgery, as reported by the Association of American Medical Colleges (AAMC) \[2\]. This gap stems from systemic barriers such as limited access to education, financial constraints, lack of mentorship, and underrepresentation in academic and medical institutions. Despite these challenges, Latino surgeons have made meaningful progress, breaking barriers, and inspiring future generations. Many bring more than technical expertise—they often offer bilingual and bicultural competence that improves patient communication, trust, and health outcomes. In communities where language barriers can hinder care, culturally competent clinicians are essential. Latino surgeons also play a critical role as mentors and role models, encouraging young Latinos to pursue careers in medicine and science. Organizations like the National Hispanic Medical Association (NHMA) and the Latino Surgical Society (LSS) actively work to build networks of support, mentorship, and professional development. These organizations are essential in promoting Latino representation and leadership across all levels of healthcare. Furthermore, Latino surgeons are increasingly taking on leadership roles in medical institutions and academic research, advocating for inclusive policies and research practices that reflect the diversity of the patient population. Their efforts are helping to close gaps in healthcare equity and improve outcomes for all. Celebrating and supporting Latino surgeons is not just about representation or growing the six percent club—it is about building a more equitable, inclusive, and effective healthcare system for the future. 1. https://www2.census.gov/programs-surveys/decennial/2020/technical-documentation/complete-tech-docs/summary-file/2020Census\_PL94\_171Redistricting\_StatesTechDoc\_English.pdf 2. https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 ![Dr. Vargas Pinto Headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/09/image-4.png)Dr Vargas Pinto is a board-certified endocrine surgeon and current Latino Surgical Society (LSS) liaison to the AWS. She practices and lives with her family in Connecticut. During her free time, Dr Vargas Pinto enjoys traveling, music, and the outdoors. **Categories:** advocacy, awareness, diversity and inclusion, diversity and inclusion, guest blog, hispanic heritage, Underrepresented in medicine, URiM **Tags:** AWS, AWSBlog, ILookLikeASurgeon, WomenSurgeons --- ### [Called to Step In](https://blog.womensurgeons.org/called-to-step-in/) **Published:** September 24, 2025 **Author:** Blog Team **Content:** by Brett Weinstein *\*This story was shared with permission from involved parties.* I didn’t wake up that morning expecting to deliver a baby in a car parking lot. I was a fourth-year medical student on a surgery sub-internship, just finishing a long day in the OR. When I walked through the parking lot, I noticed a couple frantically waving me down. The woman was in labor, her face clenched with pain, her husband pacing at her side, panic in his eyes. “Hi my name is Brett, I’m a medical student, can I take a look?” There was no time to wait for help. She was crowning. My heart pounded, but my feet moved before my mind caught up. I jumped into the backseat of their truck, barehanded, adrenaline roaring in my ears. For a moment, the world narrowed to just us – the mother, the baby, and me. Dark hair appeared. I guided the head, then the shoulders, and in seconds, a new life slipped into the world — silently without a cry. The longest thirty seconds of my life followed. With no instruments, no suction, nothing but instinct, I turned the baby over and rubbed vigorously until fluid drained from her mouth and a cry filled the truck – loud, defiant, beautiful. Relief washed over us in waves. Minutes later, a white gurney with 15 people from the ED arrived, but by then, the miracle had already happened. I often replay that night. The chaos, the terror, the focus. It felt like a scene from a movie, but it was real. It reminded me of something essential: when women are placed in extraordinary situations, they rise. That mother, laboring without hesitation in the back of a truck. Myself, a student thrust into a role I wasn’t “ready” for but couldn’t turn away from. Women in surgery live in this space: called to jump in, improvise, act decisively, and carry others through uncertainty. It’s not about being fearless; it’s about stepping forward even while afraid. It’s about trusting our training, our instincts, and our resilience. That night, I learned more about myself, about medicine, and about women than any lecture could teach. Women are powerful. Women are brave. Women – whether bringing life into the world or working in the operating room – can do anything. **Author Bio:** Brett Weinstein is a 4th year medical student from New York Institute of Technology College of Osteopathic medicine applying to General Surgery residency in the 2026 match. She received her Master’s in Public Health from New York University in 2021 prior to attending medical school. Outside of surgery and her passion for improving population health, she enjoys singing, painting and snowboarding. ![Brett Weinstein headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/09/image-3-936x1024.png) **Categories:** awareness, leadership, medical students, professionalism, training, URiM **Tags:** AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Operating Through Loss](https://blog.womensurgeons.org/operating-through-loss/) **Published:** September 22, 2025 **Author:** Blog Team **Content:** By: Wissam Benhami ***Content Note:*** *This post contains discussion of pregnancy loss, a topic that may be difficult for some readers.* It was a Thursday afternoon when I walked out of the OR and drove straight to my gynecologist. The room was quiet and I let myself believe this was just another routine visit. My mind was already on the weekend ahead. He shifted the probe once, twice, and finally stopped. His voice was quiet, almost apologetic. There was no heartbeat. I nodded as he spoke, but his words dissolved before they reached me. I left the office with the image burned into my mind, a still, motionless curve on the screen and a weight in my body that felt both heavy and hollow. The next morning was Friday. A patient we had operated on the day before needed her discharge. I hadn’t slept a single hour. My eyes were swollen and red, and when people asked, I mumbled something about allergies. The truth was too raw to offer. I stepped into her room, holding her chart, my voice steady as I explained the wound care, the medications, the signs to watch for. She smiled, reassured. I smiled back. In that moment, my grief didn’t matter. What mattered was that she felt safe enough to go home. That weekend bled into a week*—* I went on operating, day after day, knowing my own body was carrying a pregnancy that had already ended, waiting for it to let go. Between cases, I sometimes caught myself watching patients in small, ordinary moments, a daughter adjusting her mother’s blanket, a man holding his wife’s hand while she drifted off to sleep. I noticed the way they protected each other, and I thought about how I had spent that week protecting everyone who came under my care, shielding them from uncertainty, from pain, I can keep everyone else safe. Why couldn’t I keep my own child safe? Surgeons are often imagined as invulnerable, decisive, composed, precise, and we are, but we are also human. We carry the weight of our patients’ pain alongside our own. Sometimes we show up to the operating room with hearts that are breaking. We keep going, not because it is easy, but because our patients need us to. I think often of that Friday morning, how I stood by my patient’s bed explaining wound care while my own wound was invisible. I think of the thousands of surgeons, especially women, who return to work after a miscarriage, a loss, or any deeply personal pain, and keep giving the best of themselves to others. This is not resilience in the glossy, motivational sense. It is quiet endurance. It is the choice to keep showing up, to keep healing, even when healing yourself feels impossible. Our patients rarely know the battles we fight outside the hospital walls, and maybe they don’t need to. I believe our humanity, our ability to care despite the cost is what makes us not only better surgeons, but better people. ![Wissam Benhami, MD headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/09/image-2.png)**Author Bio:** Wissam Benhami, MD, is a general surgeon who recently graduated from Université d’Alger, currently working at Clinique Les Orangers, an oncologic surgery clinic in Algiers. She dreams of specializing one day in hepato-biliary and pancreatic surgery. In her free time, Wissam enjoys working out, practicing Pilates, reading romance novels or self-development books, playing with her cat Olivia, and cooking indulgent meals for her husband, her love language. **Categories:** awareness, reflection, URiM **Tags:** AWS, AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [How to Be an Ally](https://blog.womensurgeons.org/how-to-be-an-ally/) **Published:** September 11, 2025 **Author:** Blog Team **Content:** By Cori DeLisi, DO On May 28, AWS came together with the Association of Out Surgeons and Allies in our Cutting-Edge Conversations webinar to answer the question “How can we be allies to the LGBTQ+ community as trainees and surgeons?” If you identify as an ally because you implicitly support your LGBTQ+ patients and colleagues, consider what others see of your allyship and how far your impact reaches. Here we expand on the webinar’s takeaways for AWS members with added perspectives from Dr. DeLisi, a trainee who has been on both sides of allyship around sexual and gender minority identities. I’m Cori (they/them), a general surgery intern in Pennsylvania. After coming out as non-binary in medical school, I faced this dichotomy of trying to introduce myself with my pronouns while also feeling worried about shifting the conversation away from patients, learning, or healthcare in general. After excluding my pronouns from my introductions throughout my sub-internships, I decided not to let my fear get in the way of setting the record straight (no pun intended) as a new resident. I still remember our “introductions” meeting with my coresidents; when it got to me, I took a deep breath and said “Hey, I’m Cori and my pronouns are they/them but don’t worry if you mess up!” Looking back, I really am proud for staying true to myself while working towards creating a welcoming environment where we can mess up and learn together, but also because the co-resident sitting next to me used “she/they” pronouns and noted that my openness made it easier for her to say her pronouns, as well. A moment of self-advocacy allowed me to be an ally to my peers! How can *you* be a good ally? Staying up-to-date with inclusive language, legal, and political ongoings within the community is a cornerstone of allyship. The use of “they/them/theirs” as a singular pronoun for non-binary individuals and of the word Queer as an identity have all been recent developments within the community. I had been out as a lesbian for five years before I met my first non-binary friend… and I messed up their pronouns a lot at first! Similarly, if you haven’t frequently been around sexual minorities (lesbian, gay, bisexual, pansexual, etc.), you may tend to describe someone’s partners with gendered terms as opposed to neutral language like “partner(s)”. I see my earlier story as an example of how even I, as a Queer person who would directly benefit from this allyship and the creation of a safe space, can have difficulty finding the right words and courage to be a good ally. Allyship isn’t necessarily a single action or a snapshot in time, but the cultivation of an environment that appreciates differences and does not force folks to choose between being themselves and taking up space. Many of the steps AWS members take to advocate for women in surgery can be applied to our Queer peers! As with AWS initiatives, inclusion of and allyship for these communities starts with *your* specific strengths: strong mentors could provide cross-mentorship to LGBTQ+ trainees, advocates could fight for equity in parental leave policies, and educators could change how we teach and how we test knowledge. To summarize, being an ally comes down to a few principles: respecting other individuals—including using correct names and pronouns, using inclusive language, speaking up in cases of discrimination, and staying up-to-date with how communities interact. Lastly, and perhaps most importantly, be kind to yourself, you might not get everything right the first time but be better the next time around. ![Cori DeLisi, DO Headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/09/image-1-819x1024.png)**Cori DeLisi, DO (they/them)** @coridelisi on instagram Hi, my name is Cori, and I am a general surgery intern just outside of Philadelphia! I’m originally from New York, went to undergrad and worked as an engineer in Massachusetts, before going to medical school in California, where I met my partner in school! I love working out, reading, my 2 cats, experiencing all the fun activities Philadelphia has to offer, and arguing with my partner about whether Ob/gyn or general surgery is the best specialty! **Categories:** advocacy, awareness, diversity and inclusion, gender differences, reflection, Underrepresented in medicine, URiM **Tags:** AWSBlog, AWSChat, ILookLikeASurgeon --- ### [Celebrating a Year of Work: AWS Resident and Fellow Committee 2024–2025](https://blog.womensurgeons.org/celebrating-a-year-of-work-aws-resident-and-fellow-committee-2024-2025/) **Published:** September 4, 2025 **Author:** Blog Team **Content:** By Camila R. Guetter, MD, MPH This past year has been an incredibly exciting and productive one for the AWS Resident and Fellow Committee. With a mission to support surgical trainees through education, mentorship, and advocacy, the committee has made significant strides in expanding opportunities, enhancing resources, and fostering a stronger sense of community among residents and fellows. We’ve held consistent monthly committee calls, which have served as a collaborative platform to share ideas, launch initiatives, and build connections across training levels and institutions. Our bi-monthly webinar series continues to be a cornerstone of our programming, each designed to address critical challenges surgical trainees face, and attracting attendees from all geographical regions and levels of training. Topics this year included fertility preservation and family planning in surgical training (speaker: Dr. Bortoletto), crafting your research years (speaker: Dr. Martinez Quinones), parental leave in surgical training (speaker: Dr. Altieri), “Dear Intern” (panel of residents/fellows), and shaping your surgical career (Dr. Kulaylat). You can access recordings from previous sessions in the [Webinar and Workshop Library](https://www.womensurgeons.org/index.php?option=com_content&view=article&id=64:webinar-library&catid=20:site-content&Itemid=162) on the AWS website. **Upcoming webinars will cover contract basics of negotiation (September 9, 2025,** [**register here**](https://amrms.zoom.us/meeting/register/tZUrdumorz0pGdJ7SJiuG3fJEqP6wSRYcPAz#/registration)**) and personal branding strategies for trainees and surgeons (December 9, 2025,** [**register here**](https://amrms.zoom.us/meeting/register/PcXcK51YTYSLE6ZwyK06gg#/registration)**).** To extend the impact of these webinar discussions, the committee has collaborated with the AWS blog team to produce companion blog articles that summarize key points and link to resources. These efforts make our content accessible and shareable even after the events have concluded, especially for those trainees who are interested in the content but unable to attend the event live. Examples of blog articles regarding the webinars on fertility preservation/family planning and parental leave can be found [here](https://blog.womensurgeons.org/fertility-preservation-and-family-planning-in-surgical-training-highlights-from-a-much-needed-discussion/) and [here](https://blog.womensurgeons.org/parental-leave-in-surgical-training-webinar-highlights/), respectively. The committee has also been working on manuscripts for publication in academic journals on the topic of fertility preservation and the importance of supporting trainees through their fertility journey and procedures, reflecting the committee’s commitment to both advocacy and academic engagement. This year also saw the creation of a monthly “Resident and Fellow’s Corner” in the AWS newsletter, providing regular updates, tips, and highlights among AWS resources tailored to trainees. A welcome packet for newly matched residents is also being developed to help ease the transition into surgical training and introduce new members to AWS and our committee’s resources. Collaboration has remained a key theme. The committee has worked closely with the Medical Student Committee to mentor journal club participants and provide moderators for discussions, as well as assist with selecting abstracts for the AWS Annual Conference scientific session (AWS Starr Forum), and plan for the Resident and Student Mixer at the 2025 AWS conference. Behind the scenes, the committee has also undergone a leadership restructuring, creating more opportunities for residents and fellows to take active roles in shaping our work within the committee. As we plan for the year ahead, leadership elections for the new year have just opened up. **If you are interested in getting more involved with AWS as a resident or clinical fellow, make sure to apply by September 25th using this link:** [**https://womensurg.memberclicks.net/resfellapp2025**](https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fwomensurg.memberclicks.net%2fresfellapp2025&c=E,1,zOML5i2kmmMcm-ordUDU9eWzcpr54EXIe8SnPYtqudZlhdi5FNyMp-YbV_eUHr41pX2st-XOE5hc2hZ0WOQcMA1ghCey6FPi2ymS17FD-z611pPgd8GFoPE_9BU,&typo=1)**.** We are always looking for new voices and perspectives. Whether you’re passionate about mentorship, advocacy, research, or simply want to connect with others in the surgical training community, we encourage you to get involved. [**Join one of our committee calls**](https://amrms.zoom.us/meeting/register/DvF_vy1nTVqVKjEy-ZaQdQ#/registration)**, which happen on the first Thursday of every month at 8:30 PM EST, where you can learn more about what we do or how to get involved!** It has been an incredible pleasure and honor to lead this group this year, and I can’t wait to see all of the wonderful things the AWS Resident and Fellow Committee will continue to accomplish in the years to come! ![Dr. Guetter headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/09/image.png)Camila Guetter, MD MPH, is a General Surgery Resident at Beth Israel Deaconess Medical Center, in Boston, MA. She is currently in her research years of residency, working as a research fellow in vascular surgery clinical outcomes at BIDMC and pursuing a PhD in Clinical Epidemiology at Harvard T.H. Chan School of Public Health. Before residency, she obtained a Masters in Public Health degree with a focus in Epidemiology and Biostatistics from the Johns Hopkins Bloomberg School of Public Health. Her interests include vascular surgery and its interface with populational health and surgical outcomes research. She has been actively involved with AWS since medical school and currently serves as Chair for the Resident and Fellow Committee of the AWS. **Categories:** residency, training, URiM **Tags:** ILookLikeASurgeon, residency, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [The Power of Social Media for Premedical and Medical Mentorship](https://blog.womensurgeons.org/the-power-of-social-media-for-premedical-and-medical-mentorship/) **Published:** August 27, 2025 **Author:** Blog Team **Content:** By Ashley Cianchini In Medicine, mentors become the most important asset to thrive. The mentors we make along the way provide the most powerful insight on experiences they lived to keep us focused and motivated. Students without mentors often feel lost and have difficulty persevering through the biggest challenges in Medicine. Sadly, the traditional mentorship experience through shadowing, physician family members, or undergraduate experiences may often be inaccessible for some students, specifically underrepresented minorities and first-generation students. These students often become the first in their families to graduate high school or college. The dream of becoming a physician can feel extremely unachievable. [Only 5.8% of the physicians in the United States are Latino, and only 5% are Black.](https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018) This creates barriers for students with similar backgrounds, who struggle to identify with other physicians. Coming from a small school in the middle of Puerto Rico, it was difficult for me to find guidance. I had always dreamt of becoming a doctor, but it was hard to find information about how to prepare, what classes to take, when to take the MCAT, and all of the costs related to applying to medical school. As I struggled to organize my path, I searched for other ways to receive mentorship and feedback. This mentorship came faster than I had hoped, as I stumbled upon an Instagram post by an alumni from my high school sharing news of her medical school acceptance. She had done it. She had gotten into medical school. I quickly messaged her, asking her for guidance through this process. I’m unsure if she knows the great effect her words had on me, but she has been the reason I have continued in Medicine. My inner thoughts transformed from *“Can I really do this?”* to *“If she can do it, so can I”*. **Why Social Media Works** Social media provides increased accessibility to these mentorship relationships. We can see how students study for their exams, apply to research programs and match into residency. Thus, social media becomes an endless source of information and guidance for premedical and medical students. It also provides physicians from different backgrounds a platform to share their stories, helping students on the other side of the screen to identify with their message. When I posted my own medical school acceptance letter, I did not expect so many students to reach out. The connections I made with other students during college gave them the confidence to message me, asking me to guide them. This motivated me to create my own mentorship platform: CianchiniMed. CianchiniMed started as a space for students from all sorts of backgrounds to receive mentorship and guidance, after not being able to receive it myself. My main message stood as “If I can do it, so can you”. In the past 4 years, I have provided mentorship to thousands of students, free workshops for their medical school preparation, and redefined the traditional mentorship relationship. Most students message me with easy questions, such as how do I study for the MCAT or what prerequisites are needed, but others have much deeper dilemmas. One of my mentees asked me for advice regarding taking the MCAT as a mother and full-time nurse. We spoke about the pros and cons of applying as an older candidate, organized accessible resources for her, and made a year-long plan to prepare her for her MCAT. I cannot deny that the path was difficult for her. She struggled with studying for an exam in English as a Hispanic and re-learning material she took in college more than 10 years ago. The day she received her 515+ MCAT score, we were ecstatic. Her win felt as much as hers as mine. Through this entire process, I have never met her in person, but I have had the privilege of being a part of her journey. Another student wrote to me because they couldn’t afford medical school applications. They lived with their parents and worked part-time to pay for college. Nevertheless, they didn’t want to give up on their dream of becoming a doctor. We coordinated a Zoom call, and I guided them through the AAMC Fee Assistance Program, along with free resources to study for the MCAT. They didn’t know this program existed, but quickly applied and got approved. This student is currently in medical school, making their dreams come true. I have hundreds of stories like theirs to go around, all because I decided to make an Instagram page. **Benefits vs. Challenges of Social Media** It may sound very *Gen Z* to think that Social Media is this pivotal part of our lives, but for many students, it is! I wouldn’t be here if it weren’t for Social Media. Though, as good as it may be, Social Media may also bring challenges. People post fake content all the time or edit themselves to fit a certain social standard. This can affect the way students visualize themselves, thinking they aren’t fit for this career. Other people may only post happy parts of their journey, which I believe has both positive and negative effects. Seeing happy moments may motivate students to continue their path, but ONLY seeing happy moments may give the idea that it is ALL happy moments (which we know isn’t the truth). This content may romanticize a career in Medicine with unachievable standards. Students who don’t have straight, happy paths like the ones they see may be triggered to believe they are doing something wrong. Social Media creates another environment for competition and comparison, a much bigger one. As a content creator myself, I have tried with CianchiniMed to reflect the most honest and real content. I want students to know the ups and downs of Medicine, how to persevere through the toughest times, and learn from my mistakes. Sharing stories of rejection and failure through social media is incredibly difficult. I often feel I will receive backlash or hate for not having a straight path. Nonetheless, I think of myself 5 or 6 years ago…what would I have liked to see from the creators I follow? I would have liked to see how they retook the MCAT and got into medical school, how they had to take a gap year, or how they balanced their social life and their career. I would have liked to see genuine content of perseverance and determination. It would have made me feel much less alone throughout the process of becoming a physician. I cannot deny that I have certainly received hate regarding how I talk, where I am from, and the decisions I have made, but I also have received hundreds of messages from students going through the same situations as me. Students who needed someone to listen to them and motivate them. Those are the messages that matter; the rest becomes noise. Additionally, other students needed to see this real content to decide against a career in Medicine. It may sound counterproductive for my initial mission with my platform, but I have had students who have seen my content and decided on a different career path. Some students cannot visualize themselves dedicating 24/7 to studying, others didn’t love the idea of so many board examinations, and others had a different idea for their future lifestyle. I do believe that this helped them decide early in their career instead of quitting halfway through medical school. **Other medical creators** Other physicians have taken their role in sharing genuine content, too. On MATCH Day 2025, dozens of physicians and attendings shared their stories on TikTok about how they didn’t match to residency the first time they applied. After 4 years of medical school, receiving a letter saying you didn’t match to the specialty you applied to has to feel like the most heartbreaking moment of a medical student’s career. All of your training and studying have been for this moment, which can make this experience very difficult. In support, physicians shared their stories on how they coped through their experience of not matching and how this drove them to become the physicians they are today. In return, students felt identified with their stories, feeling much less alone in their journey. Without social media, this would not have been possible. I believe that this honest content is what will change the competitive culture seen in Medicine. It normalizes obstacles and creates a cooperative environment for students. Medicine does need this cultural shift. With a physician shortage, we should be motivating each other to get into the career rather than pushing others down. **What YOU can do** To physicians, attendings, and residents, thank you for mentoring the future generation of doctors. Whenever you can, be honest with them and answer their questions when you can. Your words guide us every morning we wake up. Many of us don’t have anyone else to rely on through this journey. To students, don’t fear reaching out because your mentor may be one DM away. These relationships will take you very far in the search for your dreams. ![Ashley Cianchini headshot](http://blog.womensurgeons.org/wp-content/uploads/2025/08/IMG_2224-1.png) **Ashley Cianchini** is a fourth-year medical student from the University of Puerto Rico School of Medicine and is pursuing a career in general surgery. She founded CianchiniMed to expand mentorship opportunities for premedical and medical students, especially those from underrepresented backgrounds. Her research centers on surgical oncology and disparities in pediatric surgical care for Hispanic populations, reflecting her commitment to equity and advocacy in medicine. **Categories:** awareness, career development, education, medical students, mentorship, networking, resources, training, women **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [A Journey Inside the U.S. Healthcare System as an IMG](https://blog.womensurgeons.org/a-journey-inside-the-u-s-healthcare-system-as-an-img/) **Published:** August 20, 2025 **Author:** Blog Team **Content:** By Andrea Iturralde, MD **I want to start with: What is an International Medical Graduate (IMG)?** An IMG is someone who received their medical training outside the United States and wants to pursue a medical residency in the United States. When I think about navigating the U.S. healthcare system as an IMG, many challenges come to mind. First, I want to focus on one of the biggest difficulties: moving to a new country. This transition can be overwhelming. You’re not just learning a new healthcare system, you’re also adapting to an entirely new life. Renting a house, handling paperwork, even opening a bank account—these are all tasks you must complete before you can even think about practicing medicine. Once you’re established, it’s important to recognize that the healthcare system may work differently from that of your home country. For example, in the U.S., nurse practitioners and physician assistants play key roles in patient care. They diagnose, treat, and prescribe medications. In many countries, these roles either don’t exist or function quite differently. Electronic health records (EHRs) are another challenge. In my home country, most records were handwritten or managed in very basic systems. Here, everything is digital. I recommend taking the time to explore and practice with the EHR system whenever possible, as familiarity will make your clinical work more efficient and smoother. ERAS offers an EHR course for IMGs matching in the US, which is excellent training. Another challenge for many IMGs is presenting patients. Doing this in a second language requires organizing thoughts clearly, translating medical terms while adjusting to the communication style of U.S. medical students and residents. It can feel intimidating at first, especially if you’re worried about making mistakes, but this is simply part of the acclimatization process. In the end, you’ll succeed! Something I struggled with was using medical abbreviations. Back home, I rarely used them, but in the U.S., they are part of every medical communication. I still remember the first time I heard one—I tried to figure out its meaning while the conversation kept moving forward without me. The good news is, within a few weeks, you’ll get used to them and start using them naturally. Networking is also a crucial element for IMG success within the U.S. healthcare system, more than any other system I have been exposed to. Attending professional meetings and conferences provides excellent opportunities to connect with physicians who share your interests and can guide you through the process. Remember, not every contact will be the right fit for you. Seek mentors who align with your goals and values, and be genuine in your interactions. Even if some physicians don’t fully understand the IMG experience, many will try to help if they can and if you show interest. When they can’t, they’re often honest about it—which is just as valuable, because it helps you find the right mentor more quickly. Ultimately, mentorship is one of the most powerful resources for navigating the medical system. The right mentor can offer guidance, open doors, and help you adapt successfully to your new professional environment. Through my own residency application journey, I’ve learned that understanding and showing interest in the U.S. medical system is essential. While it may feel intimidating, this knowledge will give you a real advantage when applying for positions. With some extra effort, you’ll be surprised at how quickly you can start using the tools that the U.S. medical system offers to make your practice easier and more efficient. I want to end with the same question: **What is an International Medical Graduate (IMG)? An IMG is a brave professional who dares to step out of their comfort zone, choosing to grow within a new system, in a new language, in a new culture. They embrace change and discover strengths they never knew they had. An IMG is living proof that determination and passion can cross any border. ![Andrea Iturralde, MD headshot.](https://lh7-rt.googleusercontent.com/docsz/AD_4nXcIrGHYTAvAp85l6J6Vxhyt6Yl7eyjhyRrhHF9fISq5QFyS8zaBJ5VXyJJ-7qeTtVLz9vumv6dMgUO1avnu6ysx0SGhSkeffWYQp8UrGpNIy-dQf0TD76NmqelLnvVkRAeZW5L-ZQ?key=3sAchn4vQIBowFOoljsHmw)**Andrea Iturralde, MD** I am an IMG from Ecuador, currently working as a postdoctoral research fellow in the Vascular Surgery Department and the Neurosciences Department at the University of New Mexico. I am applying for General Surgery in the 2026 match. I am passionate about addressing surgical disparities and improving access to surgery in low-income countries. Outside of medicine, I enjoy photography, painting, and exploring the outdoors. **Categories:** awareness, global surgery, reflection, training, URiM **Tags:** ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Locked In: Training Under Pressure in the Dominican Republic's Public Health System](https://blog.womensurgeons.org/locked-in-training-under-pressure-in-the-dominican-republics-public-health-system/) **Published:** August 19, 2025 **Author:** Blog Team **Content:** Medicine in Latin America *By Paria Remolina* Medical training across Latin America often takes place in environments defined by limited resources, high patient volumes, and immense service demands. These challenges do not reflect a lack of knowledge or dedication but rather the difficult realities faced by public health systems stretched to their limits. In this piece, we explore the structure and expectations of surgical residency in the Dominican Republic, where young physicians must navigate not only the complexities of clinical care but also the pressures of a deeply hierarchical and demanding training environment. **A Culture of Respect and Responsibility** In the Dominican Republic, respect for seniority is central to medical culture. Attending physicians and fellows are regarded with deep formality, greeted with titles, and addressed with deference. It is expected to stand in their presence. These gestures reflect a longstanding tradition of respect for experience and authority. For residents, this cultural framework brings both pride and pressure. They are easily identified by their formal white attire and expected to represent the discipline and commitment the profession demands. However, in the context of overstretched hospital systems, the expectations placed on residents often extend beyond typical working hours and duties and into a realm of physical and emotional endurance, and even distress. **Trancado: When Training Demands Endurance** One of the most striking practices that residents may encounter is colloquially known as trancado, a term that translates to “locked in.” It refers to extended shifts in which residents remain in the hospital well beyond standard duty hours, sometimes indefinitely, often as a response to perceived lapses in performance or communication. While the intent may be to instill accountability, the result can place a heavy toll on trainee well-being. These extended hours are not guided by formal limits on resident work schedules. Residents in the Dominican Republic are not classified as employees or students in a way that provides clear labor protections. Instead, they occupy a space of intense clinical responsibility with few systemic safeguards to ensure adequate rest or balance. **Training in a System Under Strain** The expectations placed on residents reflect the reality of a health system striving to care for many with limited resources. Hospitals serve as both training grounds and safety nets, and the immense need can create conditions where policies and traditions persist without reevaluation. As a medical student rotating through public hospitals over the last two years, I have witnessed firsthand how these conditions affect resident morale. I have seen dedicated young doctors managing complex surgical cases while also navigating the weight of traditional disciplinary structures. In one instance, a surgical resident was warned, perhaps seriously, perhaps not, that he would remain in the hospital for a week if students under his supervision failed to complete an assignment. The tone may have been ambiguous, but the silence in the room said enough. These moments underline the immense pressure residents face to meet not just clinical standards but institutional expectations rooted in long-standing norms. **A Call for Reflection** This piece is not a critique but a reflection, an invitation to consider how systems can evolve while respecting cultural values and professional standards. The dedication of Dominican physicians and trainees is undeniable. Their commitment keeps the public health system functioning under immense strain, but even the most committed professionals need structures that support their growth, health, and dignity. Change does not happen overnight. It begins with honest conversations among trainees, mentors, institutions, and communities. This is one such conversation. A whisper, perhaps. But even whispers, over time, can lead to meaningful change. **About the Author** Paria Remolina (she/her) is a final-year medical student in the Dominican Republic, originally from the USA. With prior experience as a geriatric volunteer in the US healthcare system, and now working within the Dominican Republic’s healthcare system, Paria has gained a unique perspective on the disparities between the two. Her experience has deepened her appreciation for the challenges faced by students, particularly those pursuing surgery, and she is passionate about highlighting these issues in order to drive change. ![Paria Remolina Headshot](https://lh7-rt.googleusercontent.com/docsz/AD_4nXf0Euk22aIUJ4Fi6nL1oI2isjVkt-TiEwDTa4s3lhTU92ujcvsOki3SRXDiuT-ITPad0wsMiAKlPT08Rvj3_x6EgWppg3S_NiD9ormSrVopVjuEhJgzXjcZfFjClh43RDTMFt4U8Q?key=ILrmyCFr_56TxZAfQ9iKQw) **Categories:** awareness, global surgery, medical students, training, URiM **Tags:** AWSBlog, ILookLikeASurgeon, medical student, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Healing Hands: Crafting Care from Medicine to Lei Making](https://blog.womensurgeons.org/healing-hands-crafting-care-from-medicine-to-lei-making/) **Published:** August 7, 2025 **Author:** Blog Team **Content:** By: Jamie McDermott “May day is Lei Day in Hawaii nei” is a saying that rings through the air every May 1st in Hawaii. Have you ever seen visitors wearing flowers around their necks? Or noticed hula dancers draped in floral designs at a luau? **What is the history?** In 1923, the Hawaiʻi Territorial Legislature passed Joint Resolution No. 1, recognizing floral emblems. This resolution aimed to designate the hibiscus (aloalo) as the official flower emblem of the territory. Their argument succeeded by drawing on the widely accepted association between specific colors, lei, and their corresponding islands. As time passed, more people started wearing leis on May 1, giving rise to the tradition of “May Day is Lei Day in Hawaii.” Even during the COVID-19 pandemic, when large gatherings were limited, the island community found creative ways to honor this uniquely Hawaiian celebration. **What is a lei?** A lei is a traditional Hawaiian garland or wreath, often made from flowers, leaves, shells, nuts, or even feathers. It is commonly worn around the neck or head and is given as a symbol of **love, respect, celebration, or honor**. Leis are often exchanged during special occasions such as birthdays, graduations, weddings, and the Hawaiian holiday Lei Day on May 1. My personal favorite is a combination of puakenikeni flowers and ti leaves. ![Photo of lei examples](https://blog.womensurgeons.org/wp-content/uploads/2025/08/Lei-4.png)**What does this represent?** Many of my colleagues entering medical school came with me from the Biomedical Sciences Master’s Program. Through that experience, I formed long-term friendships and a strong support system that fueled my motivation and eagerness to thrive in medical school. When my family flew to Arizona from Hawai‘i, they brought a plastic bag filled to the brim with handmade leis, each thoughtfully designed for those friends. I chose **plumeria** for compassion, **gardenia** for resilience, and **crown flower** for stability. To me, a lei represents more than just a token of celebration. Deeply rooted in Hawaiian culture, it symbolizes ***love, respect, unity, and the passing of knowledge—values that resonate deeply within the field of surgery***. Just as a lei is carefully crafted from individual flowers, each contributing to its beauty and significance, surgery is built upon meticulous skill, teamwork, and dedication to patient care. The act of giving and receiving a lei mirrors mentorship in surgery, where experienced surgeons pass down wisdom and techniques to the next generation. Similarly, just as leis are worn to honor achievements and milestones, the surgical field celebrates perseverance and excellence, whether through white coat ceremonies, graduations, or the privilege of earning the title of “surgeon.” Ultimately, both the lei and surgery embody a commitment to tradition, growth, and a profound sense of responsibility to others. While many places may not have the same native flowers as Hawai‘i, I encourage everyone to look up a tutorial, create a lei with the resources available to them, and take a moment to admire the beauty of their creation. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/08/AD_4nXdrdPPGtZ7iCDlxposjZx0vcTrfA3ahlcTpeIFHZv9YpcGApIWfZl-4uJAYoPv31VVMwoboHYn5ZGoeB52AXmV04-BU1bs-la7hf0_WhycG5h0L-usOcgzOJqZlRnUYSvhamBqQUg.jpg)**Author Bio** Jamie McDermott is a third year medical student at Arizona College of Osteopathic Medicine. She is from the island of Kauai and double majored in Biochemistry and Psychology at Central Washington University. Her current interests are colorectal surgery and surgical oncology. She is a proud member of the Association of Women Surgeons and serves on the AWS Communications Committee. In her free time, she enjoys spending time with her two cats, riflery, and baking treats for her colleagues. **Categories:** awareness, diversity and inclusion, mentorship, reflection **Tags:** AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Parental Leave in Surgical Training: Webinar Highlights](https://blog.womensurgeons.org/parental-leave-in-surgical-training-webinar-highlights/) **Published:** August 1, 2025 **Author:** Blog Team **Content:** **Authors:** Kylie Dickerson, MD, MS; Nensi Ruzgar, MD; Camila R. Guetter, MD, MPH; Alizeh Abbas, MD; Maria S. Altieri, MD, MS In March 2025, the Association of Women Surgeons Resident and Fellow Committee hosted a discussion on Parental Leave in Surgical Training. The session began with a presentation by Dr. Maria Altieri, Section Chief of GI Surgery and Director of Bariatric Surgery, Pennsylvania Hospital at the University of Pennsylvania, who has published multiple papers on parental leave policies during surgical training. The presentation was followed by a Q&A session with a panel of trainees who shared their experiences related to childbearing during clinical residency or dedicated research time, being a non-birthing parent, and exploring adoption. The goals of the webinar were to discuss different pathways to childbearing and parental leave policies during surgical training. Dr. Altieri discussed her personal experiences with childbearing during different phases of training, from medical school to residency, fellowship, and as a junior attending surgeon. She provided some staggering data showing that most medical schools in the US do not have official parental leave[ policies](https://www.ama-assn.org/medical-students/medical-student-health/most-medical-schools-don-t-have-defined-leave-policies) and that the US ranks poorly among other nations in regards to[ paid parental leave](https://oecdstatistics.blog/2023/01/12/paid-parental-leave-big-differences-for-mothers-and-fathers/). Policies for parental leave vary between institutions and among state and national levels. State-specific policies include parental leave through the Family and Medical Leave Act (FMLA). On a national level, the American Board of Surgery has guidelines including a minimum number of clinical weeks per year (48) with an additional 4 weeks which can be taken for family or medical leave once during PGY1-3 and again during PGY 4-5. ACS released updated [guidelines](https://www.facs.org/about-acs/statements/revised-statement-on-the-importance-of-workplace-support-for-pregnancy-parental-leave-and-lactation-for-surgical-trainees/) in 2024 highlighting the importance of supporting trainees. Institutional policies vary significantly among residency programs and can also differ in the amount of time off between maternal and paternal leave and the type of birth, including additional time for Cesarean sections. In addition to this discussion on parental leave policies, the webinar also included discussions on data regarding the fact that female surgeons have decreased fertility rates compared to the national average.[ Data published in 2021](https://pubmed.ncbi.nlm.nih.gov/34319353/) showed that female surgeons are more likely to delay childbearing, require Assisted Reproductive Technology (ART), and have fewer children than their non-surgical counterparts. On average, women surgeons experience more than double the rate of miscarriages compared to the general population. Panelists for the Q&A session included residents with varied experiences with pregnancy during different phases of training, in addition to being a non-birthing parent and the process of adoption. The trainees discussed the level of support from their program leadership and co-trainees, adjustments they were able to request or make, and other considerations they had not expected. The panelists agreed that understanding policies is crucial, in addition to having buy-in from their program leadership, which is essential in order to have an easy transition to parenthood, while reducing the impact on surgical training. In conclusion, this session shed light on some of the gaps that still exist in parental leave policies both at the institutional and national levels. As women make up an increasingly higher percentage of the surgical workforce, it is critical that these issues are discussed as we strive towards solutions. Anyone interested in the topic can access the recording of the session on the[ AWS online webinar library](https://womensurg.memberclicks.net/resident-fellows-library?servId=20057) or attend one of our[ upcoming webinars](https://amrms.zoom.us/meeting/register/tZUrdumorz0pGdJ7SJiuG3fJEqP6wSRYcPAz#/registration). ![Kylie Dickerson Headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/08/Screenshot-2025-08-01-125732.png)Kylie is a PGY4 general surgery resident at the University of Arizona in Phoenix who is pursuing a career in Surgical Oncology. She is from Monterey Bay, California and recently had her first child during clinical residency. She currently serves as a Regional Liaison for the AWS Resident and Fellow Committee. **Categories:** advocacy, awareness, diversity and inclusion, family life, Fellows, parenting, residency, resources, training, Underrepresented in medicine, URiM, women **Tags:** ILookLikeASurgeon, residency, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Doctors Need to Give Better Talks: How the Signature Speaker Series Can Help](https://blog.womensurgeons.org/doctors-need-to-give-better-talks-how-the-signature-speaker-series-can-help/) **Published:** July 23, 2025 **Author:** Blog Team **Content:** by Nimmi S. Kapoor, MD, FACS Doctors give the worst talks. Now I understand why it is hard for me to stay awake, pay attention, and understand the point of all these talks at all these conferences I go to, and it’s not just because my phone is too distracting. Indeed, my phone distraction has spared me from some of the dreadfully boring talks I have been subjected to year after year. The Association of Women Surgeons (AWS) Signature Speaker series helped me realize why and how some talks hit the mark, while most others don’t. The lessons learned from this experience were transformative for me. I was able to move past my own anxiety with speaking—I tend to have a bit of a shake in my voice at the beginning of every talk—and learn the tools to give a meaningful, impactful talk. Our Motivational Speaker and Instructor, Patrick Combs, taught us how to engage with our audience, how to make the audience feel respected and important, and how to move past our own flaws, limitations, and fears, and move toward a stylistic approach that aligns with our own personal style and values. I am not a storyteller—or so I thought—but I can tell you about my patients. I am not good at telling jokes, but I can make snarky comments that will make you smile. After a few group sessions with Patrick and a personal one-on-one session, my entire approach to giving a talk shifted. Then we had a fantastic session with Slide Expert Brigette Callahan that has forever changed how I look at slides. Did you know that a white background should be a “never?!” It is harder for our eyes to adjust to words on a white background than if they were on a tinted or darker background. Our eyes will strain for too long, especially if the environment we are in is dimly lit. Charts and graphs are also often way too crowded with useless information and the “big picture” hidden from easy view, rather than the speaker highlighting the one line they want us to look at? If people want all the data, they will ask for it or they can read the full paper. After I had taken the Signature Speaker sessions, I was able to experience a grand rounds where the speaker hit all the marks. He showed up early and got to know the room, greeted the participants as they arrived, and became a person to them. Then he started telling stories, he stood near the audience instead of behind a podium, and his slides were colorful but simple with minimal words. He concluded with his stories, connecting all the dots and relating himself to us yet again. He was not talking to us, he was with us, carrying us through a journey he created for us. *This* doctor knows how to give a talk. We doctors should all strive to be more like this. Rather than talking *at* people, we can try talking *to* people. People (even doctors) need relatable stories. We need to feel respected, and we don’t want to stare at overloaded graphs and charts for too long. Thank you, AWS, for creating this series, it will undoubtedly change how I give a talk, and I hope many others will have the opportunity to gain from this training program. ![](https://lh7-rt.googleusercontent.com/docsz/AD_4nXd7tmb3nfB3eh4KdrWOy41oYspUiaDrbiSjyhhYnzMvgsN2voBOuH_0cGfPueXKPFlOM6eeqiHYSR6dZ9vUtTnv2ff9Ug286fSOgS4tygrKWIntTO1WcRaziWXOEp84JaWPuOJZyA?key=8Txz6PHr5pvYcdlHFobeGQ) **Categories:** awareness, career development, education, leadership, professionalism, resources, women **Tags:** ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Permission to Pause](https://blog.womensurgeons.org/permission-to-pause/) **Published:** July 16, 2025 **Author:** Blog Team **Content:** by Dr. Trisha Lal Like many general surgery residents, I’ve opted to pursue two years of academic development during my training. After two clinical years, I recently completed my first research year. It was a year of growth and learning – learning how to do research, and also, unexpectedly, learning how to rest. When I transitioned into research last July, I was genuinely elated at the idea of a slower pace. I pictured sunlit mornings with coffee and breakfast, focused work sessions, and midday walks. I told myself I would paint again. But instead, my days looked eerily familiar: I woke up early, jumped straight into work, ate lunch at my desk, and felt restless if I shut my laptop at 6 p.m. I realized, quickly and uncomfortably, that I didn’t know how to not be busy. After two years on the clinical grind, during which I spent 12-14 hours at the hospital followed by ABSITE prep or case reviews at home, I had developed a near-constant need to be productive. Stillness felt wrong. In that realization, I came face-to-face with the toxic effects of productivity. Since then, I’ve gone through what has felt like the five stages of grief. Denial was short-lived. Anger and depression showed up together: Why didn’t I enjoy spending time with myself? Bargaining looked like reopening my laptop after dinner just to feel like I had “done enough.” Finally, I arrived at acceptance. Without the constant demands of clinical life, I had to confront a silence I hadn’t felt in years. I had internalized the idea that my value came from my output – notes written, tasks completed, cases logged. In the absence of those metrics, I started to question if I was doing enough. It turns out that stillness is deeply uncomfortable when your sense of worth has been tethered to productivity. Learning how to slow down has been its own form of hard work. It’s taken deep reflection and small, intentional shifts. As a lifelong checklist devotee, I started adding “fun” tasks to my to-do list: cooking a new recipe, going to pilates, calling a friend, or finally taking that midday walk. I’m motivated by goals, so I signed up for a 10-mile race and discovered a newfound joy in running. I still struggle with rest, but I’m proud of the progress I’ve made. While it feels like a radical act in a culture that glorifies overwork, making room for restoration is not indulgent. I firmly believe that stepping away from the productivity trap has helped me exceed my academic goals this year. If any of this feels familiar, I want you to know that you are not alone. Many of us, especially women in surgery, have been conditioned to prove our worth through tireless effort, to equate busyness with value. I hope we can start talking more openly about the guilt, the pressure, the quiet fear of slowing down – and that we can give ourselves, and each other, permission to pause. ![Dr. Lal headshot](https://lh7-rt.googleusercontent.com/docsz/AD_4nXe5XBNYBC8dfrM2PmfQGOSsblMF1w4RppiVRtFp753-oiSO6cqukJqe-2iDRtkWt_oNMRf5b0vrkmPVl-KpnzcRHlCdf3bc44OZx9OH643ISFTg-9eN-doqENb1rvMQqrRmLLjngw?key=FPna5oL_tTG9oqvCO-AnhQ)Trisha Lal, MD is a general surgery resident at University Hospitals in Cleveland, Ohio who aspires to be a surgical oncologist one day. She is a first-generation immigrant and passionate about health equity. In her free time, Trisha likes to cook, do arts and crafts, binge reality TV, practice yoga, and watch basketball (go Celtics). **Categories:** career development, health, professionalism, reflection, self-care, URiM **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery --- ### [Across the Pond: The Language of Healing](https://blog.womensurgeons.org/across-the-pond-the-language-of-healing/) **Published:** July 9, 2025 **Author:** Blog Team **Content:** By Shreya Sankar I learned at a young age that medicine transcends the borders of culture and time. Growing up, our medicine cabinet teemed with remedies: Advil for headaches, *ajwain* seeds for stomach pains, NyQuil for flu symptoms, and eucalyptus oil for congestion relief. A beautiful melange of Eastern traditional and Western lab-based remedies. While languages and methods of treatment may differ, the core purpose of medicine endures: healing through human connection. This vision remained central as I began my medical studies — 3700 miles away from Charlotte, North Carolina — in Dublin, Ireland. My first few months in the Emerald Isle were a steep learning curve, as I adjusted to the pace of medical school, learning clinical skills, attending lectures, and, just as importantly, developing skill sets and vocabulary tailored to Irish healthcare. *Theatre*, instead of operating room. *Consultant*, instead of attending. *General Practice*, instead of primary care. As I started rotations on the wards, I fell in love with medicine all over again. Each lab value, each CT scan, each Kardex form filled with prescriptions, became more than data — they were puzzle pieces fitting together as I delved deep into patients’ lives and stories. In County Dublin, I bonded with a retired engineer in hospice care over hydropower: both our hometowns utilize rivers to generate electricity; the Liffey in Dublin and the Catawba in Charlotte. At the bedside of a patient from County Waterford, I learned that traditional Irish medicine recommended using the *yarrow* plant to staunch profuse bleeding, a practice reminiscent of ancient *Ayurvedic* treatments. In County Louth, I met a retired Irish rugby player with spinal degenerative disease who struck a deal with me: he would teach me the intricacies of his sport, if I set up his TV to play NFL highlights. These conversations reminded me that medicine is more than just lectures, procedures, and prescriptions; it is also about real human connection. Whether it’s analyzing Aaron Rodgers’ game-winning 2015 Hail Mary alongside a rugby player with osteopathy, or swiping through photos of the Catawba River with a patient who hadn’t traveled outside Ireland, I cherished the essence of medicine: the patients themselves. Studying in Ireland as an Indian-American, I had the unique opportunity to experience healthcare across states, backgrounds, and countries. I learned to listen — finding nuance and meaning in patients’ stories, using medicine as a bridge. After all, healing isn’t solely defined by medications, histories, and exams, but by the humanity that binds us all. ![Shreya Sankar headshot](https://lh7-rt.googleusercontent.com/docsz/AD_4nXdF6M-8lHoANu8JcvVSxooXY9AgX1hjnttamXwONB-7LjQexbXJaZR2aWeO0svCeDgxpoJBJtAptDVLKjyPb8TZW8Qmw-_fqQWLJosMIXFWYzhratoJyJlci0K5N50nk5cJAtEECg?key=1PMxlFZ2mXUwm8vcmINkZw)Shreya Sankar is a fourth-year medical student at the Royal College of Surgeons in Ireland. She is the president of the Walter E. Dandy Neurosurgical Society and the Neurology and Neurosurgery Interest Group (NANSIG) in Ireland. She is actively involved in research and excited to encourage collaboration between Irish and American surgical and research groups to create real-world impacts. LinkedIn: <https://www.linkedin.com/in/shreya-sankar-611889221/> **Categories:** Uncategorized --- ### [Applying the Growth Mindset in Surgery](https://blog.womensurgeons.org/applying-the-growth-mindset-in-surgery/) **Published:** July 2, 2025 **Author:** Blog Team **Content:** **By Fara Bellows** In surgery, the only constant is change. With each passing milestone in our careers, we encounter new challenges, new demands, and new surroundings. We also face novelty within clinical medicine: the literature is always growing, new technologies and techniques arise, and practice changes can seemingly come out of nowhere. Surgeons tend to be perfectionists. We strive to do our best and to deliver exceptional patient care. But we are human, and as humans, we are never perfect at something the first time we do it. So it can be difficult to stray from our comfort zone and incorporate new techniques into our toolbox, perhaps due to fear of failure or fear of the unknown. It can also be painful to experience patient-related complications and struggle with learning curves. However, we cannot shy away from novel therapies or ideas. We must embrace novelty: a successful career relies on incorporating new surgical skills and techniques into our practices in order to provide high-quality care. But how do we reconcile our desire for growth with the potential for failure? I recently read a fascinating book called “Mindset” by Carol Dweck, Ph.D. “Mindset” is an easy read that delves into the psychology of utilizing a growth mindset to cultivate success. In the book, Dr. Dweck contrasts the “fixed” mindset, which suggests that intelligence and skills are static and that no progress can be made from one’s current state, against the “growth” mindset, which argues that people have the potential to learn and cultivate new skills. Dr. Dweck uses many real-life examples of some of history’s most talented athletes, businesspeople, and other high-level performers to demonstrate that through hard work and dedication, one can build a skill they feel they are missing. We can utilize the growth mindset to build our surgical skill sets and fine-tune our surgical practices without feeling like failures. According to Dr. Dweck, “your basic qualities are things you can cultivate through your efforts, your strategies, and help from others.” She goes on to add that “everyone can change and grow through application and experience.” I think the following quite applies well to surgery: “Even in the growth mindset, failure can be a painful experience. But it doesn’t define you. It’s a problem to be faced, dealt with, and learned from.” The steps towards adopting the growth mindset include: – Embracing challenges – Persisting in the face of setbacks – Seeing effort as a path to mastery – Learning from criticism – Finding lessons and inspiration in the success of others. We can all benefit from utilizing the growth mindset in our careers. The growth mindset can help to attenuate the guilt we may feel when we have complications and can help us to develop as surgeons. We owe it to our patients to be our best selves, and the growth mindset can help us accomplish that. ![](https://lh7-rt.googleusercontent.com/docsz/AD_4nXfLAkZgpr8hNpePfG0kxd15g5SaFMt-6npi0QXR-Lt1S59d3DGf-dKP2eFE4p61DeDUcw0Wyv8XG_8kIEx96p7EUZ8zYzGVZfmMAVd-17ech3jhzVd1CenX6yr-qNrg_u5MEtMy?key=7EU1sAxLkBhYwNXKpxChpQ)**Fara Bellows** is a general urologist in White Plains, New York. She can be found on TikTok @FaraBellowsMD. **Categories:** awareness, career development, practice, professionalism, reflection, resources, URiM, women **Tags:** womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Preserving Hobbies](https://blog.womensurgeons.org/preserving-hobbies/) **Published:** June 25, 2025 **Author:** Blog Team **Content:** by Olivia T. Zhou To me, the age-old adage of “you can’t pour from an empty cup” holds especially true today. Medicine is a deeply meaningful but often all-consuming career. The intensity of training, long hours, and emotional demands can easily displace relationships, hobbies, and interests that once brought joy and balance. Because of these challenges, maintaining a connection to a life outside of medicine is particularly essential. Hobbies can offer space for self-expression, stress relief, and identity beyond our professional roles as physicians. Most of us know that participating in creative or physical activities can improve well-being, build resilience, and reduce burnout, but we often struggle with consistency and upkeep. However, even a modest investment can provide noticeable benefits. Here are some strategies that have helped me preserve my hobbies throughout my training so far: - **Schedule dedicated time:** Blocking off regular time for a hobby, just like scheduling other responsibilities, can help ensure it remains a priority and actually gets completed. I schedule time for a weekly weekend walk with my sister to get exercise, unwind, and spend time with loved ones. - **Keep materials visible and accessible:** Putting instruments, art supplies, or athletic gear in sight and/or easily accessible areas serves as a physical reminder and motivator. I like to keep my knitting supplies and completed projects on a shelf, so they can serve as both decoration and as a reminder. - **Take advantage of short bursts of time**: Even 10–15 minutes between tasks can be very effective for short activities like journaling, sketching, or stretching. A five minute stretch routine helps me with both headaches and recentering during a busy day. - **Find online communities around hobbie**s: Joining interest groups can promote a sense of accountability and connection, and online groups can be much more accessible and convenient than in-person commitments. I have joined gaming and DnD groups on Discord and made some life-long friends along the way! - **Integrate hobbies into routines**: This could be listening to podcasts or music during commutes, meal-prepping creatively, or biking to work. Finding ways to combine a hobby and another activity that you have to do, can help maintain consistency. Personally, I love exploring new music on my commutes to and from work. - **Minimize online time**: It’s easy to sink any free time into the mindless task of scrolling through social media, but setting time limits for phone use can free up even a few minutes a day to be used for hobbies. I use the built in Apple screen time monitor, but there are countless apps that can track and limit your screen time. To me, the goal of hobbies is not perfection or productivity, but presence and preservation of self. Physicians and trainees often hold themselves to high standards in every domain, but hobbies should offer a space free from performance metrics. Valuing these activities as essential, rather than optional, can help us create more balanced, sustainable lives in medicine; one in which our personal identities can continue to evolve alongside our professional growth. ![Olivia T. Zhou headshot](https://lh7-rt.googleusercontent.com/docsz/AD_4nXfQm8jxLIara3Y_hAoc1rFHWYrdCzEHwLAE8SE-K9VIrUo47jog04sMP7_Au4I4nVc4cyWmMzJqXGQ6AtwdktiKw7ybPGfesAs9RrJvAuXgKhLj7_g-o4Xhh0FH97FUzyTD-gy81Q?key=1aiGn0DDq-qQ2TlBsqolcA)Olivia T. Zhou is a 4th year medical student at Boston University Chobanian and Avedisian School of Medicine who is applying for orthopedic surgery residency in the upcoming match cycle. She serves as a member of the blog committee at AWS. **Categories:** medical students, reflection, resources, self-care, training, URiM, women **Tags:** AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [What Transition Taught Me About Gender, Power, and Medicine](https://blog.womensurgeons.org/what-transition-taught-me-about-gender-power-and-medicine/) **Published:** June 29, 2025 **Author:** Blog Team **Content:** By Jailyn Avila, MD, FP-AEMUS, RDMS One afternoon, when I was a young attending at a large academic center, I was paged to the trauma bay to receive a patient in traumatic shock. Our team of 10-15 multidisciplinary medical professionals assembled in the trauma room as the medics wheeled our patient in, solely focused on saving the patient’s life. Immediately after the medics brought the patient into our trauma area, my senior resident asked for the patient’s history, after which the medic paused and stated, “You have really pretty hair.” My senior resident then politely asked the medic to continue their report, ignoring the inappropriate and unprofessional comment. After stabilization and disposition, I attempted to locate the man who had been so inappropriate with my resident, but his team had already departed. I circled back with my resident, who acknowledged the experience and how inappropriate it was, but she informed me that it wasn’t that uncommon for her. Transitioning has taught me self-love, patience, and compassion that I never had access to before. My entire life had been a mix of varying shades of gray, and I learned to see the full spectrum of life. I learned to love myself to a scale I had never known possible. I also learned that while I had taken pride in myself as a man who advocated for women, minorities, and the LGBT+ community, I had done this from a position of immense privilege that I had never quite known the magnitude of until my transition. Post-transition, I possessed the same academic pedigree, degrees, and medical experience that I had before, but found that my voice suddenly mattered less. I learned how frequently women are interrupted, spoken over, and dismissed. I learned what it felt like to be viewed as less than human. I learned what it feels like to be discriminated against, ridiculed, and looked over. I’ve watched as my rights to exist, both in the workplace and outside of it, have been relentlessly eroded. I’ve learned what it feels like to consider the likelihood of assault at the hands of both the public and those sworn to protect me when deciding to relieve myself. I’ve been sexually and verbally harassed in my hometown solely for being present on the sidewalk. I’ve learned how it feels to be hated, and I’ve learned to fear death. Even if it had been a thousand times harder, I would go down this path again. Still, I must acknowledge that the journey has laid bare the profound challenges women face in medicine. I’m deeply grateful for all I’ve learned—and especially thankful for the friendships and support that have formed around me along the way. Most relevant to this specific audience, I’ve learned how important it is to believe us when we say that things need to change and how crucial it is to be a champion for those with less privilege. ![Dr. Jailyn Avila Headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/07/Avila.png)**Bio:** Jailyn Avila is a board-certified emergency medicine physician, a transgender woman, a wife and mother of three. She completed medical school in Loma Linda, California, residency in Chattanooga, Tennessee and an ultrasound fellowship in Lexington, Kentucky. She has been heavily involved in medical education with an emphasis on bedside ultrasound and runs an organization along with Ben Smith called Core Ultrasound, delivering online educational content. In 2021, Jailyn began her gender transition and “completed” said transition in 2023. Jailyn is currently Core Faculty for the UHS SoCal MEC Emergency Medicine Residency in Temecula, California where she also functions as the Associate Ultrasound Director and Ultrasound Fellowship Co-Director. She also functions as the Director of Digital Education for FemInEM. In her free time, Dr. Avila enjoys spending time with family (wife and 3 children), dancing, reading, Pilates and all things Disney. **Categories:** advocacy, awareness, diversity and inclusion, diversity and inclusion, gender differences, guest blog, reflection, Underrepresented in medicine, URiM, women **Tags:** ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Beyond the Banners: The Quiet Cost of Pride](https://blog.womensurgeons.org/beyond-the-banners-the-quiet-cost-of-pride/) **Published:** June 23, 2025 **Author:** mcooke@amrms.com **Content:** by Anthony Tannous, MD, FACS *This is a special edition blog post presented in partnership with the* [*Association of Out Surgeons and Allies*](https://www.outsurgeons.org/) *in celebration of Pride Month.* June bursts forth in a riot of color, a seemingly utopian vision of equality and dignity, often accompanied by a healthy dose of corporate branding. Around the Western world, joyful — and perhaps slightly inebriated — celebrants reclaim public spaces, belting pop anthems and radiating pure, unadulterated queer joy. This year, however, the glitter feels heavier, the music a little more poignant. The comfort and acceptance we’ve come to expect are under strategic, relentless attack. Bigotry has shed its hood and robe for tailored suits and eloquent speeches. It occupies podiums, commands microphones, and infiltrates mainstream podcasts. They begin, as always, with the most vulnerable: our trans siblings. But history, that unsparing teacher, reminds us that the target will inevitably widen to include all whose difference threatens the fragile comfort of uniformity and challenges a monochromatic worldview. In this chilling context, Pride is not just important; it is vital. So why, then, does the exuberance of the celebration feel… uncomfortable to me? Why do I scroll through social media posts proclaiming, “Love is love” (especially if you’ve diligently sculpted that Pilates body all year) and find myself overwhelmed with sadness? I’ve tried to deconstruct this feeling, tracing it back to my own unlikely journey. I am a proud, out gay man. My coming out began at 28, amidst the grueling demands of surgical residency–a quiet ripple that slowly widened into a wave of truth. I was born in Lebanon, a land of tenacious beauty ravaged by war. As a shy, overly sensitive, tall kid with acne, I learned early that safety lay in self-containment, in building and inhabiting my universe. Good grades became my currency for affection, my entire personality. Scholarships and academic excellence became my ticket, naturally leading me to the “most impressive” career: medicine. Surgical training in Lebanon, however, was steeped in a toxic machismo–a hostile environment for women and anyone remotely queer. Cisgender heterosexual men thrived at the expense of all else, their dominance reinforced at every turn. It became clear: to live authentically, I had to leave. My academic prowess opened the doors to the United States. At 25, I immigrated; at 28, I landed in Texas. Through trials and triumphs, the path to an authentic life meant shedding the armor, coming out, and embracing my true self. I found my chosen family, my tribe, my unwavering support system. Twelve years on, I’m still working on my pride, a journey made easier when your government, workplace, and community offer their unwavering support. Yet, this isn’t the reality for many. When I speak with international immigrant residents and surgeons, most live double lives; they come to the U.S. seeking truth, but sometimes find the path back home less clear. While their loving families celebrate their achievements, their queer selves might remain shielded. They maintain two social media accounts, two distinct lives. Even their American friends, well-meaning as they are, often don’t fully grasp the immense stakes. “Be loud! Take up space!” they exhort, but at what cost? Pride comes at a steeper price when it demands extracting yourself from the very structures that shaped you. While a grand, color-coordinated wedding in Lebanon or raising children within the embrace of my large, supportive Lebanese family may not be my path, my story of pride is built on self-acceptance, on a meticulously cultivated chosen family, and on the quiet, profound freedom of being authentic in my daily life. This is the untold narrative of countless gay and lesbian immigrant doctors. To truly champion them is to understand and celebrate their brave decision to leave their armor behind, to walk a path of authentic pride, and to build a life where their true selves can flourish. ![Dr. Tannous headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/07/Screenshot-2025-06-23-115728.png)*Anthony Tannous, M.D., is a Clinical Associate Professor in the Department of Surgery at UT Southwestern Medical Center. He specializes in emergency and trauma surgery. He also has a focused interest in critical care and trauma education for surgical residents and medical students.* *Dr. Tannous earned his medical degree at the American University of Beirut Medical Center in Lebanon. He completed a residency in general surgery at the Johns Hopkins Hospital and the University of Texas Health Science Center in Houston and gained advanced training in surgical critical care through a fellowship at the University of Maryland R Adams Cowley Shock Trauma Center. He has since practiced in both rural and urban settings and in both community and academic settings.* *In addition to his clinical duties, Dr Tannous mentors numerous students and residents through their surgical and trauma training. He serves as an associate program director for the surgical residency and as the director of the UTSW Surgical Launch program aimed at preparing medical students and preliminary residents to succeed in the Match.* **Categories:** advocacy, awareness, diversity and inclusion, diversity and inclusion, guest blog, reflection, Uncategorized, Underrepresented in medicine, URiM **Tags:** ILookLikeASurgeon --- ### [A Love Letter to PM Rounds](https://blog.womensurgeons.org/a-love-letter-to-pm-rounds/) **Published:** June 12, 2025 **Author:** Blog Team **Content:** **By Aparna Ragupathi** \*All names have been changed for patient and staff privacy It’s 4:12 PM when I leave the PACU. One of the chaplains in the hallway smiles at me, and I realize I’m still wearing my OR bonnet. I take it off and toss it in the trash can by the security desk. On my phone, I scroll past the class group chat notifications and Uber Eats deals to find what I’m looking for. A text message. “*PM rounding on 5T,”* one of the surgical floors at our hospital. I trade my phone for the folded patient list in my back pocket. The elevator beams me up to 5 Tower and I find my residents in front of room 6. The fishbones on Jamie’s list have numbers now, which feels like a full tank of gas. We meet Carter in room 6, Jeannine’s brother. He brightens up when we tell him that, because his sister’s LFTs are down, we can add Tylenol to help with pain. It’s a familiar name, a medicine they have in their cabinet at home. To Carter, this is a sign that things are going back to normal. He squeezes Jeannine’s hand. Ms. Thompson isn’t in room 9 when we stop by, but we see her on the way to room 13. She’s walking with her daughter, who has her eyes and talks just like her. She’s a physical therapist, and she’s very good at taking her mother on walks. Ms. Thompson laughs and pats her daughter’s arm. I like seeing Ms. Thompson like this. In James Pearson’s room, the four of us collectively describe the hospital cafeteria so that his father can get him some solid food. You can tell that I like the protein shakes from the way I recite the flavors, that Jamie frequents the salad bar, and that John has tried every pudding concoction in the dessert fridge. James Pearson now wants to try a bit of everything. He gives his father a respectable shopping list. Yesterday, he decided he liked the chicken broth more than the vegetable broth and told us that he will give us a full review of the solid food when we see him tomorrow. With a sigh and an eye roll, he agrees to our chief resident’s request for him to eat more peanut butter and cottage cheese. Thanks to PM rounds, we’ve learned that James Pearson loves to cook and knows more about food than we do. Ms. Baker is watching National Geographic in room 14. She turns the volume down so we can see her drains better. She tells us she loves animals. At home, she has a dog and two cats. Her sister takes good care of them while she’s here. I follow the team through the stairwell shortcuts as we go down and up, and then back down through our patient list. We finish back on 5 Tower, and as they sit down to do their notes, I see a tail from behind the nurse’s station. A nurse practitioner gasps and squats down to greet Jack the therapy dog. I go up to his owner and ask if he’s still seeing patients. I pull my list back out and ask if he can stop by Ms. Baker’s room. And maybe James Pearson’s. I tag along with Jack to visit Ms. Baker, who is overjoyed. Jack licks her hand, and she can’t stop smiling. A blessing, she calls him. \*\*\* When I first told people I wanted to go into surgery, I was often met with surprise. “Aren’t you a people person?” “I thought you’d do well in primary care.” For some, the thought of operating on patients under anesthesia or having limited follow-up periods meant that meaningful connections were few and far between in surgery. And in the darkness of morning rounds, it could be easy to let patients become their abdominal exams and NG tube outputs. In the daylight, during visiting hours, I get to catch a trademark James Pearson eyeroll, be proud of Ms. Thompson’s daughter, and cheer Ms. Baker up with a therapy dog. In clinic, my mentors draw diagrams on the exam table paper to explain procedures. Residents take a knee to be eye-level with family members in the ED. Patients hug attendings during their two-week post-op visits, and some send their friends and family to the same surgeon who operated on them. Sometimes, as a medical student on surgery, I get to hold a patient’s hand when they go under general anesthesia. Thanks to PM rounds, I know that surgery isn’t just about what happens in the OR. Through quiet moments and conversations, surgeons build trust and incredibly meaningful relationships with their patients. They treat people, not just problems. So, as a people person, I can’t wait to become a surgeon. ![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Ragupathi_Aparna_ERAS.jpg) **Aparna Ragupathi** is a 4th year medical student at Robert Wood Johnson Medical School who is applying for general surgery residency in the upcoming match cycle. She is a writer and a Spanish-English medical interpreter that is passionate about patient-surgeon communication and understanding the effects of social determinants on surgical outcomes. She is also a proud member of the blog and podcast committees at AWS. **Categories:** education, medical students, training, URiM, women **Tags:** AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [To Come Out (Again) or Not? A Surgeon's Reflections on Identity in the Workplace](https://blog.womensurgeons.org/to-come-out-again-or-not-a-surgeons-reflections-on-identity-in-the-workplace/) **Published:** June 16, 2025 **Author:** Blog Team **Content:** *This is a special edition blog post presented in partnership with the* [*Association of Out Surgeons and Allies*](https://www.outsurgeons.org/) *in celebration of Pride Month.* **By Dr. Kayleigh M. Herrick-Reynolds** As I am speed-rounding to get to the OR on time, my patient catches a glimpse of my wedding ring and asks, “Is your husband a doctor too?” This question—a genuine interest in my life and a plea for the normalcy of casual conversation as I wake them at 6:00 a.m—is also just the first of many times that day I will have to choose how to answer. Surgical training requires intense focus, commitment, resilience, and sacrifice. For anyone who does not fit the stereotype of “surgeon” or who holds a non-traditional identity, the mental choreography of deciding how much of ourselves to share in the workplace adds a layer of stress to an already high-stakes job. Particularly as a trainee, [the rigid hierarchy of the surgical community](https://pmc.ncbi.nlm.nih.gov/articles/PMC5165663/) can exacerbate the weight of these micro-calculations out of fear that retaliation may limit learning opportunities or create a hazardous work environment. Indeed, [LGBTQ+ trainees report higher rates of bullying (74.8% vs 66.9%; p=0.005), and are twice as likely to consider leaving their residency programs (OR 2.04, 95% CI 1.52-2.74)](https://jamanetwork.com/journals/jamasurgery/fullarticle/2785365). The most frequently reported source of mistreatment in this study was the attending surgeon. The unique decision fatigue associated with repeatedly concealing or affirming one’s identity is difficult to explain to someone who has not experienced it. Should I correct the attending who asks about my husband, when I have a wife? Do I explain to my patient that it was my wife who carried our daughter? Will this disclosure help or harm me in this situation? Do I have time for this conversation? Will I regret the answer I gave? There are also awkward moments: “you don’t look gay” or “I’ll put you in touch with so-and-so, she’s gay too!” Although well-meaning, these comments show us how far we still have to go. Do we educate? Let it go? Choosing when and how to correct others becomes another emotionally draining task in the surgeon’s day. The culture of surgery leaves little time for reflection on these questions of identity. We are trained to speak when spoken to, blend in, grin, and bear it. Precise, efficient work and people who just get the job done are prized commodities. I often circle back to the fact that I hope to be seen as a surgeon—not a female surgeon, not a queer surgeon. At the same time, I feel pressure to be doubly prepared and twice as qualified to ensure that my gender and sexual identities are not blamed for any small failures. As I transition into a more senior role, this visibility becomes more complex. I want to represent these identities proudly, but I wonder: how vulnerable should I be in the process? I think about the times I have felt most safe and seen in the workspace: colleagues who remember my partner’s name and include her in casual conversation without hesitation; those who correct others on my behalf; those who share a knowing glance when a cringeworthy comment is made. The ones who wear a rainbow pin or lanyard—a small, physical reminder that says, you belong here. I am immensely grateful for their leadership, friendship, and allyship. Ultimately, many of us just want to do the work—to be seen for our dedication to patients and our surgical skill, not our identity. Is that selfish or self-protective? There are no perfect answers, but if you have felt this tension, know that you are not alone. To answer my patients’ question—yes, my wife is a doctor. But on some days, the answer is simply “no.” When we build spaces where all identities can coexist with our professional roles—without causing distraction or emotional turmoil—I believe we will achieve the best outcomes for our patients, our trainees, and ourselves. I look forward to a career navigating these questions and holding space for a diverse cadre of exemplary female surgeons. ![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Screenshot-2025-06-16-162438.png) **Bio:** Dr. Kayleigh Herrick-Reynolds is a Complex General Surgical Oncology fellow at the University of Pittsburgh Medical Center and an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences. She completed her residency in General Surgery at Walter Reed National Military Medical Center, and earned her medical degree from the Yale University School of Medicine. **Categories:** advocacy, awareness, diversity and inclusion, guest blog, reflection, resources, Underrepresented in medicine, URiM **Tags:** AWS, ILookLikeASurgeon --- ### [Stitch by Stitch](https://blog.womensurgeons.org/stitch-by-stitch/) **Published:** June 18, 2025 **Author:** Blog Team **Content:** **By Tala Abedalqader** I’ve always found a certain sense of purpose in using my hands. Whether it’s an embroidery thread sliding through fabric or suture material passing through layers of skin, I found that there’s a rhythm and purpose that drives me. Whether it’s art or surgery, my hands are driven by the same intention – to create and repair. Crocheting, embroidery, and sketching were creative outlets I picked up in medical school that gave me a sense of peace and the opportunity to relieve stress. As I grew more interested in surgery, I started to notice how these hobbies weren’t just therapeutic, but they were also shaping my skills in meaningful ways. The dexterity I harbored from manipulating threaded needles and hooks granted me with fine motor skills that I would use, first in simulation, then in the operating room. Similarly, sketching proved to be an excellent and highly useful skill in learning, allowing me to visualize structures and minute details of essential anatomy. When my hands weren’t moving, I read. Stories became my compass and reminded me why I chose this path. Reading about inspiring characters who overcame obstacles and persisted, whether fiction or real-life, grounded me when my journey felt uncertain. They reminded me that setbacks are part of the story, not the end of it. That mindset became critical when I went unmatched in my first cycle. That was a painful truth to sit with. For a while, everything felt uncertain. But I also knew this wasn’t a defeat. It was a pause, a moment to breathe, reflect, and keep going. I chose not to view it as an ending, but as a detour. Just like a misplaced stitch might offset a pattern, sometimes you have to rethread the needle and adjust your perspective to see the bigger picture again. In that year, I focused on growth. I took time to reassess — not whether I still wanted to be a surgeon, but how I would become one. I doubled down on my commitment, seeking out hands-on opportunities wherever I could. I continued teaching medical students with renewed passion and found opportunities to contribute to meaningful research. What I gained in that time couldn’t have been learned in a textbook. I found patience. I found clarity. And above all, I found that setbacks don’t erase purpose; they can refine it. I know that the path ahead is one filled with difficult moments and challenges. However, just as I am slowly training my hands to create art, I will certainly gain more surety as a surgery trainee. Stitch by stitch, my aspirations, similar to so many others on the same path, will be realized. ![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Tala-Abedalqader.png) **About the Author** Tala Abedalqader is an international medical graduate from Saudi Arabia and an upcoming general surgery preliminary PGY-1 resident at Cleveland Clinic. She is particularly passionate about medical education and has previously held a position as a teaching assistant at her university. She is committed to mentoring and contributing to the learning of the upcoming generation of medical students. **Categories:** awareness, diversity and inclusion, education, global surgery, medical students, reflection, self-care, training, URiM, women **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Visibility and Possibility](https://blog.womensurgeons.org/visibility-and-possibility/) **Published:** June 9, 2025 **Author:** Blog Team **Content:** *This is a special edition blog post presented in partnership with the* [*Association of Out Surgeons and Allies*](https://www.outsurgeons.org/) *in celebration of Pride Month.* **By: Aeryn Kangas-Dick MD** I knew I was transgender since I was a child, but I never had the language to say what that meant. All I knew was what I saw on television— transgender people were often played for comic relief, or sometimes for shock value. Role models were few and very far between, and I had certainly never heard of a transgender surgeon. During my planned research year between my second and third years of surgical training, I was called to serve as an ICU resident during the height of the COVID-19 pandemic in New York City. As many did after confronting the horrors of this experience, I realized I didn’t want to spend more time pretending to be something I wasn’t. However I was terrified about what that would mean for me, my family, and my career as a surgeon. I started hormone replacement therapy, but continued to hide who I was at work as I returned as a senior resident. I found support in a few places: my spouse and my class of co-residents. I wasn’t sure that a transgender person could be a surgeon. I spent many hours on the internet, doing what I had been trained to do—performing a literature review. I was searching for someone, anyone, who might serve as a role model. Finally, I found Drs. Marci Bowers and Michaela West. It meant the world to me to see these surgeons leading and excelling in their field. I was inspired to be authentically myself in my professional life, and along the way, found the support of colleagues, mentors, friends, and family. I benefited enormously from the sponsorship and mentorship of surgeons (both members of the queer community and allies) who helped me realize that I might have a place in academic surgery. Visibility is a frightening thing in a high-pressure specialty like surgery, but it is something that is sorely needed. In 2018, an Association of American Medical Colleges (AAMC) survey found that only 0.7% of graduating medical students identified as Transgender or non-binary. This is similar to the 1% figure often quoted in popular media. Due to increased awareness and support, more people may be able to openly recognize and share their transgender identity: according to data collected by Gallup, the total percentage of adults in “Generation Z” (born after 1997) identifying as transgender has increased to 4.1%. Relatedly, the number of Gen Z adults who are members of the LGBTQIA+ community is reported to be 23.1%. Also, per the AAMC in 2024, the last year for which data was available, there were 20,857 graduates from US MD schools. Even using the 2018 percentages, this implies that a significant number of transgender and gender diverse medical students and residents are entering training who need role models and mentors. Visibility and representation are vital for these students and residents to find a place in academic medicine. Now, as a fellow starting my career, I have found community in expanding my participation in affinity surgical organizations such as [AOSA (Association of Out Surgeons and Allies)](https://www.outsurgeons.org/) and the AWS. These organizations represent a vital opportunity for mentorship, sponsorship, and “role-model”-ship to many students and residents. In addition, social media has been a helpful avenue to connect with medical students and residents who are using their platforms to advocate for marginalized queer and trans identities. I have found myself connecting with a large group of surgeons and students alike in ways that have allowed me to begin to act as a role model and mentor to medical students. These have ranged from informal calls/meetings to helping to build a formal mentorship group for transgender and gender diverse medical students and residents. This year, during Pride month, it is more important than ever to be visible and to connect with our students, residents, and mentees to share the possibility of a career in surgery while celebrating and honoring our diverse identities. I would urge everyone who reads this to recommend that their students and mentees join groups like AWS and AOSA and to reach out to create mentor and sponsor relationships, both formally and informally. As a queer woman, I know that visibility can feel frightening, but it is also vital to help the next generation of surgeons realize what is possible. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/06/Kangas-Dick.png) **Bio:** Aeryn Kangas-Dick is currently completing her fellowship in complex general surgical oncology at Roswell Park Comprehensive Cancer Center, and will be joining the faculty at the West Michigan Cancer Center and the Homer Stryker MD School of Medicine at Western Michigan University in the Fall. Her clinical focus is Hepatobiliary, gastric, and esophageal surgery, and her research interests include increasing access to care for cancer patients and predictive and prognostic genetic markers in hepatocellular carcinoma. Outside of work, she is an avid skier and rugby player. **Categories:** advocacy, awareness, diversity and inclusion, gender differences, reflection, self-care, Underrepresented in medicine, URiM --- ### [Thyroid Cancer Awareness](https://blog.womensurgeons.org/thyroid-cancer-awareness/) **Published:** January 3, 2018 **Author:** Blog Team **Content:** 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](https://www.cancer.org/cancer/thyroid-cancer/causes-risks-prevention/risk-factors.html) 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) and multiple endocrine neoplasia type 2 (MEN2). Thyroid cancer is present in the spectrum of malignancies of several different cancer syndromes. These include familial adenomatous polyposis (FAP) where the APC gene is mutated; Gardner’s syndrome; Cowden’s Syndrome, where the PTEN gene is mutated; and Carney complex type 1. Even if a cancer syndrome has not been identified, a family history is still significant in raising the risk of cancer in a patient being evaluated for thyroid nodules. The histologic [subtypes](http://www.thyca.org/about/types/) include papillary, follicular, medullary and anaplastic. Staging for papillary and follicular tends to be predominant Stage I and stage II; they are more frequent and slow-growing. In contrast, medullary and anaplastic are far more aggressive, and may require more resection. Statistically, disease that is limited to the thyroid has a five-year survival of 99%. Local disease that extends beyond the thyroid has a five-year survival of 98%. Metastatic disease has a 5-year survival of [55%](http://www.thyca.org/about/thyroid-cancer-facts/). Lifestyle issues, such as radiation exposure or low iodine diet, still play a role in risk and outcome in addition to family history and histologic type. No excuses for those of us who need to don a thyroid shield during fluoroscopy! In a month known for its garnet birthstone, carnation flower, and traditionally bed linen & towel sales, sharing this exercise has sharpened our awareness for the coming year! --- ![](http://blog.womensurgeons.org/wp-content/uploads/2017/08/beth-e1518712060125-150x150.jpg)*Dr. Elizabeth Shaughnessy is in an academic practice at the University of Cincinnati, with an emphasis on breast cancer and breast disease. She serves as Surgical Director of the multidisciplinary breast cancer program. In her free time, Dr. Shaughnessy likes to garden, hike, and do yoga.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, resources, self-care, training --- ### [Defining the Resident Role in the Operating Room](https://blog.womensurgeons.org/resident-role/) **Published:** January 13, 2018 **Author:** Blog Team **Content:** 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.](https://www.sciencedirect.com/science/article/pii/S0003497517307105) 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](https://twitter.com/hashtag/awschat) will explore these issues through facilitated questions led by three distinguished moderators: - [Dr. Shari Meyerson](http://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=20331) ([@lungteacher](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjjyMOz0tXYAhXl3YMKHZ3PA5YQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Flungteacher&usg=AOvVaw3e43G1s6T5VQN1YkC_u-bI)), thoracic surgeon and Program Director for the General and Thoracic Surgery Residency Programs at Northwestern, Feinberg School of Medicine - [Dr. Nell Maloney Patel](http://umg.rwjms.rutgers.edu/doctor_page.php?phys_id=2082) ([@MaloneyNell](https://twitter.com/maloneynell?lang=en)), AWS member, colorectal surgeon, and General Surgery Residency Program Director at Rutgers Robert Wood Johnson Medical School - [Dr. Rebecca Hoffman](https://ldi.upenn.edu/expert/rebecca-hoffman-md) ([@drbeckyhoffman](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiOyeOT09XYAhWW3oMKHdPsDScQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Fdrbeckyhoffman&usg=AOvVaw2Kz91aFuGS6UF10aslWXmr)), Vice Chair of the Resident and Associate Society of the American College of Surgeons Executive Committee as well as Research Fellow at the Center for Surgery and Health Economics and Chief General Surgery Resident at the University of Pennsylvania Perelman School of Medicine In the chat, scheduled on January 15 @ 8PM EST using the hashtag [\#AWSchat](https://twitter.com/hashtag/awschat), we will explore the following questions: 1. As a resident, how much should I “do” in a case? Who gets to decide? 2. As an attending, what metrics do I use to decide how much a resident does in a case? 3. How should the discrepancies in expectations of autonomy in the operating room between resident and attending be resolved? 4. How much transparency is owed to patients regarding the resident’s role in the OR? 5. Who should discuss the [\#surgresident](https://twitter.com/hashtag/surgresident) role in the [\#OR](https://twitter.com/hashtag/or) with the[ #patient](https://twitter.com/hashtag/patient)? --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/01/LoggheHeadshot157-e1518712217183-150x150.jpg)Dr. Logghe is a longtime member of AWS and currently a Surgical Research Fellow at Thomas Jefferson University. She graduated medical school at the University of California, San Francisco and has completed two years of general surgery residency at the University of North Carolina, Chapel Hill. As founder of the #ILookLikeASurgeon social media movement, she is passionate about creating an inclusive and supportive environment for surgeons in training and practice. She believes that supporting physicians in optimizing their own physical and emotional health enables surgeons to take the best possible care of their patients.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, current events, education, Fellows, mentorship, professionalism, residency, resources, training **Tags:** Resident Autonomy, Surgical Education --- ### [Practice Building for the Young Surgeon: Putting the Three A’s into Practice](https://blog.womensurgeons.org/the-three-a-practice/) **Published:** January 17, 2018 **Author:** Blog Team **Content:** It is often said that the keys to building a successful new practice are the three A’s: availability, affability, and ability. But what does that actually mean? What are the practical steps a surgeon can take in order to operationalize the 3 A’s? I’ve spent a lot of time over the past few months collecting advice from mentors and senior surgeons at my hospital, observing how others run their clinic as I set up my own, and have tried to consolidate the principles into the following: **Availability** *Provide fast and good service.* One of my senior partners told me that I should be prepared to see patients in clinic every day. While I have not gone to that extreme (as it it creates too much chaos for our clinic manager) I do have clinic multiple days a week so patients requiring urgent appointments can be accommodated within 48-72 hours. *Find the gaps and move upstream.* Understand where your referrals will come from. Is it primary care or GI or nephrology or endocrinology? There is a shortage of endocrinologists in Houston, leading to long wait times for new appointments. After meeting with multiple endocrinology groups in my area, I realized that they don’t mind if I do my own fine needle aspirations of new thyroid nodules or do the biochemical work-up for an adrenal incidentaloma because otherwise these patients would have to wait months for an appointment. Furthermore, I have the luxury of onsite adequacy check for FNAs whereas many private endocrinology groups do not. Therefore, I also am referred more complex biopsies or biopsies that were previously inadequate for interpretation. *Communicate.* When meeting a new physician, always exchange cell phone numbers. Ask them how they want to receive information after they send you a patient. Do they want a quick text after surgery or do they want a faxed copy of the operative note report and path results? Make their jobs easy. I use a templated H&P but I also make sure to write something of substance in the assessment and plan to the primary care and the referring physician. Referring physicians care that you are a thoughtful surgeon. *Organize.* Actively look at your clinic schedule on a weekly basis in order to maximize convenience to the patient and the referring physician. Can you schedule tests and other consultations on the same day as the new patient appointment? Make sure that your medical assistant and schedulers have a good working relationship with other offices so that you can consolidate appointments for your patients. **Affability** We hear all the time that “networking is key!” As a relatively introverted person, one of the most challenging social situations for me is to stand in a room full of unfamiliar faces, trying to approach a friendly group to make small talk. There are a couple of strategies I use to overcome this issue: *Find a buddy.* I joined my practice around the same time as one of my partners, a surgical oncologist. We take new physician meetings and go to networking events together. Women are often too modest to talk about their accomplishments or if they do, they can be perceived as being “too confident.” When we meet new physicians, we talk each other up. *Network virtually.* Most of my referrals come from young women physicians. Where did I meet these physicians? Online. There are bevy of online groups that can be sources of contacts. The popular Facebook group [Physician Mom’s Group](https://www.facebook.com/physicianmomsgroup/) has regional subgroups in your area. Additionally, there are patient support groups who welcome physician members. As an endocrine surgeon, I am part of a Facebook group dedicated to promoting awareness of primary hyperparathyroidism. There is undoubtedly a Facebook or Google group for the condition(s) that you have dedicated your career to treating. Ask your colleagues at national meetings if they know of these secret groups. Additionally, if your institution helps you put on a webinar for a topic that you are an expert on, you will have a ready audience from the support group. *Network the old fashioned way.* Even when you meet someone online, it is still a good practice to shake their hand in person and visit their office and meet their staff. Their medical assistant may be the person who processes the referrals so it is crucial that they know how to reach you or your medical assistant if they are having difficulties scheduling with your office. Other networking opportunities include events put on by your local medical or surgical society, university or company sponsored health fairs and church events. It is unlikely that I am going to find a thyroid nodule or a patient with primary hyperparathyroidism at a health fair, but I go to meet the other physicians. **Ability** *Know what makes you different.* Most young surgeons will be fellowship trained. Make sure that your website and other marketing materials clearly articulate any special skill sets you may have. If you are fortunate enough to have a business development office or marketing department, meet with them regularly. They are not clinical people and have no idea what you do. Similarly, if you have a centralized call center, meet with the schedulers to give them a quick talk about the types of patients you wish to see. *Know your limits.* It goes without saying that you should do all you can to avoid having a major complication in your first years of practice. There is a good chance that unless you are in rural practice, you have a senior partner who will be happy to mentor you and help you with difficult cases. They may not be fellowship trained like you, but good surgical technique is good surgical technique. Look for these people before accepting a job. Know who you’re going to call in the middle of night to help if you need it. I’d love to hear practice building tips from others out there! --- *![](%5Bsiteurl%5D/wp-content/uploads/2018/01/feibi.jpg)Dr. Feibi Zheng is an endocrine surgeon at Houston Methodist Hospital in the Texas Medical Center. She attended medical school at the University of California, San Diego. During her surgical residency training at Houston Methodist, she helped to establish the General Surgery Leadership and Health Care Administration Track, an 8 year program which blends clinical surgery training with practical experience in optimizing hospital systems for improved patient care and safety. She then completed her endocrine surgery fellowship at UCLA. In addition to her clinical practice, she is the Assistant Clinical Program Director of Surgical Quality and Population Health for Houston Methodist Hospital, where she is leading the development of a telemedicine program for surgical patients who live long distances from specialized centers of care. She also currently serves on the Committee for Perioperative Care of the American College of Surgeons which works to improve the quality of care for surgical patients across the country.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Mentorship is a Two-Way Street](https://blog.womensurgeons.org/two-way-street/) **Published:** February 1, 2018 **Author:** Blog Team **Excerpt:** I almost cancelled. It had taken us about 4 months to set up this meeting, but it had been a long week of operating and I was tired; I just wanted to go home, read for my cases, and go to bed. I had signed up to be a mentor through the Harvard Medical School medical student chapter of AWS with initial excitement almost 10 months ago. I have to admit, I was a little disappointed that I was matched with a dental student. I didn’t think I’d have anything in common with her and I wasn’t sure how I could be a good mentor to her with limited knowledge of dental school and future careers in that field. **Content:** I almost cancelled. It had taken us about 4 months to set up this meeting, but it had been a long week of operating and I was tired; I just wanted to go home, read for my cases, and go to bed. I had signed up to be a mentor through the Harvard Medical School medical student chapter of AWS with initial excitement almost 10 months ago. I have to admit, I was a little disappointed that I was matched with a dental student. I didn’t think I’d have anything in common with her and I wasn’t sure how I could be a good mentor to her with limited knowledge of dental school and future careers in that field. We met at a hip new restaurant near Fenway Park. I was immediately struck by Ann’s (name changed) enthusiasm and energy. She was fascinating! Not only was she earning her DMD and MD to become an oral surgeon, but she was also planning to earn her MBA with the goal of helping create new technologies that could be used in global surgery efforts in pediatric craniofacial surgery. I was envious and inspired by her ambition! I was surprised to learn that there were very few females in the world of oral surgery and she didn’t feel like she had many female residents or attendings to look up to. She was, therefore, very excited to meet me, someone who has (almost) made it through general surgery residency at a rigorous program while managing to maintain a semblance of a life outside of medicine. She related to me that some family and friends along the way have discouraged her from pursuing her lofty goals, telling her that she was trying to do too much. I was disappointed to hear this all-too-common narrative in such a clearly driven and determined student. I encouraged her in her efforts and was able to connect her to my former senior resident with similar interests. It was hard to end the night without feeling happy and rejuvenated. Despite my initial fears, I felt I had made a difference in this young woman’s life, and she had made a difference in mine too. In this era of medicine where burnout and depression have been thrust into the forefront, it can be hard sometimes to remember why we went into this career. We become tired with the daily tasks of charting, paperwork, and imposed guidelines and sometimes lose sight of that initial enthusiasm we once had as fresh-eyed and energetic medical students. Meeting with Ann brought me back to those early moments and not only reminded me of my earlier passion, but truly inspired me by showing me what’s to come from her and her colleagues in the future. I can’t wait for our next meeting! --- *![](http://blog.womensurgeons.org/wp-content/uploads/2015/03/AndreaMerrill-150x150.jpg)Dr. Andrea Merrill is a chief resident in general surgery at Massachusetts General Hospital. During her residency she did a year of breast surgery outcomes research followed by a yearlong editorial fellowship at the New England Journal of Medicine. Next year she will be starting a surgical oncology fellowship at the James Cancer Hospital at the Ohio State University. She is currently serving as the AWS Resident and Fellow Committee representative. You can find her on twitter at @AndreaLMerrill.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* We are restarting the resident-medical student mentorship program nationwide through the Medical Student and Resident/Fellow committees. This program matches AWS medical student members interested in surgery with a current surgical resident mentor from AWS. Stay tuned for more information soon via email! **Categories:** Uncategorized --- ### [An Open Letter to AWS Members from Communications Committee](https://blog.womensurgeons.org/open-letter-commcommteam/) **Published:** February 22, 2018 **Author:** Blog Team **Content:** Two years ago, a friend and mentor approached [me](https://www.womensurgeons.org/page/DrStephanieBonne) and asked me to help manage the communications team for AWS. Like I do with most things, I approached this with gusto. I got organized, made lists, set up accounts, and enthusiastically began to partner with my co-chair, [Dr. Yeo](https://www.womensurgeons.org/page/DrHeatherYeo). It has been extraordinarily rewarding to plan, communicate, and interact with the AWS membership in a very daily and contemporary way – on social media and our blog. But more has happened than just tweeting and sharing news. I’ve have learned much about our organization, and the enthusiastic, brilliant, and spectacular women that make up our membership. In the communications leadership, we really feel like we have our “finger on the pulse” of the women’s surgeons community. We see your comments, we share your triumphs, and we feel your pain on your down days. Through this process, we have come to know some of you on a more intimate level, by reading your thoughts in your emails and your blogs. We value your words to us and feel privileged to have a window into your very human experiences. Some of the submissions for our [blog](http://blog.womensurgeons.org/) or newsletter are deeply and painfully intimate. We appreciate that women surgeons share with us their very personal times and their very personal challenges, and we thank each of you for your willingness to share those experiences. There are times, however, when we cannot share this with our membership at large. We want to talk about the issues facing women surgeons, but we have the responsibility to be sensitive that our social media and web communications. We must always be mindful that we represent our organization in its professional capacity. The [AWS blog](http://blog.womensurgeons.org/), newsletter, and [social media](https://www.instagram.com/womensurgeons/) sites are carefully curated and edited material that is important and relevant to our readership, and present one face of our organization. After serious and thoughtful consideration within the communications committee leadership, we have come to a consensus about setting limitations on the experiences shared and the manner in which they are shared on the AWS arenas (i.e., blog, [social media](https://twitter.com/WomenSurgeons), and newsletters). We encourage open discussion about the more serious issues we face, such as burnout, depression, harassment or frustration. While sometimes the private experiences of our membership are relevant to some, they may not serve the needs of all, or our format may not be the best venue through which to share them. We also cannot in good conscience, publish intimate accounts of these experiences which may trigger emotional reactions in our readership under the header of AWS. We feel it’s unfair to, without warning, publish something that could prompt a very emotional response in an otherwise unsuspecting reader. Furthermore, we are very sensitive about publishing material that is submitted anonymously. However, as an organization of support, if these types of pieces are submitted or published elsewhere, we do feel comfortable giving our support and offering resources for those who need them. We thank all of you for your dedication to AWS, and your willingness to stand by the values we uphold: to engage and empower women surgeons to excel. Keep your material coming, as we are happy to consider all contributions to our efforts. We hope you understand when we make a difficult choice not to publish a specific piece. Thank you to all of you for your tremendous contributions, to yourselves, your colleagues and, most importantly, your patients. *If you are facing a challenging time in your life, please reach out for help. Here are some resources specifically aimed at helping physicians:* [**American Foundation for Suicide Prevention**](https://afsp.org/healthcare-professionals-mental-health-and-suicide-risk/) **[Federation of State Physician Health Programs](https://www.fsphp.org/state-programs)** **Suicide Prevention Hotline 1-800-273-TALK (1-800-273-8255) or text TALK to 741741 .** **[ACGME Physician Well-being Tools & Resources](http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources)** **[AMA Steps Forward](https://www.stepsforward.org/modules/preventing-physician-suicide)** **[ACS Surgeon wellness test](https://www.facs.org/member-services/surgeon-wellbeing)** **Categories:** leadership, resources, self-care **Tags:** #HeForShe, Awareness, burnout, ILookLikeASurgeon, Medical Student Members, medstudents, Parental Leave, Resident Mentor, residents, safety, self-care, stress, trainees, Wellness, work-life balance --- ### [9th International Women in Surgery Symposium - Realizing the Quadruple Threat](https://blog.womensurgeons.org/wis2018/) **Published:** March 5, 2018 **Author:** Blog Team **Content:** I had the privilege of attending the 9th Annual Women in Surgery Symposium on February 16-18, led by [Dr. Sharona Ross](https://twitter.com/RossSharona) and [Dr. Patricia Turner](https://twitter.com/pturnermd). The Women in Surgery Career Symposium started 9 years ago in Dr. Ross’s living room as a way to provide professional and academic development for women surgeons and to inspire those pursuing a career in surgery. The theme of [this year’s conference](https://women-in-surgery.com) was the *Quadruple Threat: Clinical Excellence, Confidence, Character and Charisma.* ***Clinical Excellence*** was present in every aspect of the conference, from the session on Friday evening where upcoming changes in healthcare, billing and coding were discussed, to the Sunday morning session moderated by [Dr. Sandra Wong](https://twitter.com/sandralwong) on quality outcomes. The session focused on patient satisfaction, the importance of online reviews, and the value of ERAS and NSQIP to improve patient outcomes. [Dr. Paula Ferrada](https://twitter.com/pferrada1) led a session for students and residents on how to navigate the American College of Surgeons: “Show up, start local, contribute, follow up, reach out, persist and have fun.” ***Confidence*** amongst participants was built through different sessions. A special session discussing building a CV and research, tips to succeed in residency and mock interviews was offered for residents and medical students on the first night. The Saturday sessions continued the theme, starting with tips from Dr. Lattisha Bilbrew on how to stand out in medical school and residency by having a plan and staying organized. [Dr. Vani Sabesan](https://twitter.com/VaniSabesanMD) provided suggestions to build financial confidence by discussing the importance of finding a financial advisor, getting disability insurance early in your training and carrying that through after graduating residency. Contract negotiation was provided with the advice, “Everything is negotiable, all you have to do is ask.” ***Character*** building and development were important topics of discussion throughout the weekend. [Dr. Dana Telem](https://twitter.com/DanaTelem) delivered a powerful speech about unconscious and implicit bias. In her speech, Dr. Telem described how unconscious bias leads to inequity and how our experiences have created biases that contribute to who we are and the way we start to overcome those biases is with awareness of their existence. Awareness leads to change in behavior and subsequently increased collaboration, inclusiveness and satisfaction. Her closing remarks and my takeaway message from her speech is that “diverse teams perform better.” We touched on the importance of emotional intelligence with a session held by Dr. Schwaizberg followed with emphasis on important characteristics of individuals with a high emotional quotient (EQ): self-awareness, self-management and social awareness. ***Charisma*** – with multiple networking opportunities available during the entire conference, we were able to apply this theme in action. Sessions focused on the importance on finding a mentor and sponsor, while life coaching was discussed in a session moderated by [Dr. Christine Laronga](https://twitter.com/clarongamd) included speakers such as [Dr. Susan Pories](https://twitter.com/SusanPoriesMD) , Dr. [Nancy Gantt](https://twitter.com/nganttmd) , Dr. Patricia Numann, [Dr. Stephanie Bonne](https://twitter.com/scrubbedin), Dr. [Celeste Hollands](https://twitter.com/CelesteHollands) and [Dr. Rajesh Aggarwal](https://twitter.com/docaggarwal). In summary, the 9th Annual International Women in Surgery Career Symposium delivered an opportunity to develop *clinical excellence,* build *confidence*, develop *character* and express *charisma.* P.S. below are a list of books that were recommended throughout the conference: - [White Coat Investor](https://www.whitecoatinvestor.com/the-book/) - [The Millionaire Next Door](https://www.amazon.com/Millionaire-Next-Door-Surprising-Americas/dp/1589795474) - [The Diversity Bonus](https://press.princeton.edu/titles/11077.html) - [Nice Girls Don’t Get the Corner Office](https://www.amazon.com/Nice-Girls-Dont-Corner-Office/dp/1455546046) - [Getting to Yes](https://www.amazon.com/Getting-Yes-Negotiating-Agreement-Without/dp/0140157352) - [Ask for It](https://www.penguinrandomhouse.com/books/6885/ask-for-it-by-linda-babcock-and-sara-laschever/9780553384550/) ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/MadelineTorres.jpg)[Madeline B. Torres](https://twitter.com/MadelineBTorres), M.D. is a general surgery resident currently completing a research fellowship in surgical oncology at the National Cancer Institute (NCI). Dr. Torres was born and raised in El Salvador. She immigrated to the United States with her mother and brother at the age of nine. Dr. Torres obtained a B.S. in chemistry from the University of Colorado at Denver and her M.D. from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors. Her interests include: surgical education, surgical oncology, work-life balance and encouraging women and minorities to pursue surgery and careers in medicine. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** AWSFood4Thought, ILookLikeASurgeon, leadership, self-care, WomenSurgeons --- ### [Too Young to Have Colon Cancer?](https://blog.womensurgeons.org/too-young-to-have-colon-cancer/) **Published:** March 9, 2018 **Author:** Blog Team **Content:** We all have that anecdotal story that changes our practice. We read the literature and pretend we are data driven until we have a patient with a complication, or see the crazy zebra diagnosis that makes us paranoid or concerned, and changes our practice. For me, as a colorectal surgeon, it was a gastroenterology colleague who was anemic. A bit tired and run down, she eventually went to have a colonoscopy after several months. The cancer in her colon had already spread to her ovaries. But she isn’t the only story… How many times have I heard the story from a patient with rectal bleeding diagnosed with hemorrhoids without even a rectal exam? How many times did the change in bowel movements get ascribed to irritable bowel disease rather than getting a colonoscopy? How many times did I need to see a patient under the age of 50 who waited months to be diagnosed with a symptomatic cancer? The data is there. An article published in [Journal of the National Cancer Institute in 2017](https://academic.oup.com/jnci/article/109/8/djw322/3053481%29) demonstrates the incidence of colon and rectal cancer is increasing in younger patients. In fact, while rates of rectal cancer decreased in those over 55 since the 1970’s, they doubled in patients under 55. In patients under the age of 40, the rate of colon cancer increased from 1.0% to 2.4%. Compared to a patient born in 1950, the rates of developing colon cancer in someone born in 1990 are twice as high, and they have four times the risk of developing rectal cancer. We have yet to fully understand why rates are increasing in this younger population, but the increased risks may be associated with [obesity and increased smoking and alcohol use. ](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779921/) [Recommendations for screening](https://gi.org/guideline/colorectal-cancer-screening/%29) have yet to evolve based on these findings, but patients with changes in bowel movements, bleeding per rectum and anemia are not eligible for screening colonoscopy – *they need a diagnostic colonoscopy*. Insurance rules are different for people undergoing a diagnostic colonoscopy rather than a screening colonoscopy. The number of patients I see with delayed diagnoses because either they, or their physician, ignored potential signs of colon cancer, is heartbreaking. So, if you are caring for someone who has the signs, or if you, yourself, have signs that might be colon cancer, consider getting a colonoscopy this month. Someday, if we stop ignoring signs, colon cancer may be preventable. When found early enough, colon cancer can be cured in up to 90% of patients. I for one, will be happy to be out of a job. More information about the diagnosis and treatment of colon cancer can be found through the American Society of Colon and Rectal Surgeons at [fascrs.org](https://www.fascrs.org) --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/stein.jpg)*Sharon Stein is a Associate Professor of Surgery and Program Director of Colon and Rectal Surgery at University Hospitals/Cleveland Medical Center. She serves as Vice President of the Association of Women Surgeons. You can tweet at her* *[@slsteinmd1](https://twitter.com/slsteinmd1).* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, resources, self-care **Tags:** Colorectal Cancer Awareness --- ### [A Surgeon's Scope of Practice](https://blog.womensurgeons.org/a-surgeons-scope/) **Published:** March 14, 2018 **Author:** Blog Team **Content:** For the 18th year, March has been dedicated to Colorectal Cancer Awareness. [Since the mid-2000’s](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf), 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](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf), 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](https://www.ncbi.nlm.nih.gov/pubmed/9449087). 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 the hepatic and splenic flexure, and adhesions. This can help us guide the endoscope through the colon while keeping track of our precise location. However, surgeons have had to advocate for their right to continue to perform endoscopy procedures. Many surgeons have forgone their endoscopy privileges, some do so to preserve referrals from gastroenterologists. From the gastroenterologists point of view, [they perform many more endoscopies](https://www.ncbi.nlm.nih.gov/pubmed/15578503) per year than most surgeons or primary care physicians. Their extensive fellowship training includes a higher number of procedures required for competency than a surgery resident ([140 colonoscopies and 130 EGDs](https://www.asge.org/docs/default-source/education/practice_guidelines/doc-competence.pdf?sfvrsn=6) for gastroenterology fellows vs [50 colonoscopies and 35 EGDs](https://www.acgme.org/Portals/0/UPDATED_DEFINED_CATEGORY_MINIMUM_NUMBERS_EFFECTIVE_ACADEMIC_YEAR_2017-2018_GENERAL_SURGERY.pdf) for surgery residents.) They become more efficient at recognizing pathology, while completing the endoscopy in a timely and safe manner. One study suggested patients who had colonoscopies done by gastroenterologists, as opposed to primary care physicians or surgeons, had a [lower risk of colorectal cancer](https://www.ncbi.nlm.nih.gov/pubmed/20854818) specific death (65% lower risk for GI vs 45% lower risk for surgeons). This retrospective study does have some limitations. It did not examine any complication rates for these procedures and did not evaluate the initial indications for those colonoscopies. Many times, the patients referred to surgeons have more concerning symptoms of colon cancer, which may have affected those results. From the surgeon’s perspective, one benefit of having a surgeon-performed colonoscopy is that our intimate knowledge of anatomy increases accuracy in locating lesions during colonoscopy. This may translate to shorter operative time and a more precisely planned surgical resection to remove the lesion. A recent comparison of localization error in colorectal cancer showed a significantly [lower error rate](https://www.ncbi.nlm.nih.gov/pubmed/27450208) for surgeons when compared to gastroenterologists. There was also a [shorter time frame from endoscopy](https://www.ncbi.nlm.nih.gov/pubmed/27450208) to surgery, which may result from eliminating the need for an additional referral. We also perform endoscopies rapidly, [with low morbidity and mortality.](https://www.ncbi.nlm.nih.gov/pubmed/11344424) Additional research has shown no differences in the [complication rate](https://www.ncbi.nlm.nih.gov/pubmed/14569450) between gastroenterologists, general surgeons and colorectal surgeons. Also, our surgical expertise is usually required to manage the potential complications such as perforation, and pathologic findings, such as complete obstruction of endoscopy. While gastroenterologists have become the primary referral base for endoscopy, it is vital for surgeons to remain involved in the timely diagnosis and management of colorectal cancers. Plus, there is plenty of business to go around! Especially in rural and underserved areas, where surgeons and primary care physicians supplement the few gastroenterologists available. In addition, only [13% of the gastroenterologists](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843135/) in the US are women! A recent survey revealed that female patients have a [stronger preference](https://www.ncbi.nlm.nih.gov/pubmed/21704811) to the sex, primarily female, of their endoscopist than men do. Therefore, female surgeons may be able to provide endoscopy services to meet patient demand. This is why I will continue to advocate for my right to perform endoscopy. My patients deserve a choice. They deserve the best. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/lovano.jpg)*Dr. Lovano is a General Surgeon at Clinton Memorial Hospital in Wilmington, OH. She is fellowship trained in Minimally Invasive Surgery and is a Faculty Advisor for the Instagram Committee for the AWS. She enjoys doing the weekly ‘Surgical Instrument Saturday’ posts for the AWS IG/Facebook, and posting too many pictures of her dogs on her personal Instagram.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, current events, education, resources **Tags:** Colorectal Cancer Awareness --- ### [Sati’s Surgery: An Exploration of a Surgeon’s Vulnerability Through Kuchipudi Dance](https://blog.womensurgeons.org/satis-surgery/) **Published:** March 18, 2018 **Author:** Blog Team **Content:** In Greek mythology, Chiron, the master of the healing arts, suffered an incurable wound from Hercules’s arrow. Carl Jung referenced the centaur’s fate when he developed his famous “wounded healer” archetype, using Chiron as his inspiration for understanding how one’s own pain drives our desire to heal others. It was during my surgery rotation that I began to understand the impact of this shared vulnerability on both patient and physician. A small, thin incision was drawn across the patient’s neck. I watched from behind the patient’s head, retractor carefully held in place as the thyroid slowly came into view. Four hands worked seamlessly, dissecting away the tissue holding the organ in place. Suddenly, the blood started to pool. There was some whispering from the surgeons: *Why is she bleeding so heavily?* The two surgeons peered in closer. The culprit was a bleeding vessel which gave everyone a sense of relief as they cauterized, closed, and left a nearly invisible scar. While the outcome was excellent, that moment of unease in the OR is what I soon understood to be a few seconds of fear. When the surgery produces such small surprises, surgeons seemed to feel fear and with it self-blame almost instantly; surgeons understood the gravity of their work and in doing so, become intimately aware of their patient’s and their own shared vulnerability. In 2005, [**Cousley** ***et al***](https://www.ncbi.nlm.nih.gov/pubmed/25109033) published a literature review on perioperative vulnerability as felt by patients in physical and psychological forms. The paper concluded that, although vulnerability is transient, it is enough to negatively impact anesthetic, surgical and postoperative management. **[Torjuul *et al* ](https://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-6-2)** evaluated ethical experiences narrated by surgeons and explained the gray line differentiating medical error from accidents. Errors are often experienced as personal defeats, rendering a surgeon utterly vulnerable. It is a space many never wish to re-enter once they have left. I believe the solution to healing two vulnerable souls is to form a connection. In 2010, Brown presented on the power of vulnerability to the TED audience ([***TED.com***](https://www.ted.com/talks/brene_brown_on_vulnerability)) and stated that showing your emotions in vulnerable moment allows for that authentic empathy to flow between two people—in this case, between surgeon and patient. This openness is not easy to achieve, as it requires breaking down walls training has built up. However, I believe that creating (and, to a lesser extent, consuming) art can facilitate this state. This idea inspired my creation of the dance piece, Sati’s Surgery. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/Dance-300x298.png)[***Sati’s surgery***](https://www.youtube.com/watch?v=6-3kLYXSUqU) uses a narrative dance form from Andhra Pradesh, India, called Kuchipudi. It depicts the story of the patient in tandem with the story of the surgeon performing her operation. The patient takes on the role of Sati, a goddess from Indian mythology. Throughout the piece, parallels between the rituals Sati and the surgeon perform are drawn: Sati’s morning rituals and the surgeon’s scrubbing in, for example. At the climax of the piece, Sati is betrayed by the people closest to her. Behind her, the surgeon faces a suddenly unstable patient. They both show their vulnerability through self questioning and fear. Despite the rituals of constant practice, methodical cleansing, and creative maneuvers, both Sati and Surgeon realize that sometimes, the outcomes of surgery and life are beyond one’s control and to find inner peace and resilience with that truth. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/OR-300x226.png)Creating this piece allowed me to explore how vulnerability leads to courage, and how a lack of that vulnerability can lead to poor outcomes. In Sati’s world, neither her parents nor her husband understood her feelings or her position; she was at the mercy of powers beyond her control. In our world, patients and surgeons alike can often feel the same way in a hospital: misunderstood, isolated, and at the whim of the environment around them. Traditional Kuchipudi dance performances on modern stories of medicine as a way to explore our interconnected vulnerabilities such that they turn into strength. Our shared vulnerability with our patients and ourselves—our pain and wounds—reveal what it truly means to be human and to be healed. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/Shilpa-222x300.png) Shilpa Darivemula is a fourth year medical student at Albany Medical College and a graduate of Union College’s MBA/MS/MD combined degree program. Shilpa began dance training in Kuchipudi with Ms. Sasikala Penumarthi and performed her solo debut recital–her Rangapravesham–in 2011 with Ms. Anuradha Nehru and Mr. Kishore Mosalikanti.. Shilpa has served as AMWA Artist in Residence in 2016, an ASTMH Kean Fellow in 2017, and a Thomas Watson scholar in 2013. She has performed at the United Nations CSW, ArtWallahLA, Southern Vermont Dance Festival, and Toledances International Dance Festival. Shilpa continues as Founder of the [**Aseemkala Initiative**](http://www.aseemkala.org) , a project aimed at transforming medicine through traditional dance, along with Rohini Bhatia as co-director. She plans on continuing blending dance with medicine as an OB/GYN. *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** Food4Thought, Kuchipudi, Medical Student Members, narrative dance --- ### [The Myth of the Young, Healthy Physician-in-Training](https://blog.womensurgeons.org/the-myth/) **Published:** March 21, 2018 **Author:** Blog Team **Content:** Surgical residents are in an often unrecognized position—encouraging and reminding patients to see their primary doctor for regular preventative health tests and cancer screening. Rotations on various surgical services provide an opportunity to discuss injury prevention and substance abuse issues (trauma), smoking cessation (vascular), obesity (bariatrics), and various cancer screenings, especially breast and colorectal cancers. Indeed, every rotation brings a new challenge of mastering the proper cessation and screening guidelines for a particular surgical patient population. Despite having an important role in preventative health for surgical patients, surgical residents are among the most at-risk young health professionals for neglecting preventative health care needs, at times delaying or even ignoring their own age-appropriate vaccinations and family history-directed cancer screenings. In a systematic analysis of resident well-being, residents were found to have lower self-rated mental health scores and well-being that the similarly aged population norm ([**Raj 2016**](http://www.jgme.org/doi/full/10.4300/JGME-D-15-00764.1?code=gmed-site)). Residents were also found to have worse work life balance and less frequent exercise compared to faculty. When schedules become busy, regular exercise routines are often the first activity to get cut from an overwhelming schedule. Overnight calls, bloated daytime rounding, and operating room schedules make vending machines and fast food easy and convenient, yet unhealthy and self-sabotaging options. Even simple tasks like twice yearly dental check-ups and cleaning may get pushed off or even skipped over altogether. Potentially even more damaging than poor behavioral health habits are the poor mental health habits that are often cultivated during residency training. Trainees are often told that the 80-hour work week rule makes life much better than it was in years past, yet sleep deprivation and busy call schedules are still the norm. When a resident is feeling overwhelmed, underappreciated, or some combination of the two, there is minimal space for a “pop-off” valve. Downtime that allows for a resident to secure a moment to themselves to rest are few and far between. Even more elusive are periods of time where the resident can reflect on a difficult complication, patient death, or even more rare, engage in mindfulness activities that have been shown to aid in overall mental health well-being. As demonstrated in the FIRST trial, residents in the flexible policy arm of the study were more likely to perceive negative effects of restrictive duty hours on activities away from the hospital, including rest, health, extracurricular activities, and time with friends and family. Dr. Weinstein, a trauma surgeon, recently shared his personal struggle with severe depression in an article encouraging other physicians to stop ignoring their own self-care needs. While not all surgical trainees, students, or faculty will suffer in that way, when talking to most attending physicians, many will reflect on various struggles they had when they were in training. Balancing the psychological demands of training with the difficulty of maintaining a healthy lifestyle can be hard to achieve. Despite this, fostering healthy behaviors during training will increase the likelihood that young trainees will continue these habits as they advance in their careers. During my first two clinical years of residency, I spent of a lot of time learning about perioperative management of patients and very little time attending to my own physical and mental health needs. It wasn’t until my lab years that I began running regularly (including finishing not one, but two half marathons) and cooking healthy meals. I started using the free iPhone app [**Stop, Breath & Think**](https://www.stopbreathethink.com) for meditation several times per week, which helps to calm my busy mind at the end of a long day. As surgeons increasingly focus on preventative health for our patients, we must not forget to focus on our own health needs. As physicians, we should take the time to cultivate positive coping mechanisms and healthy habits surrounding nutrition, sleep, and other self-care needs earlier in our careers. We should ask ourselves every day, what I am doing to further my own health and wellness today? The better we take care of ourselves, the better we can serve our patients. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/Picture1-300x249.png)Allison Martin is a general surgery resident at the University of Virginia. After completing her undergraduate education at the University of Louisville, she pursued an MD at Vanderbilt School of Medicine and spent an additional year obtaining an MPH at the Harvard School of Public Health. During residency, she completed a two-year research fellowship in surgical oncology, including a year-long Fogarty fellowship in Rwanda. Her future plans include a career in surgical oncology and global surgery. She currently serves as the AWS Facebook Subcommittee Chair. You can find her on Twitter [@globalsurgallie](https://twitter.com/globalsurgallie). ​ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care **Tags:** Awareness, burnout, self-care, Wellness, WomenSurgeons, work-life balance --- ### ["Dear Pat" responds to a "Feeling lost, Surgical Mom"](https://blog.womensurgeons.org/dear-pat-surgical-mom/) **Published:** March 25, 2018 **Author:** Blog Team **Content:** **Dear Pat,** I just returned to my clinical rotations after completing my research years in the lab and having my first child. Before I left for the lab I was planning on a career in Cardiothoracic, Transplant or Vascular surgery. Now as a new mother, a lot of the attendings I work with have suggested I consider “lifestyle” specialties with more controlled hours. Am I being nearsighted in my specialty choices? I love being with my family, but I feel I have come too far to make career choices based primarily on “lifestyle”. However, I do not want to pick a specialty based on “ego” either. Part of me wants to prove everyone wrong — but will my children and family pay the price? Feeling lost, *Surg Mom* **Dear Surg Mom,** There is no right time to have a child(ren). Regardless of when you choose to start a family, childbearing and childrearing poses challenges on your surgical career, regardless of specialty. We do not choose our surgical specialty based on lifestyle; we choose it because it resonates with our true self. This is where our passion lies, and this is our calling. Yes, things will need to be modified, adapted, and negotiated as we weave out a way through work-life “integration”. I had both of my children during training and today they are both in college. The lessons I have learned include: (1) for every “yes” you say to work or home, there is a “no” to the other; (2) needs / demands change over time as work / children evolve; (3) I will not be the best surgeon or the best mother, but wherever I am I give it 100%; and (4) quality time trumps quantity of time every day of the week. Let me elaborate on these lessons. When children are small, they have little sense of time and can’t tell if you were gone one-hour or 14 hours. At this age, we self-inflict the guilt. Grade school is when they start to inflict the guilt. Missing school events because the school only gave a week notice; yet all the other “moms” were able to be there. Incomprehensible to your child, but this will pass and then comes the “a-ha” moment. The moment when they finally get what your work is all about. For example, one time I was just walking through the door after a long day and barely getting to hug them when my beeper summons me back to work. Instead of cries and complaints from my children, my oldest says “someone sick at the hospital, needing your help, Mom?” You reply “yes. I am really sorry but I have to go and won’t be able to hear about your day until tomorrow.” “It’s okay, Mom, because if I was sick, I would want someone as caring and smart as you coming in to take care of me.” In that brief moment, years of guilt was lifted off my shoulders and I realized quality of time spent with my children was more valuable than the amount of time, especially if that time was spent regretting a choice of specialty for lifestyle reasons. I, too, was recommended by many to reconsider my specialty for lifestyle reasons. If I settled for less than whom I am, then I would translate that message and feeling to my children. I didn’t want that. I wanted my children to dream big and accomplish all that they want. I see them doing just that in college; both are following their calling. Yes, there were rough times. I had to adapt and negotiate. Time is our biggest commodity. When I became a single mom, I had to cut back on my physical time at work and do all the charting, billing, and research at home where my kids needed me to be. At the end of the day, I managed both and so can you! I may not be the best mom or the best surgeon, but I have two phenomenal children in college and a successful career by being true to myself. Sincerely, Dr. Christine Laronga, MD, FACS *The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat”answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted anonymously and will be answered by***[ *AWS council members*](http://www.womensurgeons.org/page/Leadership)***. This monthly blog is published the fourth Sunday of each month. We want to hear from you, so if you are interested in submitting your anonymous question , use***[ *this link*](https://www.surveymonkey.com/r/BSW2VR2)*.*** --- ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/CLaronga-238x300.jpg) *Christine Laronga is a Senior Member at Moffitt Cancer Center and a Professor of Surgery at the University of South Florida and specializes in disease of the breast. She joined the Association of Women Surgeons as a resident and has been an active member for over a decade. She is also the Immediate Past President. Follow her on Twitter* [*@clarongamd*](http://twitter.com/@clarongamd)*.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life **Tags:** AWSFood4Thought, Dear Pat, Parental Leave, self-care, work-life balance --- ### [Difficult Conversations](https://blog.womensurgeons.org/difficult-conversations/) **Published:** March 28, 2018 **Author:** Blog Team **Content:** 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 of those people who drives a day or two with the gas light on if I’m going short distances). I ran inside to find her intubated, hypotensive, pupils fixed and dilated. At that point I knew, but my parents didn’t, and they had a 6 hour drive to get here. Her team worked tirelessly to keep her with us until our family could arrive. I was with her when she died. I was alone with her and I became that family member, the one who was falling out. Nothing prepares you for that intense grief. I knew it was coming, yet I couldn’t handle the reality of it. That experience, while grueling, made me a better doctor. I am able to relate to patients and their families on a different level than before. I am able to have those tough conversations with a new perspective. The point of this is: end of life situations are hard. They are even harder when the situation happens suddenly and unexpectedly. Many families have not had the discussion to know what their loved ones would want. As surgeons, we have unique perspectives and should be having these conversations with patients and their families. My perspective clearly comes from one of trauma and critical care, but many surgeons are caring for patients that may benefit from discussions regarding serious illness planning. We know that 55% of first time end-of-life discussions in a large group of cancer patients happened while the patients were in the hospital and many of these conversations happened in the last 33 days of life.1 We owe it to our patients to be honest and to have conversations beyond the mortality risk from the operation. We owe it to them to discuss their overall prognosis and how what we are doing fits into that prognosis. We need to focus not only on diagnosis and treatment, but the human concerns associated with end-of-life discussions as well. For those of us who feel untrained or uncomfortable with these conversations, there are checklists and resources available to help guide our discussions, as listed here:2,3 ![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/berry1-300x233.jpg) At the end of the day, we all want the best for our patients and there is good evidence that suggests open, honest communication about end-of-life scenarios, even in the surgical population, is beneficial. The American College of Surgeons has published the document Surgical Palliative Care: A Resident’s Guide available at: <https://www.facs.org/~/media/files/education/palliativecare/surgicalpalliativecareresidents.ashx> 1. Mack JW, Cronin a, Keating NL, et al. Associations between end-of-life discussion charcteristics and care received near death: a prospective cohort study. J Clin Oncol. 2012; 30(35):4387-4395. 2. Bernacki RE and Block SD. Communication About Serious Illness Care Goals: A Review of Synthesis and Best Practices. JAMA Intern Med. 2014; 174(12): 1994-2003. 3. <http://www.talkaboutwhatmatters.org/documents/Providers/Serious-Illness-Guide.pdf> --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/03/berrt1.jpg)Stepheny Berry, MD is an Assistant Professor of Surgery at The University of Kansas Health System. She completed her general surgery residency at Henry Ford Hospital in Detroit, Michigan and her surgical critical care fellowship at The University of Tennessee-Memphis. When she’s not taking care of patients, Dr. Berry is passionate about animal rescue, family and KU basketball (not necessarily in that order). You can tweet her @Dr\_Stepheny.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, education, leadership, residency, resources **Tags:** palliative care --- ### [The Dickey Amendment: Low-Hanging Fruit](https://blog.womensurgeons.org/dickey/) **Published:** April 4, 2018 **Author:** Blog Team **Content:** 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 how this may best be accomplished, and the national discussion is frequently emotional and polarizing. Gun violence is a complex issue. As scientists we believe that public policy decisions should be informed by good research. We do not know, for example, if raising the age limit to purchase firearms will have a meaningful impact on gun violence. We do not know if arming teachers will enhance school safety. We do not know what effect a three-day waiting period to purchase weapons will have. Decisions like these require unbiased information, not emotion-laden speculation. Unfortunately, government scientists who want to study gun violence have been hobbled by the so-called [Dickey Amendment of 1996](https://www.google.com/url?q=https://magazine.jhsph.edu/2017/fall/features/cassandra-crifasi-hopkins-moderate-gun-owner-gun-policy-researcher/how-the-dickey-amendment-affects-gun-violence-research.html&sa=D&ust=1522887207341000&usg=AFQjCNGOEwcZDwIXT-RAKypxjglQmhEA_A), which stipulates that “none of the funds made available for injury prevention and control at the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention) (CDC) may be used to advocate or promote [gun control](https://en.wikipedia.org/wiki/Gun_control).” This law, along with the recurring failure of Congress to fund firearm research in any meaningful way, has had a chilling effect for more than two decades. It has remained despite multiple medical organizations calling for its repeal, as well as [Congressman Jay Dickey](https://www.theatlantic.com/health/archive/2018/02/gun-violence-public-health/553430/) himself, in the latter years of his life, lobbying against his eponymous piece of legislation. In the most recent omnibus continuing resolution passed by Congress just last week, the Dickey amendment itself remains, although the language in a report accompanying the bill clarifies that the CDC can, in fact, conduct research into gun violence. What remains is for it to be funded. Gun violence should be approached as the public health problem it truly is, and research dollars appropriated to it. It’s long overdue for the federal government to fully invest in quality firearm violence research. --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/copeland.jpg)Dr. AJ Copeland has been a civilian member of the USUHS faculty since 2005, serving first as a Clinical Site Coordinator for the Surgery Clerkship, and since 2012 as the Clerkship Director. She is in active clinical practice with a special interest in breast surgery and in surgical educational research. She is a member of the Association for Surgical Education and completed a Surgical Education Research Fellowship with that organization.* *Dr. Copeland earned her bachelor’s degree in Biology from Brown University in 1981 and subsequently attended the University of Connecticut Health Sciences School of Medicine on an Army Health Professions Scholarship Program, graduating in 1985. She completed her residency in general surgery at Walter Reed Army Medical Center in 1991. As a general surgeon Dr. Copeland was stationed at Fort Belvoir VA, San Antonio TX, Portsmouth VA, and finally at USUHS before retiring from the Army in 2005 at the rank of Colonel.* *Dr. Copeland is a longtime member of the Association of Women Surgeons, joining the Council in 2002 and serving as the organization’s President in 2008-2009. She is a Fellow of the ACS, and a member of the Women in Surgery Committee of the ACS. She began her term as the third AWS Governor to the American College of Surgeons in 2012. She treasures the many friendships she has made through the AWS and the opportunity to associate with so many beautiful, talented, and smart women surgeons (and surgeons-in-training) of all generations.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education, leadership, training **Tags:** Dickey Amendment, Gun Violence --- ### [Allergic Contact Dermatitis: A Surgeon’s Dilemma](https://blog.womensurgeons.org/allergic-dilemma/) **Published:** April 12, 2018 **Author:** Blog Team **Content:** In early 2014, I reluctantly made my way to the Dermatologist’s office as encouraged by my Fellowship Director. “How long have you been having these symptoms?” he asked. I thought carefully back to the first time I noticed that my hands blistered and started itching at least four years before that visit. By the time I finally sought help, my hands were raw under the cotton gloves I wore after applying steroid ointments or Vaseline. The problem had slowly worsened over time probably due to developing allergic contact dermatitis as well as increasing exposure to the offending substances. The Dermatologist recommended skin testing which involved placing numerous discs of various allergens on my back for five days. I was skeptical since I had performed my own latex avoidance trial using only nitrile gloves at the bedside and in the operating room for several months with no improvement. That avoidance test failed because I am not allergic to latex but to a rubber accelerator called carba mix, which is a chemical used in the processing of latex products such as [surgical gloves](https://www.dermnetnz.org/topics/allergy-to-rubber-accelerators). It turns out that it is also used in many nitrile gloves. Suddenly, I was halfway through my final year of surgical training with a disease directly related to my occupation. It is estimated that [8-12% of healthcare workers](https://www.osha.gov/SLTC/latexallergy/index.html) are latex sensitive compared to 1-6% of the general population. Occupational skin reactions are the [second leading cause of occupational disease](https://www.cdc.gov/niosh/docs/96-115/diseas.html) in the United States after traumatic injury. The most common reaction to latex is irritant contact dermatitis with dry, itchy skin and is not a true allergy. [Allergic contact dermatitis](https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/allergydiagnostictesting.pdf) is delayed blistering of the skin similar to the reaction many people have to poison ivy. The next level in severity is immediate hypersensitivity, with symptoms ranging from rash or hives, to runny nose and wheezing or even anaphylaxis which may be triggered by simply being in the same room with the allergen. [Risk factors](http://www.aaaai.org/conditions-and-treatments/Library/At-a-Glance/Latex-Allergy) for developing latex or latex-associated allergy include ongoing latex exposure, personal history of atopic disease, and personal history of multiple medical procedures or surgeries. Several measures for reduction in latex allergies were recommended by the Centers for Disease Control National Institute for Occupational Safety and Health ([CDC NIOSH](https://www.cdc.gov/niosh/docs/97-135/pdfs/97-135.pdf)) in the late 1990s including: 1. Use non-latex gloves for contact with non-infectious materials 2. Use powder-free latex gloves when using latex 3. frequently clean areas contaminated with latex dust 4. Frequently change ventilation filters and vacuum bags used in latex-contaminated areas However, I was exposed to latex powdered gloves at multiple facilities during my training. When you are diagnosed with a chemical allergy, the treating physician gives you instructions on how to avoid contact with those chemicals. I found sterile and non-sterile gloves that I could safely use. At home, I had to replace hundreds of items including: shampoo, deodorant, household cleaners, nylon stockings, toothpaste, diaper cream, and dish soap. Thankfully, the team at Mayo Clinic developed a database to identify safe products for home use and it is available for a fee under the name [Skinsafe](https://www.skinsafeproducts.com/). Mayo and the hospitals where I now work ordered the gloves and soaps I need without protest. My situation is manageable now, but I have talked to many healthcare workers who suffered skin reactions for years without resolution. Please care for yourself and colleagues who experience allergic contact dermatitis by learning how to prevent and recognize this common work-related illness. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/erdahl.jpg)Lillian Erdahl, MD, FACS is an Assistant Professor of Surgery at the University of Iowa where she practices Breast and General Surgery. She is also Associate Program Director in General Surgery; head of the Iowa City VA Breast Clinic; and involved in curriculum development for medical students, residents, and fellows. Her research interests include breast cancer prevention and treatment, faculty development, and surgical education. Her work for gender equity in medicine includes involvement in the Association of Women Surgeons as co-chair of the Twitter subcommittee and work with the @PROWDWomen group. **Categories:** advocacy, education, resources, self-care **Tags:** Allergic Contact Dermatitis --- ### [Diversity & Inclusion in Surgery](https://blog.womensurgeons.org/diversity-inclusion-in-surgery/) **Published:** April 17, 2018 **Author:** Blog Team **Content:** *By Shree Agrawal* **Join in our upcoming Tweetchat in partnership with Association of Academic Surgery (AAS) on Monday, April 23, 8 pm ET. To participate, be sure to follow the moderators for this chat, Drs.** [**Christian Jones**](https://twitter.com/jonessurgery) **(@jonessurgery) of** [**AAS**](https://twitter.com/AcademicSurgery) **(@AcademicSurgery) and** [**Michaela West**](https://twitter.com/MichaelaWst?lang=en) **(@MichaelaWst) of the Association of Women Surgeons (AWS). Please tag all of your tweets with the hashtag #AASAWSchat .** ## **Diversity** Diversity in medicine to me emphatically represents individuals with grit, who have overcome long-standing norms within their profession, and allies who have recognized and advocated for the inclusion of all individuals. I am inspired when I meet trailblazers who bring the intersections of diversity up the ladder in surgery. Despite the advances many have made before us, diversity in medicine and especially surgery still have room to grow. Medical education is beginning to become more diverse: women comprise 51% of medical school matriculants since 2017, and underrepresented minorities account for 11% of US medical graduates. Despite these positive changes, approximately 30% of students who identify as a non-binary gender or a sexual orientation minority, do not reveal their identity for [fear of discrimination](https://med.stanford.edu/news/all-news/2015/02/many-lgbt-medical-students-choose-to-stay-in-the-closet.html). Furthermore, data has not been collected to represent minority populations as defined by gender and sexual orientation within medical education. However, there is a stark contrast in the practice of surgery from post-graduate training to patterns in the workforce: - - [Across all medical specialties](https://www.aamc.org/data/workforce/reports/458766/2-2-chart.html), 29% of all full-time faculty are women, of which 4% also identify as an underrepresented minority - - Among full professors of surgery, [less than 10% are women and only 22 of surgical department chairs](https://www.ncbi.nlm.nih.gov/pubmed/27649976) in the United States and Canada are women. - - As of 2008, [underrepresented minorities made up 7%](https://www.ncbi.nlm.nih.gov/pubmed/18948795) of surgical faculty members and 5% are considered surgical full professors. - Of all surgical trainees, 10% identify as an underrepresented minority. [AAMC 2016 Physician Specialty Data Report](https://www.aamc.org/data/workforce/reports/458766/2-2-chart.html) ## **Inclusion** *“Belonging is being somewhere where you want to be, and they want you. Fitting in is being somewhere where you want to be but they don’t care one way or the other.” – Brene Brown* [In the business sector](https://hbr.org/2016/11/why-diverse-teams-are-smarter), companies who intentionally created a more diverse workforce were more innovative, able to see potential obstacles more easily and created an additional 15-35% financial return. In the landscape of healthcare disparities with a diverse patient population, it would seem essential to have diversity among healthcare providers addressing patient needs. The visibility of diversity within our healthcare institutions provides a natural forward momentum to create inclusion at leadership and faculty levels. To demonstrate the value of individuals from diverse backgrounds to continue to enter fields in which they are underrepresented, visibility and inclusion demonstrate progress. Inclusion also requires advocating and becoming allies for our peers to promote their own advancement. Executing both roles can be challenging in academia and other practice settings. Below we provide a few tips for becoming an advocate and ally: - - Be a listener - - Keep an open mind - - As with our patients, respect and dignity are an undeniable right every human deserves, regardless of background. - - Be mindful of your language—it matters. Be intentional about your choice of pronouns, humor, and mannerisms. - - Everyone has bias-confront your bias and prejudices. - When you recognize discrimination, speak up to promote respect for your colleagues and patients and support your colleagues as they advocate for themselves. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/visualabstract.png) Diversity includes, but is not limited to, race, socioeconomic background, gender, sexuality, and/or religion. Within each aspect of diversity, individuals face varying degrees of discrimination, exclusion, and privilege, but it is at the intersections of these categories, that further challenges occur and can be compounded. It is important to understand the unique, additional factors individuals may have had to overcome to be where they are today in medicine and look beyond the data we typically focus on such as race and binary gender. The future of surgery relies on our ability to reflect the population of patients we serve – to be both diverse and inclusive. How can we best support each other and be allies to those around us? **We hope to hear your thoughts next Monday to talk more about diversity within surgery and how to become an ally and advocate for inclusion. #AASAWSChat with @WomenSurgeons and @AcademicSurgery** *![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/Shree-Agrawal-Headshot-2018-261x300.jpg)Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and serving as the Chair of the AWS National Medical Student Committee. Shree is passionate about research surrounding patient decision-making and medical education. In her free time, she enjoys blogging for AWS, practicing yoga, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, gender differences, professionalism, resources, women --- ### [National Minority Health Month 2018: Together we can achieve health equity](https://blog.womensurgeons.org/nmhm18/) **Published:** April 19, 2018 **Author:** Blog Team **Content:** > “To eliminate disparities, we must know enough (research); do enough (deliver the outcomes); care enough (commitment); and persevere enough (do not get discouraged).” > David Satcher, MD, PhD, Director, Morehouse School of Medicine April is National Minority Health Month and this year’s focus is on “Partnering for Health Equity.” This month offers an opportunity to learn more and raise awareness about the health status and disparities in healthcare provided to racial and ethnic minority populations in the United States. Racial and ethnic disparities exist in surgical outcomes and care as well. Patients of lower socioeconomic status have increased complication, mortality and failure-to-rescue rates after major cancer surgery ([Reames et al. 2014](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412271/)). African American and Hispanic patients have increased odds of mortality after trauma, as do uninsured patients ([Haider et al. 2008](https://pdfs.semanticscholar.org/cea1/cee3da2da6f90bf40b9da31f49b2f577561b.pdf)). Multiple factors at the patient, provider, and organization level influence surgical disparities. We must understand surgical disparities in order to help mitigate them ([Hisam et al. 2016](https://www.ncbi.nlm.nih.gov/pubmed/26526625)). As a surgical community we can help address these disparities by learning about cultural competency, focusing on our doctor-patient communication and encouraging our institutions and professional organizations to provide the necessary assistance services to the patients who receive care there. Cultural competency can take many forms. It entails trying to understand the patient’s culture, which is not static. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients ([Betancourt et al 2002](http://www.commonwealthfund.org/usr_doc/betancourt_culturalcompetence_576.pdf)). A patient’s culture is shaped by myriad things, including where they were born, raised, live, and work. All of these factors impact their health. Providing culturally competent medical care is one strategy that can help reduce racial and ethnic health disparities. Minority patients and individuals from lower socioeconomic backgrounds tend to receive less health-related information from their providers compared with non-minorities and individuals from higher socioeconomic backgrounds due to barriers in communication. These communication hurdles lead to patient dissatisfaction and poor comprehension, negatively affecting patient compliance with treatment plan and, in our case, affecting surgical outcomes. As an individual what can you do to address health disparities? - Read the American College of Surgeons Statement on Optimal Access - Learn more about National Minority Health Month resources and activities by visiting: https://www.minorityhealth.hhs.gov/nmhm18/ - Join the conversation on Twitter, Facebook & Instagram by using the hashtag [\#NMHM18](https://twitter.com/hashtag/nmhm18?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Ehashtag) - Explore resources for providing culturally and linguistically appropriate health services on the Think Cultural Health website: <https://www.thinkculturalhealth.hhs.gov> - Encourage your organization to provide effective communication and language assistance services to culturally and linguistically diverse individuals receiving care and services from your organization. <https://hclsig.thinkculturalhealth.hhs.gov> Everyone plays a role in reducing healthcare and surgical disparities. Collaboration between individuals, organizations and healthcare systems is necessary to advance health equity and help improve the health of our patients and communities. The first step we can take as physicians is to ensure culturally competent patient–provider communication, always have shared decision-making, and build trust as this will enhance the quality of care of all patients, not just racial and ethnic minorities. Through collaboration we can work toward achieving health equity. > “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” > Martin Luther King, Jr. --- *![](http://blog.womensurgeons.org/wp-content/uploads/2017/02/Dr-Patricia-Marinez-Quinones-240x300.jpg)Patricia Martinez Quinones is a general surgery resident at the Medical College of Georgia at Augusta University. She was born and raised in Ponce, Puerto Rico. Dr. Martinez received her M.D. from the University of Puerto Rico School of Medicine. She hopes to continue her career path in academic trauma and critical care surgery. Patricia is an AWS Communications Committee member. You can find her on Twitter at [@PMartinezMD.](https://twitter.com/PMartinezMD)* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, leadership, networking, resources **Tags:** National Minority Health Month, NMHM18 --- ### [Earth Day: Reducing OR Waste](https://blog.womensurgeons.org/earth-day-reducing-or-waste/) **Published:** April 24, 2018 **Author:** Blog Team **Content:** *By Shaleen Sathe* **The Association of Women Surgeons hosts an annual “Greening the OR” Contest to celebrate Earth Day and to bring innovative proposals for environmental sterwardship in the field of surgery. [More information about Greening the OR can be found here.](http://www.womensurgeons.org/?page=GreeningOR&hhSearchTerms=%22greening+the%22) The deadline for this upcoming year will be in June 2018.** Last year, Pawarissara Osathanugrah, Varsha Muralidhar, and Alexus Skobodzinski, medical students at Boston University School of Medicine (BUSM), proposed a procedural change in the operating room (OR) at Boston Medical Center (BMC) to reduce the amount of recyclable material that is discarded as hazardous waste. Although many operating rooms separate recyclable waste from waste contaminated by bodily fluids during a procedure, there is a high risk for cross-contamination that reduces the amount of recyclable material that is actually recycled. The proposal to green the OR was to have only one waste receptacle in the OR at a time to avoid any cross-contamination. A receptacle for uncontaminated, recyclable material would be placed in the OR at the beginning of the procedure, so that only recyclable materials such as drapes, packaging, etc. are disposed of without the risk of hazardous contamination. Then, just as the procedure begins, at time-out, this recyclable receptacle would be removed from the OR and replaced with a new contaminated waste receptacle in order to collect the contaminated material from the procedure itself. The BUSM and BMC community demonstrated strong interest in their ideas, and both faculty members and students reached out to contribute. Osathanugrah, Muralidhar, and Skobodzinski have opened dialogue about creating a more environmentally conscious OR and raised awareness of the enormous impact medical and surgical waste has on the environment. At BMC, a few hundred surgical procedures each produce several pounds of waste daily; each pound of material that is recycled instead of discarded as contaminated waste could save the hospital twenty-seven cents. The hope in implementing this small procedural change would drastically minimize not only hospital waste management costs but also the yearly carbon footprint that our hospital creates. Eventually, we hope to gather even more support from students, faculty, and staff who will participate in this initiative to facilitate the movement of waste receptacles around the OR and to start this as a permanent practice not only at Boston Medical Center, but at hospitals all over the nation. *![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/shaleen-headshot-300x300.png)Shaleen Sathe is a first-year medical student at Boston University, where she also completed her undergraduate studies in Medical Science and Spanish. She currently serves as the AWS New England Regional Representative on the national medical student committee. Shaleen has also been very involved with Socially Responsible Surgery at Boston Medical Center, a non-profit organization that works to integrate the practice of surgery with patient advocacy, education, and elimination of health disparities. Shaleen continues to pursue her interests in general surgery, ophthalmology, and social determinants of health, while trying to balance her hobbies outside of medicine.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, resources **Tags:** Greening the OR --- ### [Dear Pat responds to "I'm the Boss"](https://blog.womensurgeons.org/im-the-boss/) **Published:** April 29, 2018 **Author:** Blog Team **Content:** **Dear Pat,** My intern is a tall, white male. Every morning on rounds I introduce myself as the Chief Resident and state the roles of everyone on the team. However, patients continue to direct their questions and concerns to him and look to him for the plan. My intern is uncomfortable with this, and appropriately redirects the patients to me. How do I better establish that I am the Chief Resident? I know this is something that I may face for the rest of my career, how do I stand up for myself without letting this drive me crazy? Sincerely, **I’m the Boss** For this month’s “Dear Pat”, we have two AWS [council members](http://www.womensurgeons.org/page/Leadership) – Drs. [Amalia Cochran](https://twitter.com/AmaliaCochranMD) and [Marie Crandall](https://twitter.com/vegansurgeon) – share their strategies in response to “I’m the Boss”. **Dear “I’m the Boss”,** These situations can be challenging. Some cultures or age groups struggle with identifying women as surgeons, and that is likely contributing to the obstacles you are encountering. I want to start by telling you “Great Work!” for being meticulous about introducing your team and everyone’s roles to patients and families. It can be easy to forget that they don’t know who is who and what they do. I also want to praise your intern for being #heforshe in what sounds like his consistent efforts to redirect patients and families to you as the team leader. It’s important to realize that your team is doing things well, and that this is a broader societal problem that you cannot fully “fix” on your own. What you can do is continue to educate your patients and do your job well. Also, I would encourage you to see if there are system options that could help out. Are there white boards in the patient room in which team member names and roles can be written? I know a few places include photos with the names of their healthcare team, which might also be helpful in your situation. I would encourage you to explore these options with attendings, nursing, and administrative leadership; it might help minimize your frustrations, and could also improve patients’ satisfaction with care. Good luck. It’s still not always easy, and you are doing a great job. **![](http://blog.womensurgeons.org/wp-content/uploads/2013/09/AmaliaCochran-160x224.jpeg)** [**Amalia Cochran MD, FACS, FCCM**](http://www.womensurgeons.org/page/DrAmaliaCochran) --- **Dear “I’m the Boss”,** This is a common source of frustration for women residents AND attendings, as well as doctors from underrepresented minority groups in medicine. I cannot say there is a universal solution, but there are some things that worked for me, as a smaller, young-looking woman. First, you have done exactly the right thing by engaging your team; if you want to be the point of contact and the person leading the discussion with the patient, walk into the room first, have everyone stand behind you, and say something like, “Hi, it’s Dr. XYZ and your trauma team.” That tacitly puts you as the leader without diminishing your junior residents’ roles. Also, hold eye contact, answer all questions, and use body language. I have found that standing with a slightly wider stance (picture military, if you will), and a slower, deeper voice that projects across the room has been very helpful. Finally, I don’t know your patient population, but my patients would not be familiar with what “Chief Resident” means, so I rely on body language and confidence. Consider providing a definition of your role. If these things aren’t natural for you, see what works for you (and let us know!), but it’ll definitely get easier with time. Sincerely, ![](http://blog.womensurgeons.org/wp-content/uploads/2016/04/Crandall-MD-Marie-2010-NMFF-214x300.jpg) [**Marie Crandall MD, MPH, FACS**](http://www.womensurgeons.org/page/DrMarieCrandall) --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png)The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat” answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted by residents and fellows anonymously and will be answered by*[ ***AWS council members***](http://www.womensurgeons.org/page/Leadership)*. This monthly blog is published the fourth Sunday of each month. We want to hear from you, if you are interested in submitting your anonymous question, use*[ ***this link.*** ](https://www.surveymonkey.com/r/BSW2VR2) *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** DearPat **Tags:** AWSFood4Thought, communication, Dear Pat, sexism, Teamwork, workplace --- ### [“Cure Sometimes, Treat Often, Comfort Always”](https://blog.womensurgeons.org/palliative/) **Published:** May 2, 2018 **Author:** Blog Team **Content:** Six years ago, I was attending a Pain and Palliative Care Symposium when I heard a medical oncologist say, “We treat disease. We do not treat emotion.” She was an outspoken advocate for palliation in all aspects of care, be they spiritual, mental, or corporeal, and during all stages of illness ranging from curative treatment to terminal care. Initially, her words struck me as false, almost antithetical to the entire profession of medicine. Today, they resonate as precise if not true. In understanding what palliative medicine is, it is imperative to know what it is not, and what it could be. Coincidentally, the recent death of our former first lady, Barbara Bush, known to be receiving “comfort care” in her final days, prompted the National Hospice and Palliative Care Organization (NHPCO) to release a statement clarifying the nomenclature and respective roles of palliative care, comfort care, and hospice. According to the NCPCO’s April 16 statement, comfort care refers to “care plan for the patient that is focused on symptom control, pain relief, and quality of life.” NHPCO further clarifies the terms “hospice” and “palliative care” as two forms of comfort care, respectively defined below: “[Under hospice](http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3356) care, a person receives medical care as well as emotional, psychosocial, and spiritual care delivered by an interdisciplinary team of professionals that includes a physician, nurse, social worker, allied therapists, counselors, home health aides, spiritual and grief support and trained volunteers. “[Palliative care](https://youtu.be/_3ZgsImIqH0) means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.” Palliative medicine, more specifically, specializes in minimizing symptoms, like pain, intractable nausea, or difficulty breathing, and in reducing stress, which can take place at with any type of illness at any time. The goal is to ease a patient’s suffering and provide them with the best quality of life possible throughout the course of their illness. Palliative care is neither synonymous with end-of-life care nor is it the last-ditch effort we meekly resort to when treatment fails. We should consider a palliative care consult or evaluation when the health care team seeks further measures to assist a patient in coping with his or her illness, whether there is a short-lived active problem or a terminal prognosis, thereby assisting the primary care team with optimal symptom relief for the patient. Treatment continues as per standard of care for patients seeking palliation. These consults enhance, rather than substitute, the interdisciplinary and patient-centered treatment plan, and often lead to a dialogue on life goals and advance care planning, conversations that are never too premature to initiate with a patient and their family. Patients who desire to forgo treatment for a terminal illness altogether may also benefit from palliation of their stress, pain, and other physical symptoms brought on by the illness, prior treatment, or even treatment withdrawal. Those who are additionally burdened with a prognosis estimated to be fewer than six months receive hospice, or end-of-life, care. According the NHPCO, the focus of hospice is providing the terminally ill patient with “high-quality” psychological and spiritual support while tending to symptomatic management “to the whole person and to family caregivers”. Curing the life-limiting illness is not the goal of hospice care, which concentrates in providing as much comfort and as best of quality of life as possible. Delivered by a multidisciplinary team of healthcare providers, social workers, volunteers, and religious figures, hospice can take place at a dedicated inpatient ward, outpatient facility, and, most often, takes place at home. Patients who later are in remission of a terminal illness may discontinue hospice care and proceed with management as clinically warranted. As providers, we are expected to be empathetic, if not sympathetic, to the pain, suffering, and anxiety alongside our patients. In addition to the support provided to patients and their families, palliative care specialists are skilled at supporting the providers themselves, who too often face these challenges rife with emotions but without mental relief or understanding from their care team colleagues. Medical students planning their fourth-year are encouraged to spend time or rotate with a palliative care team to learn about what can be offered to patients as well as strategies to help cope as an aspiring health care provider facing serious illness and death regularly. Ask about Palliative Care and Hospice at your hospitals, and visit the [National Hospice and Palliative Care Organization (NHPCO](http://www.caringinfo.org/i4a/pages/index.cfm?pageid=1)) for more information. Check out NHPCO’s public awareness campaign [Moments of Life: Made Possible by Hospice.](https://moments.nhpco.org) --- ![](http://blog.womensurgeons.org/wp-content/uploads/2017/12/fatima-150x150.jpg)*Fatima Elgammal is a fourth-year medical student from St. George’s University School of Medicine. She spent four years at Rutgers New Jersey Medical School in the Department of Neuroscience, Pharmacology and Physiology studying neuronal changes in traumatic brain injury models of epilepsy, and developed an interest in critical care and trauma during her surgery clerkship at Hackensack University Medical Center. A native of New Jersey, Fatima will begin General Surgery Residency July 2018 at Rutgers.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education, resources **Tags:** Hospice Care, palliative care --- ### [What is Private Practice Anyway?](https://blog.womensurgeons.org/private-practice/) **Published:** May 7, 2018 **Author:** Blog Team **Content:** Private Practice. Academic Practice. It used to be a straightforward decision as the end of training loomed in the distance. It is a common enough query, a conversation starter as you scrub with your attendings through training—will you pursue an academic career, or are you heading in to private practice? How to decide? What to consider? What does it mean? What used to be a simple fork in the road of a surgical career, with the occasional chance to jump the track from one path to the other, is now much more complex and nuanced than ever. Lines have blurred, the business of medicine has evolved, and this just isn’t so simple any more. Academic practices are increasingly aware and mindful of the business side of medicine; and fewer private practice surgeons are working in the traditional independent solo or small group setting, instead are joining large multispecialty groups or becoming employed. As these payment/employment models change, so have the ways a practice might be accurately described. Urban tertiary center, rural critical access hospital? Teaching affiliate or independent community hospital? Large multi-hospital system, or stand-alone hospital? These lines don’t always break along simple academic practice versus private practice lines, either. What does it mean to be a private practice surgeon with an academic appointment/affiliation versus the academic department surgeon, teaching residents at a tertiary hospital? What about the surgeon practicing in a suburban or rural hospital, how will she make the decision to remain independent or accept employment by the hospital system? There are many more permutations and models out there and distinguishing among them has become more difficult and nuanced, and it will likely continue to become more complicated. Data from 2012 suggest the trajectory of trends which have continued or even accelerated. The [American Hospital Association](https://www.nmms.org/sites/default/files/images/2013_9_23_ama_survey_prp-physician-practice-arrangements.pdf) demonstrated that the number of physicians employed by hospitals in 2012 had increased by 32% compared to the year 2000. In the December 2012 [Archives of Surgery](https://jamanetwork.com/journals/jamasurgery/fullarticle/1485559), surgeons who report being self-employed (the traditional form of private practice) decreased from 48% to 33%. There are many factors to consider about a life in surgery beyond training, and important among these are the type and style of practice to pursue and enjoy. It is also important to consider the setting which will help foster and maintain the joy in practice, and allow each surgeon to fulfill her calling to her utmost ability. The challenges of practice—clinical, education, practice management, compensation; and the challenges of the career—maintaining wellness, pursuing outside interests, family, avoiding or mitigating burnout, are significant and can seem daunting at times. When faced with these challenging and divergent paths, we can find support and mentorship in others who have navigated these decisions in the past. Please join [Dr. Sasha Adams](https://twitter.com/SashaTrauma) and the [AWS](https://twitter.com/WomenSurgeons) Clinical Practice Committee to discuss “The Challenges and Opportunities of Private Practice Surgery” on May 14 at 8 pm ET using the hashtag #AWSchat. We will share our perspectives and experiences with those who continue to chart their career course, and those who are just beginning the journey. Psychologist [Dr. Hilda Davis](https://twitter.com/HRDavisWellness) will also be participating as our special guest to offer tips on how to maintain wellness even when stressed. *![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/IMG_1345-261x300.jpg)Dr. Kathryn A. (Kathy) Hughes, FACS is a General Surgeon, hospital-based/acute care general surgery. She has spent the majority of her career in private practice in community hospitals, where she has had leadership roles as Chief of Surgery and Vice-President of the Medical Staff, as well as multiple hospital committee appointments. In addition to the ACS and AWS, she is a member of the American Society of Breast Surgeons, the AMA, and the Massachusetts Medical Society, where she represents the Barnstable District in the House of Delegates, serves as Chair of the Committee on Women in Medicine, serves on multiple committees and task forces, and is an alternate delegate to the AMA representing the MMS. She currently resides and practices in Cape Cod, Massachusetts. You can find her on* [*Twitter*](https://twitter.com/DrKathyHughes)*,* [*Facebook*](https://www.facebook.com/profile.php?id=100007134646929) *and on her page* [*Behind the Mask*](http://behindthemaskmd.com/about/)*.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice **Tags:** academic practice, AWS, AWSChat, private practice, Tweetchat --- ### [Balancing Act: Not Letting The #GymGrind Grind You Down](https://blog.womensurgeons.org/gymgrind/) **Published:** May 10, 2018 **Author:** Blog Team **Content:** ![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/IMG_0567-300x225.jpg)The Santa Hustle Half Marathon on a chilly, windy Galveston day in December 2016 “Everything in moderation” is one of those phrases we all toss around when it comes to nutrition and wellness. For me, it was one of my mother’s broken-record-phrases that she applied to everything from exercise to broccoli to peanut butter (gasp, I know). Long before mind-body wellness and balance were hip themes for marketing fitness products, they were core values that my parents prioritized in our family. As I considered our blog themes for this month-[Mental Health Awareness](https://www.nami.org/mentalhealthmonth) and [National Physical Fitness & Sports Month](https://healthfinder.gov/NHO/MayToolkit.aspx)– I began to realize the intricate relationship the two have, especially in my life. I’ve always been an athlete, from tee ball to high school track & cross country, to college intramurals (with [just a few](https://www.utrecsportsmedia.org/search#q=natalie+tully) championships along the way). Sports have always been an outlet for my pent up frustration and competitive nature. Transitioning to adulthood meant trying to fill that void in my life-which initially took the form of adult soccer leagues, but has turned into distance running. It started with 10k races when I was working as a research technician, but while I’ve been in medical school, I’ve channeled my studying stress into running 2 half marathons in 2016 and 2018 and one full marathon in 2017. Especially during USMLE STEP 1 studying, my morning 4 mile runs gave structure to the start of my days. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/IMG_0947-240x300.jpg)After finishing the Austin Marathon on a steamy day in February 2017 As I’ve transitioned to clinical rotations this year, keeping my previous schedule-waking up after 7, running, and having time to eat breakfast and start studying at my own pace-is simply not possible. But I find that this year, more than ever, demands that I keep myself as sharp- mentally, physically, and emotionally-as I possibly can. For me, working out for 30+ minutes is a way to clear my head and process stress, whether before or after work. It helps me to feel my best, and have my clearest mind ready for patients and the rest of the care team. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/IMG_2643-225x300.jpg)Finishing the Lubbock Mayor’s Half Marathon in April 2018 Recently, however, I’ve started to notice that perhaps the thing which I hold in such high regard as my psychological savior & emotional washcloth may have taken on some damaging characteristics. In completing training for my last race, every run-but especially those in the last few weeks- felt like an absolute chore. My left knee constantly hurt, and the scale tipped from my daily run being something I wanted or needed to do to something I had to do. The day I called both my boyfriend and my parents crying (not unusual) about a stressful day but included my run as a stressor (very unusual) was a stark warning that my relationship with running and myself probably needed some tending to. Luckily, I came to this realization at the end of a challenging clerkship and was able to take a week to partake in my recharge ritual: [The Pizza and Couch](http://blog.womensurgeons.org/medical-students/dressing-your-best-inside-out/)/[Couch Potato](https://twitter.com/utully13/status/836057262334623746) Cleanse. While the week didn’t allow for a full restoration, it gave me enough insight to realize that I need to make changes to support my relationship with physical fitness to maintain balance in my mental health and overall wellness. So, where do I go from here? I’m not totally sure just yet. For now, I’m working on doing a better job of listening to my body and my mind-when I need to take a nap and order tacos, that’s a better option than slogging through a run I’ll hate. That said, I know that sometimes the best way to pull myself out of a slump is to go get some endorphins flowing. The focus for me, though, has to be on balancing the two-because a heart rate in the 40’s does nothing if the brain it’s pumping blood to is too frazzled to enjoy a restful afternoon on the patio. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/thumbnail_Tully2c-Natalie-200x300.jpg) *Natalie Tully is a 3rd year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. She is an avid runner, homebrewer, and #SurgBBQ fan. She will apply to General Surgery Residency this Fall in hopes of pursuing a career in Pediatric or Trauma Surgery.* Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** advocacy, current events, leadership, medical students, self-care, training **Tags:** Mental Health Month, National Physical Fitness & Sports Month --- ### [“How do you envision your family looking?”](https://blog.womensurgeons.org/envision-your-family/) **Published:** May 13, 2018 **Author:** Blog Team **Content:** My face crumpled up and tears erupted from my eyes as soon as the young doctor in front of me asked this question. I reflexively reached for a Kleenex to cover up my face and erase the signs of weakness. My cheeks turned bright red in embarrassment. But she took it in stride and gave me a moment to sob out, “I don’t know. I just want to be able to have *a* family someday.” I was in a fertility clinic. From the second I walked in, I felt out of place. There were a few couples in the waiting room. I was the odd one out—a single woman in this stark place for couples struggling to have children. I wondered what they thought of me—*what was this single woman doing at a fertility clinic?* Maybe they imagined a partner somewhere in my life who just wasn’t present today. Or more likely they didn’t imagine anything at all because they had their own problems to deal with. Having “high standards” and being “accomplished” have apparently made it difficult for me to find a partner in life. As a surgeon I can’t honestly say I have spent a lot of time looking for one. I’ve been too busy spending my time with people—patients, colleagues, nurses, staff—in hospitals. That’s not the full explanation, though. I have prioritized my career over my personal life because I cannot tolerate the idea of being anything less than the best I can be at this job. People trust me, incredibly, to take a knife to their skin while they are completely unconscious. I owe it to them to be my very best. Unfortunately that doesn’t leave a lot of time for finding love. Or friends. Or hobbies. There are people who do this better than me, for sure. There are people who draw boundaries and stick to them. But there are also many, many physicians and surgeons who are just like me. We are taught that the patient comes first. Tacitly we are taught to put ourselves last. So after making a plan two years ago to see a fertility specialist and freeze my eggs, I finally made an appointment. For the past two years I have been dragging my feet, pretending I would maybe meet someone. (Where? On my couch?) Now that I am 37 it is time for me to admit failure in this one part of my life and seek help. As I sat in the doctor’s office, I didn’t realize that help would sound so much like torture. The kind young doctor described to me how, depending on the protocol, I would have to give myself two to three shots a day. I would have to come in every four to five days for an ultrasound and lab draws. Whenever there were enough follicles, we would proceed with egg retrieval. As she was describing all this, I wondered how I would manage to take care of my patients. She said I needed to be available in the mornings to have tests done. And while she assured me that I could keep working throughout all this (while staying flexible and being available for tests throughout), she admitted that the day of the retrieval I would have to take the day off. Of course we cannot predict when that will be since it will depend on the lab tests and the ultrasounds. And by the way, there is a risk of injuring major blood vessels or intestines while performing the retrieval. As she was talking, I was thinking about my work schedule—time in the operating room, time in the clinic, time in the endoscopy suite—and how I could possibly make this schedule work. I often don’t eat or drink anything all day as I am running around from one thing to another. How can I possibly fit in all this testing? And an unpredictable day off somewhere in there? Finally we talked about the cost. Apparently the procedure itself costs about $10,000. The medications cost an additional $3000-4000. Yikes. This is all for one round of treatments. She advised that at the end of all this, if we are able to retrieve six eggs we will have a 50% chance of ending up with a viable embryo down the line. There is, however, no way to predict how many eggs we will be able to retrieve. That’s when I asked her how many times I would have to go through all this, and she responded with: “How do you envision your family looking?” How many children I want to have will dictate how many rounds we might need to do. When she asked that question, all I could think was that I had no idea what my family should look like. I haven’t even managed to find the partner with whom I would have this mythical family. How can I possibly know how many children I would want? And why has it come to this? The majority of adults are able to find mates. Even though I went to great schools, have received amazing training, and am, by most accounts, a reasonably attractive and fun person, I have not been able to perform the most basic human function: reproduce. After an uncomfortable pelvic ultrasound, the visit was over. I walked back to my office, just a couple of blocks away, and tried to focus on emails and academic work. If this visit rattled me this much, would I be able to do the injections and the whole protocol? Maybe I am just weaker than other women, but a little voice inside was screaming, “No! No! No! Are you crazy? Take two weeks off so you can languish on your couch.” Or maybe don’t do it at all. For now all I need to do is get some labs drawn in a few days. That, at least, seems doable. If you are interested in learning more about fertility treatments, here are some resources I have found useful: - The Washington Post recently published a sobering piece on the [harsh realities of egg freezing](https://www.washingtonpost.com/news/national/wp/2018/01/27/feature/she-championed-the-idea-that-freezing-your-eggs-would-free-your-career-but-things-didnt-quite-work-out/?noredirect=on&utm_term=.56577bf88985). - The New York Times also recently published a summary of what to look for [regarding egg freezing](https://nyti.ms/2tLsB4q). - The Mayo Clinic has a good page on [basic introductory information](https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322) for both men and women. - The [American College of Obstetricians & Gynecologists](http://www.acog.org) also has some [useful FAQs](https://www.acog.org/Patients/FAQs/Treating-Infertility). - There is not a lot of great cost information out there as insurance benefits vary widely, but some [anecdotal data](https://www.self.com/story/the-cost-of-infertility) gives you a sense of the range of costs. *![](http://blog.womensurgeons.org/wp-content/uploads/2017/02/Picture-252x300.png)Dr. Arghavan Salles completed medical school, residency, and her PhD at Stanford University. She finished her formal training with a fellowship in Minimally Invasive Surgery where she has stayed on as faculty. Her dissertation research focused on negative stereotypes about women in surgery and how those affect women training to become surgeons. Her current research focuses on diversity in medicine as well as physician wellness. She invites you to follow her on Twitter [@arghavan\_salles.](https://twitter.com/arghavan_salles?lang=en)* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** parenting **Tags:** AWSFood4Thought, ILookLikeASurgeon, MothersDay, self-care, Wellness, WomenSurgeons --- ### [The Transition: Adding to the Picture of Surgical Care in India](https://blog.womensurgeons.org/the-transition-india/) **Published:** May 16, 2018 **Author:** Blog Team **Content:** My fourth trip to Nanakpur but my first in a hospital setting. We had five cases posted for the day: open inguinal hernia repair; open cholecystectomy; renal stone removal; bladder stone removal; and diagnostic cystoscopy. The surgeon arrived at 9 AM, asked for the list of patients and began to order the cases based on complexity and tool requirements. This was different from the U.S. where elective cases were scheduled for a time slot. The first patient was already in the OR getting prepped but the anesthetist was unable to gain access. Instead of using an ultrasound to find the vessel, the anesthetist told the patient to to return after two of the other cases. The surgeon had to complete all 5 cases before the staff left at 2 PM and did not have the luxury of time. We moved on. The next patient walked himself to the table and laid on his left side so the anesthetist could administer spinal anesthesia. Within 45 minutes, the surgeon had completed the nephrolithotomy with nephroplasty, began the next case, and the patient even walked himself to recovery thirty minutes later. I had never seen a postoperative patient walk himself anywhere immediately after surgery. I was shocked. However, these sort of surprises were expected based on my previous experiences in Nanakpur. In 2015 as second year medical students, Varshini Cherukupalli, a now soon-to-be surgical intern and co-founder of our work in Nanakpur, and I completed a population-based surgical needs assessment and a surgical and trauma capacities assessment of the community and healthcare facilities in Nanakpur, India. We quantified Nanakpur’s shortage of surgical personnel and procedures at lower-level facilities and determined that patients’ limited access to higher-level facilities was due to a lack of transportation. Based off our assessments, we concluded that there was a need to reallocate resources to lower-level facilities to increase access to surgical care. I would later realize that our survey-based conclusions did not factor in how the healthcare system operated in Nanakpur. In 2018, I returned to Nanakpur to complete a surgical rotation at two of the public hospitals. The rotation was very different from anything I expected. The time I spent allowed me to complete the picture of surgical and healthcare access in Nanakpur. In 2015, the assessment I performed showed a lack of general anesthesia at the lower-level public hospitals, but my rotation revealed most of the procedures could be completed with spinal anesthesia. The population survey from 2015 underscored the financial difficulty patients experienced while waiting at the hospital without knowing the exact time of their procedures or appointments. While working with the surgeon, I learned the lack of pre-scheduling allows flexibility to make changes in order to complete all the cases in the shortened workday. The surgeons were not confined by their limited resources and shortened operative day. The ability to continue to strengthen the surgical and trauma capacities of Nanakpur requires insight into a unique healthcare system and an understanding of the community’s perception of healthcare, the availability and use of resources, and the surgeons’ skill set. In order to improve a system, one must have truly a complete understanding of all perspectives, so as not to undo the balance, meticulously maintained, but instead amplify the strengths inherently present. --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/manisha.jpg)Manisha Bhatia is a fourth-year medical student from Texas Tech University Health Sciences Center. She started her work in Nanakpur as a co-founder of the Northwestern University chapter of Project RISHI (Rural India Social and Health Improvement), an undergraduate organization dedicated to working with rural community partners to develop sustainable health solutions. Her passion for global health stems from empowering the individual to help the community. She will begin her General Surgery Residency July 2018 at Indiana University and plans to continue improving access to surgery globally. @manishab917* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, medical students, networking, training **Tags:** Global Surgery --- ### [Is taking time to do research right for me?](https://blog.womensurgeons.org/taking-time-right/) **Published:** May 23, 2018 **Author:** Blog Team **Content:** Is a professional development year right for me? Should I do research? What is the benefit? These were some of the questions raised during the last “hang-out” session hosted by the Resident and Associate Society of the American College of Surgeons ([RAS ACS](https://twitter.com/RASACS)) on May 7th. “Hang-outs” are informal conference calls designed to help medical students navigate various aspects of surgery such as work-life integration, academic development years, residency interviewing tips and more. Our last discussion with the medical students got me thinking about the reasons I am spending (two or maybe three) years in the middle of general surgery residency dedicated to research: 1) a desire for an in-depth understanding of basic science research, and 2) to increase my probability of matching into the fellowship of my choice. I’ve always had a passion for basic science research. As a chemistry major in college, I made Cisplatin, a cancer drug, from scratch and synthesized a novel [metallo-organic](https://www.tandfonline.com/doi/full/10.1080/00958972.2013.770485?scroll=top&needAccess=true) framework that allowed me to explore the various applications of these frameworks: energy storage and drug delivery across the brain blood barrier. However, my research opportunities in college and medical school were limited in time generally lasting 3-6 months and lacked the structure that an advanced degree or dedicated research time provides. I craved the opportunity to learn to think like a scientist, ask a question, develop a hypothesis, perform the experiment and get an answer. I also wished to further understand and explore cancer biology to improve patient care. The second reason I signed up for academic development years is the promise of increasing my probability of matching into a Surgical Oncology fellowship. Surgical Oncology, like many fellowships, is a [highly competitive](http://www.nrmp.org/wp-content/uploads/2016/03/Results-and-Data-SMS-2016_Final.pdf) subspecialty to match into, with 86 applicants in 2016 for 59 positions available for matching. Fellowship spots – like residency spots – have more applicants than positions available each year. Additionally, the 2016 National Resident Matching Program (NRMP) Program Director [Survey](http://www.nrmp.org/wp-content/uploads/2017/02/2016-PD-Survey-Report-SMS.pdf) reported involvement and interest in research as one of the top 5 determining factors for matching into a fellowship. There are a few key things to consider if professional development years are right for you, think about where you see yourself practicing in 10-15 years. Do you see yourself in an academic, private or other type of practice? Do you envision yourself doing any type of research, if so what type? Do you wish to pursue an advanced degree? Are you considering fellowship training, and what have previous applicants done to match in that fellowship? If you answered yes to any of those questions or want more information, talk to senior residents who have done research, ask them about their publishing productivity. Did they have enough support from the faculty and program? Talk to your program director and other faculty, ask what projects if any they have available. Inquire about outside research opportunities and if your program would support you leaving the institution. If you are thinking about taking time for professional development, start planning early; [find a mentor](http://blog.womensurgeons.org/uncategorized/maximizing-a-research-year-6-things-you-should-know-as-a-medical-student/), create a timeline of what you wish to accomplish, draft a [research](http://blog.womensurgeons.org/uncategorized/how-to-become-a-wildly-successful-researcher/) proposal and plan. Find funding opportunities and ask for help when needed. As I complete my first research year at the National Cancer Institute, I’ve honed my scientific skills to develop a hypothesis, ask unambiguous questions and develop a research plan to help answer these questions. I look forward to the next year as I continue my work in cancer therapeutics and refine my scientific skills. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/torres-297x300.jpg)*Madeline B. Torres, M.D. is a general surgery resident at Penn State Milton S. Hershey Medical Center in Hershey, PA, currently completing a research fellowship in surgical oncology at National Cancer Institute (NCI) in Bethesda, Maryland. Dr. Torres was born and raised in El Salvador. She immigrated to the United States with her mother and brother at the age of nine. She then went on to obtain her B.S. in chemistry from the University of Colorado at Denver and earned her medical degree from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors. Her academic interests include surgical education, surgical oncology, work-life balance, and encouraging women and minorities to pursue surgery and other careers in medicine.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, mentorship, networking, residency, resources, training **Tags:** Professional Development, RASACS, Research Time --- ### [Dear Pat Responds to Surgeon-Mother-to-Be](https://blog.womensurgeons.org/dear-pat-mother/) **Published:** May 26, 2018 **Author:** Blog Team **Content:** Dear Pat, I’m a second-year surgery resident and somewhat older than my co-residents. I am considering getting pregnant during residency, but I am unsure if my co-residents will be supportive. I don’t want them to be mad at me. What should I do? Sincerely, **Surgeon-Mother-to-Be** For this month’s “Dear Pat”, AWS Council Member [Dr. Simone Betchen](https://www.womensurgeons.org/DrSimoneBetchen) shares her strategies in response to “Surgeon-Mother-to-Be”. Dear **Surgeon-Mother-to-Be**, How exciting! No one can tell you when is the best time to start a family, but since you asked, here’s what I think. The best time to start a family is when the timing is right for YOU and your family. While it is kind of you to think of your co-residents, your co-residents will step up and survive without you during maternity leave because no one is indispensable. And it goes both ways, If any one of them had an issue in future, I’m sure you would be there for them as well. I have watched my colleagues try to time their pregnancy or adoption to the benefit of their work colleagues, but it usually doesn’t go as planned because pregnancy and adoptions don’t happen on demand. Deciding to wait to have children may lower your chances as you get older and getting pregnant may take longer than you expect. Adoption is also a long process that requires a lot of time, patience and significant involvement. On the flip side, deciding to try to have a child with the idea that it will take a while, didn’t work so well for myself, and I ended up pregnant before I had expected. Whatever scenario you’ve dreamed up for the ideal time to have a child is unlikely to go as planned. Accept that and decide to start your family when you feel it is best for you. Colleagues that support you will do so whenever you choose to have a family. Colleagues that are less than supportive of you starting a family will be that way no matter your age or stage in your training. These colleagues will not be any more understanding next year, the year after that, the research year, or the chief year. Anyone who is disappointed that you choose to have a child, at what seems like an inopportune time for them, will have to manage his or her own feelings like an adult. Don’t worry about them. Having children at any stage for a working mother is tricky. Having had children at a couple of points during my training and as attending faculty, I will tell you that the farther along I was in my career, the more difficult it was to have a child. Being pregnant was harder, taking maternity leave was harder, and rebuilding my practice once I got back was harder as my career progressed. While it may not be true for everyone, many women surgeons echo this sentiment. All this being said, I do recommend you speak to human resources, review your institution’s housestaff manual, or look at your hospital’s policies on maternity leave. This might help you in planning your time off, the resources available to you from your institution, and what you may expect of your family in helping when a child does come along. Be sure to also take a look at the AWS maternity leave policy for [residents](http://blog.womensurgeons.org/wp-content/uploads/2015/03/ResidentPolicy.pdf) and [surgeons in practice](http://blog.womensurgeons.org/wp-content/uploads/2015/03/SurgeonPolicy.pdf). Best of luck! Simone Betchen, MD, FACS --- ![](http://blog.womensurgeons.org/wp-content/uploads/2016/11/Simone-Betchen-300x261.jpg)*Dr. Betchen is a board-certified neurosurgeon. She currently practices at Maimonides Medical Center in Brooklyn and is proud to have served the community there for a decade now. Dr. Betchen received her medical degree from Johns Hopkins Medical School. She did internship and neurosurgery residency at Mt. Sinai Hospital in New York City. After completing a neurosurgical oncology fellowship at Memorial Sloan-Kettering Cancer Center she made the big move south to Brooklyn where she now treats a wide variety of clinical problems in both the brain and spine including tumors, hydrocephalus, chiari malformation, herniated discs, and spinal stenosis. Her research interests are in clinical outcomes and quality of life with neurosurgical treatment. Outside of the hospital she is married with two children.* *Dr. Betchen is a member of the Congress of Neurological Surgeons, the American Association of Neurological Surgeons, Women in Neurosurgery, and a Fellow of the American College of Surgeons. She serves on the board of the Brooklyn-Long Island Chapter of the ACS. She joined AWS at the time of initiation into the college and is thankful she made that choice. Joining has expanded my circle of successful, strong, and dedicated female surgeons across specialties and has given me a better view as to what great heights are achievable. I am honored to be the membership committee chair and entrusted with building the membership of this wonderful organization.*![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png)** *The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat” answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted by residents and fellows anonymously and will be answered by [AWS council members](http://www.womensurgeons.org/page/Leadership). This monthly blog is published the fourth Sunday of each month. We want to hear from you, if you are interested in submitting your anonymous question, use this [link](https://www.surveymonkey.com/r/BSW2VR2).* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, DearPat, education, family life, gender differences, mentorship, parenting, professionalism, residency, resources --- ### [Mental Health Awareness Month- Beyond Resilience](https://blog.womensurgeons.org/beyond-resilience/) **Published:** May 30, 2018 **Author:** Blog Team **Content:** Across the United States, organizations and individuals are recognizing Mental Health Awareness month, shedding much needed light on an issue that affects nearly [1 in 5 US adults every year](https://www.nami.org/learn-more/mental-health-by-the-numbers). Rates of mental health distress among healthcare professionals are even higher, with a 2015 meta-analysis demonstrating a prevalence rate of nearly [30% among residents](https://jamanetwork.com/journals/jama/fullarticle/2474424) and 300-400 physicians [committing suicide every year](https://afsp.org/our-work/education/healthcare-professional-burnout-depression-suicide-prevention/) in America. Yet despite the attention the crisis has received, both within the medical community and in the general population, it persists. Much of the current discussion and wellness programming responding to this issue has focused on increasing resilience among trainees. [Suggested strategies](https://insights-ovid-com.proxy.uchicago.edu/pubmed?pmid=23442430) for improving resilience include promoting recognition of stressors, stress reduction through mindfulness training, and improving self-regulation of stress responses. But at what point is asking trainees and physicians to become more resilient simply adding another task to what seems to be at times an endless to-do list? And to what extent does the focus on resilience lead trainees to feel that they have ‘failed’ when they feel they are no longer able to be resilient, further adding to the stigma associated with seeking care for mental health disorders? In the long term, yes, we should be helping our medical students, residents, fellows, and even attending physicians to develop skills and habits that will help them cope with the stresses and challenges of a medical career. However, we also have to create a culture which recognizes that even resilience has its limits. Physicians and trainees need to feel empowered to seek treatment for mental health issues. However, [they often hesitate](https://www.washingtonpost.com/national/health-science/why-doctors-are-leery-about-seeking-mental-health-care-for-themselves/2017/01/06/b19bc4ba-ad02-11e6-a31b-4b6397e625d0_story.html?noredirect=on&utm_term=.277cae24ed79) due to barriers to seeking care such as repercussions during the medical licensing process, concerns about confidentiality, and difficulties scheduling counseling visits during typical clinic hours while also working 80 hours a week. A [paper](https://wire.ama-assn.org/education/5-things-institutions-can-do-prevent-resident-burnout) published in the Journal of Graduate Medical Education (JGME) describes five steps institutions can take to help prevent resident burnout. The second focuses on the need to build systems to confidentially identify and treat depression. While no single, comprehensive set of best-practices for building these systems has been developed, a number of institutions and organizations have come forth with solutions. On a national scale, the AMA’s [Steps Forward](https://www.stepsforward.org/modules/preventing-physician-suicide) includes some suggestions for systems-level practices, including making resources available on a webpage that does not require a password and will not track user visits. On an individual institutional level, [Oregon Health & Sciences University](http://www.ohsu.edu/xd/education/schools/school-of-medicine/gme-cme/gme/resident-fellow-wellness-program/index.cfm) has promoted confidential care by making it easily visible on their website that counseling visits are not documented in EPIC. We may also be able to learn from the many undergraduate institutions across the country who have developed [“Let’s talk”](https://health.cornell.edu/services/counseling-psychiatry/lets-talk) programs, providing students with confidential, free, drop-in counseling hours on campus. Providing a similarly styled, highly confidential counseling program at a discreet in-hospital location could provide residents of all specialities with a convenient access point to mental health care. While not a substitute for long-term care, it could help a struggling resident take that first step. Lastly, as the final point made by the authors of the JGME article mentions, we need to continue to foster efforts to learn more about resident wellness. Like in any other area of medicine – we need evidence based approaches to address these barriers to seeking care and reduce the stigma that continues to surround mental illness – the health of our patients and our own health depends on it. *If you are interested in learning more about physician wellness and suicide prevention, please refer to the February 2018 open letter from the AWS Communications Committee which contains a number of resources, found [here](http://blog.womensurgeons.org/leadership/open-letter-commcommteam/).* *If you or someone you know is going through a difficult time, please reach out for help.* - *Suicide Prevention Hotline **1-800-273-TALK (1-800-273-8255)** or text **TALK to 741741*** --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/05/hoefer.jpg)*Lea Hoefer is a fourth year medical student at the University of Chicago Pritzker School of Medicine. She is originally from Iowa, and completed her undergraduate education at Iowa State University. Her clinical interests include surgical oncology, clinical ethics, healthcare disparities, and increasing access to surgical care globally. She is excited to be continuing her training at the University of Chicago in the General Surgery residency program, beginning July 2018. Her twitter handle is @lehoef.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, resources, self-care **Tags:** Mental Health Awareness Month --- ### [The AWS Coaching Project](https://blog.womensurgeons.org/the-aws-coaching-project/) **Published:** June 3, 2018 **Author:** Blog Team **Content:** When I started my residency 7 years ago, not many people talked about physician depression, suicide, or burnout. It was like a dirty word, there, but hidden beneath the surface as many suffered silently. In the past few years, however, the topic of physician burnout has reached the forefront. It is hard to open twitter or even top medical journals without seeing a new article related to physician burnout. Burnout is defined as “feelings of emotional fatigue, cynicism and poor self-efficacy secondary to occupational stress”. Recent studies have shown high rates of burnout in surgery residents, up to 69% in one study 1, with higher rates in women. The drivers of burnout in women surgery residents may be different compared to their male colleagues and include gender bias, work-life balance stressors, and a challenge in finding effective mentorship in a field that is still lagging in promoting women to leadership roles. The question is: how do we address this to reduce rates of burnout in women surgeons to promote the AWS mission “to inspire, encourage, and enable women surgeons to realize their professional and personal goals”? The AWS has been fortunate to team up with a coaching expert from the Massachusetts General Hospital, [Dr. Kerri Palamara](https://twitter.com/palamaramcgrath?lang=en), to pilot a professional development coaching program through AWS. Her coaching program pairs faculty with residents to use positive psychology exercises to foster professional and personal development. She has implemented this nationwide with studies showing reduced rates of burnout 2. The AWS in conjunction with Dr. Palamara has been awarded a large grant to implement and study this program across AWS. The exercises will be specifically tailored towards women surgeons and the unique issues and adversities we face. All AWS resident and faculty members are welcome and encouraged to sign up. For more information about The AWS Coaching Project and to sign up, please go [here](https://www.womensurgeons.org/page/CoachingProject) 1. Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. Journal of the American College of Surgeons. 2016;223(3):440-451.Shanafelt TD, Hasan O, Dyrbye LN, Sinsky S, Satele D, Sloan J, West CP. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-13. 2. Palamara K, Kauffman C, Bazari H, Stone V, Donelan K. Promoting success: A professional development coaching program for interns in medicine. JGME. 2015; 7(4);630-7. 1 --- *![](http://blog.womensurgeons.org/wp-content/uploads/2015/03/AndreaMerrill-254x300.jpg)Dr. Andrea Merrill is a chief resident in general surgery at Massachusetts General Hospital. During her residency she did a year of breast surgery outcomes research followed by a yearlong editorial fellowship at the New England Journal of Medicine. Next year she will be starting a surgical oncology fellowship at the James Cancer Hospital at the Ohio State University. She is currently serving as the AWS Resident and Fellow Committee representative. You can find her on twitter at @AndreaLMerrill.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Summertime Safety](https://blog.womensurgeons.org/summertime-safety/) **Published:** June 13, 2018 **Author:** Blog Team **Content:** As a trauma surgeon, there are days of the year that we know will be busy calls. New Year’s Eve, Halloween, and the upcoming Fourth of July. It’s a good reminder that we all need to be safe and keep our loved ones safe over the summer. It’s also a good reminder that no matter what kind of physician or surgeon you are, you have a unique opportunity to bring messages of safety to your patients. As healthcare practitioners, the respect we get from the public and the position we have at anchor institutions in our communities puts us in the position of being able to spread public health messaging. For me, this includes safety messaging, but even if you’re not a trauma surgeon, take the opportunity to say, “Hey, it’s warm out. Don’t forget to be safe at the pool and to wear a bike helmet.” Or, print off some safety messages and brochures and leave them in your waiting room. This summer, let’s remember, for ourselves and remind our patients: - Children should never be left alone around water. Pools, lakes, ponds, and bathtubs are all drowning risks for children, and even capable swimmers are at risk of drowning. Even adults should never swim alone, and children must be watched at all times. Lifejackets should be worn when boating. Pools should have covers that can support the weight of a child, should be fully fenced and locked, and door alarms should be on all homes with pools. You can learn more about swimming pools safety at: <https://www.healthychildren.org/English/Pages/default.aspx> - Fireworks and firecrackers are fun, but need to be used with adult supervision. Fireworks should never be lit out of a hand, they should always be lit on a concrete surface with ample distance between the observers and the fireworks. Make sure not to wear loose clothes and always have water nearby. Consider glow sticks for small children instead of sparklers. To learn more on firework safety visit: <https://www.safekids.org/> - Bike helmets should be worn at all times, by adults and children when riding bicycles or scooters. Check your state for rules regarding children and motorcycle helmets, as some states require motorcycle helmets for children, and some do not. Despite your state laws, the safest way to ride a motorcycle or any recreational vehicle is to wear a helmet and appropriate clothing to protect from engine burns and road rash. If you need help finding a bike helmet, or if your patients want one for free, you can get one at: <https://helmets.org/cheapies.htm> - Bites, stings and sunburns can be prevented by using bug spray and sunscreen. Don’t forget, and reapply often! If you are hiking or live in an area where ticks are endemic, be sure to check yourself and any children in your care for tick bites. You can check if your area is endemic for ticks at: [https://www.cdc.gov/ticks/geographic\_distribution.html](https://www.cdc.gov/ticks/geographic_distribution.html) Please share the above links with your patients, family and friends, tweet them out from your personal accounts or the accounts for your practice or hospital. Have a great summer, have fun and be safe! --- *![](http://blog.womensurgeons.org/wp-content/uploads/2015/12/Bonne-picb-0715-200x300-200x300.jpg)Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force. Dr. Bonne is the current Communications Chair for the AWS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education, resources **Tags:** safety --- ### [An Intern’s Advice on Thriving through Fourth Year](https://blog.womensurgeons.org/an-interns-advice/) **Published:** June 20, 2018 **Author:** Blog Team **Content:** As I was entering my last year of medical school, I did not feel like I had a good source of information for navigating the demands fourth year, so I decided to write this post in hopes of providing my advice on how to be successful as a female medical student entering surgery. I have attempted to touch on all aspects of fourth year from away rotations to ERAS to interviews. I have also attempted to stress the importance of staying true to yourself as you conquer the exciting, yet challenging, year ahead of you. **Define your role.** Be straightforward in asking what is expected of you. Rotations as a fourth year student can be frustrating because you’re dying to show that you can take on more responsibility, but you’re limited by what you can do as a medical student. Try to see the positive in getting to focus on learning, with no true responsibilities. **Away or visiting rotations** are becoming more common and provide a great opportunity to see different programs. They can be very beneficial if you’re willing to work hard and make a good impression. Know the reason why you’re going to a particular program and what you want to get out of the experience (recommendation letter, connections, location close to a significant other, etc). You need to be 120% committed and should treat it like a month long interview. Even if you find out the program isn’t right for you or the program doesn’t offer you an interview, stick it out and give it your best every day. No one can fault you for that. On **ERAS**, the safest thing to do is apply broadly with programs distributed in a bell curve. Most applications should go to programs where you consider yourself an average applicant, and fewer applications to programs you consider your fall backs or reaches. Start working on ERAS early. It takes much longer than you would think to transfer information from your CV into their format. You want to have something in every category (research, work experience, volunteer experience). Remember that everything you list is fair game during interview season. Don’t lie or embellish your role. You need to be able to talk intelligently about your experiences and how they impacted you. **Have a pitch.** You are your biggest sales representative on your application and during interview season. Figure out what it is about you that will make a program want you–how are you going to make that program better, or how are you going to change your field for the better? And say it with confidence. **Ignore the “too’s.”** You’re too nice, too smart, too pretty, too something that makes people think you should try something else besides surgery. Only you know what’s right for you, so stand firm in your truth. There is no one way a surgeon looks, or acts, or talks. And that’s great! That diversity is what drives us forward as a field. So don’t ever think because you’re different, you can’t be a surgeon. **Interview attire:** conservative is always the way to go. It might help you to find something, a shirt or pair of earrings or shoes that when you put them on makes you feel like you’re ready to take on the world. For me, it was a coat that made me feel like my most Olivia Pope self. For the interview dinners, it’s better to be overdressed than under-dressed. **Be kind to yourself.** You’re going to meet people on the interview trail who blow you away, and it’s easy to start comparing yourself to them (especially because you know you’re being compared to them behind closed doors). But your accomplishments and path to surgery are just as valuable and worthy of being heard. It’s hard not to anchor your self-worth to your rank list. But remember you are more than which programs you list 1, 2 and 3. --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/06/ebarrett-196x300.jpg)Emily Barrett is a general surgery intern at the University of Michigan. She is originally from Arkansas. She completed her undergraduate education at Hendrix College, and her medical education at the University of Arkansas for Medical Sciences. Her clinical interests are surgical education, global surgery, and critical care. Her twitter handle is @Emily\_CBarrett.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, medical students, networking, professionalism, residency --- ### [Dear Pat responds to "Please Call Me Doctor"](https://blog.womensurgeons.org/please-call-me-doctor/) **Published:** June 24, 2018 **Author:** Blog Team **Content:** Dear Pat, I am a junior general surgery resident rotating at a new hospital. No matter if I’m wearing my badge which says MD in large letters or my white coat which also says MD on it, patients and staff continue to call me by my first name. I didn’t mind at first, but then I overheard the staff tell the patient that I would be coming in to evaluate them and referenced me by my first name to the patient. I understand I am a resident, but the male residents seem to be called doctor more often. I’m not sure how to politely address this issue. Don’t I deserve to be called doctor too? Sincerely, **Please Call Me Doctor** For this month’s #DearPat, AWS Council Member Dr. Marie Crandall shares her strategies in response to “Please Call Me Doctor.” Dear Please Call Me Doctor, This can be a really frustrating and insidious issue. On the one hand, staff may simply feel friendlier to you, hence more comfortable using your first name, which is somewhat flattering. On the other hand, staff are generally addressed by their first names and doctors by “Dr. LastName”, which might indicate the gender disparity to which you alluded. I have a few suggestions: - Always refer to yourself as “Dr. LastName” when introducing yourself to patients, even if someone else has just introduced you as “FirstName”. Do so with a friendly smile. Even if it feels like it’s for the 7000th time. - If you have any friends on the staff, maybe take them aside and ask them if they’ve noticed the fact you’re more likely to be called by your first name than male residents, and ask them for their help in changing this. You can say straight out, “I would really appreciate it if you referred to me as ‘Dr. LastName’ to our patients; especially since I’m a woman and young, I defy the doctor stereotypes. I think it’s important to ensure that patients know and trust me as their doctor.” This both acknowledges the important relationship that staff has with patients and enlists assistance for what can be an uncomfortable topic. - If you feel like any of this is intentional or that this is a pervasive institutional issue, you may want to engage administration, the GME (especially the Designated Institutional Official (DIO)), and other allies to address common themes such as implicit bias, gender discrimination, and bullying in the workplace. - If none of this works or isn’t feasible for your situation, you may feel as if your only choice is to wait it out. Fortunately, attitudes toward women physicians are gradually changing. Also fortunately, once you’ve been doing this for a while, you acquire this doctor aura that people can spot from a mile away (just like cops) and eventually even your family and friends will be calling you “Dr. LastName!” Sincerely, **Marie Crandall, MD, MPH** --- ![](http://blog.womensurgeons.org/wp-content/uploads/2016/04/Crandall-MD-Marie-2010-NMFF-214x300.jpg) Dr. Crandall is Director of Research and Professor of Surgery at University of Florida Jacksonville. Dr. Crandall is originally from Detroit, MI, a product of Head Start and local public schools. She obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley and attended medical school at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001. In 2003, Dr. Crandall completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA, where she also obtained a Masters in Public Health from the University of Washington. Dr. Crandall has been a member of AWS since residency. In 1996, surgical residencies were 20% women across the nation, so it was very encouraging to see the phenomenal achievements of other women surgeons. She began committee service as an attending, first serving on the Academic Practice Committee (now the Clinical Practice Committee), and subsequently served as Vice Chair, then as Chair of this committee. Currently, she is in the third year of a three year term as Guest Editor for the annual American Journal of Surgery issue highlighting Association of Women Surgeons research. This has been incredibly rewarding and has led to the publication of approximately 20 member-authored articles per year in AJS. Finally, she is currently serving a 3-year term as the AWS Liaison to the American College of Surgeons Women in Surgery Committee. She remains amazed and grateful at how incredibly supportive and instrumental to her career the network of women surgeons has been. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png) The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat” answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted by residents and fellows anonymously and will be answered by [AWS council members](http://www.womensurgeons.org/page/Leadership). This monthly blog is published the fourth Sunday of each month. We want to hear from you, if you are interested in submitting your anonymous question, use this [link](https://www.surveymonkey.com/r/BSW2VR2). Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** DearPat **Tags:** #HeForShe, AWS, communication, Dear Pat, ILookLikeASurgeon, Resident Mentor, workplace --- ### [What is the surgeon’s role in preventing gun violence?](https://blog.womensurgeons.org/surgeons-gun-violence/) **Published:** June 28, 2018 **Author:** Blog Team **Content:** During my pediatric surgery rotation, I distinctly remember taking care of a teenage girl who presented with a thoracic cord transsection and paraplegia after a drive-by shooting; she had previously lost both her parents to gun violence as well. It was disheartening to watch someone so young lose so much. In honor of National Safety Month, I have decided to devote this blog to a topic surgeons are unfortunately well familiar with: gun violence. On average, [96 Americans, including 7 children/teens](https://everytownresearch.org/gun-violence-by-the-numbers/), are killed with guns each day, and the numbers [increase each year](https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm) in the United States (US). Compared to other high-income countries, the US has[ 25.2 times more](https://journals.lww.com/jtrauma/Fulltext/2016/06000/Gun_violence_in_the_United_States___A_call_to.1.aspx) firearm related deaths. As surgeons, we are ready to respond with medical and surgical resources once gun violence victims enter our ED doors. However, we are limited with medicine/surgery alone to combat the detrimental effects of gun violence, as exemplified by the paraplegic teenager from my night on call. In the US, political and social factors influence gun violence mortality well before the bullet is fired. The modern interpretation of the 2nd Amendment is controversial and varies by state, social/racial disparities increase the risk of mortality from trauma including firearms, and federal funding for the investigation of gun violence is relatively underfunded, as recently mentioned by Dr. Copeland in a recent [AWS blog post](http://blog.womensurgeons.org/training/dickey/) .2 Given the complex political and social context underlying gun violence, we as surgeons may question our role in preventing gun violence: what is our responsibility and what if anything can we do about it? Shortly following the Parkland shooting earlier this year, the [ACS published an open statement](https://www.facs.org/quality-programs/trauma/violence-prevention) on the surgical community’s responsibility regarding gun violence prevention:. As “everyone’s problem,” the ACS Committee on Trauma (Cot) has created a Firearm Strategy Team (FAST) to implement three main areas of focus: legislation advocacy, research, and education. Legislation supported includes increased regulation of assault weapons as well as mandatory background checks. Education includes patient counseling on safe firearm ownership and the [Stop the Bleed](https://www.dhs.gov/stopthebleed) campaign designed to train civilians as first-responders to crises. Research goals include building a national firearm injury database in order to guide federal health policy. Although as surgeons we are inevitably limited by time and energy to address all the challenges we face, we are often the [sole primary healthcare providers](http://journalofethics.ama-assn.org/2018/05/msoc1-1805.html) for survivors of violence and thus we have a responsibility to screen and prevent disease witnessed as specialists in other fields do, such as gastroenterologists who screen for colon cancer or urologists who screen for prostate cancer.2 Hospitals have documented success attempting such interventions called violence intervention programs (VIPs) targeted at victims of violence and aimed at preventing injury recidivism.3,4,5 But, despite their documented success, VIPs are secondary prevention measures, and more needs to be done even further upstream—as outlined by the ACS COT FAST—to prevent inciting trauma. As surgeons we witness the devastating effects of gun violence every day; we owe it to our patients—past, present and future—to use our knowledge to address the root causes of gun violence in order to both prevent and treat this public health epidemic. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/06/broecker.jpg)*Justine Broecker is a first year surgery resident at Emory originally from Atlanta, GA. She completed medical school at Emory University and her undergraduate degree at UVA. Her twitter handle is @jasb805.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, education, leadership **Tags:** Gun Violence, Stop The Bleed --- ### [Meet the Association of Women Surgeons Blog Team](https://blog.womensurgeons.org/meet-the-blog-team/) **Published:** July 5, 2018 **Author:** Blog Team **Content:** The AWS Blog publishes material that is curated and edited to be relevant to our membership. We encourage discussion about issues faced by our membership. Our blog serves as a forum for our members to speak, and as such, statements made in the AWS Blog represent the opinions of the authors and are not necessarily the opinion of the Association of Women Surgeons. Meet the AWS Blog Team, a subcommittee of the Communications Committee and the individuals who work behind the scenes to bring you the AWS Blog content. **Medical Student Members** **Shree Agrawal** ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/Shree-Agrawal-Headshot-2018-261x300.jpg)Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and applying for Urology residency this fall. She has served as the Chair of the AWS National Medical Student Committee and blogs for AWS and Doximity. Shree is passionate about research surrounding patient decision-making and transitional congenital care. In her free time, she enjoys boxing, practicing yoga, and cooking. Twitter: [@ShreeAgrawal21.](https://twitter.com/ShreeAgrawal21) --- **Natalie Tully** ![](http://blog.womensurgeons.org/wp-content/uploads/2018/07/Natalie-Tully-243x300.png)Natalie is a fourth year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, Texas. She is a 2013 graduate of The University of Texas at Austin with a bachelors degree in Human Biology. Natalie is applying to general surgery residency this coming fall. She most recently served on the AWS Medical Student Committee as the National Chapter Coordinator and periodically writes for the AWS Blog. She is an avid runner, homebrewer, and #SurgBBQ fan, and you can find her on Twitter [@utully13](https://twitter.com/utully13). --- **Camila Guetter** ![](http://blog.womensurgeons.org/wp-content/uploads/2017/08/camila-199x300.jpg)Camila is originally from Curitiba, Brazil. She is a fifth-year medical student at Universidade Federal do Paraná in Brazil, and serves as general coordinator of a Trauma Surgery Interest Group at her institution. Camila received a one-year scholarship to study Biomedical Sciences at the University of California, Los Angeles. Subsequently she worked as a research student at Beth Israel Deaconess Medical Center studying pancreatic cancer, Hepatobiliary surgery outcomes, and patient education. Camila is passionate about pursuing a career in academic surgery and is very active in AWS. She is a member of the Publications and Communications committee, and is currently the Communications Chair of the National Medical Student Committee. You can find her on twitter at [@camila\_guetter](https://twitter.com/camila_guetter). --- **Resident Members** **Patricia Martinez Quinones, MD** ![](http://blog.womensurgeons.org/wp-content/uploads/2017/02/Dr-Patricia-Marinez-Quinones-240x300.jpg)Patricia Martinez Quinones is a general surgery resident at the Medical College of Georgia at Augusta University and a PhD student in Biomedical Sciences at Augusta University. She is originally from Ponce, Puerto Rico. Patricia received her MD from the University of Puerto Rico School of Medicine in 2010. As an undergraduate at Baylor University she studied Biology and Chemistry and was awarded Fellow of the Academy for Leader Development and Civic Engagement. As a graduate student Patricia is studying the innate immune system activation after traumatic injury and she hopes to continue her career path in academic trauma and critical care surgery upon completion of residency. Patricia has been an AWS Blog Committee member since 2017 and serves as resident mentor for the AWS medical student chapter at Augusta University. She enjoys spending time with her husband, her dog Lady, running obstacle course races and is training for her first half-marathon this year. You can find her on Twitter at [@PMartinezMD](https://twitter.com/PMartinezMD). --- **Sristi Sharma, MD, MPH** ![](http://blog.womensurgeons.org/wp-content/uploads/2017/09/sristi-6-300x202.jpg)Sristi Sharma is a General Surgery Resident at University of Colorado, Denver. She is a previous Paul Farmer Global Surgery Research Associate, Harvard Medical School, a graduate of Johns Hopkins University where she got her MPH and a proud alum of Sikkim Manipal University, India from where received her MD degree. She is an passionate about advocating for global surgery. She was born in the Himalayas and is a Gorkha to the core. She loves travelling and most of her travel destinations are centered around food and coffee. Twitter: [@drsristisharma](https://twitter.com/drsristisharma). --- **Faculty Advisor** **Minerva A. Romero Arenas, MD, MPH** ![](http://blog.womensurgeons.org/wp-content/uploads/2018/07/Minerva-Romero-300x298.png)Minerva A. Romero Arenas is an Endocrine & General Surgeon at the [University of Texas Rio Grande Valley](http://www.utrgv.edu/som/surgery/index.htm). She completed a fellowship in Oncologic Surgical Endocrinology at the UT MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She received her MD and MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate. Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. She has been part of the blog team since its initiation in 2013. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations. She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, boxing and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones. You can find her on Twitter as [@minervies](https://twitter.com/minervies). **Categories:** resources **Tags:** AWS, AWSBlog, medical students, residents, surgery, Women in Surgery, WomenSurgeons --- ### [#Dearintern...tips for success that every surgical intern should know](https://blog.womensurgeons.org/dearintern-2018/) **Published:** July 9, 2018 **Author:** Blog Team **Content:** \#DearIntern, Welcome to one of the most wonderful vocations in the world. We have the ability to heal, to comfort, and to cure. It is both humbling and rewarding to walk into an operating room with the knowledge that the patient has entrusted us with this responsibility. Congratulations on taking the first steps toward being a surgeon! Here are some #TipsForNewDocs for success as you start out on your training: **You only get one first impression.** I was once told by a senior attending that people will only remember two things about your residency: how you start and how you finish. You will start forming your reputation within your department on day one of your residency. Work hard, be polite, be available, be enthusiastic, and, most of all, be honest. It is ok if you do not know how to do something… just say so, and someone will be happy to teach you. **Read!** Your patients are counting on you knowing how to care for them. Your intern year will serve as the foundation of your surgical knowledge. Read so that you can build a strong one, and to do well on the ABSITE and your future board exams. **In the operating room, be a sponge.** Watch everything and everyone. Pay attention to the small but often forgotten details. Read about procedures before you go to the operating room, and try to watch online videos of cases whenever possible. Scrub-in every chance you get. You may not be doing the big cases during your intern year, but the basics are the same for every case. Approach the patient with an abscess with the same enthusiasm that you would a patient undergoing a Whipple. **Be nice to everyone; the golden rule is not just for kindergarten.** Get to know the nurses, techs, janitors, and everyone in between. Diversity is a crucial part of what makes our job so much fun, with no role in the hospital being more important than any other. Intern year is tough and at times you may want to snap. Don’t. Take a deep breath and remember that the person on the other end of the phone at 3 am is also tired and is calling for your help. **Professionalism**. You are a professional now. Show up looking the part. Dress to impress. Be punctual to clinics and the operating room. Complete notes, discharge summaries, and case and hour logs in a timely manner. Respond to pages and emails in a timely manner. **Identify a mentor.** I have had multiple mentors at different stages of my career. These relationships and the advice I have received are my most valuable career assets. Mentorship will be essential as you progress through residency and choose a specialty. See [previous AWS blogs](http://blog.womensurgeons.org/?s=mentor) on the topic of mentorship for more advice. **Take care of yourself!** If you are not well, you will not be able to care for others. This includes both physical and emotional wellness. According to the most recent [2018 Medscape National Report On Physician Burnout And Depression](https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235), nearly two-thirds of U.S. physicians report feeling burned out, depressed, or both. If you are depressed or feeling overwhelmed or burned out, you are not alone. Talk to someone. Get help early. Inquire about resources your program has available to residents struggling with emotional wellness. Additionally, the [American College of Surgeons](https://www.facs.org/member-services/surgeon-wellbeing) provides resources available to members. Make time for your friends and family and be sure to spend time doing things that make you happy. Remember, “Happiness is not a goal…it’s a by-product of a life well lived.” ― Eleanor Roosevelt For more information on how to participate in a Tweetchat and other Twitter tips, here is a previous blog by Heather Yeo: <http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/> **The joint Tweetchat will take place 7/16/18, 8 pm EST. It is designed to help new interns in surgery to gain tips for success in surgery now and in the years to come. To participate, be sure to follow @womensurgeons and @RASACS as well as the moderator for this chat @KylaTerhune and to tag all of your tweets with the hashtags #AWSChat and #DearIntern** ![](http://blog.womensurgeons.org/wp-content/uploads/2018/07/RHilton-206x300.jpg)Dr. L. Renee Hilton is an Assistant Professor at the Medical College of Georgia at Augusta University Medical Center. She is the Director of Bariatric Surgery as well as the Center of Obesity and Metabolism at Augusta University. She is also the Associate Program Director for the general surgery residency program. She completed her general surgery residency at Jackson Memorial Hospital at the University of Miami in Miami, Florida and then fellowship in bariatric and minimally invasive surgery at Yale University. She serves in multiple leadership roles within the department including being the director of the residency surgical skills lab and Chair of the Surgical Simulation Committee. She currently resides and practices in Augusta, Georgia. You can find her on [Twitter](https://twitter.com/DrKathyHughes) @reneehilton30 and [Facebook](https://www.facebook.com/profile.php?id=100007134646929). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** AWSChat, ILookLikeASurgeon, medstudents, residents, Teamwork, Tweetchat, work ethic, workplace --- ### [Closing the Gap: Making History at Tulane](https://blog.womensurgeons.org/making-history-at-tulane/) **Published:** July 11, 2018 **Author:** Blog Team **Content:** Gender disparities and inequality in the workplace has been a subject of much discussion in the past century. Thanks to the relentless struggle and arduous fighting that many men and women have ignited, female surgeons presently stand light years away from some of the struggles our predecessors faced. The medical profession has been privy to a significant increase in number of women that have joined male counterparts in their oath to help and advocate for patient health and wellbeing. Women surgeons have risen through the ranks in a traditionally male-dominated field and have amassed positions of authority and influence in some of the most renowned institutions. Notwithstanding, as of 2017, women comprise only 29% of all full-time faculty and 10% of full professors. In spite of these surprising statistics, in the last decade we have witnessed the strengthening presence of women in surgery with three ACS presidents in the past seven years and an increase from four female chairs in 2014 to [twenty-two in 2018](https://www.womensurgeons.org/page/FemaleSurgeryChairs). In 2019, for the first time, a general surgery program will graduate five female chief residents under the mentorship and tutelage of both [Dr. Mary Killackey](https://medicine.tulane.edu/departments/surgery-program-medical-ethics-and-human-values-adjunct/faculty/mary-t-killackey-md), Chair, and [Dr. Rebecca Schroll](https://medicine.tulane.edu/departments/surgery-simcenter/faculty/rebecca-schroll-md), Program Director, at Tulane University. The best part about this is that this is only the start! As it stands, [Houston Methodist](https://www.houstonmethodist.org/education/medical/graduate-medical-education/general-surgery-residency/) is to follow suit in 2020 graduating not five, but six female chief residents under the direction of [Dr. Barbara Bass](https://www.facs.org/media/press-releases/2016/bass120616), Chair and current ACS President, and [Dr. Sylvia Martinez](https://www.houstonmethodist.org/doctor/sylvia-martinez/), Program Director. When I reflected on the significance of this achievement, Neil Armstrong’s famous words came to mind. Thanks to the sacrifice thousands of women have made in order to serve patients in need, we each have taken one step forward towards what today is a giant leap for women in Surgery. During my [surgery residency at Tulane](https://medicine.tulane.edu/departments/surgery/academic-programs/general-surgery-residency), we have prided ourselves in having a prominent female resident presence, yet, after conversing with Dr. Killackey, I realized this wasn’t just about numbers and ratios. The true accomplishment lies in a cultural transformation within the Tulane medical community where female leaders have begun to be seen as the norm and not the exception, and where expecting and achieving greatness as surgeons occurs irrespective of gender. Unfortunately, this changing environment and transformation in attitudes and perceptions is not uniform across the board. Much has been accomplished thus far, but there remains a long road ahead. I hope that with the continued dedication and collaboration of women in Surgery, independent of title or position, the gap in gender inequality will be eradicated. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/07/Tulane-Chiefs-300x201.png) **2019 Tulane University General Surgery Chief Residents** (Left-to-Right) Dr. J Ochoa, Dr. M Martin, Dr. A Smith, Dr. M Killackey, Dr. R Schroll,Dr. M Llado-Farrulla, Dr. S McChesney --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/07/Monica-Llado-198x300.png)Monica M. Llado-Farrulla is a general surgery resident at Tulane University in New Orleans, Louisiana. She was born and raised in San Juan, Puerto Rico. Monica pursued her undergraduate studies at Boston College where she obtained a Bachelor’s in Biology and Chemistry. She subsequently returned to Puerto Rico to receive her MD from the University of Puerto Rico School of Medicine. Monica loves spending time with her pets, woodworking, car mechanics, and exploring new restaurants. She will be attending University of Pennsylvania for her fellowship in Plastics and Reconstructive Surgery starting in 2019. You can find her on Twitter at [@MFarrulla\_MD](https://twitter.com/MFarrulla_MD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** AWS, Gender Disparities, ILookLikeASurgeon, Resident Mentor, residents, Women in Surgery, WomenSurgeons --- ### [Matching into a competitive surgical program: What you should know](https://blog.womensurgeons.org/matching-into-competitive-surgical-program/) **Published:** July 20, 2018 **Author:** Blog Team **Content:** ***“**Two roads diverged in a wood, and I—*** ***I took the one less traveled by,*** ***And that has made all the difference.”*** ***– Robert Frost*** In retrospect, the past year has been one of pain, uncertainty, and great transformation. The months after my homeland of Puerto Rico was [struck by hurricane Maria during my surgical away rotations ](http://blog.womensurgeons.org/medical-students/handties-heartbreak-pr/)was one of great introspection, resilience, and metamorphosis. I am proud to say now that despite all the hardships, and despite the odds, I matched into my desired surgical specialty: urology. When I became interested in surgery, I found it hard to know what to do to become a competitive applicant. If you are medical student with an interest in surgery (or a surgical specialty), here are some important aspects to consider as you start your journey: **1. Don’t be afraid to test the waters early** When I became interested in surgery during first year of medical school, I began to seek opportunities to spend time in the operating room and meet the surgery residents at my institution. The benefits of these early interactions are three-fold: gain exposure to the OR before third year clerkships, networking, and exposure to diverse surgical specialties. To my surprise, it was during these early experiences that I met one of the urology attendings who became my mentor two years later. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/07/MMartinez_Match-300x225.jpg)**Match day! When I found out I was going to become a urologist.** **2. Become an active member of national professional organizations** Professional organizations such as the Association of Women Surgeons (AWS) provide a great venue to meet women surgeons who can become great role models, sponsors and mentors. I highly encourage you to[ join AWS](https://www.womensurgeons.org/page/Students) and/or to start a [AWS chapter at your institution](https://www.womensurgeons.org/page/Students). Other organizations where I found great support and mentorship are LMSA and NHMA. Seek opportunities to actively participate in national conferences, committees or initiatives where you can meet potential mentors. **3. Mentorship is crucial** You will be surprised how far these mentorship relationships can take you! From general residency application advice to helping you secure clerkships at highly competitive programs. Do not limit your mentors to attendings within your surgical field of interest. The most valuable mentor I have is not a urologist, she is a general surgeon. I am confident that without her guidance and her constant support I wouldn’t be where I am today. I invite you to take advantage of the AWS [Find a Surgeon Tool](https://www.womensurgeons.org/search/custom.asp?id=4841) to find a surgeon and AWS member near you. For advice on fostering your mentor-mentee relationship read: [The Four Golden Rules of Effective Menteeship](http://careers.bmj.com/careers/advice/The_four_golden_rules_of_effective_menteeship). **4. Don’t be afraid to step out of your comfort zone** During fourth year clerkships, be strategic about where you conduct your rotations. These are great opportunities to gain exposure, learn more about the program, and possibly get a strong letter of recommendation. A good letter from a good surgical program director can go a long way during applications. Don’t be afraid to do away rotations in cities or programs that you had not considered before. An excellent resource to learn about surgical residency programs is [FREIDA Online from the AMA](https://www.ama-assn.org/life-career/search-freida-online-ama-residency-fellowship-database). **5. You will be entering a male-dominated profession. Do it proudly! We all contribute to change the trend** It is no secret that surgery has been (and still is) a field dominated by men. Statistics from the [Medscape compensation report ](https://www.medscape.com/features/slideshow/compensation/2016/female-physician#page=1)show that male physicians (65%) are more likely to pursue surgical training than female physicians (35%). According to the AWS, in 2015 [19.2% of surgeons in the US were women](https://www.womensurgeons.org/page/AboutAWS) and women in surgery still earn [8% ](https://www.womensurgeons.org/page/GenderEquity?)less than their male counterparts. The [AAMC Physician Specialty Databook 2014](https://members.aamc.org/eweb/upload/Physician%20Specialty%20Databook%202014.pdf) estimates that only 38% of general surgery residents are women. The [American College of Surgeons ](http://www.acshpri.org/documents/ACSHPRI_Surgical_Workforce_in_US_apr2010.pdf)has shown that the gender disparity is greater among surgical fields such as urology and orthopedic surgery (Figure 3). Despite, being in minority we have proven to deliver exceptional care to our patients. A recent [study](http://time.com/4975232/women-surgeon-surgery/) published in BMJ, suggested that female surgeons had lower death rates, complications, and lower post-surgical readmission rates compared to their male counterparts.Currently, more women are pursuing careers in surgery and are gaining more visibility with the viral sensation of [\#ilooklikeasurgeon](http://bulletin.facs.org/2015/11/ilooklikeasurgeon-goes-viral-how-it-happened/#.WzGykRL0now) and the [replicas of the New Yorker Cover](https://www.newyorker.com/culture/culture-desk/the-new-yorker-cover-thats-being-replicated-by-women-surgeons-across-the-world) across the world. I encourage you to join the increasing trend of women becoming the new faces of surgery in the US. After all, it is up to us to pave the way for women who aspire to become the surgeons and healers of tomorrow. ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/MarielaMartinez_Photo-275x300.jpg)Mariela R. Martinez Rivera is a Urology Resident in NY. During her medical training, Mariela became a recipient of the American Medical Association (AMA) Minority Scholar Award and has been inducted as Junior Member of the Alpha Omega Alpha and Gold Humanism Honor Society for her commitment to serve communities in Puerto Rico. She studied Biology at University of Puerto Rico Mayaguez where she conducted research in Genetics and Admixture of the Puerto Rican population. Mariela then completed a Masters Degree in Human Genetics at the University of California-Los Angeles where she received the prestigious Eugene Cota Robles Fellowship and the NSF Graduate Research Fellowship. She graduated from from Ponce Health Science University School of Medicine with honors. Her interests include urology, oncology, surgery, health disparities, health advocacy, non-profit leadership, genetics and molecular biology. A native from Puerto Rico, Mariela has spearheaded diverse initiatives to increase leadership and advocacy among Latinos throughout her involvement in the Latino Medical Student Association. She is also passionate about increasing the representation of women in medicine and in surgical fields. She enjoys painting, photography, and singing. Mariela also loves going to the beach and spending time with her family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** career development, Gender Disparities, ILookLikeASurgeon, Medical Student Members, medstudents, Resident Mentor, residents, Women in Surgery, WomenSurgeons --- ### [#BanTheBouffant](https://blog.womensurgeons.org/banthebouffant/) **Published:** July 27, 2018 **Author:** Blog Team **Content:** *By Mary L. Brandt* If you don’t work in an operating room, you may not be aware of the controversy going on about OR caps. To get right to the point – the surgeons think they should be allowed to wear the cloth hats they have worn forever. The Association of Operating Room Nurses (AORN) developed [guidelines](https://www.ncbi.nlm.nih.gov/pubmed/25645036) which included [covering the ears and all hair](https://www.ncbi.nlm.nih.gov/pubmed/28958316) (which means a bouffant paper hat). These guidelines were then implemented by [JACHO](https://www.jointcommission.org/) which means they became “law” in every hospital in the United States. ![](https://i2.wp.com/wellnessrounds.org/wp-content/uploads/2018/03/Screen-Shot-2018-03-17-at-6.10.26-PM.png?ssl=1)Anonymous surgeons demonstrating extremely effective covering of all hair with bouffant hats. I’m a real believer in evidence based medicine (and policies) so I decided, like others, to look into what is really known about the issue. Because it is a conflict of interest, I need to disclose that I can’t stand the bouffant hats and I really, really miss my (clean and washed) cloth hats. (which BTW cover all my hair!) ![](https://i0.wp.com/wellnessrounds.org/wp-content/uploads/2018/03/Screen-Shot-2018-03-17-at-6.14.15-PM.png?resize=584%2C545&ssl=1) **What do the data say about the use of bouffant hats and infection rates?** - [In a review of NSQUIP data of 6,517 patients, there was no difference in infection rates after the rules were put in place that required the use of bouffant hats.](https://www.ncbi.nlm.nih.gov/pubmed/29408507) - In a very satirical, but [evidence based review](https://wellnessrounds.org/2018/03/17/banthebouffant/Naked%20surgeons%253F%20The%20debate%20about%20what%20to%20wear%20in%20the%20operating%20room), which looked at the used of bouffant hats (no evidence they reduce infections), the authors also pointed out that naked surgeons would shed less bacteria than surgeons wearing scrubs. - In [a review of 15,000 cases](https://www.ncbi.nlm.nih.gov/pubmed/29447369), half done before the rule was implemented and half after, there was no change in surgical site infections (SSIs) - [The American College of Surgeons task force on operating room attire recommended the following](http://bulletin.facs.org/2016/10/statement-on-operating-room-attire/#.Wq2X58gh3SI): “During invasive procedures, the mouth, nose, and hair (skull and face) should be covered to avoid potential wound contamination. Large sideburns and ponytails should be covered or contained. There is no evidence to suggest that leaving ears, a limited amount of hair at the nape of the neck, or modest sideburns uncovered contributes to wound infections.” - A [study of 6210 patients](https://www.ncbi.nlm.nih.gov/pubmed/?term=Is+there+an+association+between+surgeon+hat+type+and+30-day+wound+events+following+ventral+hernia+repair%3F) undergoing hernia repair showed no difference in rate of infections based on the type of cap their surgeon wore during surgery. - In [a study of bearded surgeons vs clean shaven surgeons](https://www.ncbi.nlm.nih.gov/pubmed/?term=To+Beard+or+Not+to+Beard%3F+Bacterial+Shedding+Among+Surgeons.) there was no difference in bacterial shedding, suggesting that the new requirement for “beard hats” is not necessary. **Why don’t surgeons like bouffant hats?** **It’s harder to keep them in place when wearing loupes or headlamps.** If the goal is to keep the hair covered, this is a real problem. When moving headlamps, operating microscopes or loupes, [the bouffant hat often moves substantially – or even comes off entirely](http://bulletin.facs.org/2017/10/the-surgical-cap-symbol-science-argument-and-evidence/#.Wq2YgMgh3SI). **They are hot.** [Many surgeons feel (me included) that the bouffant hats are uncomfortable and are hot.](https://www.bostonglobe.com/business/2016/08/31/hat-wars-flaring/abr7FuB9EZna1FRtECDR1K/story.html) One can argue that anything that increases surgeon discomfort could affect concentration, which might be reflected in less focus on the operation. **Bouffant hats are expensive and bad for the environment.** On Amazon, 100 bouffant hats cost $7.45. There were [48 million inpatient operations performed in 2009](https://stanfordhealthcare.org/medical-clinics/surgery-clinic/patient-resources/surgery-statistics.html). When you add the [48 million outpatient procedures](https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf) performed, that means there are roughly 100 million operations performed per year. (Mind you, these data are almost 10 years old, so it’s likely to be more now). If we assume an average of 4 cases/day by an average surgical team (nurses, CRNA, anesthesiologist, assistants/resident) and they all wear their hat for the day, the number of hats needed per year would be 100 million cases x 6 members of the team = 600 million hats/yr. 600 million hats divided by 100/box = 6 million boxes x $7.45 = $44,700, 000. Over 44 million dollars a year for the bouffant hats… all of which (600 million/year) end up in a land fill or are incinerated. p.s. Given that hats are often changed during the day, this number is probably on the low side. **It affects morale.** In a [survey](http://bulletin.facs.org/2016/10/young-surgeons-speak-up-stringent-or-attire-restrictions-decrease-morale-without-improving-outcomes/#.Wq2V9Mgh3SI) of young (<45 years of age) surgeons, 71.2% stated that the new rules had affected surgeon morale. **They are inferior in blocking bacteria when compared to other caps.** In [a study of bouffant hats, disposable skull caps and cloth hats](https://www.ncbi.nlm.nih.gov/pubmed/?term=Hats+Off%3A+A+Study+of+Different+Operating+Room+Headgear+Assessed+by+Environmental+Quality+Indicators.), the bouffant hat was the worst in preventing airborne bacterial contamination in the operating room. “I expect our findings may be used to inform surgical headgear policy in the United States,” he said. “Based on these experiments, surgeons should be allowed to wear either a bouffant hat or a skullcap, although cloth skull caps are the thickest and have the lowest permeability of the three types we tested.” [Troy A. Markel, MD, FACS](https://www.facs.org/media/press-releases/2017/markel) ![](https://i2.wp.com/wellnessrounds.org/wp-content/uploads/2018/03/Screen-Shot-2018-03-17-at-6.17.16-PM.png?ssl=1)[Photo credit](https://www.generalsurgerynews.com/In-the-News/Article/05-17/Surgical-Caps-Get-Clean-Bill-of-Health/41337) I’m confident that in the very near future we will be back to wearing our clean, cloth hats. When you look at the data, and weigh the pros and cons, it seems pretty obvious what needs to be done…. This article was originally posted on [Wellness Rounds](https://wellnessrounds.org/2018/03/17/banthebouffant/) on March 17, 2018. ![4171_1095770688051_1640107282_214823_5256875_n1](http://blog.womensurgeons.org/wp-content/uploads/2016/09/4171_1095770688051_1640107282_214823_5256875_n1-234x300.jpg) *Mary L. Brandt, M.D. is Professor of Surgery, Pediatrics, and Medical Ethics at Baylor College of Medicine and a practicing pediatric surgeon at Texas Children’s Hospital. She has held numerous educational roles including Program Director of General Surgery and Senior Associate Dean of Student Affairs. She actively [blogs](http://wellnessrounds.org/about/) and [tweets](http://twitter.com/drmlb) about medical education and self-care for students, residents and practicing physicians.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** guest blog **Tags:** safety, workplace --- ### [Dear Pat responds to Surgical Oncology Hopeful](https://blog.womensurgeons.org/surg-onc-hopeful/) **Published:** July 29, 2018 **Author:** Blog Team **Content:** Dear Pat, I am a second-year general surgery resident interested in a surgical oncology fellowship. I come from a community general surgery program without the opportunity for basic science research or research years. What can I do to make myself a competitive candidate for surgical oncology fellowship interviews? Sincerely, *Surgical Oncology Hopeful* Dear “Surgical Oncology Hopeful”, Surgical training programs are highly variable in terms of requirements and/or availability of research opportunities (basic, translational, and clinical). Those differences are taken into account when reviewing an applicant for a fellowship position. For example, expectations of accomplishments for someone at a training program with 2-year research programs built-in will be very different than for someone coming from a community program. Having said that, what sets you apart from other applicants is what you have achieved. Retrospective charts reviews can be conducted without dedicated research years. They should be completed, presented at national meetings and translated into a published manuscript. A small case series of a novel topic may not even require IRB approval at many institutions and can be easily completed. Additionally, think outside the box – a survey of trainees, recent graduates from your program, and current faculty can be created by you to investigate a plethora of topics. Examples could include: generational differences in learning (social media, podcasts vs didactic lectures, textbooks), perception of instruction vs guidance in the operating room – how to teach judgment vs technique, assessment of burnout at various years of training / practice, etc. Perhaps your training program has an opportunity for an away elective or volunteerism in a 3rd world country. Make the most of this opportunity by preparing in advance a survey comparing differences between your training program / hospital environment / resources. Alternatives to research include: developing a skills session for medical students interested in surgery, a guidebook with tips and tricks for successful internship, or building a mentoring program for junior residents. You may also consider seeking resident membership in the professional society for the fellowship field in which you are interested. Resident membership often opens up many opportunities for networking and mentoring which may also lead to collaborations in your field, and with people at institutions that may have research opportunities more readily available. The key to a competitive application is to have items on your CV that separate you from everyone else with the same inservice, STEP scores, and glowing letters of recommendation. Show success by completing the task, making the most of your training environment and opportunities, demonstrating team building and leadership, and thinking outside the box. Showcase your uniqueness. Sincerely, *Christine Laronga, MD, FACS* --- ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/CLaronga-150x150.jpg)*Christine Laronga is a Senior Member at Moffitt Cancer Center and a Professor of Surgery at the University of South Florida and specializes in disease of the breast. She joined the Association of Women Surgeons as a resident and has been an active member for over a decade. She is also the Immediate Past President. Follow her on Twitter* [*@clarongamd*](http://twitter.com/@clarongamd)*.* --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png)The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat” answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted by residents and fellows anonymously and will be answered by [AWS council members](http://www.womensurgeons.org/page/Leadership). This monthly blog is published the fourth Sunday of each month. We want to hear from you, if you are interested in submitting your anonymous question, use this [link](https://www.surveymonkey.com/r/BSW2VR2). *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** DearPat **Tags:** AWSFood4Thought, Dear Pat, fellowship, residency, Resident Mentor, Women in Surgery, WomenSurgeons --- ### [The Keyboard is Mightier than the Sword](https://blog.womensurgeons.org/keyboard-mightier-than-the-sword/) **Published:** August 3, 2018 **Author:** Blog Team **Content:** *By Suzanne M. Murphy* In a world where most people are connected on one or more social media platforms, the power of a social media campaign has never been higher. It is estimated that in 2019, 2.77 billion of the world’s population will be on social media, this figure is up from the 2017 figure of 2.46 [billion](https://www.statista.com/statistics/278414/number-of-worldwide-social-network-users/). Facebook alone has 1.86 billion active [users.](https://www.statista.com/statistics/278414/number-of-worldwide-social-network-users/) This offers huge potential for sharing of information and ideas. Health systems do not tend to tap into this market when launching health education programmes. Individual pages for various support groups have a wealth of information on their area of relevance but there are few pages offering comprehensive health information. The Health service executive (HSE), Ireland’s public system, has a [facebook page](https://www.facebook.com/HSElive/) which offers a lot of information about the various health campaigns currently being undertaken by the HSE. However the page has just over 85,000 likes, while the estimated number of Irish people actively using Facebook is estimated to be 2.2 million, more than 50% of the [population](http://www.thejournal.ie/ireland-facebook-breakdown-1215572-Dec2013/). This is just one example of how a health service is not doing enough to engage with their service users. Since the launch of the Human papillomavirus (HPV) vaccine in Ireland and in the United Kingdom (UK) in 2008, there has been a rapid decline in the uptake of the [vaccine](http://www.thejournal.ie/hpv-vaccine-8-3572223-Aug2017/) . This can be partially attributed to the power of various social media groups. The vaccine has been approved by the World Health Organization, the International Federation of Obstetrics and Gynaecologists and the National Immunisation Advisory Committee. However uptake of the vaccine dropped from from 90% to just 50% across [Ireland](http://www.thejournal.ie/hpv-vaccine-8-3572223-Aug2017/). Various groups objected to the addition of the vaccine to Ireland’s childhood vaccination schedule. Groups were predominantly organised by parents who feel that their daughter’s health has suffered since receiving the vaccine. They believe the vaccine is associated with chronic fatigue syndrome, complex regional pain and postural orthostatic tachycardia. [Multiple studies ](https://doi.org/10.1503/cmaj.170871)[regarding side effects](http://www.jahonline.org/article/S1054%E2%80%90139X(17)30701%E2%80%902/fulltext) of the[ HPV vaccine](https://doi.org/10.1093/infdis/jiy075) have found [no correlation](https://doi.org/10.1007/s40264%E2%80%90017%E2%80%900625%E2%80%90z) between the vaccine and the conditions [above ](http://www.who.int/vaccine_safety/committee/topics/hpv/en/). However the strong social media influence of the groups against the vaccine had a wide reach and the influence of this on the decline in vaccine uptake is not something that can be dismissed. Similarly, In 1998, a doctor in the UK, Andrew Wakefield, along with several other authors published a case series in the Lancet suggesting a link between the Measles, Mumps and Rubella (MMR) vaccine and autism. The research was quickly disproved and the [Lancet ](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/abstract)retracted the paper. The medical paper got so much media attention at the time, that there led to a global decline. It took more than a decade for the numbers of people vaccinating their children to return to how they were prior to the paper’s [publication](https://www.telegraph.co.uk/news/health/news/9705374/MMR-uptake-rates-finally-recovered-from-Wakefield-scandal-figures-show.html) . Now in 2018, Wakefield’s claims are still being shared by the public on social media sites, highlighting how social media can allow a set of beliefs to persist. For many individuals the internet and social media can be the first port of call when they have concerns regarding their health. There are a lot of individual charities and support groups doing fantastic work in sharing factual, accessible information about a variety of conditions. However a gap persists for health services who wish to promote better health. Nowadays, as social media plays an important role in information sharing (correct information or not), healthcare campaigns are many times put in jeopardy. HPV and MMR vaccines are just two examples of the potential influence of social media. However it should be noted that the power of social media is not limited to just vaccinations. Social media can allow for the promotion of new treatment options available that patients may not otherwise be aware of. This is particularly useful in more rural communities, where patients may not have the same access to the newest information and technologies.Furthermore it provides a forum for patients and their loved ones and carers, who may not be in a position to attend support groups. Group therapy can be hugely beneficial for helping the sense of isolation that can often accompany a chronic illness. It also allows for the sharing of ideas and research amongst colleagues. Going forward doctors and health systems will need to consider a new approach to health campaigning. An effort should be made to share information across all social media platforms. Perhaps, each health service should consider having a social media manager who, through liaison with healthcare professionals, can ensure the safe and effective sharing of knowledge. They should be clear, concise, and written in an easy language, so that everyday people with little or no medical knowledge may understand and spread the information. This will allow them to be in charge of their own health. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/08/Untitled.png)Suzanne Murphy is a fourth year medical student in the Royal College of Surgeons Ireland (RCSI) . She originally trained as a general nurse at Trinity College Dublin in 2011. In 2014, she completed a postgraduate diploma in tissue viability from RCSI before returning to RCSI fulltime in 2015 as a medical student. Suzanne is interested in pursuing a career in neurosurgery and her research interests include epilepsy and hydrocephalus. She is currently the director of RCSI’s student run journal, RCSI Student Medical Journal). You can find her on twitter at @suzannemmurphy1. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized **Tags:** Healthcare, social media --- ### [Not All Surgeons Fit the Stereotype](https://blog.womensurgeons.org/not-all-surgeons/) **Published:** August 9, 2018 **Author:** Blog Team **Content:** I recently went to my high school reunion where a classmate said to me “you seem too nice to be a surgeon”. It was a reminder to me that the stereotype of the mean, angry surgeon as recently discussed in the[ AMA Journal of Medical Ethics](https://journalofethics.ama-assn.org/article/evolving-surgeon-image/2018-05) is present outside of the medical field. I first learned about this stereotype as a medical student, and was surprised since my own experiences as a surgical patient were very different from what is perpetuated in popular culture and surgical lore. My first memory of meeting with a surgeon was at age twelve when I was told that my spine had a curvature seen on a chest x-ray for pneumonia. I was referred to see an Orthopedic Surgeon at my local academic medical center. We went through a series of steps that day starting with specialized x-rays to further examine the abnormal curvature of my spine. Finally, I met with Dr. Stuart Weinstein and a plethora of orthopedic trainees and students. Noting my nervousness at being examined by a crowd, he sat down and explained that I would contribute to their education if I allowed them to participate in the visit. He emphasized that it was my choice. Not only was he compassionate and patient, this doctor was talking directly to me and making the visit about me rather than my parents. I stopped feeling terrified and began to feel empowered. This was the beginning of a long journey of scoliosis treatment. Eventually I was given a back brace to wear 23 hours a day to try to stop my double curvature from progressing. I met with Dr. Weinstein every 6 months for the next several years to check the progress and my brace fit. Each time, he spoke directly to me with the same level of compassion encouraging me to continue activities like dance that would maintain a strong core. At some point, I learned that he was a renowned expert on my disease. Yet he approached me with the same humility even when I returned years later for a second opinion after another doctor recommended that I undergo surgery even printing research articles for me to read. My other encounter with a surgeon was for an elective jaw surgery. I met with Dr. Edward Lorson several times over the years leading up to my surgery which included bracing to correct my teeth which had grown crooked to compensate for a prognathic mandible. He patiently explained to me a technique for surgery involving the placement of screws in my jaw via small neck incisions that would allow me to avoid having my jaw wired shut for six weeks. It was a difficult decision for a 17-year-old and he addressed my concerns about having visible scars on my neck. He took the extra time necessary to counsel me regarding the pros and cons leading me to the best option in a shared decision-making fashion. As a surgeon, I now understand that this takes more time and patience than a paternalistic approach to informed consent. Being a patient is not easy even when treatment goes as planned. During my recovery from jaw surgery, I felt depressed and horrified at the swollen unrecognizable face staring back at me in the mirror. Dr. Lorson encouraged me to wash my tender face, get out of the house, and continue the protein-rich shakes to promote healing. It cannot have been easy to deal with me during that time, and I still appreciate his compassion and patience. Experiencing surgery first as a patient helps me to understand how important it is to maintain compassion and patience even when we are under stress ourselves. I am fortunate that my experiences as a young patient were marked by compassion, patience, and respect for me as an individual. As humans, we all have moments where we act in haste or say things out of anger that we regret. If we stop believing that this is the dominant behavior of surgeons, then we can begin to show patients and each other the same compassion that alleviated my concerns so many years ago. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/erdahl.jpg)Lillian Erdahl, MD, FACS is an Assistant Professor of Surgery at the University of Iowa where she practices Breast and General Surgery. She is also Associate Program Director in General Surgery; head of the Iowa City VA Breast Clinic; Communications Director for [@UIowa\_Surgery](http://twitter.com/uiowa_surgery); and involved in curriculum development for medical students, residents, and fellows. Her research interests include breast cancer prevention and treatment, faculty development, and surgical education. Her work for gender equity in medicine includes involvement in the Association of Women Surgeons as co-chair of the Twitter subcommittee and the [@PROWDWomen](http://twitter.com/prowdwomen) group. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** professionalism **Tags:** communication, Healthcare, humanism in medicine, ILookLikeASurgeon, Teamwork, work ethic --- ### [The Changing Face of Medicine: Part Two](https://blog.womensurgeons.org/changing-face-medicine-two/) **Published:** August 12, 2018 **Author:** Blog Team **Content:** ![](http://blog.womensurgeons.org/wp-content/uploads/2018/08/IMG_3876-169x300.jpg)We are celebrating five years of the [AWS Inspiring and Encouraging Women Surgeons Blog](http://blog.womensurgeons.org/)! First of all, we want to thank all of our members for contributing to the blog. You have shared your wins, hopes, concerns with us through candid pieces on the experience of being a Woman Surgeon. When we started this blog in 2013, there were not many surgeons on social media or blogging yet. It would be an understatement to say we are proud of the success of our blog and how engaged our members and audience has become. We have grown from monthly pieces to bi-weekly and now weekly scheduled posts. We have also introduced special interest pieces like #AWSFood4Thought touching on current events and #DearPat which was introduced by the Residents & Fellows in AWS. We have seen a radical change in the face of medicine. In 2017, a record 10,810 women matriculated into medical schools across the US, marking the [first time that women surpassed the number of male medical students](https://www.aamc.org/download/321470/data/factstablea7.pdf) (10,516). Furthermore, we have seen a growing presence of physicians in social media. Our community has found a way to stay connected beyond annual meetings to ongoing virtual interactions via e-journal clubs, tweet chats, and blogging. We saw the rise of movements like #ILookLikeASurgeon, the #NYerORCoverChallenge, and #HeForShe. Recent reports suggest that [women physicians can benefit professionally from a healthy social media](http://mededu.jmir.org/2018/2/e11140/) presence. In 2014, HCLDR opened up its weekly Tuesday night chats on healthcare leadership to discuss the increasing presence of women leading to the [Changing Face of Medicine](https://hcldr.wordpress.com/2014/05/07/changing-face-of-medicine/) HCLDR chat. It was the first time many participants had engaged on that topic on Twitter and in a tweetchat format, particularly members of our professional medical organizations like [AWS](https://twitter.com/womensurgeons?lang=en), [AMWA](http://twitter.com/amwadoctors), and [WITS](https://twitter.com/womeninthoracic?lang=en) supported & participated in this inaugural chat. Four years later, we have a strong monthly #AWSchat and we would like to celebrate by partnering up with HCLDR again. Join us on Tuesday August 21, 2018 at 830pm EST/530pm PST to discuss the ongoing changes to the face of medicine. Look for the questions from both the [@WomenSurgeons](http://twitter.com/womensurgeons) and [@HCLDR](http://twitter.com/hcldr) handles during our one hour online discussion. Be sure to follow me, [@minervies](https://twitter.com/minervies) as guest moderator for this celebratory tweetchat. We will be using both #HCLDR and #AWSchat hashtags so that the two communities can participate easily. 1. How has your social media presence positively impacted you on a professional level? 2. Has your social media community helped you deal with a real life issue? 3. In the time you have been on social media, how has your perception of or attitude towards issues faced by Women Surgeons and other minority groups changed? 4. What can we do to better engage with each other, the healthcare community, and patients on social media as well as in real-life? ![](http://blog.womensurgeons.org/wp-content/uploads/2018/07/Minerva-Romero-300x298.png)Minerva A. Romero Arenas is an Endocrine & General Surgeon at the[ University of Texas Rio Grande Valley](http://www.utrgv.edu/som/surgery/index.htm). She completed a fellowship in Oncologic Surgical Endocrinology at the UT MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She received her MD and MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate. Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. She has been part of the blog team since its initiation in 2013. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations. She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, boxing and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones. You can find her on Twitter as[ @minervies](https://twitter.com/minervies). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** Awareness, communication, hcsm, Healthcare, ILookLikeASurgeon, SoMe, Tweetchat, Women in Surgery, WomenSurgeons --- ### [Succession is the key for change](https://blog.womensurgeons.org/succession-key-for-change/) **Published:** August 16, 2018 **Author:** Blog Team **Content:** *By Susana Vargas-Pinto* I recently had a casual conversation about fellowship with one of our Chief residents who matched into cardiothoracic surgery, which lit up my curiosity and expectation. “*It is a great experience that will bring growth and maturity, you should look forward to it*”. These words came from an international medical graduate with a family, who didn’t match the previous year. How could this be such a great experience? During my fellowship interview trail I met many successful women surgeons who shared some of their career experiences with me. Although still a minority, these well accomplished women overcame the obstacles in their journey and are now empowering younger surgeons in their career paths. While reflecting on this I was curious to know more about the first female physician in the USA and her own journey. Was it different from ours? Since [Elizabeth Blackwell ](https://cfmedicine.nlm.nih.gov/physicians/biography_35.html)made history as the first female earning a medical degree from Geneva Medical College in Western New York in 1849, women continue to face challenges in their medical careers. Dr Blackwell held firm despite the prejudices of the time, lack of peer support and the financial struggles of establishing a clinical practice in New York City. The New York Infirmary for Women and Children served the underserved for over a century when it merged with the present Lower Manhattan Hospital in 1981. Dr Blackwell never fulfilled the dream of becoming a surgeon after contracting an eye infection while working as a midwife resulting in unilateral vision loss. Nevertheless, she opened a way for other women to become physicians when she founded the Women’s Medical College of New York and its affiliated hospital and by remaining faculty at the London School of Medicine for Women, also founded in collaboration with one of her mentees. In 2017, women composed [50.7% of medical students](https://news.aamc.org/press-releases/article/applicant-enrollment-2017/) matriculants according to the Association of American Medical Colleges. Women represented only [38.2 % of surgical residents ](https://www.aamc.org/download/481180/data/2015table2.pdf)and [23 % of full-time General Surgery faculty members](https://www.aamc.org/download/481182/data/2015table3.pdf) in the United States in 2015. Issues like parity and hostile work environments remain present 169 years later. We may not need to leave the country after obtaining a medical degree to practice as a midwife in Europe like Dr Blackwell did, but there are many challenges to face. Like Dr Blackwell, many women kept thriving, opening doors for those of us who embrace the journey to become a surgeon in the 21st century. They give to us, create new opportunities and reciprocation. When we invest in others our vision grows. The opportunity to influence the medical community over time and making a lasting impact does not rely on one individual but rather on the leaders they create. Dr Blackwell exemplifies the legacy of a successful leader which transcends over time after great adversity. By continuing to open doors for the next generation of female surgeons we ensure that our vision will expand beyond our own and change will continue to happen.Susana.jpg ![](http://blog.womensurgeons.org/wp-content/uploads/2018/08/Susana-238x300.jpg) Dr. Susana Vargas-Pinto was born and raised in Puerto Rico. She obtained a Bachelor’s Degree in Industrial Microbiology from the University of Puerto Rico at Mayagüez, Puerto Rico. She then earned her Medical Doctorate from Ponce Health Sciences University in Ponce, Puerto Rico. She is a Chief Resident at the General Surgery Residency Program at the University at Buffalo, in Buffalo, New York, and intends to pursue a career in Endocrine Surgery. She enjoys teaching and mentoring medical students. Dr. Vargas-Pinto is also a wife and mother of a 2 year old. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, leadership **Tags:** AWS, Gender Disparities, ILookLikeASurgeon, womeninmedicine, womeninsurgery --- ### [What potential impact do surgeons have on breastfeeding?](https://blog.womensurgeons.org/impact-on-breastfeeding/) **Published:** August 23, 2018 **Author:** Blog Team **Content:** *By Nikki Mills* In celebration and recognition of breastfeeding awareness month, I decided to write an article for the Association of Women Surgeons weekly blog. Some female surgeons have first hand experience in breastfeeding, and many have stories about their own personal challenges and experience. For those that rely only on the education they received on the topic during their medical training, their knowledge may be quite limited. On the positive side, awareness is increasing on the broad-ranging benefits of breastfeeding for both Mum & Baby. Research in this area has increased exponentially in the last decade, and the wonders and complexities of breastmilk composition are continuing to unfold. [Antenatal education](http://www.who.int/elena/bbc/breastfeeding_education/en/) for mums is improving, and the [motivation and intention to breastfeed](https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.12376) is at an all-time high. Unfortunately, for a proportion of Mums, the breastfeeding journey does not progress as expected. When difficulties occur with breastfeeding, it can be a huge emotional and physical challenge for the dyad. In the last decade there has been wonderful research that has completely revolutionised our understanding of [biomechanics of sucking](http://www.pnas.org/content/pnas/111/14/5230.full.pdf) during breastfeeding. They have shown that babies extract milk from the breast [by vacuum](https://www.clinicalkey.com.au/#!/content/playContent/1-s2.0-S0378378215301584?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0378378215301584%3Fshowall%3Dtrue&referrer=) (NOT positive pressure) and that there is [no anterior tongue peristalsis](https://www.clinicalkey.com.au/#!/content/playContent/1-s2.0-S0378378207002538?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0378378207002538%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F18262736). This is quite different than the biomechanics of babies drinking from a bottle, upon which all previous biomechanics of breastfeeding was presumed. My PhD research (recently presented at the Academy of Breastfeeding Medicine Conference, Gold Coast, Australia) has shown (using flexible endoscopy during breastfeeding) that gravity (latching position) can be used to improve an infant’s ability to protect their airway during swallowing. We have been successful assisting breastfeeding babies with a variety of pathologies to be positioned at the breast for feeding in a manner that keeps them fully orally feeding when traditionally they would have been made nil by mouth because of aspiration risk. There is probably only a very small number of surgeons that would see infants with breastfeeding problems as their presenting problem, so the understanding of breastfeeding sucking and swallowing may be outside of the area of interest for most of you. However, when our patient happens to be a breastfeeding Mum or Baby – we as surgeons have a potential impact, even if the nature of our surgical procedure may seem unrelated. Failure to consider our potential disruption to the breastfeeding relationship may inadvertently cause unplanned weaning, or may lead to failure for a Mum with a newborn to ever establish breastfeeding. If you are going to operate on Mum or Baby, create an individualized plan and an environment that actively supports their breastfeeding relationship. If a breastfed baby is nil by mouth for surgery, ensure the Mum has access to an appropriate space and equipment for expressing milk, and that there is a location for storing expressed milk. Arrange for suitable chairs for breastfeeding in the recovery room. Make sure that there is lactation consultant support if there is likely to be a longer period without feeding at the breast, to help the Mum know how best to maintain her milk supply. If the Mum is the patient, ensure that any [information given](https://www.infantrisk.com/) about not being able to breastfeed postoperatively because of medications is up to date and specific. Make a plan with the Mum about how to maintain milk supply if separated from her baby. Advocate for “rooming in” of baby with family support wherever possible. If breastfeeding is difficult for the Mum and/or baby, arrange “in house” lactation consultant support – and if you don’t have access to one, think about how this might be possible. I encourage you to make asking about breastfeeding part of your patient history taking in this cohort. Make it your workplace culture to actively support breastfeeding, as a passive approach is unlikely to contribute to breastfeeding success. Talk to your colleagues and management to get others on board. Challenge historical constructs around when breastfeeding is not recommended or is told to mothers it is unlikely to succeed – to ensure that we are not using outdated information to come to this conclusion or recommendation. Understand that as surgeons we have an impact on breastfeeding – let’s do our best to make sure it is positive. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/08/Nikki-Mills-1.jpg) ![](http://blog.womensurgeons.org/wp-content/uploads/2018/08/Nikki-Mills-2.jpg)Nikki is a Paediatric Otolaryngologist from “Down Under”. She completed her training in New Zealand and subspecialty Fellowship in at Great Ormond Street Hospital in London. Nikki has subspecialised in airway & swallowing disorders, with a passion for helping Mums and babies who are having difficulty with breastfeeding. She is currently undertaking a PhD on “The functional anatomy of sucking and swallowing in a breastfeeding infant”. --- Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** awareness, family life **Tags:** Awareness, Breastfeeding, ILookLikeASurgeon, womeninsurgery, work-life balance --- ### [Have you asked for it?](https://blog.womensurgeons.org/have-you-asked/) **Published:** August 31, 2018 **Author:** Blog Team **Content:** *By Ko Un ‘Clara’ Park* When I was a trainee, my co-trainee was getting her manuscript finalized for submission, “It says the submission fee is $60.” Sure, sixty dollars isn’t a lot of money but to a trainee on a budget who wasn’t guaranteed reimbursement, it was a lot. I asked, “well have you asked your mentor to help pay for it?” To which the response was, “No.. I just feel weird asking for something like that.” The research mentor has funds to pay for activities related to research including cost of publication. She knew this but because the mentor didn’t initially offer to pay, she felt uncomfortable asking. While in training, I had a great opportunity to hear one of the authors of the book “Women Don’t Ask” speak at a symposium. The financial repercussions of not negotiating were staggering. What was more eye opening to me were the missed opportunities because women didn’t ask for them. Leadership roles, a raise, promotions, or lead on a project – women tend to think ‘if I deserve it, then those who see the hard work I put in will offer it to me’. The fundamental reasons why women don’t ask are complex and deeply rooted in our culture. (So really, it’s not just me who feels uncomfortable asking) The authors of the book point out that men were ‘offered’ higher salaries or more opportunities sometimes because they asked for them and their female counterparts did not. I couldn’t believe it. Was it really as simple as that? I just needed to get over the uncomfortable feeling or preconceived notion that asking equals demanding and ask for it?! I set out on a personal social experiment. Every time I thought ‘I hope they offer me that’, I ignored the rising heart rate, simply took the initiative and asked for it (luckily the sequel to the book “Ask for it”, had some nice wording I could use). A poster for a conference – I was wondering as my research mentor if you had funds to help cover the cost of the poster? A committee I wanted to join – I am interested in joining this committee, is it possible for me to join? Funding to attend a conference – I think it would be a highly valuable experience for me to attend this meeting and was wondering if there are any funding to help me attend? Sure, it doesn’t always work and it needs to be something within reason (recently I asked if I could get my flight upgraded to first class for free – it didn’t work). What was most reassuring for me was knowing that there were no negative repercussions to asking. Also, with practice, the entire process of asking became more natural and less forced. Regarding that submission fee, my co-trainee reported the next week that her mentor would be paying for it. Her mentor said it wasn’t even a big issue and my co-trainee was so glad she asked. So, have you asked for it? ![](http://blog.womensurgeons.org/wp-content/uploads/2018/08/Clara-Park.jpg) Dr. Ko Un ‘Clara’ Park (@KClaraPark) is a breast surgical oncologist at The Ohio State University. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, negotiating **Tags:** AWS, communication, ILookLikeASurgeon, negotiating, womeninmedicine, womeninsurgery, WomenSurgeons, workplace --- ### [Oh What A Night: An Interns Guide to Staying Afloat](https://blog.womensurgeons.org/interns-guide/) **Published:** September 6, 2018 **Author:** Blog Team **Content:** *By Rachael Sundland* As a brand new baby intern, the prospect of starting off with a month of night call feels like someone has just handed you the keys to a cruise ship and asked you to sail across the world. Each night you are faced with the daunting prospect of docking said cruise ship in a teeny-tiny harbor without destroying the marina or killing the passengers. My first night as an intern was an easy Sunday night. Not much was happening on the floors, everyone was stable and in general it was a pretty straightforward night. And thank God that it was! As the pages began to roll in I realized that I had never put in an order before. So that was step one, figure out where to click to place an order. Step two was much trickier. Could I actually order IV acetaminophen even though there was a shortage? Did I have to check liver enzymes? Why was the person not on acetaminophen already? Was I missing something? With all of these questions swirling around, step two quickly became: see the person you got paged about, text the seniors and ask them what to do. Then Step 3 was, do what they said and move on to the next page. As the first week went on, I began to settle in and feel more comfortable. Which obviously meant I had stopped checking my blind spots and the ship was about to crash into the harbor. I had my first official experience of being signed out a “no issues for this person overnight, NTD” which actually meant “this patient is going to try to die tonight”. Namely, one small bloody bowel movement turned into two more VERY large ones leading to a precipitous drop in hemoglobin. Meanwhile, I was on the main surgical floor confidently taking care of post-operative checks and pain calls, when I got the gut wrenching text from my chief… “Why aren’t you in step down?!” As I ran to the step down unit I only had one thought, “f\*\*ck, f\*\*ck, f\*\*ck”. On arrival, I found the entire overnight team already putting in IV lines as I was handed the massive transfusion protocol paper and sent directly to the blood bank. Needless to say my chief was not happy with my initial absence. Fortunately, I was then provided with an opportunity to redeem myself as a newly admitted patient slid down the slippery slope of septic shock, and I was the first to raise the alarm. This up close and personal experience with being the last person to find out something was happening, when I should have been the first, was startling. As I was having a breakdown in an empty SICU room the next morning, I had a heart to heart with one of my favorite intensivists. He said to me, “Rachael, you should be excited about last night. Because not only did you get to learn about hemorrhagic shock, but you got to learn about septic shock too!” I decided at this point that every “near miss” was going to be treated as a one time learning opportunity. It is a mistake that can be made one time, and one time only. There are no second chances to miss hemorrhagic shock. The second time, someone may die and that’s on me. But it is okay to make mistakes, and I will miss things and it is something everyone goes through because it is a part of learning and is also the reason we have a team. The important thing is that I learn from these mistakes, realize where my weaknesses lie, and make sure to learn from everything I do, everyday. It’s also imperative that, as an intern, I ask for help whenever I am even a little unclear about what to do in a situation. Honing clinical intuition takes as much time as honing clinical skill and it something that seniors can help guide me to learn, but only if I ask. Learning to drive a car was not easy, and maneuvering this cruise ship is exponentially more difficult, but I wouldn’t have it any other way or with any other co-captains. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/Rachael-Sundland.jpg)Rachael Sundland (@rsundland) hails from Colorado, her educational journey has moved her from St Louis (undergrad), to Atlanta (Emory, Masters in Public Health) and to Grenada for medical school at St George’s University. Now she lives in Brooklyn and is a first year surgical intern at Maimonides Medical Center. During medical school she found her passion for women’s health as a member of her schools chapter of AMWA. She plans to take this passion for women’s health to her new program by participating in fundraising events for breast cancer and other women’s health issues, especially during the month of October. She has also developed a passion for promoting women practitioners in surgery and strengthening the presence of AWS at her institution. In her free time she enjoys sleeping, watching Netflix, doing yoga and playing with her friends dogs. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency, training **Tags:** AWS, ILookLikeASurgeon, Resident Mentor, womeninsurgery, WomenSurgeons, workplace --- ### [What Interviewers Don’t Say](https://blog.womensurgeons.org/interview-tips-tweetchat/) **Published:** September 10, 2018 **Author:** Blog Team **Content:** ***AWS National Medical Student Committee Tweetchat September 17, 2018 8 PM EST*** *By Shree Agrawal* Congratulations! You have finished your third year of medical school, and hopefully you are nearing the end of acting internships at your home and away programs! The long road of ever-changing clinical clerkships is coming to a finish line. As September 15th approaches, the next steps include synthesizing your journey up to this point and presenting yourself as a polished residency applicant to your field of choice. While the match and interview processes have evolved over time, common themes are expected. Next week, in our Association of Women Surgeons (AWS) National Medical Student Committee tweetchat, we approach the interview process, focusing on how to ask essential questions about residency programs, navigate personal questions, and ensure you are communicating who you are throughout the interview experience. As more women enter surgical subspecialty residencies, the number of female residents has increased, but the number of female faculty members within surgical subspecialties has been [slower to increase](http://blog.womensurgeons.org/women/diversity-inclusion-in-surgery/). This phenomenon leaves a dearth of easily identifiable female mentorship to look to when navigating implicit bias that may occur during the interview process. Two years ago, I had the opportunity to talk with Dr. Patricia Numann, founder of the Association of Women Surgeons, at the annual Association of Women Surgeons Conference. She described the process of entering a surgical field when she was a medical student. The questions she was asked in the interview process then, related to her gender and how it could “impact” her training. These questions were both shocking and yet, familiar- I have heard similar accounts from classmates who have recently applied for surgical subspecialty residencies. Join the AWS National Medical Student Committee along with our moderators with Dr .Sareh Parangi, Professor of Surgery at Massachusetts General Hospital and president-elect of AWS, Dr. Lisa Ferzoco, Director of the Hernia Center at New England Baptist Hospital and moderator of the [AWS Annual Conference Mock Residency Selection Committee Workshop on 10/21](https://www.womensurgeons.org/page/ConferenceProgram), and Dr. Justin Dimick, Division Chief of minimally invasive surgery at the University of Michigan, on Monday September 17, at 8 PM EST to discuss interviewing for residency as a medical student. We hope you join us to contribute with your questions and perspectives as both faculty and applicants prepare for the next step towards joining a residency program! **AWS Tweetchat hosted by the National Medical Student Committee** **Moderators:** Dr. Sareh Parangi ([@SarehParangiMD](https://twitter.com/sarehparangimd?lang=en)) Dr. Justin Dimick ([@jdimick1](https://twitter.com/jdimick1?lang=en)) Dr. Lisa Ferzoco ([@LisaFerzoco](https://twitter.com/lisaferzoco)) **Medical Students from the AWS National Medical Student Committee:** Shree Agrawal ([@ShreeAgrawal21](https://twitter.com/ShreeAgrawal21)) – Past Chair, M4 at Case Western Reserve University School of Medicine Faith Robertson ([@FaithCRobertson](http://twitter.com/FaithCRobertson)) – Current Chair, M4 at Harvard Medical School Camila Guetter ([@camila\_guetter](http://twitter.com/camila_guetter)) – Marketing and Communications Chair, M6 at Universidade Federal do Paraná – Curitiba, Brazil Sarah Armenia ([@SarahJArmenia](https://twitter.com/sarahjarmenia?lang=en)) – Research Chair, M3 at Rutgers New Jersey Medical School Ashley Choi – Vice Chair, M3 at Duke University School of Medicine **To participate, be sure to follow @womensurgeons, moderators and medical students for this chat. All of your tweets and responses will be tagged with the hashtags #AWSChat and #SurgInterviewTips. For more information on how to participate in a Tweetchat and other Twitter tips, make sure to read this** [**previous blog**](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) **by Dr. Heather Yeo.** **Preliminary Questions for Tweet Chat:** 1. What are the most important factors to consider when looking for a residency program and how can a candidate identify them? 2. What is a good way to get a feel for a program’s culture and whether a program will be a good fit? 3. What type of implicit bias questions might students face in an interview? How can students prepare to tactfully answer these questions?? 4. What are common pitfalls to avoid during the interview visit? 5. What tips do you have any tips for the social events the night before interviews? 6. How and when should candidates contact residency programs after the interview is over? ![](desktop)![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/Shree.jpg)[*Shree Agrawal*](https://www.doximity.com/profile/6509956) *is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. She is passionate about research surrounding patient decision-making and is applying for urology residency this fall. Shree has recently completed a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and currently blogs for Doximity and the Association of Women Surgeons. She served as the past Chair of the AWS National Medical Student Committee. In her free time, she enjoys boxing, practicing yoga, and cooking. Twitter:* [*@ShreeAgrawal21*](https://twitter.com/ShreeAgrawal21) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat, medical students, residency **Tags:** AWS, AWSChat, ILookLikeASurgeon, medstudents, Tweetchat, WomenSurgeons --- ### [On Becoming A Woman Surgeon Scientist](https://blog.womensurgeons.org/woman-surgeon-scientist/) **Published:** September 13, 2018 **Author:** Blog Team **Content:** By Ashley M. Holder Although a surgical career is becoming a path more traveled by women, few of them are pursuing the track of surgeon scientist. In an era when fewer surgeons, regardless of gender, are winning NIH grants, remaining competitive in research while balancing clinical, teaching, and administrative responsibilities leaves many surgeons feeling that there is simply not enough time for research. Despite the challenges, I believe that we, as women surgeons, must remain engaged in research and encourage each other to chase the breakthroughs needed to advance our profession. As a rookie surgeon scientist, I wanted to share my lessons learned thus far with those considering a similar path. To evaluate the hypothesis that any woman can be a successful surgeon scientist with enough support, determination, and persistence, I propose the following aims: Specific Aim #1: To determine that you can’t do this alone. Most successful researchers recognize that, like raising children, it takes a village to produce a surgeon scientist. First, you must seek out and learn from other successful researchers. Capitalize on opportunities for training in conducting research: courses in grant writing, basic science or population health techniques, manuscript preparation. Though those with graduate school training have formal coursework, many successful surgeon scientists have created their own curriculum from patching together institutional and/or societal seminars such as those offered by [AACR](https://www.aacr.org/EducationTraining/Pages/default.aspx), [SWOG](https://thehopefoundation.org/research-funding/juried-programs/young-investigator-training-course-yitc/), and [AAS](https://www.aasurg.org/wp-content/uploads/2018/07/AAS2018_fallcoursebrochure.pdf). Secondly, I have been most fortunate to have had a group of co-residents and faculty to support me during my development. My program director at Washington University in St. Louis, graciously permitted me to be away from our program for two years so that I could pursue a T32 Fellowship with Dr. Funda Meric-Bernstam, a fantastic woman surgeon scientist. Likewise, you must find a chair and a department who believes that the work you do as a researcher matters—for me, that is Dr. Barbara Bass (@ACSprez) at Houston Methodist. Specific Aim #2: To develop the ability to say “No”. Your time is precious. If you are fortunate to have protected research time, guard those days with all your being. Resist the temptation to see patients on your dedicated research days or to schedule elective cases. Certainly, your patients are your top priority, but non-urgent issues can wait for your dedicated clinical days. Likewise, do not over-commit yourself with teaching and administrative duties. From hospital committees to serving as director of the medical student clerkship, there is no better way to sink your research career than continuing to say “yes” to each request. To your colleagues who are not researchers, you may appear to have a wealth of free time since you have fewer clinic days and operate less. Be a team player and do your part; however, it is OK and necessary to decline those invitations that will torpedo your next experiment, grant application, or manuscript revision. Specific Aim #3: To establish that no one said this would be easy. Fortify yourself for the naysayers and critics. You will hear: “No one wins this grant from our institution” or “You’re not established enough in the field to be competitive.” One of my colleagues shared her secret to winning one of the first K-awards as a junior surgeon scientist at our institution: YouTube videos. If you don’t have the expertise at your program, be creative. As a surgeon, you are an expert problem solver. Finally, look to your fellow women surgeon scientists for support when experiments fail, grants are rejected, and no journal seems to want to accept your manuscript. Let your path be illuminated by the words of Estee Lauder: “I never dreamed of success. I worked for it.” **![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/Ashley-Holder.jpg)**Ashley M. Holder, MD, is an Assistant Professor of Surgery in Nanomedicine at Weill Cornell Medical College/Houston Methodist Hospital with a lab focused on developing nanoparticle platforms to improve drug delivery to tumors and reduce toxicity for patients. She completed her Complex General Surgical Oncology fellowship at the UT MD Anderson Cancer Center. She graduated from General Surgery Residency at Washington University in St. Louis. She received her medical degree, where she was a Howard Hughes Medical Institute Medical Student Research Fellow, from Baylor College of Medicine. Her outside interests include fishing, cooking, and spending time with her husband and family. --- Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** career development, research **Tags:** AWS, ILookLikeASurgeon, research, womeninsurgery, WomenSurgeons --- ### [Meet the experts on what you want to do, and be the best version of yourself](https://blog.womensurgeons.org/meet-the-experts/) **Published:** September 20, 2018 **Author:** Blog Team **Content:** *by Julia Barber* I’m a 33 year old surgeon from Argentina. I always knew I wanted to stay in my country to practice medicine. I know we have the limitations of a developing country and that medicine is not the best paid job here. However, all my family and friends live here, and I know there’s a lot I can do to help the people around me. I never doubted my decision to stay. Still, I know that you need to look beyond your own horizons to make sure your direction is the correct one. And by this, I mean that you always have to make sure that whatever your decision in your career is, you are making a conscious one. This happened to me at different levels and in different moments of my career. 1. Choosing a specialty: when studying medicine in Argentina, you sign up for only one specialty at the time you take the test to enter residency. So it was a huge decision to make. Before I made it, I remember visiting different services at different types of hospitals and talking to the residents and attendings. I needed to make sure they had the life I’d like to have, did things I´d like to do, and that they could pursue the goals I was pursuing. It was an incredible opportunity to learn about myself and make one of the most important decisions of my life, to become a general surgeon. 2. Choosing a sub-specialty: as years in residency go by, you need to choose a second specialty (unless you want to go with general surgery for life, you need to define a sub-specialty). For this matter, I had an “elective” rotation in my residency program. I made sure to choose the best local places, and those I could have an opportunity to get into. Finally it happened, and I got into my own hospital’s program for Breast Surgery and Oncoplastics. 3. Going away and coming back home: There are lots of opportunities to learn from the “giants” and try to be better at our own practice. Once I finished my second residency, I had the chance to visit MD Anderson Cancer Center (MDACC) in Houston, TX and the European Institute of Oncology in Milan, (IEO by Italian acronym) I learned a lot from both experiences, and I was able to bring “new” experiences/skills home. There are several observerships and fellowships available at the most prestigious institutions across the world. You only need to seek these opportunities, it’s really easy. In my particular case, I was an observer in Breast Surgery at the IEO in Milan and a couple years later, I did the same in Breast Surgical Oncology and Plastic Surgery at the MDACC. I really learned a lot from them. Not only was I able to participate of their lectures and committees, but I could discuss all recent data available, watch them perform surgeries and become aware of new research protocols. It was an invaluable experience for me. It gave me some ideas to apply in my own service and let me realize we were going on the right direction. I always thought my hospital was one of the bests in Argentina, but now I can definitively say, that we in fact are not that far from the best places in the world. Even if you don’t want to leave home (like me), don’t miss the chance to look and learn from the bests, and try to be the best you can be with the resources that you have. And if you do want to leave, there are lots of opportunities too, you just have to try… ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/Dr.Barber-2.jpg) Dr. Maria Julia Barber is a General Surgeon and a Breast Oncoplastic Surgeon. She earned her Medical Degree at the Faculty of Medicine of the University of Buenos Aires, where she graduated with Honors. She was also an Assistant Professor of Anatomy for 6 years, teaching the students, creating prosections for anatomy courses, and training other Assistant Professors. She completed a 4-year residency program in General Surgery, plus 1 year as a Chief Resident and a second 2-year residency program in Breast Surgery, plus 1 year of Residents Instructor. She is now attending surgeon at the Breast Center of the Austral University Hospital in Pilar (Buenos Aires Province, Argentina) and a member of the Argentinian Society of Mastology. Dr. Barber is also a member of the Argentinian Association of General Surgery. Her academic/research interests include Oncology, Oncoplastic Surgery, and Patients Quality of Life. She is the only MD in a really big family, and even when that sometimes can be a big burden, she honestly enjoys their crowded reunions and the big family life. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** AWSBlog, fellowships, womeninmedicine, womeninsurgery --- ### [Lessons Learned: A Surgeon at Sea](https://blog.womensurgeons.org/surgeon-at-sea/) **Published:** September 26, 2018 **Author:** Blog Team **Content:** *By Pam Choi* Shortly after graduating from general surgery residency, I checked-in aboard an US Navy aircraft carrier as the only surgeon for an entire strike group of about 6500 sailors. While my former co-residents were beginning their fellowships or new attending jobs, I was entering a different world. I had to adjust from working as a surgery resident in a civilian hospital to a naval officer and sole surgical provider on a warship. My year included the ship’s pre-deployment training cycle as a well as part of a deployment, and so I was away from my family for 7 out of those 12 months. Sometimes, I would be out at sea for 4 weeks, return home for 4 weeks (during which time I would still be working on the ship), and then go out again for another 4- 8 weeks. Additionally, living and working on a ship comes with its own challenges- I couldn’t go for a run in the park, get some Thai food, or even shower without shower shoes. When out at sea, every sailor works every day. There is no “day off”. As a medical department, we saw patients everyday, and we were always on-call. Despite the challenges and struggles, it was also a year of significant personal growth. I became a better doctor and a stronger person. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/Untitled-300x225.jpg) **1) Keep your head on a swivel (AKA Maintain Situational Awareness)** An aircraft carrier is one of the most unforgiving working environments in the world. As such, situation awareness remains critical for not just for personal safety but also for the safety of those around you.Of course, situational awareness was also critical to us as medical providers. As a constantly moving ship, much of our treatment plan depended on our location and our ability to medevac. Should I operate now or send him to a hospital with more resources? How far are we from the nearest hospital? Was there evena hospital within range of our helicopters or planes? What are the weather conditions like for flying a helicopter? My decisions were no longer about a single patient, but also potentially the lives of pilot and aircrew, not to mention the ship’s assets. We also had to be aware of the ship’s mission, and how our plan may impact the ship’s operations. Additionally, our patients were not just patients but sailors. Each sailor had a role in the daily operations of the ship. There are more ratings (enlisted occupations) in the Navy than there are medical specialties, and I had to learn and understand these ratings, from an Aviation Boatswain’s Mate to Yeoman. I had to understand how their illness, treatment, or recovery would impact their ability to work and live aboard a ship as well as impact their department. The experience forced me to take a broader view of each patient I encountered as well as each procedure I performed. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/pic2.jpg) **2) Conflict Resolution is an essential skill.** Nothing forces conflict resolution more than necessity. Within our medical department, I worked with 10 officers and 40 enlisted Corpsmen. We saw each other every day. Seven days a week. And we didn’t just work together- we often ate together, worked out in the same gyms, hung out in the same common spaces. Frankly, there is nowhere else to go, and for better or worse, we were stuck with each other. Not to mention that for the first time since college, I was sharing a room with a roommate and had communal bathroom/showers. You don’t realize how small an aircraft carrier can seem until you are stuck there with the same people everyday. I was very fortunate in that our department was quite cohesive and got along very well. But that’s not to say we did not occasionally get on each other’s nerves. In such close proximity, it is easy to become annoyed or irritated with each other’s idiosyncrasies, and minor disagreements or slights can feel like major arguments or aggravations. But the reality was that we had to learn to resolve these issues, either by working it out or just letting it go. I had to not only mind my own emotions and attitudes towards others, but I had to do the same for my enlisted sailors as well. Communication was more important than ever, either in trying to resolve my own conflicts or help others resolve theirs. But what’s more- I really did learn to let some of the small things go, which I had struggled to do in the past as a resident. Grudges can ruin group dynamics. Being in the military, it is imprinted within us that more important than the individual is the team, and even greater, the mission. In the medical department, we all had the same mission of delivering the highest care possible to each sailor in our ship or strike group. All other things are secondary. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/pic3.jpg) **3) Loneliness can build Self-Reliance.** Despite being surrounded by several thousand people all the time, there is nothing lonelier than knowing that you’re the only surgeon in thousands of miles surrounded of open ocean. I had this distinct thought while doing an appendectomy during a particularly bad spot of weather. While we had checked with meteorology before starting, the weather was only going to get worse if we waited. The ship was pitching and rolling so badly that one corpsman was assigned to just hold the OR table. To make matter worse, there was an issue with the ventilation in the OR, which unfortunately had only just happened a few hours before the case started, and so it felt very hot in our space. And of course, there was a lot of inflammation and adhesions, which made it difficult to even find the appendix. I was actively sweating it out- intellectually, emotionally, and physically. There was nobody else. There was nowhere else to go. I kept my mouth shut because I didn’t want the other corpsmen or officers in the OR to know how much I was struggling, and just worked through it. The patient ended up doing fine. And I completed the surgery while also managing not to pass out or vomit. While at sea, I felt a loneliness that I had never experienced before during residency. I was used to a community, a locker-room, or a lounge of surgeons where we could discuss interesting or challenging cases or simply gripe. Not just to discuss our professional struggles, but personal ones as well. I struggled emotionally as well as professionally. But like any sailor, I had to learn how to make best of the circumstances. I tried to be critical and introspective for each case I did in order to improve myself. I tried to do whatever I could to keep busy and contribute to our department by teaching, even going so far as to make a chest tube practice set from a large cardboard box and taping together some tongue depressors and creating some tracheas out of toilet paper rolls and gauze in order to teach the corpsmen how to insert chest tubes and tracheotomies. I focused on other goals, including earning my Surface Warfare Medical Department Officer pin, a year-long process which involved learning multiple topics (including but not limited to Engineering, Damage Control, Seamanship, Reactor, Air Operations) and passing 2 oral boards. In the end, all we have to judge our self-worth is ourselves. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/pic4.jpg) **4) Semper Gumby** I had just returned home after being away for six weeks and was looking forward to spending time with my family. However, after less than 30 hours of being home, I was notified that a hurricane was anticipated in the area. As a result, all of the ships on the naval base had to leave base (to avoid damage to the ships and the pier) and would spend some time out at sea for an undefined amount of time. We were to pack and board the ship by tomorrow morning. Obviously, I was dismayed (as were my husband and young son) that I would be leaving so soon after returning, but I packed my seabag and mentally prepared myself. However, an hour later, I was told that I would be leaving with a different ship with a different crew for staffing reasons. I wasn’t particularly thrilled about going out to sea with a ship and crew I had never met before, but I dutifully called to check in with the Senior Medical Officer on my new ship. Half an hour later, I was called and notified that the plan had changed again, and that I was going with my original ship. An hour later, I was told that, no, I was going with a new ship. For a while it seemed like I was being called with a new plan every hour or so. In the morning, the hurricane had bypassed us completely, and we no longer had to go out to sea. The emergency recall was canceled. By then, I was so exhausted by the multiple changes that I was simply resigned to whatever was going to happen. Being flexible is not an option in the military, it is mandatory and a way of life. There were many things that are beyond our control. Plans changed multiple times with short notice. At certain times, we found that we just had to plan for nearly every contingency, only to find out at the last minute something completely different was going to happen. As surgeons, we like to think that we have some control over what happens. We plan and react and plan again. I had never minded change as long as I was prepared for it. I could even deal with unpredictability when it was compartmentalized- I was fine with the unpredictability of what could happen for the 24 hours when I was on call. But this was something different- there were too many things I could not predict or control. My experience forced me to become comfortable with last minute changes, the unknown, and the lack of control. The by-product of this was that it enhanced my resiliency to deal with such stressors. **5) Leadership is a verb.** As officers, we are naturally expected to lead our enlisted sailors. Working with the Corpsmen became the most rewarding part of my tour. I invested in them professionally and emotionally, and the dividends were far greater than anything I could have anticipated. The most memorable times from my deployment were not anything I did as an individual, but witnessing the accomplishments of my sailors. I taught them clinical topic and skills and helped them study for their exams. I wrote letters of recommendation or award citations. Each promotion, medal, or warfare device that they earned was the greatest source of pride. I also had helped them when they were struggling as well. When someone was not meeting expectation, I would have to sit down with them to figure out what was going on and figure out solutions. When there was conflict, I would meet with the involved individuals to help them try to resolve it. Most importantly, I took an interest in their lives. I knew what their goals were, their family lives, and who their favorite Avengers character was. I didn’t realize how much of an impact something simple like this had until right before I left, when so many Corpsmen thanked me for simply caring or making deployment easier to endure. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/pic5.jpg) **6) The Navy \[Surgeon\] Spouse is the hardest job in the fleet.** Like everyone on the ship, I missed my family terribly. Pictures of my husband and son were posted all around my stateroom and my office, and I thought about them all the time. During one phone conversation, my husband told me how our son had gotten sent home from school for hitting another child. He was three years old at the time, and it was an incident due to over-excitement and lack of self-control rather than any malice, but I still cried after I hung up. Was it because I wasn’t there? Whether it was or not, I still blamed myself. I felt gu ilty all the time- not just because of the way my son was acting, but because my husband was essentially dealing with it by himself. He worked a full-time job, and at the same time he was effectively a single father. I felt guilty because we moved away from my husband’s family, friends, and work to a place where we had no friends and family, and his career trajectory had effectively stalled. I felt guilty because we were going to have to move three times in three years. Once in a while, somebody will thank me for my service, but it’s my family who should be thanked. My poor husband didn’t just deal with all the sacrifices required of the spouse of a surgeon, but the spouse of a Navy Surgeon. To a certain degree, he sacrificed more than I did. I’m very fortunate that he stood by me during this last year. He supported me through everything without any malice or regret or jealousy. He dropped me off at the pier at 3AM before our deployment, gave me a hug and kiss, and reassured me that they would be alright and not to worry (even though, of course, I still did). He told me to be the best Naval officer and surgeon I could be for my sailors. While I was away, he worked, and he took care of our son and managed our household. He arranged a move half-way across the country by himself. When I returned from deployment, he picked me up at the airport in a new city from the one where we last saw other. And now, after being a husband of a deployed Navy surgeon, he gets to be the husband of a pediatric surgery fellow. Thank you, Nick, for everything. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/pic7.jpg) ![](http://blog.womensurgeons.org/wp-content/uploads/2018/09/headshot.jpg)Pam Choi (@pmchoi) graduated medical school as the University of Rochester and completed general surgery residency at Washington University in St Louis. While in St Louis, she met her awesome husband, Nick, and had their son, Calvin. After residency, they moved to Norfolk, VA where she was the ship surgeon for an aircraft carrier. She is presently the junior pediatric surgery fellow at Children’s Mercy Hospital in Kansas City and is also a Lieutenant Commander in the U.S. Navy. In her free, she enjoys eating, running, conquering Escape Rooms, and visiting National Parks with her family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarilythe opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** AWS, AWSBlog, NavySurgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Dear Pat responds to Missing Mentors](https://blog.womensurgeons.org/missing-mentors/) **Published:** October 1, 2018 **Author:** Blog Team **Content:** Dear Pat, Many of my male faculty have suggested that I find a female mentor to help me with career development. However, we have a handful of female faculty at my program, and I do not have a close working relationship with them. How do you go about identifying female mentors who are in the field and job type you’re interested in if your own program doesn’t have any? Also, do I need to have a female mentor as a woman? Sincerely, ***Missing Mentors*** Dear “Missing Mentors,” Mentors come in all shapes and sizes and genders. Rarely will you find a single mentor that can truly help you with all aspects of your life and career. In fact, I would highly recommend that you seek out and develop multiple mentoring relationships – more folks who you can bounce ideas off, get perspective from, and help you grow. Certainly, men can be exceptional mentors to women in most topics. Most of us women in surgery have benefited greatly from strong male mentors. A mentor may not even be in your chosen specialty! I have mentored women going into gynecology, family practice and gastroenterology. Looking outside your specialty may be helpful. When you don’t find a good mentor at your home institution, there are lots of places to start looking for remote mentorship. Ideally, it is really nice to have some personal contact with that person, so start by looking at organizations where you are a member, such as Association of Women Surgeons or other professional organizations. There may be local surgery groups within your city that meet in person. People are even finding good mentors through social media – twitter, Surgeons Mom’s Group, etc. With any mentoring relationship, you want to find someone with whom you “click”. Whether it is the same love of colorectal surgery, a research interest in quality outcomes, or having children the same age, having a mutual area of interest helps start the relationship off in a good place. Walking up to someone and asking “Will you be my mentor?” is rarely the beginning of a great relationship. Working with a surgeon who has similar ideas, perspective, or just seems like a great person is a better start. Take some time to do some research: What do they write about? What do they talk about? How do they say it? Then try to find a project or activity where you can work together and see if they are a good fit for you. Good luck! ***Sharon Stein, MD FACS FASCRS*** For more information on mentorship from prior posts in the AWS Blog see below: - [May is mentorship month](http://blog.womensurgeons.org/uncategorized/may-is-mentorship-month/) - *[Lean In book discussion and review](http://blog.womensurgeons.org/women/lean-in-book-review-discussion-part-two/)* - [Mentorship is a two-way street](http://blog.womensurgeons.org/medical-students/two-way-street/) ![](http://blog.womensurgeons.org/wp-content/uploads/2016/05/stein-194x300.jpg)Dr. Stein is a board-certified surgeon in general and colorectal surgery. Her clinical interests are in the minimally invasive treatment of colon and rectal diseases and inflammatory bowel disease. Dr. Stein is active in education; in addition to being the Program Director of Colorectal Surgery Residency at Case Western School of Medicine, she has directed or served as faculty on more than fifty courses in laparoscopic colon and rectal and minimally invasive surgery. She is an Associate Examiner for the American Board of Colon and Rectal Surgery. She is creator and co-director of the annual Colon and Rectal Surgery Career Course, which focuses on providing real world skills to graduating colon and rectal surgery residents. She serves as the faculty advisor for the Case Western School of Medicine women in surgery interest group and a founder of the Northeastern Ohio Women In Surgery networking and educational group. Dr. Stein earned her medical degree from University of Colorado School of Medicine. She completed her internship and residency at Massachusetts General Hospital and a fellowship in Colon and Rectal Surgery at New York Presbyterian Hospitals of Cornell and Columbia. She worked for Medecins sans Frontieres prior to joining the staff of New York Presbyterian Cornell Hospital, and moved to University Hospitals/Cleveland Medical Center in 2009. She became active in the Association of Women Surgeons as an attending, and has appreciated the outstanding networking opportunities within the organization. “To me, connectivity is key. Through the Association of Women Surgeons, I have had the opportunity to interact with amazing leaders in surgery, who I might not have met otherwise. The AWS gives us a common bond, allowing us a starting point to create new relationships and find mutual interests”. She is honored to be selected as a 2016-2017 Kim Ephgrave Visiting Professor. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png) The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat” answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted by residents and fellows anonymously and will be answered by [AWS council members](http://www.womensurgeons.org/page/Leadership). This monthly blog is published the fourth Sunday of each month. We want to hear from you, if you are interested in submitting your anonymous question, use this [link](https://www.surveymonkey.com/r/BSW2VR2). *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** DearPat **Tags:** #HeForShe, AWSBlog, Dear Pat, LeanIn, Resident Mentor, Women in Surgery --- ### [“Peri-Menopause”](https://blog.womensurgeons.org/peri-menopause/) **Published:** October 4, 2018 **Author:** Blog Team **Content:** *By Arghavan Salles* In January of this year, I started investigating the process for [egg freezing](http://blog.womensurgeons.org/parenting/envision-your-family/). Having spoken with three more reproductive specialists after my original consultation, I have been told three versions of a similar message: I have waited too long, and my chances of having a child that carries my DNA are pretty low. After my initial visit, I obtained the obligatory testing (FSH, estradiol, AMH levels) which indicated that I might not have success with stimulation (for a nice summary of what tests you can expect see [here](https://www.shadygrovefertility.com/blog/trying-to-conceive/the-infertility-work-up-whats-routine-and-whats-not/)). I had been on oral contraceptives for 18 years due to a diagnosis of ovarian cysts, so we decided to stop the pills and repeat levels after I had a few “normal” periods. Having been on the pill for so long, I had no idea what my “natural” cycle would be like. There was a significant delay (three months) before I had a period. Then another three months passed before I had a second period. My repeated labs after that were *maybe* slightly better than they had been the first time. In the meantime, I met with a friend, a physician, who had gone through several cycles of IVF. She had all sorts of recommendations, ranging from easy to not-so-easy to do. I should note she also has a PhD and is a scientist. - Wear socks at night (*why not?*) - Download a fertility app and use the guided meditations (*they’re somewhat soothing and involve imagining going to an island in the middle of a serene lake. There are worse things to try*) - Take coenzyme q10 (not just any version, but a specific one which costs $100 per bottle; take 2-3 times a day—*why not?*) - Take ground flaxseed (*admittedly have not picked up any so haven’t done this*) - Avoid saturated fat (*sure*) - Go gluten free (*I protested this one—doesn’t that seem like too much to ask?)* - Minimize stress (*Sure. Would love to*) - Sleep well (*See above*) She also emphasized the importance of the lab where one does the retrieval. The success rate of egg freezing is so low (about 6%) that having a lab that has the best protocols for freezing and thawing is essential. She suggested Shady Grove in the Washington, D.C. area. Of the three centers she had tried, this was the one where she ultimately had success. This private practice clinic is apparently the highest volume center in the US for these types of procedures. Their [recent paper](https://www.ncbi.nlm.nih.gov/pubmed/26604065) was cited to me by two of the three specialists I spoke to. Examining all their data, they have generated graphs that patients can use to determine how many eggs they might need to achieve their family planning goals. I spoke with three more specialists, one at my local center and one on each coast. Their interpretations of my situation were subtly different and ranged from predicting I might not be able to generate any mature oocytes to thinking I might be able to get one or two to thinking I might be able to get up to five or six. In the last consultation I had, the specialist was so concerned that she said I was “essentially in peri-menopause.” No, I don’t really know what that means but it doesn’t sound good. I have no more insight now into what I want my family to look like than I did at my initial visit, but that may be a moot point. According to the [Shady Grove paper](https://www.ncbi.nlm.nih.gov/pubmed/26604065), to have a 50% chance of having one child, a woman my age needs to freeze at least 15 eggs. My last consultation was with one of the physicians at Shady Grove, and she said she usually recommends women my age freeze 30 eggs to have a 75% chance of having one child. Given what we seem to “know” about my ovaries 30 eggs does not seem a realistic goal. Fifteen might be doable, depending on how things go. I have been lucky to have other women in similar positions to commiserate with. One of my colleagues was told she has premature ovarian failure and can’t try stimulation. Another colleague froze a number of eggs but then was unsuccessful when they tried to fertilize them. Another colleague just went through her first cycle and was able to freeze seven oocytes. Experiences like ours are not uncommon. A [recent study](https://www.ncbi.nlm.nih.gov/pubmed/25260684) of surgeons from multiple specialties found that 32% of women surgeons had difficulty with fertility. In comparison, only 11% of women in the US report infertility. Thirteen percent of babies born to women surgeons were conceived using assisted reproductive technologies. I’m going ahead with my first cycle to see what happens. But I’m also making it my mission to raise awareness among younger women, particularly those in long surgical training, to take advantage of fertility when they have it. Far too many of the women in my generation are now facing the toll of having prioritized our career during the most fertile part of our lives. Hopefully armed with knowledge and data, younger women can make informed choices while they still have options. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/10/Salles.jpg) *Dr. Salles completed medical school, residency, and her PhD at Stanford University. She finished her formal training with a fellowship in Minimally Invasive Surgery where she has stayed on as faculty. Her dissertation research focused on negative stereotypes about women in surgery and how those affect women training to become surgeons. Her current research focuses on diversity in medicine as well as physician wellness. She invites you to follow her on Twitter @arghavan\_salles.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life, parenting **Tags:** AWS, AWSBlog, AWSFood4Thought, Food4Thought, work-life balance --- ### [Do you dare to be you?](https://blog.womensurgeons.org/do-you-dare-to-be-you/) **Published:** October 10, 2018 **Author:** Blog Team **Content:** *By Dr. Jaime D. Lewis* Do you dare to be you? Have you taken a chance on yourself to live out your dreams? To be true to the voices inside your heart? When was the last time you truly failed? And you truly flew? Who supports you when you take on the cynics? And believes every word that you say? Where do you land when you fall? And who picks you up when you can no longer walk? Who raises you up to celebrate your victories? And who helps you face defeat without losing heart? As women in medicine, it can be difficult to expose our true selves and risk the consequences. We want to point out the inequities, but not be seen as unworthy. We are challenged to lean in, but fear that we might lean in too far. We want to share our stories, but we aren’t sure if anyone else really wants to listen. We want to succeed, often forgetting that failure is part of that process. We feel alone, noting that we are the only one in the group who looks like us. And we are discouraged we review that statistics that seem to be improving at barely a snail’s pace. Then we are reminded of the [Association of Women Surgeons](https://www.womensurgeons.org) and the [annual conference](https://www.womensurgeons.org/page/AnnualConference) where we are able indulge in the friendships, mentorship, and fellowship of those in attendance. These relationships provide us with courage we need to truly dare to be ourselves. And with the passing of the year, many of us are anxiously awaiting the renewal of the energy we gain at each meeting. This year’s conference is scheduled to start in a little over a week. The [lineup of speakers](https://www.google.com/url?q=https://www.womensurgeons.org/page/ConferenceProgram&sa=D&ust=1539093043627000&usg=AFQjCNFZG3I3wAwnxo0HzQm6MQi9doNQfw) is worthy of a red carpet rollout. [Dr. Caprice Greenberg](https://www.womensurgeons.org/page/Greenberg?&hhsearchterms=%22caprice+and+greenberg%22) will speak about gender equity. [Dr. Melina Kibbe](https://www.womensurgeons.org/page/Kibbe?&hhsearchterms=%22melina+and+kibbe%22) with provide the keynote address entitled, Implication of Sex Bias in Research. [Dr. Celeste Hollands](https://www.womensurgeons.org/page/DrCelesteHollands) will end the Saturday session, and an outstanding term, with her presidential speech. We will have to opportunity to explore ways to lean in, remain standing, celebrate success, and navigate failure. We will hear about landmark papers in surgery. We will make new friends, strengthen old relationships, and engage as mentees and mentors. We will learn to coach others and probably learn more about ourselves in the process. Are you attending AWS 2018 in Boston? If not, go ahead, sign up ([To register click here](https://www.google.com/url?q=https://www.womensurgeons.org/page/AnnualConference&sa=D&ust=1539093043627000&usg=AFQjCNEQvYdG6xoOKGqS69jBP9D6SxMjew)). My challenge coin is waiting. I. Dare. You. To. Be. You. Engage. Empower. Excel. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/10/Dr.-Lewis.jpg) [Jaime D. Lewis, MD, FACS](https://twitter.com/JaimeDLewisMD), practices breast surgery at the University of Cincinnati College of Medicine in Cincinnati, Ohio where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Dr. Lewis is committed to improving wellness and professional development opportunities of the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys running and time with her family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, leadership, medical students, mentorship, networking, resources **Tags:** #AWSConference18, AWS, womeninmedicine, womeninsurgery --- ### [Top Tips for Surgical Interviews – an AWS Tweetchat Summary](https://blog.womensurgeons.org/top-tips-for-interviews/) **Published:** October 17, 2018 **Author:** Blog Team **Content:** *by Camila Guetter* On September 17th, the AWS Twitter Committee in partnership with the AWS National Medical Student Committee hosted another extremely successful #AWSchat tweetchat to discuss Surgical Interview Tips. The tweetchat focused on important aspects of interviews for medical students seeking a surgical residency including how to ask essential questions about residency programs, navigate personal questions, and ensure you are communicating who you are throughout the interview experience. We would like to thank all of our AWS members and followers – faculty, fellows, residents, and medical students – that participated in this tweetchat using the hashtags #AWSchat and #SurgInterviewTips. We appreciate all your comments and all the tips you have shared with our current and future applicants! In addition, we would like to state our appreciation for this tweetchat moderadors: - Sareh Parangi ([**@SarehParangiMD**](https://twitter.com/sarehparangimd?lang=en)), Professor of Surgery at Massachusetts General Hospital and president-elect of AWS - Justin Dimick ([**@jdimick1**](https://twitter.com/jdimick1?lang=en)), Division Chief of Minimally Invasive Surgery at the University of Michigan - Lisa Ferzoco ([**@LisaFerzoco**](https://twitter.com/lisaferzoco)), Director of the Hernia Center at New England Baptist Hospital and moderator of the [AWS Annual Conference Mock Residency Selection Committee Workshop to take place on ](https://www.womensurgeons.org/page/ConferenceProgram)October 21st. Lastly, we would also like to acknowledge our medical student moderators who greatly contributed to the organization of this project: Shree Agrawal ([**@ShreeAgrawal21**](https://twitter.com/ShreeAgrawal21)), Faith Robertson ([**@FaithCRobertson**](http://twitter.com/FaithCRobertson)), Camila Guetter ([**@camila\_guetter**](http://twitter.com/camila_guetter)), Sarah Armenia ([**@SarahJArmenia**](https://twitter.com/sarahjarmenia?lang=en)), and Ashley Choi. Amongst so many great interview tips, here are a few highlights I gathered during the chat: **Question #1: What are the most important factors to consider when looking for a residency program and how can a candidate identify them?** The most important factors when ranking potential programs ultimately depend on what you are looking for in a program. What are your goals? Are you looking for academic training? Of what kind? What other professional goals do you have? Is the program interested in training the type of surgeon you are interested in becoming (academic practice, competitive fellowships, private practice, etc.)? **A valuable tip is to keep a journal with a list of what matters most to you as well as questions to ask each program.** **Question #2: What is a good way to get a feel for a program’s culture and whether a program will be a good fit?** The best way to do that is by doing an away rotation in that program or talking to someone who has done so in the past. If that is not possible, the second best way is by talking to as many trainees as you can. **Attending the dinner before the interview is a must!** It is a wonderful opportunity to talk to residents, ask about group activities and social events. In addition, trying to talk to residents outside the formal process is also a great idea so as to get less biased information. Crucial questions to be asked include but are not limited to: “What is the best thing you like about the program?”, “How do the residents get along?”, “What do you wish you had more of?”, “What would you change or improve in the program that would enhance your experience?”, “ Would you stay if they offered you a job after residency/fellowship? Why or why not?” **Question #3: What type of implicit bias questions might students face in an interview? How can students prepare to tactfully answer these questions?** Firstly, asking these type of questions is illegal and it should be reported to ACGME (there are anonymous ways to do it). However, if you still come across such a question (“When are you planning to have children?”, “Is this place ‘diverse’ enough for you?”, “What is your spouse’s employment situation?”), interviewers only need to know that you are prepared to **excel** and complete the work necessary to be an outstanding resident. Redirect the conversation by emphasizing that regardless of your family/personal life, you intend to focus on your training during your residency and that it is your **key priority**. **Question #4: What are common pitfalls to avoid during the interview visit?** So many important aspects of surgical interviews were discussed at this point of the tweetchat. Firstly, make sure to stand out only in good ways. Smile, make eye contact, have a firm handshake. **Treat everyone you encounter with respect**, as if every encounter from residents to the secretary are all part of the interview. Avoid negative statements. Moreover, **do your homework!** Read about the program beforehand and know how it aligns with your goals. Have prepared questions that demonstrate that you have made that effort. In addition, **keep your phone in your pocket** and not take it out unless it rings. Lastly, don’t be someone you’re not. **Be proud of what you have accomplished**, but don’t act like you know it all. Nothing worse than an interviewee with and attitude. **Question #5: What tips do you have for social events the night before interviews?** Be strategic, know what you want to learn about the program. Practice your **elevator speech:** (1) Who you are. (2) Why you are there (both in surgery & at that program). (3) What you want in a residency program. (4) How you will make an excellent resident surgeon. (5) Where you’re headed in your career (to the extent you know at this time). *Credits to Dr. Lillian Erdahl (@LillianErdahlMD) on this!* Lastly, **be professional** (don’t drink to much or show off) **and be yourself!** **Question #6: How and when should candidates contact residency programs after the interview is over?** This was a somewhat controversial topic during the tweetchat. Some faculty mentioned they like receiving a thank you note (some by email, some handwritten). They feel it helps people to remember you and lets them know what you got out of the visit. On the other hand, other faculty mentioned that focused reconnections are a better use of time. They argue that sending thank you notes to everyone is less valuable than reaching out to those who you want additional information from. For those who were unable to attend this tweetchat, you can read the full transcript [here](https://www.symplur.com/healthcare-hashtags/AWSchat/transcript/?hashtag=AWSchat&fdate=9%2F17%2F2018&shour=16&smin=55&tdate=9%2F17%2F2018&thour=18&tmin=5). Also, check out Shree Agrawal’s blog [article](http://blog.womensurgeons.org/medical-students/interview-tips-tweetchat/) for more information on what was discussed on this #AWSchat. Follow AWS on twitter (@WomenSurgeons) and look out for our upcoming monthly tweetchats! ![](http://blog.womensurgeons.org/wp-content/uploads/2018/10/Camila.jpg)Camila is originally from Curitiba, Brazil. She is a sixth-year medical student at Universidade Federal do Paraná in Brazil, and serves as general coordinator of the Trauma Surgery Interest Group at her institution. In her third year of medical school, Camila received a one-year scholarship to study Biomedical Sciences at the UCLA (Los Angeles, CA). Subsequently she worked as a research student at Beth Israel Deaconess Medical Center (Boston, MA) studying pancreatic cancer, hepatobiliary surgery outcomes, and patient education. Camila is passionate about pursuing a career in academic surgery and is very active in AWS. She is a member of the Publications and Communications committee, and is currently the Communications Chair of the National Medical Student Committee. You can find her on twitter at [@camila\_guetter](http://twitter.com/camila_guetter). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat, medical students **Tags:** #womeninmedicine #womeninsurgery #residencyinterviews #AWSTweetChat #AWS #AssociationofWomenSurgeons --- ### [Becoming a Woman in Surgery](https://blog.womensurgeons.org/becoming-a-woman-in-surgery/) **Published:** October 25, 2018 **Author:** Blog Team **Content:** *by Rachel Salinas* Becoming a surgeon is an intimidating endeavor. The moment I said it out loud, people would comment on how hard the hours are, how mentally and emotionally exhausting this career is, and they would always encourage me to research other specialties. For a Hispanic female, it just felt as though the world was saying *“Don’t do it”*. I constantly second guessed the path that felt so right for me from the beginning of my venture into medicine. In August of this year, I received an email about an essay contest being held by my institution.[The University of Texas Rio Grande Valley School of Medicine ](https://www.utrgv.edu/school-of-medicine/index.htm)Surgical Interest Group held a contest in which winners would be awarded support to attend the Association of Women Surgeons (AWS) 2018 [Annual Conference ](https://www.womensurgeons.org/page/AnnualConference)held in Boston. I jumped at the opportunity because I have never had the resources to travel to Boston to visit my dream residency program. Contestants were tasked with writing an essay describing what this year’s slogan, “Dare to be Me,” meant to them as future surgeons. As I wrote my essay, I reflected on the sacrifices and changes that I made in order to become a medical student. After years as a theatre stage manager, and while in the middle of my career as a public high school English teacher, it was administering CPR for the first time to a victim of a car accident that made me aware of my true calling. Writing the essay made me realize the courage that it took to leave that life behind in search of more. Few words can describe how I felt when it was announced that I had won. The AWS Conference provided me with the opportunity to meet countless successful women surgeons, surgical residents and medical students at various levels of their training. The amount invaluable information and advice I received was astounding. The topics covered were all interesting, some of the more memorable ones included: Dr. Jo Shapiro’s talk on “Bouncing Back from Failure” and Dr. Melina Kibbe’s eye-opening address on “The Implications of Sex Bias in Research.” During Dr. Kibbe’s talk, I realized that I had to make some changes to the data analysis of my current research project on treatment of phlebolymphedema patients to make sure that we also compared the effects of the proposed treatment between the sexes. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/10/image1-1-300x183.jpeg)Ms. Rachel Salinas with Dr. Romero Arenas & fellow medical students from UTRGV at 2018 AWS Conference In addition to the AWS conference, I also had the opportunity to attend the first business meeting of the [Latino Surgical Society](https://latinosurgicalsociety.org/) as well as the [American College of Surgeons Conference](https://www.facs.org/clincon2018). I felt a part of the surgical community, and realized that I already had two incredible mentors at home. Dr. Minerva Romero Arenas and Dr. Sam Snyder went out of their way to provide me with every opportunity to meet the people who could make my dreams a reality, and I am beyond fortunate to have them be a part of my home institution. I left Boston certain of two things: I am going to be a surgeon, and I will see you all again next year in San Francisco. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/10/Untitled.jpg)*Rachel Salinas is from Edinburg, Tx and a medical student at the University of Texas Rio Grande Valley School of Medicine. She completed prior studies at Texas A&M University where she earned a Double B.A. in Theatre Arts and English as well a M.Ed in Curriculum and Instruction. After a combined 10 years in the theatre and 7 years in the classroom, performing CPR for the first time allowed her to discover her passion for helping others. She is a new member of the Assoc iation of Women Surgeons and plans to become a surgeon though loves too many types of surgery at the moment to know what kind. She loves her family, her cats and her french bulldog. Twitter: @rachesalinas* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, women **Tags:** #AWSConference18, #daretobeyou, AWS, ILookLikeASurgeon, Medical Student Members, medstudents, Women in Surgery, womeninmedicine, womeninsurgery --- ### [The Importance of Mentorship and Experiences](https://blog.womensurgeons.org/mentorship-and-experiences/) **Published:** October 31, 2018 **Author:** Blog Team **Content:** *By Fabiola Valenzuela* As one of the winners of an essay contest held by the University of Texas Rio Grande Valley School of Medicine (<https://www.utrgv.edu/school-of-medicine/>) Surgery Department and Interest group, I was given the opportunity to attend the Association of Women Surgeons (AWS) annual conference and American College of Surgeons (ACS) Clinical Congress. Attending the ACS Clinical Congress and AWS annual conference was a very rewarding experience for me. It was my first time attending a surgical conference, which provided exposure to various surgical specialties, and encouraged and empowered women to pursue a career in surgery Moreover, I was exposed to panels ranging from novel research findings to presentations regarding clinical experiences and surgical techniques. I was surprised to see the wide variety of topics that were discussed including ethics and how to deal with medical error and resilience. Among so many different sessions, a few that most captivated me were a surgical education session and a panel on iatrogenic nerve injuries and techniques of avoidance and management. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/10/groupphoto.jpg) The surgical education session discussed the importance of higher quality surgical training from medical students to attendings, and. It also highlighted the importance of research on monitoring outcomes and safety in surgical training, as many medical students, residents, attendings, and fellows presented their research findings and perspectives on the field. I was very impressed by the presentations by the medical students, and how supportive the ACS panelists were of their work while providing constructive criticism. Regarding The Iatrogenic Nerve Injuries panel, this was the first time I heard a discussion on surgical nerve repair, and I was fascinated by the techniques and research advancements in this field. Moreover, it was nice to see various surgical specialties collaborated in the discussion to prevent and better manage nerve repair injuries. Throughout the ACS conference I had the opportunity to engage in various networking opportunities, which were facilitated and directed by a couple of faculty surgeons from my school, my mentor Dr. Romero Arenas and Dr. Snyder. I particularly enjoyed attending the Latino Surgical Society (LSS) reception with Dr. Romero Arenas along with other medical students and surgeons. The LSS reception presented me the opportunity to engage and connect with various Latino surgeons from all over the country. I very much appreciated the willingness of LSS members to share their personal experiences and advice. These networking opportunities along with mentorship are important especially during such an early stage in our medical careers as students because they have an enormous impact in our career pathway, from establishing what type of surgeon we want to become to providing support and guidance throughout the process.I am very grateful for this opportunity as it allowed me to engage with many surgeons of various surgical specialties and career stages, which provided me with a better understanding of surgery and how to better prepare for a career in surgery. My experience at the ACS further motivated and inspired me to pursue a career in surgery. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/10/head.jpg)Fabiola Valenzuela is from Arlington, TX. She is a medical student at the University of Texas Rio Grande Valley School of Medicine. She completed her B.S. at Duke University, and then worked on Neuroimaging research for two years at Stanford School of Medicine. She is currently working on an endocrine surgery research project studying thyroid hormone replacement therapy dosing. Fabiola serves as national Service Chair of the Latino Medical Student Association (LMSA) and Vice President of the UTRGV School of Medicine LMSA Chapter. She is very passionate about diversity and inclusion in medicine, and is the student representative of the diversity and inclusion committee at her medical school. She is a new member of the Association of Women Surgeons and the American College of Surgeons. You can find her on twitter @fabiola\_valenz. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, mentorship, networking **Tags:** #AWSConference18, #daretobeyou, #womeninsugery, womeninmedicine --- ### [Women in Surgery - How to Deal](https://blog.womensurgeons.org/women-in-surgery-how-to-deal/) **Published:** November 7, 2018 **Author:** Blog Team **Content:** There has been a lot of conversation about what is the role of women in the workplace and especially surgery with the #MeToo and #ILookLikeASurgeon campaigns and what are ways we can prepare ourselves as an upcoming generation of surgeons to deal with some of these issues. I talked to Dr. Nancy Baxter about some of the problems residents and trainees might face in the workplace and what’s her advice. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/headshot1.jpg) Dr. Nancy Baxter is a General Surgeon and Chief of the General Surgery Department at St. Michael’s Hospital,Toronto, Canada. She also has a Scientific appointment at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and is a Professor of Surgery at the University of Toronto. Dr. Baxter went to medical school at the University of Toronto. Through the Surgeon-Scientist program, she completed her Ph.D. in Clinical Epidemiology and general surgery residency at the University of Toronto. She is board certified in colon, and rectal surgery. Her primary research focus are health services outcomes and evaluation, and clinical effectiveness. Dr. Baxter also has a podcast, [**The Differential**](https://itunes.apple.com/ca/podcast/the-differential/id1361351945?mt=2)**,** that highlights various issues in health services delivery and research. You can follow Dr. Baxter on Twitter @enenbee. **What made you choose general surgery as a specialty?** I liked working with acutely and severely ill patients and surgery. General surgery is a specialty that’s also very broad (at least it was then) and you could branch off into many different specialties. **A** [**meta-analysis**](https://jamanetwork.com/journals/jamasurgery/fullarticle/2593310) **published in 2016 reported high attrition rates among general surgeons, men 15% and women 25%. In light of the “Me Too” movement and the awareness campaigns on social media such as the #WomeninSurgery and #ILookLikeASurgeon, what do you think still needs to be changed to improve retention of women in General Surgery?** Attrition is present in all specialties, but in surgery, some are due to its work demands. However, there has historically been some exclusion of women and other people such as introverted men, people of colour or underrepresented minority groups in the schema of surgery. General surgery is hierarchical, and we are all subconsciously more comfortable choosing people, supporting people, mentoring people who look like us. Unless we take action this will not get any better. We have to do something now – everyone with a talent and passion for surgery needs to be welcomed. The good thing is there is awareness now, and with continued discussion and action, I am optimistic that things will change. **What advice do you have for female medical students aspiring to be general surgeons?** Remember women physicians/surgeons experience sexism from patients and paramedical staff as well. Make a plan. You can either get crushed by (the sexism), or you can have a plan to deal with it. It is crucial to include men in the discussions, so they know what to do as well – there should be no bystanders in 2018. The next time, a patient asks you to change their diaper or bring them a bedpan because they think you are a nurse, you would know what to do and how to deal with this. And the guys also need to do something to support their female colleagues. It is everyone’s responsibility. **How do you achieve work-life balance?** The new term is now “work-life integration.” I think for me it was essential to accomplish my goals in life. If for someone else, that is having a family, then they should aim for that. For me, that was not my priority, and at the end of the day as long as I am doing what I want to do, I am (content). **You can follow Dr. Baxter on Twitter at @enenbee.** Interview Conducted by Anisa Nazir – AWS Communications Committee ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/headshot2.jpg) Anisa Nazir is a medical graduate from Foundation University Medical College, Islamabad, Pakistan. She is currently a research student at St. Michael’s Hospital, Toronto, Canada studying antimicrobial resistance in critical care and global health. Anisa is also the VP for Communications for the Canadian Global Surgery Trainees Alliance which is the national working group of the InciSioN network. She is passionate about pursuing a career in general surgery and serves on the AWS Communications committee. She loves travelling, hiking and music. You can find her on Twitter @anisanazir. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, gender differences, self-care, training, women **Tags:** AWS, womeninmedicine, womeninsurgery --- ### [Finding the Leader Within](https://blog.womensurgeons.org/finding-the-leader-within/) **Published:** November 12, 2018 **Author:** Blog Team **Content:** *By Jennifer A. Villwock* When I think about the development of leadership during my medical training, I immediately recall residency, where my faculty was 100% male. I learned many lessons from these men, but I felt something was missing. As a chief resident, I was invited to one of the first meetings of the Women in Rhinology section. I can be awkwardly introverted at times; I hesitated as I approached the meeting room and stopped at the threshold. *Am I sure I’m invited? What if I’m supposed to contribute something. I’m not prepared.* The women in the room came from all career levels, types of practice, and were respected and established leaders. I had read their papers and seen their presentations, but didn’t think I belonged in this group. One of them saw me and kindly beckoned me in. It was like finally taking a deep breath after holding it for way too long. *Ah, so this is where the women are and this is how they do it.* With that breath came a shift in my perspective. This leadership thing could be for me too. There is a wealth of emerging data that supports the critical role of women in medicine. Women are undisputedly an [integral part of the medical community](https://wire.ama-assn.org/life-career/finding-hidden-leadership-figures-among-women-physicians). Female physicians tend to stay in academia longer than their male counterparts. Women assume more teaching roles and play a very direct role in educating future physicians. The patients of female physicians [may even have superior outcomes](https://www.ncbi.nlm.nih.gov/pubmed/27992617). Female leaders – per objective review of their work and ratings by peers and superiors – [were found to be](https://www.tlnt.com/women-may-be-better-leaders-than-men-so-why-arent-there-more/) just as, or even more, effective than male leaders. All this data reinforces the importance of women leaders, at all levels, to claim their voices and join the ongoing conversations around us that are influencing patient care and health policy. The first forays into leadership can be daunting, but women tend to have many skills to leverage for their authentic leadership development. Remember, female leaders [rank higher](https://www.tlnt.com/women-may-be-better-leaders-than-men-so-why-arent-there-more/) in twelve of sixteen competencies that go into outstanding leadership and tend to be rated as [better leaders](https://www.ncbi.nlm.nih.gov/pubmed/24773399) than their own self-perception. This is also a time of increased awareness of bias. The result should be more intentional mentorship, sponsorship, and equity. Dr. Julie Silver (@JulieSilverMD) recently published [*\#BeEthical – A Call to Healthcare Leaders: Ending Gender Workforce Disparities is an Ethical Imperative*](http://sheleadshealthcare.com/wp-content/uploads/2018/09/Be-Ethical-Campaign.pdf) to address this need. It is a wonderful primer combating an unfortunate reality – i.e. “gender disparities are discouraging women from reaching their full professional potentials” and “traditional approaches to achievement of gender equity have not worked” – with concrete strategies.5 In short, women belong in leadership. While there is plenty of discouraging data out there as well, it’s important to know this information, as we must continue to make forward progress and not allow our responses to come from a place of negativity. How do you claim your voice and place as a leader? What strategies in real life have been most helpful for you and your ability to amplify the voices of the women physicians around you? Looking forward to continuing the conversation during the AWS tweet chat! Join [@WomenSurgeons](https://twitter.com/womensurgeons), Dr. Rebecca Minter ([@MinterWiscSurg](https://twitter.com/MinterWiscSurg)) and Dr. Kim Templeton ([@KimTempleton3](https://twitter.com/KimTempleton3)) on Monday, November 19th at 8PM EST to discuss leadership skills in surgery. Look for questions from the [@WomenSurgeons](https://twitter.com/womensurgeons) handle and follow #AWSchat. Check out a [prior article](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) by Dr. Heather Yeo on how to participate in a tweetchat. See you there! ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/Villwock-214x300.jpg) Jennifer A. Villwock ([twitter: @docwock)](https://twitter.com/docwock) is an otolaryngologist and assistant professor at the University of Kansas Medical Center. Dr. Villwock completed fellowship training in Rhinology and Skull Base Surgery. She also serves as the Section Chief for Otolaryngology at the Kansas City Veterans Affairs Hospital. Dr. Villwock is passionate about physician leadership development, medical education, and population health. She is on the editorial boards of ENTtoday, the Otolaryngology-Head and Neck Surgery Journal, and is the Assistant Editor for Visual Abstracts of the Laryngoscope Investigative Otolaryngology journal. Outside of work, Dr. Villwock enjoys sewing dresses for her 4 year old daughter and spending time at home with family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat, career development, leadership **Tags:** AWSChat, ILookLikeASurgeon, leadership, Tweetchat, womeninsurgery, WomenSurgeons --- ### [Happy Five Year Anniversary, AWS Blog!](https://blog.womensurgeons.org/five-year-anniversary-blog/) **Published:** November 15, 2018 **Author:** Blog Team **Content:** *By Jane Zhao* It has been FIVE years since we launched the Association of Women Surgeons (AWS): Inspiring & Encouraging Women Surgeons Blog. AWS launched the blog during a time when there were ZERO other surgical specialties that had social media platforms. The AWS was light years ahead of the curve. So much progress has been made in the past half of a decade; in addition to the success of the blog, the AWS social media presence has now evolved to become one of the leading organizations among surgical professional societies. We highlight some of the accomplishments made by women across surgery and within our own organization since 2013. When we started this blog in 2013, few surgeons were on social media or blogging yet. In 2018, we have so many interested contributors that we have grown from monthly pieces to weekly scheduled posts. With over forty thousand followers across the various platforms, the connections forged through AWS social media channels are innumerable. None of this would have been possible without you. THANK YOU to all of our members for your ongoing support. **2013** - AWS promotes its presence via three different social media platforms:[ Twitter](https://twitter.com/womensurgeons),[ Facebook](https://www.facebook.com/womensurgeons/), and a[ blog](http://blog.womensurgeons.org/). Blog posts are published 1-2 times per month. - Book club begins with[ *Lean In*](http://blog.womensurgeons.org/women/lean-in-book-review-discussion-part-one/) by Sheryl Sandberg. Today it has continued on, most recently with[ *In the Land of Invisible Women*](https://www.womensurgeons.org/news/420629/Book-Review-In-the-Land-of-Invisible-Women.htm) by Dr. Qanta Ahmed. - The Medical Student Committee permits the creation of medical school chapters of AWS. - AWS creates a Social Media Subcommittee within the Communications Committee. **2014** - Tweetchats using the hashtag #AWSchat begin with the topic “ “ as the inaugural chat. - \#HeForShe campaign spreads. **2015** - \#ILookLikeASurgeon becomes a global phenomenon. - AWS signs the 2015 Bangkok Global Surgery Declaration: A Call to the Global Health Community to promote Implementation of the World Health Assembly Resolution for Surgery and Anesthesia Care. **2016** - The AWS National Day of Service is created, with the goal of having one day where all chapters across the country get together with their members and spend time volunteering in their community. - The Women Surgeons in Low & Middle Income Countries Award is established to enable a woman surgeon in a low- or middle-income country to attend a surgical meeting, participate in a workshop or other career development or educational opportunity. - The AWS[ Instagram](https://www.instagram.com/womensurgeons/) account uploads its first post. Book Club for When Breath Becomes Air is hosted. **2017** - The AWS releases statements about pay equity and sexual harassment and launches a gender equity[ toolkit](https://www.womensurgeons.org/page/GenderEquity). - \#NYerORCoverChallenge capitalizes on the success of the viral movement #ILookLikeASurgeon to challenge everyday stereotypes about how surgeons should look. - AWS launches an[ Ambassador Program](https://www.womensurgeons.org/news/397255/Get-Involved-in-the-AWS-Ambassador-Program.htm) for new attendings. **2018** - AWS announces a new member partnership with the Society of American Gastrointestinal and Endoscopic Surgeons ([SAGES](https://www.womensurgeons.org/page/SAGES)). - Dear Pat is introduced on the blog, as an advice column with a nod to Dear Abby and in honor of AWS Founder Dr. Patricia Numann. - The first AWS[ Podcast](http://awspodcasts.libsyn.com/website) is aired. - [Research](https://mededu.jmir.org/2018/2/e11140/) suggests that by participating in social media, women in academic medicine may enhance personal and academic relationships that will assist in closing the gender divide. - AWS[ Coaching Project](https://www.womensurgeons.org/page/CoachingProject) is announced to support women trainees and reduce burnout. These successes are only the tip of the iceberg of all that has been accomplished since the blog was launched. Each of the triumphs can be traced back to the cumulative, tireless efforts of our members, often from behind the scenes. We are forever grateful to the daring few who contributed their time and energy to create content for the blog and guarantee its successful inception. To make the last five years personal, here are some updates on what has taken place in the lives of some of our original bloggers. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/brit.jpg) When the blog was founded, **Brittany Bankhead-Kendall** was a preliminary surgery resident at Methodist Dallas Medical Center. Now she is the academic chief resident of the University of Texas at Austin / Dell Medical School General surgery program in the first all women Chief class. She is now mom to a boy and a girl, a graduate of the surgical education research fellowship (SERF), and on her way to becoming a trauma and critical care fellow. She is also the proud principal investigator on research looking into unconscious gender bias and in a multicenter trial in trauma. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/ama.jpg) The last five years in a nutshell: **Amalia Cochran** has served as President of AWS and the Association for Surgical Education, been named a Distinguished Alumna of the Texas A&M School of Medicine, joined the faculty at THE Ohio State, became promoted to Professor, was bestowed the AEP Endowed Chair in Burn Surgery, and also serves as the Vice Chair of Education in the Department of Surgery. She has also run 25 half-marathons. She is currently working on building the burn and education programs at OSU to make them more fantastic. She also plans to keep running half marathons, rescuing animals, and going on yoga retreats in Montana. **![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/marie.jpg)Marie Crandall** has had many accomplishments to boast about over the last five years. Highlights include her research on trauma deserts in Chicago contributing to the eventual opening of the University of Chicago as a trauma center, being promoted to full professor and Associate Chair for Research in the Department of Surgery at the University of Florida, and being accepted as a Fellow of the American Surgical Association. She hopes to continue to foster research among her faculty and residents and advocate for social justice issues that affect communities. She’s grateful for the decade she has spent with the AWS and enjoys travel and time with family and friends. She loves her job right now and thinks this could be her terminal promotion. The photo taken is a picture of Marie on “potato chip rock” on the Mount Woodson hike in San Diego. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/heather.jpg)Since the launch of the blog, **Heather Logghe** has completed two years of preliminary general surgery residency, founded the hashtag #ILookLikeASurgeon that sparked a worldwide movement, and given birth to two children. She is widely lauded as one of the original surgeon leaders on Twitter and continues to champion the educational benefits of social media, such as with the hashtag #FOAMsurg. She is currently a Surgical Research Fellow in the department of Surgery at Thomas Jefferson University Hospital exploring the intersection of social media, patient care, research dissemination, and medication education. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/sophia.jpg)Since writing for the AWS Blog in 2013, **Sophia Kim McKinley** has completed her Master of Education at the Harvard Graduate School of Education and received her MD from Harvard Medical School. She began general surgery residency in 2014 at Massachusetts General Hospital, where she is now in her second year as the Surgical Education Research and Simulation Fellow. Sophia’s research focuses on patient experience with surgical resident care and the medical student learning environment. She will complete general surgery residency in 2021 and hopes to pursue fellowship in surgical oncology. Since, 2013, Sophia has also gotten married and is expecting her first child in Fall 2018. She and her husband Greg can’t wait to introduce their new daughter to the many joys of living in Cambridge, Mass. and their favorite hobbies: hiking and exploring the great outdoors. **![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/danielle-2.jpg)Danielle Walsh** was the president of the AWS when the blog was founded. After her term ended, she became involved in other professional organizations, such as SAGES, where she recently completed two terms as a committee chair and served on the Board of Governors, and the ACS, where she serves as a committee chair and rose through the ranks of the North Carolina Chapter of the ACS, serving as President. Nine months ago, she became the General Surgery Residency Program Director at the Brody School of Medicine at East Carolina University. She also services as the Vice Chair of Diversity and Inclusion the Department of Surgery, where she relies heavily on the experiences gained in the AWS. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/lauren.jpg)Shortly after the inception of the blog, **Lauren Nosanov** gave birth to her daughter, received her MD from the University of Southern California, and moved to Washington, DC to start General Surgery residency. She has fostered a love of clinical research, focusing on Trauma and Burn surgery, which has been recognized at both a local and national level by the American Burn Association and the ACS Committee on Trauma. As a member of the ACS RAS Education Committee, she helped launch the inaugural “So You Think You Can Operate” resident skills competition. As the current Chair of the AWS Resident and Fellow committee, she is focused on increasing trainee engagement at both a local and national level. She plans to pursue fellowship in Burn surgery after completion of residency. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/callie-1.jpg)In the past five years, **Callie Thompson** completed her general surgery residency and a burn/trauma/critical care fellowship. She is now on faculty at Vanderbilt University Medical Center in Nashville, TN as a burn and trauma surgeon. She and her husband now have a 6th grader, 2nd grader, and kindergartener. She had a fourth child last year. She remains a member of the AWS and is continually grateful for their role in supporting women in surgery. This photo was taken at the start of her last case before maternity leave last year—she actually went into labor during that case! **![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/minerva.jpg)Minerva Romero Arenas** has much to be proud of in the half decade since the blog was launched. She completed general surgery residency at Sinai Hospital of Baltimore and a fellowship in oncologic surgical endocrinology at the University of Texas MD Anderson Cancer Center in Houston, TX. She is now an endocrine and general surgeon at the University of Texas Rio Grande Valley where she serves as the medical student clerkship director. She has been a part of the blog team since its initiation in 2013 and now serves as the AWS blog subcommittee chair. She has always been passionate about recruiting the next generation of surgeons and continues to be heavily involved in mentoring through various organizations. **![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/jane.jpg)Jane Zhao,** MD, MS is a general surgery resident with board eligibility in clinical informatics at the University at Buffalo, State University of New York. She recently completed an ACGME-accredited clinical informatics fellowship and master’s degree in biomedical informatics at the University at Buffalo. *S*he received her medical degree with a scholarly concentration in Clinical Quality, Safety, and Evidence-based Medicine from McGovern Medical School, the University of Texas Health Science Center at Houston and her bachelor’s degree from Vanderbilt University where she majored in Medicine, Health and Society. She is a member of the Gold Humanism Honor Society. She was a finalist in the 2017 Henry A. Panasci Jr. Technology Entrepreneurship Competition and the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award. She was the founder and chair of the AWS Blog Subcommittee from 2013 to 2014 and a founding member of the AWS Social Media Subcommittee in 2013. She currently serves as the Resident and Associate Society Liaison for the American College of Surgeons Health Information Technology Committee. She remains a proud member of the AWS. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, Fellows, leadership, resources, women **Tags:** #HeForShe, AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery --- ### [This is Everyone’s Lane](https://blog.womensurgeons.org/this-is-everyones-lane/) **Published:** November 19, 2018 **Author:** Blog Team **Content:** *By Stephanie Bonne* On a busy day in the ICU, I was back and forth between meetings, notes and patients, when my phone buzzed a couple times with twitter notifications. Something seemed to be up. I stepped out of the elevator as the page loaded, and found myself in the hallway of the hospital staring in disbelief: “Someone should tell self-important anti-gun doctors to stay in their lane. Half of all the articles in the Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves… [A tweet from the NRA](https://twitter.com/NRA/status/1060256567914909702). Seriously? Content aside, the tone is divisive, condescending, disenfranchising, and makes malicious claims about the quality of peer review, the foundation of evidence based medicine. I’m a trauma surgeon at a busy urban center. At this point, I’ve been up for 2 days, I’m a week behind on my charts, I’m burning through a grant to study gun violence, running from meeting to meeting to ensure patient quality and manage our hospital’s violence intervention program. Gun violence isn’t just my lane, it’s my highway – all day, every day. How dare they say I don’t belong here? In the moments and hours after, I went with my gut and unabashedly tweeted my reaction with a hashtag gaining traction: #Thisismylane: a bloody floor, a chair in the waiting room. And the stories: A son, a mother-to-be, a child, a husband, a father. The stories go on and on, as they do for all of us. The hashtag became a rallying cry and pretty soon I was getting calls – can you be on our show, our podcast, can you comment, can we use your photos? In the flurry of the media attention that followed, it was easy to get swept up in the excitement of all of it. But just like the rush of the trauma bay or the tension of the operating room during an ex lap (an exploratory operation, which is often required for victims of a gunshot wound), I stayed grounded in one thought. Our patients. Our patients need to be at the center of this, the way they are at the center of our trauma bays, the center of our ORs, and the center of our care, and were at the center of my day on the day the NRA decided to tweet.. That means that doctors need to be serious about a public health approach for mitigating gun violence because that is what will save our patients, and we really need to spend some time thinking about what that means. Public health is about primary prevention (stop someone from getting shot), secondary prevention (stop someone from getting shot again), and tertiary prevention (mitigating the effects of being shot). It involves 4 steps: surveillance, identifying risk factors, developing and testing program, and implementation. So, let’s look at each, and talk about the solutions, which arise from both messaging and policy. **Surveillance:** We know how many people die. We don’t have accurate data on how many nonfatal injuries there are. Without a uniform data collection system and reporting system for firearm injury, we guess it’s somewhere between 80,000-200,000/year. Maybe we could prevent gun violence if we could talk to the survivors. But we have no real way to meaningfully identify them. Funding for more robust surveillance has been poor, largely of the lack of congressional funding to the CDC as a result of the Dickey Amendment. Messaging has been pretty effective at creating some philanthropic funds, but policy on funding hasn’t really budged. We can do better here. **Identifying Risk Factors:** We’re actually pretty good here, but could do better with better surveillance. We know that depression with a firearm in the home is a risk factor. Children, the elderly, those in poverty, and victims of domestic abuse are at higher risk. The data is pretty clear on this: lethal means matter. Restricting access by children and those who may be suicidal is important, as is the restriction of ownership and access by domestic abusers. Messaging has been clear and carefully designed policies can be enacted to change all of the above; some states already have, and these have started to see decreased deaths. But messaging can only go so far and policy solutions have been hit or miss. We can do better here. **Developing and testing programs:** Without good data and a good sense of risk factors, it’s hard to create programming. Despite this, surgeons have been leaders in developing Hospital- and Community-based violence prevention interventions. These types of programs have shown success, but are woefully underfunded and highly variable in their approach. We can do better here. **Implementation:** Here is where we really get held back on the policy front. We can try our best to implement child access prevention programs, gun lock distribution, buybacks, domestic abuse restraining orders, emergency protection orders, or other policy and messaging solutions that have been shown to decrease injury and death. But until politicians are willing to act, implementation will continue to be problematic. We can do better here. We are facing an uphill batting in the work to decrease firearm injury in the United States. However, doctors have the attention of the public. This social media campaign will come and go and the 24 hour news cycle will distract us with something else soon. What will remain, however, is a new public understanding of why doctors feel so passionately about this issue and why the solutions to our problems lie squarely in the field of public health. As long as we keep that message alive, surgeons, and all doctors, can be real leaders in the fight against firearm injury and death. This is our lane, all of us, we will stay in it, and maybe we can turn it into a runway from which we can take off and fly. More information on “#ThisisOurLane” can be found at: - <https://www.bbc.com/news/world-us-canada-46186510> - <https://www.wsj.com/articles/after-nra-rebuke-many-doctors-speak-louder-on-gun-violence-1542126312> - <https://www.npr.org/2018/11/11/666762890/after-nra-mocks-doctors-physicians-reply-this-is-our-lane> ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/Bonne-1.jpg)*Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the American Association for the Surgery of Trauma, the ACS Committee on Trauma, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force, and is the surveillance core director of the New Jersey Center for FIrearm Injury Research at Rutgers University. Dr. Bonne is the current Communications Chair for the AWS, a co-editor for AJS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children. You can follow her on Twitter: @scrubbedin.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness, current events **Tags:** Awareness, AWS, AWSBlog, AWSFood4Thought --- ### [Black Clouds](https://blog.womensurgeons.org/black-clouds/) **Published:** November 22, 2018 **Author:** Blog Team **Content:** *by Alyssa Brown* “You won’t see much with Dr. C on call this weekend because he’s a white cloud,” mumbled my attending. I immediately asked what he meant. He gave me a withering look, like he always did when I asked too many questions, and went on to explain that a white cloud was a doctor to whom nothing bad or crazy ever happens while they are on call. He stopped walking, turned around looked me in the eye and said, “We are black clouds.” I was only three months into my third year, and I had already seen six patients die. I had never been called a black cloud, but it immediately stuck. Wherever I went on rotation, trouble and patients seemed to follow. On one particularly crazy night on Labor and Delivery, they finally sent me home after the sixth C-section in a row. We didn’t talk much during third year about the patients we saw die. It was a hidden knowledge that some of us had probably seen more than our fair share. It didn’t stop any of us from continuing, but those patients weighed heavy on my mind some days. I still remember my first patient who “coded”. We ran into the ICU after receiving the page and I saw blood everywhere. The nurse quickly filled us in with details; he had had an esophageal surgery the day before, vomited bright red blood twice and quickly lost his pulse. His family had left thirty minutes before to finally shower after a few days of staying with him in the ICU. Maybe that’s what struck me the most, that he died alone surrounded by strangers. None of the doctors, residents, or medical students knew him—we were just the teams there for the code blue. The surgeon who first called me a black cloud shared a rough call with me on my surgery rotation. I got a text from him at 6pm with just a room number. I slowly slid into the dimly lit room, where I could hear him already speaking to the family in hushed tones. . He turned and motioned for me to follow him out of the room. No sooner than he had made it into the hallway, he was on the phone with the OR staff, “prep the OR, this isn’t looking pretty.” Without breaking stride or looking at me, he described the case, *The patient is an 81 year-old male, small bowel obstruction, renal failure, left against medical advice, 7 days ago for small bowel obstruction.* I knew it didn’t sound good, but I figured he could fix it. As we hurried down the stairs to the basement of the hospital, he muttered that we would be lucky if the patient ever made it off the table. To keep a long story short, the patient made it through the operation, but died the next day from complications. The next morning at lecture, the surgeon asked me what could have been different to help him survive. I think I answered with something along the lines of better fluid management, but he cut me off. He said we couldn’t change what had happened seven days earlier. We did not give up on the patient, but the patient also chose to leave with a fixable problem and come back seven days later on death’s door. That stuck with me. Sometimes the dice were rolled before you got there. Through all this there were many moments of light. I will never forget seeing a pediatric heart transplant for a patient I had been caring for on the wards for months. I was on my pediatrics rotation when I overheard one of the residents talking about how someone was getting a heart that night. I thought it might be that patient, so I emailed the cardiothoracic surgeon, who told me she was on the flight to the procurement from the donor and invited me to attend the transplant. The case started at 3am– I was tired but excited. There was nothing more magical than seeing a heart beat on its own for the first time. The bypass was turned off, the muscle began to pink up, and the “new” heart took its first quivering beat in its new home. Third year of medical school was a hodgepodge of beautiful, funny, and poignant moments. I can say now that I was not prepared for it, but I don’t think any of us are/were. Maybe being a black cloud isn’t a bad thing. Maybe some of us are just magnets for long call nights and days. My mentor is a black cloud. She always joked that someone must publish her call schedule because more patients show up to the Emergency Department when she is on call. I found solace in her through my medical school years. She never really complained about her crazy nights, besides saying that she was getting too old for this. Losing a patient hasn’t gotten easier, and I hope it won’t. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/VSAS_0449-copy-214x300.jpg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. In July, she finished her third year of medical school and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. When she is not being a black cloud, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram @alyssabrown1013 and Twitter @Alyssa\_B\_MDPhD --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, self-care **Tags:** #AssociationofWomenSurgeons, AWS, AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery --- ### [Dear Pat responds to Offended and Humiliated](https://blog.womensurgeons.org/offended-and-humiliated/) **Published:** November 26, 2018 **Author:** Blog Team **Content:** Dear Pat, I went to see a consult the other day in the ED, and the patient kindly informed me that he wanted a different doctor because he felt that “women can’t be real doctors.” I was so mortified that I couldn’t think of anything to say in response, so I walked away and sent my intern to see the patient instead. I work in a department with plenty of female faculty in a relatively liberal city, so his response totally took me by surprise. Should I unfortunately find myself in a similar situation in the future, what can I possibly say in response to a comment like this? Sincerely, ***Offended and Humiliated*** Dear “Offended and Humiliated,” First, that’s exasperating, and I think you handled the situation perfectly well. Patient was seen, no one shouted, no one lost face. Happily, I think this will happen less and less as the years go by, but that almost makes it more challenging when it does happen, because what the heck can you say? And what if you’re the attending and there are no male surgeons around? Well, I have a few suggestions: - If the patient seems educable, say something like, “I’m sorry you feel that way, sir. However, I am the surgeon in charge of evaluating you and unfortunately, we think you have a surgical problem. I assure you, I am eminently capable of taking care of you; I’ve had 4 years of college, 4 years of medical school, XYZ years of residency, and this is what I do every day. Over one third of practicing surgeons are women and studies suggest our outcomes are better than male surgeons. So, tell me what’s going on with you today?” Most people will be reassured and not persist. - If the patient is hostile or uneducable, and there is an option for a man to take care of the patient, maybe try #1, but also enlist male backup. As annoying as it is, patients do have the right to choose the sex (or race, or other characteristics) of their physician, and we do care about patient satisfaction. For more information read this [ULCA Law Review](https://www.uclalawreview.org/pdf/60-2-3.pdf) “Patients’ Racial Preferences and the Medical Culture of Accommodation.” - If the patient is hostile or uneducable but there truly is no option for a man to take care of the patient (all female trauma team, rural surgeon, etc), then you say something like, “I’m sorry you feel that way, sir, but this is a surgical emergency.” Then you leave it at that. Patients do have the right to leave the hospital against medical advice and go on to die horribly, and you can advise them of that right if they insist. - Finally, it’s sometimes helpful to flip the narrative and consider what you might say to a patient if you were a male resident in an OB/GYN program where patients often request female providers. While not entirely the same thing, it made me consider that some men may be just as uncomfortable with being examined by women for reasons other than underestimation of skills or condescension. Just a thought. Sincerely, ***Marie Crandall, MD, MPH*** ![](http://blog.womensurgeons.org/wp-content/uploads/2016/04/Crandall-MD-Marie-2010-NMFF-214x300.jpg)Dr. Crandall is Director of Research and Professor of Surgery at University of Florida Jacksonville. Dr. Crandall is originally from Detroit, MI, a product of Head Start and local public schools. She obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley and attended medical school at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001. In 2003, Dr. Crandall completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA, where she also obtained a Masters in Public Health from the University of Washington. Dr. Crandall has been a member of AWS since residency. In 1996, surgical residencies were 20% women across the nation, so it was very encouraging to see the phenomenal achievements of other women surgeons. She began committee service as an attending, first serving on the Academic Practice Committee (now the Clinical Practice Committee), and subsequently served as Vice Chair, then as Chair of this committee. Currently, she is in the third year of a three year term as Guest Editor for the annual American Journal of Surgery issue highlighting Association of Women Surgeons research. This has been incredibly rewarding and has led to the publication of approximately 20 member-authored articles per year in AJS. Finally, she is currently serving a 3-year term as the AWS Liaison to the American College of Surgeons Women in Surgery Committee. She remains amazed and grateful at how incredibly supportive and instrumental to her career the network of women surgeons has been. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png) The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat” answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted by residents and fellows anonymously and will be answered by [AWS council members](http://www.womensurgeons.org/page/Leadership). This monthly blog is published the fourth Sunday of each month. We want to hear from you, if you are interested in submitting your anonymous question, use this [link](https://www.surveymonkey.com/r/BSW2VR2). *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** DearPat **Tags:** #HeForShe, AWSBlog, communication, Dear Pat, ILookLikeASurgeon, residents, WomenSurgeons --- ### [Surgical Palliative Care and the Power of Stories](https://blog.womensurgeons.org/palliative-care-and-the-power-of-stories/) **Published:** November 28, 2018 **Author:** Blog Team **Content:** *by Dr. Red Hoffman* **“There are three deaths. The first is when the body ceases to function. The second is when the body is consigned to the grave. The third is that moment, sometime in the future, when your name is spoken for the last time.”** – David M. Eagleman, Sum: Forty Tales from the Afterlives When I was nineteen years old, my father was murdered by a terrorist in Cairo, Egypt. His death – sudden, violent and surrounded by what was then a “weird” set of circumstances – left me feeling not only heartbroken but extremely isolated. All I wanted to do was tell stories about my dad, but at nineteen I lacked both the insight to entirely process my emotions as well as the language to fully express them. Somehow, blurting out, “My dad was shot in the head by a terrorist” seemed to shut down any opportunity for story-telling. I have no doubt that my father’s murder – and the urge to share his story – led me to where I am today. I attended medical school in Oregon, the first state to legalize [Death with Dignity](https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/faqs.aspx) and the birthplace of the Physician Order for Life-Sustaining Treatment([POLST](http://polst.org/about/))) form. Palliative medicine was well-integrated throughout my education and I was able to complete an elective month with the palliative care team. One of the best skills I learned – and still utilize today – is how to walk into a room full of devastated individuals and encourage them to start telling me stories about their loved one. I am still amazed by the energetic shift in the room that occurs when families start talking; suddenly it’s as if the patient, who is often intubated and sedated, is now sitting amongst us. Through these stories, I am able to learn what is truly important to this patient, what makes him “tick” and what makes her life “worth living.” This then allows me to guide families when they are called upon to make difficult decisions on behalf of their loved ones who can no longer speak for themselves. [Surgeons have a rich history](http://apm.amegroups.com/article/view/5640/6433) when it comes to the practice of palliative medicine. Few know that the term palliative care was actually coined by a surgeon, Dr. Balfour Mount, in 1972. Members of the American College of Surgeons have been discussing and researching the intersection of palliative medicine and surgery since at least 1997. Since 2008, board-eligible surgeons (and surgical residents, after completing three years of residency), can apply for a spot in a Hospice and Palliative Medicine fellowship. As of 2016, 72 surgeons have passed the Hospice and Palliative Medicine Certifying Exam. All of us as surgeons are well positioned to provide primary palliative care, defined as those clinical competencies required of all physicians, including, basic symptom management, routine discussions about code status and goals of care and managing the transition to hospice care. While these skills may not be specifically integrated into your residency curriculum, many of them can be learned through observation and practice. I encourage all learners to pay attention to the attendings who perform these skills well and to carve time out of your day to attend family meetings when you consult the palliative medicine team. [Further, the American College of Surgeons provides a free online comprehensive guide to Surgical Palliative Care. ](https://www.facs.org/~/media/files/education/palliativecare/surgicalpalliativecareresidents.ashx) While many may think that surgery and palliative medicine seem at odds with one another, I counter that the two disciplines actually complement each other well. Armed with our primary palliative care skills, we never have to say, “there is nothing else we can do for you.” Instead, we can honestly say, “while there is nothing more we can offer surgically, we can now shift our focus towards comfort and quality of life.” This enables us to truly honor the ethical concept of patient non-abandonment; just because we are done operating does not mean we have to be done caring about, or for, the patient. Third, taking the time to inquire about a patient’s life story will likely improve your history taking in general, a skill that is often overlooked when we get busy. And lastly, truly listening to a patient’s life story may very well offer you a moment of joy and levity during an otherwise hectic and overwhelming day. I can assure you that it will also bring a sense of joy to the family, the same sense of joy I feel when sharing stories about my dad. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/11/Dr.Hoffman.jpg)Dr. Red Hoffman began her career as a naturopathic physician and a yoga teacher. She is now a board-certified general surgeon with additional training and certification in both Surgical Critical Care and Hospice and Palliative Medicine. Her clinical interests are in surgical palliative care, physician wellness and medical education. She participates in the American College of Surgeons and currently serves as the Vice-Chair of the Communications Committee for the Resident and Associate Society (RAS) as well as the RAS liaison to the Physician Competency and Health Workgroup of the ACS Board of Governors. She is also an active and proud member of the Eastern Association of Trauma’s Online Education Committee. Dr. Hoffman works as an acute care surgeon at Mission Hospital in Asheville, North Carolina, picks up occasional (never enough time!) hospice shifts at the John F. Keever Solace Center and was recently named as the co-director of the surgical clerkship for the University of North Carolina Asheville campus. She is blessed with two naughty cats and an absolutely amazing boyfriend. She is happy to chat with or mentor anyone who is interested in palliative care. You can follow her on Twitter: @redmdnd. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship, self-care, training **Tags:** ILookLikeASurgeon, womeninmedicine, womeninsurgery --- ### [Death & Dying: Finding Meaning in Loss](https://blog.womensurgeons.org/death-dying-finding-meaning-in-loss/) **Published:** December 5, 2018 **Author:** Blog Team **Content:** *By Vaidehi Mujumdar* April of 2017, Siddhartha Mukherjee wrote a piece in [The New Yorker](https://www.newyorker.com/culture/cultural-comment/love-in-the-time-of-numbness-or-doctor-chekhov-writer) called “Love in the Time of Numbness; Or Doctor Chekhov, Writer.’ The last line was: “Beauty in all of its myriad forms, can only be created in opposition to numbness. That, at least for me, serves as a quiet manifesto of our times.” That same April, I had just taken my first of what will end up being three board exams to obtain a medical license in the US. It had been a year where our political landscape shifted, where we saw the effects of a changing America on our communities. It came after the death of a classmate, the loss of personal relationships, and what sometimes felt like a loss of personhood. One week after reading Mukherjee’s article, I started my third year of medical school. Third year had been a re-start for me, navigating the new landscape of clinical wards, the OR, teams, and getting closer to classmates in a professional setting. T.S. Eliot, one of my favorite poets, infamously wrote “April is the cruelest month”. Death can seem commonplace in medicine because it is a part of the job. But it affects one differently each time, perhaps not in the moment it happens, or the days that follow. At the end of my third year, I vividly remember certain patients down to what they were wearing or eating or doing. Often in medicine, one has to move forward and on to the next patient or task. Some may call this callous or ask: “How do you deal with seeing death often?” I deal through the hours it takes to craft a piece of writing, or the feeling of knowing that you are alive to run or walk during 30 minutes of cardio, or even a drink after work with friends sharing stories. In the Fall, I was on the organ transplant service during my general surgery rotation. My attending told me I had the choice: to scrub in for the organ procurement or to wait in the OR while the donor patient died. He said, “We are technicians as the transplant surgeons. We don’t often get to or should see this side of it. Tell me what it feels like for you.” I chose to wait in the OR. The last organ procurement in which I participated was a donation from a 26-year-old female who had overdosed on several substances. We made an incision from her sternum to pelvis. My job was to excise the splenic lymph nodes for research once the organs of interest had been procured. I was 26 years old, too, and for a moment I thought, “*Is this what my body would look like too split open on a table?*” We had all become so task-oriented due to the constraints of time in organ procurement, but it was in the quiet moments afterwards when the resident and I were closing her abdomen back up, that we really saw her as a person. Later during my Ob/Gyn clerkship, an expectant mother of twins had one twin die in utero, while the other survived after a stat C-section. The mother was a teenager. It wasn’t the death that took me aback. For me, the aftermath was worse because life moved on. It was walking into the mother’s room to see her watching cartoons the next morning or seeing her in the NICU with her other baby. She was a child herself, in need of support and counseling, something I’m not sure she received. As I ended third year in May, what was a long, different, exciting, but tumultuous year, I had never felt Mukherjee’s words more significantly. The best aspects of patient care that I saw, the ideas that sparked research or interventions from the patients I mention above, the advocacy or policy changes that come from a specific deaths are the result of deep emotion, compassion, a profound sense of loss, and a will to find meaning. Positive change and healing comes from a lack of numbness, from sharing stories with one another. That is the beauty. The ability to see death so intimately, to be the last person to touch, stitch, hold another human being before they take their last breath, to be able to move on from that and look for meaning. And numbness or dissociation, while easy, and so convenient in the moment cannot and does not last. It is a stopgap. A plug into an ocean, an unsustainable emotion. So be ok with feeling grief. Feel it in that moment. Grief dissipates only when it is fully felt. No conflict has been resolved, no trauma isolated, and no act of recovery or healing has come from not feeling, at least in my experience. In medicine we often view death as a failure. In the hospital, we talk about curative measures and treatment. But as we all know before we get here or at least during this journey, death is often a complicated thing. It is sometimes a relief at the end of seeing suffering. Other times shocking and accidental. Sometimes it is preventable. But it is always the process of seeing life – and the story that went along with that life – stop. But the beauty we create as human beings from death, and the way in which we find purpose from it, especially in medicine, is truly a remarkable trait I see in my colleagues, mentors, and teams every day. And for that opportunity and responsibility, I am grateful and honored. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/12/pic.jpg)Vaidehi Mujumdar is a fourth year medical student at Wake Forest School of Medicine with interests in cancer equity, the intersection of global surgery and women’s health, and qualitative research methods. She graduated from Dartmouth College with a double major in anthropology and biology and subsequently spent two years as a Dartmouth Partners in Community Service Fellow in New York City. Her writing has been published in *The Guardian,* The Almost Doctors Channel, *The Intima: A Journal of Narrative Medicine*, India.com US Edition, Media Diversified, Matador Network, and others. Follow Vaidehi on Twitter [@VeeMuj](https://twitter.com/VeeMuj). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, self-care, training **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Managing your social media presence](https://blog.womensurgeons.org/social-media-presence/) **Published:** December 10, 2018 **Author:** Blog Team **Content:** *By Lillian Erdahl* Social media is omnipresent in our modern society. According to the Pew Research Center, [seven out of ten Americans use social media](http://www.pewinternet.org/fact-sheet/social-media/). Even those who do not actively use social media will have their pictures and words shared by others. There are many sites that may be used to comment on doctors and our practices. Since it is ubiquitous, physicians benefit from being savvy regarding social media whether they use it or not. Outlining why and how to use social media can allow you to use it effectively without being overwhelmed. **Defining your objectives** When thinking about starting or growing your professional social media presence, start by asking “Why am I on social media?”. Why are surgeons on social media? [Wagner, et al](https://www.sciencedirect.com/science/article/pii/S1931720417305081) found that 69.6% of surgeons surveyed reported social media as beneficial or very beneficial for professional development and 22% responded that social media is their preferred method of networking and communication. I use social media to connect with physicians, researchers, and advocates with similar interests. A few of my interests are the treatment of breast cancer; surgical education; and diversity, equity, and inclusion for physicians. Once you know the why, you can determine the how. **Choosing the platform(s)** Since we are having a tweetchat for this topic, it may be a little heavy on [Twitter](https://twitter.com/?lang=en) strategy. However, physicians are using many other platforms to cultivate an online presence including [LinkedIn](https://www.linkedin.com/), [Doximity](https://www.doximity.com/), [Researchgate](https://www.researchgate.net/), [Facebook](https://www.facebook.com/), [Instagram](https://www.instagram.com/?hl=en), [Youtube](https://www.youtube.com/), and [Whatsapp](https://www.whatsapp.com/). Many physicians also write blogs or produce podcasts. If you are new to social media or looking to refine your presence, talk to colleagues who are doing similar work and ask them which platform(s) they use and why the find them to be beneficial. **Building your profile** What should be in your social media profile? Again, think about your goals for social media. Who is your audience and what do you want them to know about you? Start with a relevant picture that is professional such as a headshot or a picture of you speaking at a conference. Use clear language to describe you as a professional and your relevant interests or expertise. Look at the guidelines provided by the platform for suggestions. For example,[ LinkedIn gives advice](https://business.linkedin.com/en-uk/marketing-solutions/blog/posts/content-marketing/2017/17-steps-to-a-better-LinkedIn-profile-in-2017) on how to build a successful network profile. Ask a colleague to review your profile and give feedback. **Making social media work for you** When I discuss building a social media presence with healthcare professionals, I encourage them to organize it to work effectively for their goals and life. Many applications send frequent notifications which can be overwhelming. Get to know the settings and decide how to make the alerts work with your daily life and social media goals. Many platforms allow you to curate the content you see by subject or using lists of users. Content on some platforms can be searched by hashtags. How do you know which hashtags are relevant? There are several sites and tools to help identify relevant hashtags. I recommend starting with the[ Healthcare Hashtag Project](https://www.symplur.com/healthcare-hashtags/). **Avoiding the pitfalls** Effective social media starts with consistency. Set measurable goals for yourself and budget time in your calendar to complete them. Inconsistency in posting can cause your audience to disengage. Examples might be: one original tweet or Instagram post/day, participation in one monthly webinar or online journal club, or updating your online research profile monthly. Read published[ best practice guidelines](https://www.journalacs.org/article/S1072-7515(17)32123-3/abstract) for social media use in healthcare and be mindful about protecting patient privacy and[ maintaining professionalism](https://www.sciencedirect.com/science/article/pii/S1931720415001841) when posting. Join @womensurgeons with Dr. Lillian Erdahl (@LillianErdahlMD) and Dr. Susan Pitt (@susieQP8) for a tweetchat on December 17th, 2018 at 8 pm Eastern on managing your #SoMe presence by following #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo to know more. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/12/Erdahl.jpg) Lillian Erdahl, MD, FACS is an Assistant Professor of Surgery at the University of Iowa where she practices Breast and General Surgery. She is also Associate Program Director in General Surgery; head of the Iowa City VA Breast Clinic; and Communications Director for @UIowa\_Surgery. Her research interests include breast cancer prevention and treatment, faculty development, and surgical education. Her work for gender equity in medicine includes involvement in the Association of Women Surgeons as the new Vice Chair of the Communications Committee and work with @PROWDWomen. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, communication, ILookLikeASurgeon, Tweetchat, womeninsurgery, WomenSurgeons --- ### [AWS and ACS address Intimate Partner Violence in the Surgical Community](https://blog.womensurgeons.org/intimate-partner-violence/) **Published:** December 12, 2018 **Author:** Blog Team **Content:** *By Stephanie Bonne* Nearly 2 years ago, the women’s surgical community was shocked by the loss of one of our own. Dr. Sherilyn Gordon-Burroughs, a gifted transplant surgeon, accomplished researcher, residency program director, and mother of a young daughter, was found dead in her home in an apparent murder-suicide committed by her husband. Her young daughter was left an orphan, cared for by her family. The immediate responses of shock and sorrow were apparent, but in the coming weeks as those waned, an unsettling thought came to the forefront: How did this happen? Dr. Gordon-Burroughs was an African American woman who became an academic transplant surgeon-scientist at a time when the odds were overwhelmingly against her. How does someone who was so academically and clinically successful become the victim of intimate partner violence? Can this happen to my colleagues? Can this happen to me? We learned once again a few weeks ago that it can, when our emergency medicine colleague, Dr. Tamara O’Neal was shot and killed by a former intimate partner at Mercy Hospital in Chicago. The facts remain clear: 1 in 4 women experience severe intimate partner physical violence (IPV) in their lifetime, and 1 and 3 have experiences some kind of physical violence, even if it’s “lesser” violence, such as slapping or pushing. Intimate partner violence accounts for 15% of all crime, and 1 in 15 children are exposed to intimate partner violence each year. Although not relevant in this case, the presence of a gun in the household where intimate partner violence is occurring increases a woman’s chance of death by 500%. Also concerning is that intimate partner violence is most common in women aged 18-24. This can, in some cases, include some of our early preclinical medical students (<https://ncadv.org/statistics>). While no specific statistics exist about the variance in incidence of domestic violence among women with higher education, such as with medical degrees, we know that this must be occurring in our “own house” – the house of surgery. In 2017, the American College of Surgeons Clinical Congress had a special session to address this, where we heard moving stories from surgeons who are survivors of domestic violence. This was a call to action, and a launch of an initiative directed by the 2017-2018 president of the ACS and AWS member, Dr. Barbara Bass, who, as it happens, was Dr. Gordon-Burrough’s chair of surgery at Houston Methodist. Dr. Bass, along with AWS members and others, developed a task force to address IPV in the surgical community. In just 1 year, the task force authored an article outlining its own purpose and goals, has approved and published a [revised intimate partner violence statement from the ACS,](http://www.facsbulletin.com/acsbulletin/october2018/MobilePagedReplica.action?pm=2&folio=14#pg16) partnered with Committee on Trauma to author an [article on the relationship between firerarms and IPV](http://www.facsbulletin.com/acsbulletin/october2018/MobilePagedReplica.action?pm=2&folio=16#pg18), developed a panel session on IPV for the 2019 Clinical Congress, and has worked with AWS to form a [survey](https://ufl.qualtrics.com/jfe/form/SV_er0ht4OkLW4B20l) of surgeons to help identify the problem within the surgical population. The group has also partnered with the AAMC to ensure that the needs of medical students are adequately represented. You can read more about the task force in the [October 2018 *Bulletin of the American College of Surgeons*](https://www.facs.org/~/media/files/publications/bulletin/2018/october2018.ashx)*.* The goal of this workgroup is to continue to evaluate the problem of IPV specifically among our own colleagues, and discuss ways in which we can identify, intervene, and support our colleagues who may be experiencing this problem. In doing so, we hope to improve health and possibly save lives. In conjunction with this effort, AWS has revised its Intimate Partner Violence Statement, which can be found at:[ https://www.womensurgeons.org/page/IPVStatement](https://www.womensurgeons.org/page/IPVStatement) Although Dr. Bass’s tenure as ACS president has ended, the task force will live on in memory of Dr. Gordon-Burroughs and to continue the important work of developing a structure for IPV prevention and to address ongoing IPV among surgeons. As such, we can all live healthier lives and ensure that gifted members of our surgical community are able to best care for our patients. If you are experiencing IPV and need help, please contact one of the following resources, or consider reaching out to your chair, program director, or your institutions employee assistance program. Resources for IPV include: [**The National Domestic Violence Hotline** ](http://www.ndvh.org) 1-800-799-7233 (SAFE) [**National Dating Abuse Helpline** ](http://www.loveisrespect.org) 1-866-331-9474 [**Americans Overseas Domestic Violence Crisis Center** ](http://www.866uswomen.org) International Toll-Free (24/7) 1-866-USWOMEN (879-6636) [**National Child Abuse Hotline/Childhelp** ](https://www.childhelp.org/) 1-800-4-A-CHILD (1-800-422-4453) [**National Sexual Assault Hotline** ](http://www.rainn.org) 1-800-656-4673 (HOPE) [**National Suicide Prevention Lifeline** ](http://www.suicidepreventionlifeline.org) 1-800-273-8255 (TALK) *![](http://blog.womensurgeons.org/wp-content/uploads/2018/12/surg.jpg)Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the American Association for the Surgery of Trauma, the ACS Committee on Trauma, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force, and is the surveillance core director of the New Jersey Center for FIrearm Injury Research at Rutgers University. Dr. Bonne is the current Communications Chair for the AWS, a co-editor for AJS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children. You can follow her on Twitter: @scrubbedin.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, awareness, self-care, women **Tags:** #ACS, AWS, AWSBlog, womeninsurgery --- ### [Michigan Conference 2018: You Don’t Always Have To Be Perfect or Successful To Lead from Your Best Self](https://blog.womensurgeons.org/michigan-conference/) **Published:** December 20, 2018 **Author:** Blog Team **Content:** *By Andrea Merrill* In residency, we had a nightly event called “9 o’clock meal”. Born out of a former surgery resident threatening to expose our measly salary to the local newspaper, every night at 9 o’clock, the hospital cafeteria served free leftovers to the in house residents. I tried to make it to “9 o’clock meal” whenever I worked overnight, but it definitely wasn’t the food that drew me (think instant mashed potatoes, reheated fish, mystery meat, etc.). What I went for was the camaraderie it built amongst my co-residents and, if I was lucky, the stories my chief residents sometimes regaled us with of their early failures and mistakes. As a struggling and insecure intern, I clung to these stories as proof that maybe I, too, could make it through general surgery training. In my darkest moments, those stories were what I often turned to for comfort. This year’s Michigan Women’s Surgery Collaborative conference was my updated and much needed “9 o’clock meal”. I had attended the [first annual conference](http://blog.womensurgeons.org/medical-students/mwsc/) last year and left inspired and energized. I had eagerly awaited this year’s conference and was looking forward to the new sessions this year. However, as this year’s conference approached, I experienced some difficulties in my personal life that caused my enthusiasm for the conference to dwindle. The theme of the conference was “Leading from your best self” and was focused on crafting your CV, cover letter, and elevator pitch to find your ideal job. Given my personal struggles, I admit I felt a bit lost and it was hard for me to self-reflect and critically think about what I wanted in a job (which as a first year surgical oncology fellow I realize is fast approaching). Additionally, I didn’t even feel close to my normal self, how could I try to be my best self? But I made myself go. And it was inspirational and chalk full of great talks by the “who’s who” of women surgeons, but my heart wasn’t really in it to begin with. The main conference kicked off with a keynote speech by Dr. Reshma Jagsi (@reshmajagsi), a physician and researcher I’ve looked up to for a long time, who talked about the pipeline problem for women in surgery, inequity in promotion and funding, and sexual harassment. Next Drs. Julie Ann Sosa (@Jasosamd), Barbara Bass (@ACSPastPrez98 ), and Mary Hawn (@maryhawn ) gave a series of talks on various aspects of negotiating along your career path. The day ended with a networking event where I had a chance to meet some of my role models like Dr. Julie Ann Sosa who is such a down-to-earth and overall awesome person, aside from being a badass surgeon and Chair of Surgery at UCSF. The following day was run by physician and executive coach, Janet Dombrowski (@JCDAdvisors), as she helped lead us through exercises to craft our CVs, cover letters, and “elevator pitches” which was interspersed with talks by Drs. Julie Freischlag (@jfreischlag), Sandra Wong (@sandralwong), Andrea Hayes-Jordan, and Rebecca Minter (@minterwiscsurg). While these talks and exercises were excellent and highly valuable, what inspired me and really brought me back to my senses was the last session called “Making Lemonade”, or an updated version of the “9 o’clock meal” of my residency. While I had heard stories of adversity and triumph from women surgeons previously, it had never been this raw and honest. All featured speakers shared a hardship they had encountered along the ladder to success and how they overcame it. The 2 stories that stuck out to me were those of Dr. Minter and Dr. Freischlag and I think many women can identify and find comfort in their stories and journeys. Many know that Dr. Minter attended the University of Southwestern Texas for medical school and then finished her general surgery residency at the University of Florida College of Medicine. However, what most do not know is her journey between them. Dr. Minter shared with us that during her 4th year of medical school, she was going through some difficult personal and family situations that, unfortunately, affected her professional performance. She admitted that she should have asked for help at this time, but she forged on ahead with applications and interviews on her own. When match day came, she opened her envelope to find out she had not matched. She was fortunate to get a preliminary spot at the University of Florida, and eventually, with help this time, this turned into a categorical position at the same institution. She is now a highly regarded hepatopancreaticobiliary surgeon and one of the few female chairs of surgery in the country and has made it a point to “pay it forward” by helping other unmatched preliminary residents navigate this difficult situation to a future successful career. As a woman who has truly paved the way for women surgeons in this country, Dr. Freischlag, the CEO of Wake Forest Baptist Medical Center, certainly has many stories of adversity along her road to success. I have heard some of them before, but never one so personal as the one she shared with us this conference. Early in her career as a vascular surgeon at UCLA, her first husband became unhappy that she was so busy and either wanted her to quit surgery, or get a divorce. She actually contemplated quitting surgery but a mentor stopped her, telling her that surgery was her identity and she couldn’t just stop to save her marriage. She admitted that she “felt like a total failure”, that she had failed “work-life balance” which wasn’t really even a concept back then. She thought that she had failed at this perfect image of herself and that she had let down her female trainees that looked up to her. But then with the help of her mentor she realized, “Ok I’m a surgeon, just cut it out and start over”. She then moved to Milwaukee where she joined the surgery faculty and a dating service (which consisted of videos you had to create and watch in person back then) and clearly has had an extremely successful surgical career. It’s hard to believe that someone as successful, as confident, and as powerful as Dr. Freischlag, ever doubted herself (or that she scored a 203 on Step 1!). People, especially women, think we need to be seen as “perfect” all the time. We think we always need to be “on” and that it is a weakness to show faults, mistakes, failures, and emotions. Listening to these incredible women’s stories helped me realize that is ok, maybe it is even good, to stumble along the way and not be perfect. When we are always and only putting our best foot forward, it makes others think that they are not allowed to fail or make mistakes. I will be forever grateful to these amazing women for sharing their stories and vulnerabilities with us. It was so special to experience in person and I hope these stories help other young women navigating their surgical careers. Am I my best self now? Not quite yet. Will I get there? I have more hope now after listening to these amazing trailblazers in surgery. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/12/Andrea-Merrill.jpg)*Dr. Andrea Merrill is a surgical oncology fellow at the James Cancer Hospital at The Ohio State University. She completed her general surgery residency at Massachusetts General Hospital. During her residency she did a year of breast surgery outcomes research followed by a yearlong editorial fellowship at the New England Journal of Medicine. She plans to focus her career in breast and endocrine surgery and has a research interest in gender bias in surgery.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** leadership, mentorship, residency, training **Tags:** AWS, AWSBlog, leadership, mentorship, residency, Resident Mentor, residents, training, womeninsurgery, workplace --- ### [Interview with Dr. Monica Vera, President of Bolivian Surgical Society](https://blog.womensurgeons.org/bolivian-surgical-society/) **Published:** December 30, 2018 **Author:** Blog Team **Content:** **The link to their page is :** [**http://circruz.com/directiva-actual/**](http://circruz.com/directiva-actual/) *Interview by Dr. Mecker G. Möller . Translation by Dr. Luz María Rodriguez. Editing by Drs. Mecker G. Möller, Luz María Rodriguez, and Marie Crandall.* **Could you give a review on how you managed to accomplish such a high level of leadership and give advice to other women who wish to follow in your footsteps?** In addition to being the first female bariatric surgeon in Bolivia, another accomplishment that has made me known in my country is being one of the first Advanced Trauma Life Support (ATLS) instructors. Both these endeavors have allowed me to demonstrate to my colleagues my dedication to my work. I have also been a part of numerous board positions for the Surgical Society. Furthermore, I have attended various conferences in my country and have actively participated in the scientific portions as well as in the administrative meetings.I am the founder of the bariatric surgery committee in Bolivia of which I was recognized as the national president. I have been president of the Bolivian society of surgery in the Santa Cruz Chapter. All of the aforementioned efforts led to my election as president of Sociedad boliviana de cirugia. The best advice I can give to any surgeon who wishes to follow in my footsteps is to demonstrate commitment in everything that they propose to carry out until the task is completed. **During your training, did you find mentors who have guided or inspired you to achieve your goals?** Starting my residency in an environment that was dominated mostly by men was not easy; however, as I gained their respect and trust, I was able to find excellent mentors. Once I graduated, I found a great surgeon, who truly inspired me and introduced me to the ATLS. I applied this methodology to my daily life in order to continue achieving all my goals step by step. **What is the percentage of female applicants to medical schools and how many of these apply to surgical careers?** I do not have the exact data, but I do recognize that more and more women in my country are currently enrolled in medical schools. I have also noticed that the number of female residents in surgery also increases each year. Recently, we have also successfully created a group of the female surgeons from all of Bolivia, Mujeres cirjuanas de Bolivia. **How many bariatric surgeons exist in Bolivia?** We are currently 5 bariatric surgeons in different cities of Bolivia. However, only 2 or 3 of us are clinically active. **What type of methodology do you consider or use in order to teach medical students and residents during the clinical practices and within the operating room?** The best advice I can give these students is for them to grasp the courses of Advanced Trauma Life Support, Advanced Cardiac Life Support, and Pre-Hospital Trauma Life Support as these are able to teach them methodologies that can be applied to all aspects of surgery, and life itself. **Are there still stigma or social barriers upon women surgeons in Bolivia, and what alternatives do you consider possible as a way to overcome these barriers? Did you personally find some of these barriers and how were you able to overcome them?** For me, these barriers began breaking the moment I gained the respect and trust of my colleagues by showing them my commitment to the job, my academic endeavors, and my determination to always surpass my own accomplishments. **What is the perception of the public with regards to the competence of female surgeons in your country?** In Bolivia, there are still social barriers that exist towards women surgeons, especially when society expects the male figure to assume the role of a surgeon. These barriers and stigmas will break once society is able to see female surgeons as responsible and focused professionals. **What programs exist in Bolivia to help women surgeons who are also mothers or heads of families to avoid ‘burnout’ or give up on their careers?** None. These are not even considered for any professional career women in a leadership position. **How do you achieve balance between your career and your responsibilities at home? Do you have support at home regarding your role as a mother or in your personal projects/hobbies?** Being able to balance my profession with my personal life and my different roles (mother, wife, daughter, sister, aunt, etc.) was very difficult and I had to sacrifice many things. However, I had the constant support of my parents, siblings and husband which facilitated my ability to pursue my profession without neglecting my responsibilities at home. **Are there leadership differences between female and male surgeons?** Female surgeons are more attentive to details. As women, we also tend to be more maternal which is an advantage as we continuously strive to find a benefit for all those involved; sometimes often leaving behind our own personal interests. **What is your vision as president of the Bolivian Society of Surgery in order to incorporate more female surgeons in areas of leadership?** Part of my vision as president of the College of Surgeons in Bolivia is to support training for all female surgeons, help them be well-prepared and empower them to achieve more leadership positions at a national and international level. **What opportunities do you think we could explore in order to create a collaboration for training young female surgeons into a global standpoint?** I believe that together with the Association of Women Surgeons (AWS), we would help many female surgeons in the world recognize that they are not alone and that many others share similar experiences. The lessons that are presented through the collaboration between AWS and Bolivian Society of Surgery inspire and empower young female surgeons to acknowledge that surgery is no longer a field exclusively for male surgeons. **![](http://blog.womensurgeons.org/wp-content/uploads/2018/12/rod-240x300.png)Dr. Luz Maria Rodriguez** is a board certified general surgeon and a dual fellowship trained surgical oncologist and colorectal surgeon. She works at the National Cancer Institute (NCI) Division of Cancer Prevention (DCP). Prior to joining the DCP she spent nearly a decade as a translational physician-scientist in the Genetics Branch at the NCI. Her lab studied genome-wide gene expression profiles in colonic mucosa of populations at risk. This expression profiling created a foundation for biomarkers of early colon cancer detection and prevention. She developed a Clinical Cancer Genetics Program devoted to risk surveillance, assessment, genetic testing, counseling, prevention and targeted intervention for individuals at increased risk for specific cancers. These protocols involved testing and the identification of biomarkers that might be candidate for intermediates endpoints in treatment and prevention trials. At DCP, Dr. Rodriguez supports ongoing clinical trial efforts of the NCI Division of Cancer Prevention Early Phase 0-II prevention trials through protocol development, scientific review, strategic planning. DCP’s early phase clinical trials fill the void between preclinical studies and Phase III. The Early Phase trials places emphasis on intervention effects on at-risk tissue-intensive tissue collections (e.g. biopsies), invasive biomarker monitoring. Dr. Rodriguez oversees chemopreventive and treatment trials in organ sites such as the liver, pancreas, stomach, and colon using study agents such as vaccines, and drug agents such as Simvastatin, Berberine, Curcumin, Metformin, Erlotinib and Aspirin. She also serves as a consultant nationally and internationally with various scientific and clinical groups with special focus on health disparity with the hope of narrowing the gap in cancer intervention. Dr. Rodriguez is a Senior Faculty and Surgeon at the Uniformed Services University of the Health Sciences (USU) and Walter Reed Military Medical Center (WRMMC) for the past 17 years serving domestic and foreign military families in the area of GI diseases, pelvic floor disorders, soft tissue sarcoma and breast disease. She also trains medical students, residents and fellows in surgery, oncology and cancer prevention. **![](http://blog.womensurgeons.org/wp-content/uploads/2018/12/mocker-1-214x300.jpeg)Mecker G. Möller, MD,FACS** is a surgical oncologist and Associate Professor of Surgery at University of Miami Miller School of Medicine. She is the Leader of the peritoneal surface malignancy HIPEC program at University of Miami Hospital and the Associate Program Director Breast Surgical Oncology Fellowship. Dr Möller did her general surgery residency at Michigan State University and surgical oncology fellowship at USF/Moffitt Cancer Center . She is a member of the ACS international board of governors, member of the commission on cancer committee of the Florida Chapter and publications committee of the AWS. **![](http://blog.womensurgeons.org/wp-content/uploads/2018/12/Vera-300x284.jpg)Dr. Monica Vera** --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** leadership **Tags:** #bariatricsurgery, #Bolivia, #medicine, AWS, surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Getting There from Here](https://blog.womensurgeons.org/getting-there-from-here/) **Published:** January 2, 2019 **Author:** Blog Team **Content:** *By Elizabeth Shaughnessy* Much is said and written about beginning one’s surgical career; however less so about advancement. I am always curious about others who advance. How did they get there? What advice do they have? Paths are not identical; each one has a different story. Engage them in conversation! Pursuit of basic science is more defined than other career paths. The beginning investigator should identify and engage a suitable mentor, best located at their home institution with a track record of mentoring success. One can acquire additional informal mentors for advice. Initial pilot grants allow generation of preliminary data based on one’s hypothesis. Preliminary data may enable the investigator to apply for a K grant through the NIH, a career development grant through the VA or another agency. Outside funding boosts your credibility as a researcher. Mentors for a K grant must participate in mentor training, and will likely develop an agreement of interaction meant to keep the young investigator on track. It is key to obtain independent funding within 3-5 years after training. But what of those who choose to pursue clinical or translational research? Some institutions provide training, and there are also courses offered through the American College of Surgeons, and through some multi-institutional trial groups. Training is a great place to start, but it is vital to prepare your hypothesis and concepts for development as well. Here a mentor is crucial to provide another pair of eyes to critique your protocols and to make suggestions. Successful investigators of either type tend to assemble as research groups to train new investigators and to develop the more seasoned researchers. It provides an internal network of analysis and evaluation for development. But external networking is important, too. Externally, you may meet people in your field critical in the review of your submitted papers. It is helpful to bounce ideas off those you trust. They may identify holes in your process before you spend critical time on its development. They may also inform you of opening positions that may serve to help you grow as a researcher but also as a leader. Mentors can be younger or older. We all can function as a mentor within the home institution or outside of it. If you want to advance, help that person immediately above you move up, or move out, to that dream job they identified, creating space for you to grow. Later that gift may be reciprocated. For those who have aspirations of leadership, be it departmental, institutional-based, hospital-based or organizational, talk to those in the position of interest to find out what skills are needed to function in that capacity. There is no strict formula. A department chair in one institution may need to have had experience in basic or translational science, whereas in another institution he/she may not. But if you do not build your skill set over time, you may find yourself behind the competition. Volunteer for this committee, or that project. There is something to be learned with the effort. Step outside your comfort zone—finances, budgeting, ethics consults! Your skill set may determine your entre beyond just your career as a surgeon. It constitutes your armamentarium. Finally, as one progresses, it may be necessary to seek out further education, perhaps through university offerings in person or online, AAMC courses, ELAM, or independent leadership training such as Lantern. Given your goals or responsibilities, the costs may be borne by your department of institution: ask and you may be surprised! Life is change, and we must be resilient. Be reliable and make your word count for something; follow through on what you have obliged yourself to do. Your reputation is built one person at a time, and its mismanagement can come back to bite you. Advancement is a journey, as is life. Find what you enjoy doing, and go for it! Change your mind or direction, just as we do in life. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/pic.jpg)Beth Shaughnessy was born and raised in the Chicago area, with her undergraduate years spent at the University of Illinois at Urbana-Champaign. She returned to Chicago for medical school at the University of Illinois at Chicago. Following general surgery residency at the University of Illinois’ program, she pursued a fellowship in surgical oncology at the City of Hope National Cancer Center outside of Los Angeles. She is currently a professor of surgery at the University of Cincinnati. She lives with her husband and son. She enjoys cooking, yoga, the arts, choral singing, and gardening. Twitter handle: [ @DrBethS1 ](https://twitter.com/DrBethS1) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship, networking **Tags:** #mentors, AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Inspiring our future by encouraging our present](https://blog.womensurgeons.org/inspiring-our-future-by-encouraging-our-present/) **Published:** January 9, 2019 **Author:** Blog Team **Content:** *By Renee Hilton* I am asked the same question nearly every day by young female medical students aspiring to become surgeons. “Can I be a surgeon and have a normal life as a woman?” You will make sacrifices in any career that you choose in medicine, and surgery is no exception. I respond by offering encouragement while explaining the challenges and then showing them my “travel wall” in my office. My bookshelves are lined with photographs of my family and our many adventures during my years spent as a surgical resident and later as a fellow. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/desk-300x225.jpg) Even during the busiest time of my career I managed to find balance and not only have a life but really enjoy it. Part of the hesitation to pursuing surgery for many women is that traditionally surgery has been a male dominated field, but this is slowly changing. In 2018 according to the [AAMC](https://news.aamc.org/press-releases/article/applicant-data-2018/), women applying to medical schools the US outnumbered the men, comprising 50.9% of applicants. The [percentage of female surgeons](https://www.thebalancecareers.com/number-of-women-surgeons-in-the-us-3972900) has increased to 19.2%. We will see for the first time ever in 2019 a graduating class of [five female chief residents at Tulane](http://blog.womensurgeons.org/residency/making-history-at-tulane/). While the growth has been slower than most would like, simply by continuing to increase our presence within the field I believe that we will inspire many women to pursue surgery. Encouraging women surgeons already in practice is equally as important as inspiring the next generation to pursue the field. Gender bias remains prevalent within our specialty and is a source of frustration for nearly every surgeon I know. Addressing this problem remains a top priority for both male and female surgeons alike. So how do we encourage women surgeons in an environment where bias is present? We take action to eliminate the bias and encourage others to do the same. Encourage other female surgeons to apply for academic promotion. [Women are underrepresented](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2532788) in senior academic positions with only 8% of full professors being women and fewer than 10% of the country’s chair positions held by women. Why do so few women make it to full professor? There are glass ceilings and sticky floors, but also, we don’t apply. [Females apply for promotion](https://hbr.org/2014/08/why-women-dont-apply-for-jobs-unless-theyre-100-qualified) when they are 100% qualified for the position whereas men apply when they are 60% qualified. Without asking, you will not receive. We need to apply for promotion. Encourage women surgeons to ask for a salary that reflects their expertise and position. Wage gaps still exist. According to [U.S. News](https://www.usnews.com/news/health-care-news/articles/2018-04-11/report-despite-physician-salary-increases-wage-gaps-still-exist) and the [Medscape Physician Compensation Report 2018](https://www.medscape.com/slideshow/2018-compensation-overview-6009667?faf=1), female specialists earn significantly less than male specialists, a gap of 36%, when adjusted for equal work. Demand transparency from your institution. With transparency comes accountability. The AWS statement on gender salary equity is available via the [Gender Equity Toolkit.](https://www.womensurgeons.org/page/GenderEquity) Encourage women surgeons to take advantage of social media; it provides an excellent platform for promoting and encouraging women in surgery. Tweet or post about your friends’ success, share their latest article or congratulate them for receiving their first grant. Engage with women both within and outside of your specialty to collaborate on research projects. Being a woman in surgery can feel isolating if you are alone at your institution, but social media can provide an opportunity to interact with amazing women across the country and world. I look forward to meeting my “twitter friends” at conferences each year. I have received speaking, committee and research opportunities through contacts on social media. Encourage women surgeons to participate in women in surgery or women in medicine organizations both locally and nationally. The sense of belonging to a group has been shown to improve retention and physical well-being in educational settings. ([Salles, et al](https://www.ncbi.nlm.nih.gov/pubmed/?term=belonging+salles+A)) Belonging is a simple concept, but it carries enormous impact. It is not limited to residency. Inspiring and encouraging women in surgery should be effortless for most of us. Speak loudly and often about loving your job. Dispel the myths of being a female surgeon to students and residents- you can have a family and an amazing life while pursuing your career. Encourage other women surgeons to demand equal pay, academic advancement, and the same level of respect as their male counterparts. Take advantage of social media and women inclusive organizations- find a place to belong. Lastly, *be kind*. If you see that someone is struggling, ask how you can help. Sometimes the greatest encouragement and inspiration is a kind word or a helping hand. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/hilton.jpg)Dr. L. Renee Hilton is an Assistant Professor at the Medical College of Georgia at Augusta University Medical Center. She is the Section Chief of Minimally Invasive Surgery and the Director of the Center of Obesity and Metabolism at Augusta University. She is also the Associate Program Director for the general surgery residency program. She completed her general surgery residency at Jackson Memorial Hospital at the University of Miami and then fellowship in bariatric and minimally invasive surgery at Yale University. She serves in multiple leadership roles within the department including being the director of the residency surgical skills lab and chair of the Surgical Simulation Committee. She currently resides and practices in Augusta, Georgia. She enjoys spending time with her family, hiking, skiing, boating, traveling and pretty much any activity that involves the outdoors. You can find her on [**Twitter**](https://twitter.com/reneehilton30) [@reneehilton30](https://twitter.com/reneehilton30) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency, self-care, training **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [Successful Grant Application Writing](https://blog.womensurgeons.org/grant-application/) **Published:** January 14, 2019 **Author:** Blog Team **Content:** *By Luz María Rodriguez* *MD, FACS* *This is the first of a series focusing on the components involved in writing a successful grant application.* Surgeons by nature are natural scientists. Our curiosity, determination, and dedication to improve patient outcomes, including survival, new surgical approaches and translational research is part of our DNA. The United States supports an enormous research enterprise and spends more money than any other country on research and development, which is a great asset to practicing surgeons in this country. How can surgeons write a successful grant application regardless of the institutional environment? The National Institutes of Health (NIH), the world’s largest source of funding for medical research, provides the template prototype for a successful grant application. The guidance principal by the NIH provides resources to fund research proposals that excel in every one of the 5 NIH Review Criteria: Significance, Innovation, Investigators, Approach, and Environment. Below, 6 key items are outlined that every researcher should follow if she or he is to be successful. **1. Understanding the process** Get an early start by doing your homework; find experienced staff at your institution who can assist. This person may be in a central grant’s office, or it may be another investigator such as a departmental administrator. Allow ample time to plan, organize and write your application. You may need as few as 2-3 weeks for a small project and as long as a year or more for a larger project. Your grants office can also: - Provide guidance on NIH policies and processes; - Guide you through the application process, inform you of any institutional deadlines you must meet; - Offer specific advice, especially the budget; You must register in the Electronic Research Administration (***eRA Commons*)** and create a PI account. This is the site where you will be submitting your application. Search literature and grant databases using PubMed and Google Scholar. Review the NIH Research Portfolio Online Reporting Tools (RePORTER), which provides access to reports, data, and analyses of NIH research activities, including information on NIH expenditures and the results of NIH supported research. [**http://projectreporter.nih.gov**](http://projectreporter.nih.gov) Establish a timeline for your grant. The grant cycle consists of 3 cycles for submission. For the *R01* application, the deadlines *are June 5, Oct 5, Feb 5.* Grants submitted June 5th will be typically reviewed in October. Usually, there are 9 months between 1st and 2nd submission assignment of the study section. A completed grant application is due by **5pm local** time of the applicant’s organization. <http://grants.nih.gov/grants/how-to-apply-application-guide/due-dates-and-submission-policies/standard-due-dates.htm> **2. KEY Resources** Keeping informed of all funding opportunities is a must. You may subscribe to the NIH Guide to Grants and Contracts, which is a weekly publication of new funding opportunities and guide notices or check the new Funding Opportunity Announcements (FOAs) at[ https://grants.nih.gov. ](https://grants.nih.gov)To Subscribe, send an e-mail to listserv@list.nih.gov with the following text in the message body (not the “Subject” line): subscribe NIH Seminars *your name (Example: subscribe NIH\_Seminars John Smith)* *Other resources:* [Office of Extramural Research ](https://grants.nih.gov/aboutoer/welcome.htm) [Grants Policy](https://grants.nih.gov/policy/nihgps/index.htm) [Official publication for Grant Policies, Guidelines and Funding Opportunities](http://grants.nih.gov/grants/guide/listserv.htm) Another great source of information is the [Application Guide within the NIH and other PHS Agencies is (SF424 (R&R)).](https://grants.nih.gov/grants/how-to-apply-application-guide.html) **3. Mechanisms** The most common grants for clinical investigators are: **K-awards, R03, R21, and R01.** The Research Project grant *(R01)* provides support for health-related research and development based on the mission of the NIH. It can be investigator-initiated or can be in response to a program announcement or request for application. **4. Key application elements** Grants have basically the same structure. Below detailed information about these basic sections is provided. The most important part of any grant application is the written proposal itself. It consists of a 12 pages scientific research strategy with the following elements: - Specific Aims - Approach - Significance - Innovation - Research plan The Biographical sketch for each listed Senior /Key personnel and the Personal Statement are critical in the submission of a grant. <https://grants.nih.gov/grants/forms/biosketch> Each ***Specific Aim*** should provide a concise statement of exactly what you want to accomplish. Convey the importance of your area of interest for medicine/ medical care/public health/health policy. Current state of knowledge in your area of interest. Discuss Expected outcomes (payoffs) from pursuing each specific aim. It is ONE PAGE MAX and is often the *only* page most Reviewers read Describe the overall ***Research Approach & Strategy you will*** use to accomplish the specific aims of the project. Include how the data will be collected, analyzed, and interpreted. Discuss potential problems, alternative strategies, and benchmarks for success anticipated to achieve the aims. Include preliminary studies-demonstrate productivity and feasibility. Summarize what is known from existing literature. Clearly point out the gaps and highlight how this proposal will fill those gaps in knowledge to establish the ***significance*** of your proposed research. Highlight the ***Innovation*** of your proposal by discussing novel concepts, approaches, methodology, and how the application challenges or shifts the current state **5. Grantsmanship** No matter how innovative one’s ideas are, sloppy or unfocused writing can completely obscure these ideas. The basic writing skills, such as sentence structure and grammar, are essential as one’s writing needs to flow clearly from one idea to the next. It is important to *“tell a story”* clearly. Define acronyms the first time you use them and incorporate all figures. Get it reviewed internally and use spell check and grammar check. In summary, write what you are going to tell; tell what you want to tell and summarize what you told. Remember to incorporate the players, discuss their role in the proposal- PI, Co-PI, any facility, core etc. **6. Help the Reviewers Help YOU** Writing with the reviewers in mind can be summarized to one simple concept: Do not make the reviewers work harder than they have to. Reviewers may not have the same depth of knowledge you do, but do not assume they cannot find relevant literature. They are busy people, with lives and careers outside of reviewing grants; they are asked to read multiple grant applications in a short period of time. Reviewers’ time is of the essence and the majority of reviewers will make up their minds very quickly. Write **brief summary statements** at the end of each section to help guide the reviewer. - **Highlight** sentences that spell out the **Significance**, and **Innovation** - “This research is significant because…” - “These aims are innovative as they show…” - “Our work is important because…” - Write statements that justify your approach (rule in or rule out) - Why using this approach is better? - Use **Preliminary Data** to demonstrate your Expertise and Environment - Include experts. Use graphs or picture whenever possible **Summary** The essentials of Successful Grant Applications must include a strong idea – back it up with strong supporting preliminary data. You must emphasize how your previous work demonstrates project feasibility. You must have the right team and communicate scientific content accurately and concisely. Follow all the directions, start early, seek advice and critical input, including from your Program Officer, and remember to EDIT. **Additional Resources:** [National Institutes of Health](http://www.nih.gov) - [‘Open Mike’](https://nexus.od.nih.gov/all/category/blog/) [Center for Scientific Review](http://www.csr.nih.gov) - [Resources for Applicants](http://www.csr.nih.gov/ResourcesforApplicants) [NIH Grant Writing Workshops in 2019](https://regionalseminars.od.nih.gov/baltimore2019/welcome) [NIH Faculty Sponsored Grant Writing 2019 ](https://www.sbas.net/annual-meeting/#register) [Grant Writing for Success NIH by Dr. Paula Stricklan](https://www.youtube.com/watch?v=EX4gO69AGo0) [**The Grant Application Writer’s Workbook, 2018,** ](http://www.grantcentral.com/workbooks/national-institutes-of-health/)Russell & Morrison **The Elements of Style, 4th ed**. By Strunk & White Join @womensurgeons with moderators Dr. Genevieve Boland (@gmboland) and Dr. Carrie Sims (@carriesims20) for a tweetchat on January 21st at 8 pm Eastern Time on how to write a successful grant application by following #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo (@heatheryeomd) to know more. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/lUZ-240x300.png)Dr. Luz María Rodriguez is a dual fellowship trained surgical oncologist and colorectal surgeon. She works at the National Cancer Institute (NCI) Division of Cancer Prevention (DCP). Prior to joining the DCP she spent nearly a decade as a translational physician-scientist in the Genetics Branch at the NCI. Her lab studied genome-wide gene expression profiles in colonic mucosa of populations at risk. This expression profiling created a foundation for biomarkers of early colon cancer detection and prevention. She developed a Clinical Cancer Genetics Program devoted to risk surveillance, assessment, genetic testing, counseling, prevention and targeted intervention for individuals at increased risk for specific cancers At DCP, Dr. Rodriguez supports ongoing clinical trial efforts of the NCI Division of Cancer Prevention Early Phase 0-II prevention trials through protocol development, scientific review, strategic planning. DCP’s early phase clinical trials fill the void between preclinical studies and Phase III. The Early Phase trials places emphasis on intervention effects on at-risk tissue-intensive tissue collections (e.g. biopsies), invasive biomarker monitoring. Dr. Rodriguez oversees chemopreventive and treatment trials in organ sites such as the liver, pancreas, stomach, and colon using study agents such as vaccines, and drug agents such as Simvastatin, Berberine, Curcumin, Metformin, Erlotinib and Aspirin. She also serves as a consultant nationally and internationally with various scientific and clinical groups with special focus on high risk cancer families, cancer immunoprevention and health disparity with the hope of narrowing the gap in cancer intervention Dr. Rodriguez is a senior faculty and surgeon at the Uniformed Services University of the Health Sciences (USUH) and Walter Reed National Military Medical Center (WRNMMC) serving domestic and foreign military families in the area of GI diseases, pelvic floor disorders, soft tissue sarcoma, breast and anorectal diseases. She also trains medical students, residents and fellows in surgery, oncology and cancer prevention --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** research **Tags:** AWSBlog, grant writing, ILookLikeASurgeon, research, resources, surgeon scientists, womeninmedicine, WomenSurgeons --- ### [Dealing with Bullying](https://blog.womensurgeons.org/dealing-with-bullying/) **Published:** January 17, 2019 **Author:** Blog Team **Content:** *By Hilary Sanfey MB. BCh. MHPE, FACS, FRCSEd (hon)* Bullying is a persistent pattern of mistreatment that includes verbal, nonverbal, psychological, or physical abuse and humiliation. The behavior is usually hierarchical although it can come from peers or coworkers. The detrimental consequences of burnout, ranging from job dissatisfaction to suicide, are becoming more apparent as is the adverse impact on patient safety. Surgery is often cited as a specialty where such behavior is particularly prevalent. Many senior surgeons trained in an era where [ridicule and humiliation were considered to have a positive effect](https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2929.2005.02247.x) on clinical care, education, or even patient safety and thus tried to justify such behavior. Surgery is also a specialty where suffering is supposed to take place in silence; thus few victims or bystanders speak up for fear of ridicule or retaliation. Five categories of workplace bullying have been identified by [Rayner et al](https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1099-1298(199706)7:3%3C181::AID-CASP416%3E3.0.CO;2-Y): - Threats to professional status (belittling, humiliation) - Threats to personal standing (teasing, insults) - Isolation (withholding information) - Overwork (impossible deadlines, unnecessary disruptions) - Destabilization (meaningless tasks, shifting of goal posts detrimental behavior to the person and the workplace) [What are the signs](https://www.rcsed.ac.uk/professional-support-development-resources/anti-bullying-and-undermining-campaign/are-you-being-bullied) that you are subject to, or experiencing bullying? - You avoid a colleague as you know they will make derogatory remarks about you. - You feel targeted by one individual, and the rest of the team do not support you when that individual is present. - You feel too scared or intimidated to contribute to a discussion or raise a question. - You notice that a team member uses an unpleasant or different tone of voice when speaking to you. - Your team is not functioning well, and the behaviour of one or more individuals to others in the team is contributing to the problem. - When someone in the team often raises their voice or uses bad language, such that the team try to avoid triggering such behaviour. This may lead to concealment with subsequent patient safety issues. If you find yourself treating others badly, so that you are not proud of how you have behaved, you may have learnt this pattern of behaviour from the way you have been treated. The **individual** should document the behavior, and report it to a supervisor. Depending on the power differential and relationship with the bully, it may be appropriate for the victim to take a stand and indicate that such behavior is unacceptable. **Bystanders** can become “Upstanders” by not encouraging or supporting the behaviour, making it clear to colleagues that you won’t be involved in the behaviour, and not advertising or ridiculing the mistreatment of the victim, especially in social media. Direct action could include telling the bully that their behaviour is unacceptable, defending the victim and reporting the behaviour to the appropriate supervisor. Finally, there is strength in numbers and approaching the bully to let him / her know you are aware of the behaviour and that it’s not acceptable is often effective. Since bullying usually involves a power differential the most effective way to address such behavior will be at the **leadership** level. - Leaders must clearly set the example. - A no tolerance policy should be explicit and policies about these behaviors and processes in which to safely report them should exist within every department. - Appropriate avenues for reporting and investigation which include privacy and lack of retaliation must be in place. - Appropriate interventions should be readily available for those affected. On a positive note, several institutions and organizations, such as [RCSEd](https://www.rcsed.ac.uk/professional-support-development-resources/anti-bullying-and-undermining-campaign/are-you-being-bullied), [ACS](http://bulletin.facs.org/2016/10/workplace-bullying-is-a-real-problem-in-health-care/), [RACS](https://surgeons.org/about-respect/), and [AAS](http://americansurgical.org/files/2018/Equity.pdf) have spoken out against bullying in recent times indicating an increased awareness. Notably, [in one study](https://www.ncbi.nlm.nih.gov/pubmed/28742690) trainees were more likely to respond actively to observed incidents of bullying compared with consultants. This may be attributed to changes in surgical training, the greater emphasis placed on nontechnical skills in the newer surgical curricula or to a cultural change in society. Additional Resource: [Einarsen S, Hoel H, Notelaers G. Measuring exposure to bullying and harassment at work: validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work & Stress. January-March 2009;23(1):24-44](https://www.tandfonline.com/doi/abs/10.1080/02678370902815673) ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/sanfey-240x300.png)Dr. Sanfey is Professor of Surgery and Vice-chair for Surgical Education at Southern Illinois University and the Chair of the AWS Foundation. She graduated from Trinity College Dublin Medical School, underwent surgical training at RCSI and completed fellowships at Johns Hopkins University, at the University Hospital Clinic de Barcelona and at the University of Virginia. Dr. Sanfey practiced as a consultant transplant surgeon at the Royal Infirmary of Edinburgh and at the University of Virginia. Dr. Sanfey is a past president of the Association of Women Surgeons and past First Vice-president of the American College of Surgeons (ACS). She co-chairs the Steering Committee for the ACS Certificate in Applied Surgical Education Leadership program and is a founding member of the ACS Academy of Master Surgeons, a member of the American Surgical Association, and a Fellow *ad hominem* of the Royal College of Surgeons of Edinburgh. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness, leadership, professionalism **Tags:** #stopbullying, AWSBlog, womeninmedicine, womeninsurgery --- ### [A Glimpse Behind the Scenes: What Really Goes on at a Residency Selection Committee](https://blog.womensurgeons.org/residency-selection-committee/) **Published:** January 20, 2019 **Author:** Blog Team **Content:** *By Sarah Armenia* On a crisp Boston morning during the AWS annual meeting this fall, sixty medical students gradually filed into a ballroom and chatted nervously as they sipped coffee and looked at the programs in front of them. I looked around for any familiar faces to ease the anxiety I felt just by the title alone: “Mock Residency Selection Committee.” I could tell I was not the only person bracing themselves for rocky subject matter in the audience, as the mood was significantly different from the jovial atmosphere of the AWS resident and medical student mixer the night before. But this sense of doom was instantly lifted as the panelists began introducing themselves, adding humor and levity to what could have otherwise been a grim session. Dr. Abbey Fingeret (@DrFingeret) began by coaching us through the thought process behind a powerful personal statement. She emphasized it should not be a reiteration of your CV, but rather a starting point for your interview. She discussed the importance of creating our own brand, but quickly warned us that if we chose a theme that was too exotic, we would be remembered for the wrong reasons. Dr. Roy Phitayakorn (@RoyPhit) continued the session with a nuanced discussion of emotional intelligence in the context of compelling interviews. He reminded us how important it was to convey traits that would make an interviewer want to work alongside us for several years. On an even more practical note, he encouraged us all to practice speaking as much as possible. We all laughed as we realized that, throughout our medical school careers, there truly may have been days that went by without any conversation with others. He concluded with simple yet effective advice: “Just try to have a normal, human conversation about something.” Dr. Dana Telem (@DanaTelem) then led a lively discussion on how the preceding advice could apply to us particularly as future women surgeons. She seamlessly circled back to concepts from the AWS conference the day before, emphasizing how important these skills would continue to be even beyond the residency interviews we were all so focused on. The room quickly became quiet as we began the breakout session. Each table had been tasked with reviewing sample applications and forming a rank list as if we were a residency selection committee. A program director and resident were already seated at the table with us to guide each group’s discussion. We glanced at the first application timidly. Someone laughed nervously and remarked that they were already impressed and intimidated by the application in front of them. However, as we began to read through more applications, we began to see the patterns described to us countless times by our institutional mentors. Each and every application had components that popped out immediately as either highlights or red flags. No applicant was “perfect” – each had strengths and weaknesses, which accurately reflected the diversity seen by program directors each cycle. It was truly only at that moment that it finally sank in that committee members do not just discuss our board scores the entire time! At the end, we shared our rank lists with the other tables and had a discussion about our choices. It was amazing how different each group had ranked the sample applicants – just as different applicants would appeal to different programs throughout the cycle. At the conclusion of the session, we walked out with the necessary tools for tackling the application process and actual hands on experience discussing sample applicant characteristics with program directors. I would highly recommend this session to medical students preparing to enter what would have otherwise been an opaque and challenging match process. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/sara.jpg)Sarah Armenia is a third year medical student at Rutgers New Jersey Medical School interested in pursuing a residency in plastic surgery. She recently completed a basic science research fellowship at Yale’s Department of Pediatric Surgery. She currently serves as the Resource Development Coordinator for the AWS National Medical Student Committee and is a member of the ACS Committee on Medical Student Education. In her free time she enjoys practicing Krav Maga and aerial silks. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** leadership, medical students, residency **Tags:** #awsconference, #womeninsugery, AWSBlog, womeninmedicine --- ### [Gimme Shelter](https://blog.womensurgeons.org/gimme-shelter/) **Published:** January 23, 2019 **Author:** Blog Team **Content:** *By Alyssa Brown* “It’s just a shot away, it’s just a shot away,” blared the music in the OR. There was a flurry of hands and spurts of blood. But I should start at the beginning of the story. I hate to say that there is something exciting about getting called in to the hospital in the middle of the night. Logically, I know that means something bad is happening to someone else, but it makes my heart beat a little faster and my adrenaline rush to know I can potentially help. I had been following a surgeon at a local hospital all Saturday. We didn’t have any cases so we both went home to rest at 3pm. We agreed that she would call me if anything came in. She always rolled her eyes when I asked her to do this because she thought I should probably just get some sleep and enjoy my weekend. I got a text from her at 8pm, and it said, “Seems like a quiet night, so unless something changes, let’s meet at 8am to round.” She had uttered a jinx by saying it was a quiet night. I decided to go to bed early and turn my phone up loud just in case. At 1 am, I sat straight up in bed; my phone was playing its loud jangling tone. I didn’t recognize the number, but I went ahead and picked it up after rubbing some of the crust out of my eyes. “We have a case. You don’t have to come in, but if you do, come through the ED, and I’ll prop the door open so you can get up to the lounge. Be here ASAP if you’re coming, this case needs to go fast.” I quickly woke out of the fog. Before I even responded, I was pulling on a pair of scrubs. I grabbed a pair of diet colas and a granola bar before half-jogging out the door. It was pouring rain and there was a chance of the roads flooding that night. I didn’t think about it as I tore down the road probably a little too fast. My mind kept rifling through the possibilities of the case. She hadn’t revealed any details, but I knew that it probably wasn’t an appendix, which is usually not a middle of the night emergency operation. It was definitely not trauma because the small hospital was not a trauma center. I thought might be a gallbladder, but that can usually wait until the morning as well. I whipped my car into the ED parking lot. I walked into the front door of the ED and past all of the security and staff, and I shimmied through a door into the staff elevator. I slid through the propped open door to get into the PACU and down the hall to the lounge. I took a deep breath before walking into the lounge. I found the surgeon curled in a chair, covered in a blanket fresh from the warmer. She was reviewing the patient’s chart. I handed her the diet cola that she didn’t remember she needed. She was scrolling back and forth through a CT scan. She told me to throw my stuff in her locker and look at the CT. I wadded up my white coat and crammed it into the top of the locker and hurried back out. Without turning, she said, “What do you think of this CT?” My brain was still foggy with sleep, so I wasn’t sure what I was looking at, but it looked like there was a lot of bright contrast sitting in the peritoneum, which I knew wasn’t good. She began to fill in the details to add color to the black and white CT scan. The patient was an elderly female who fainted that afternoon. By that night, a CT scan had been done in the Emergency Department, and blood was visible in the abdomen. Radiology reported a possible splenic artery aneurysm that had ruptured. That’s when the surgeon had gotten called. It was her turn to try to make this patient better. She looked at me, and said, “We are going to get in there, get out, and pray that we can patch it up enough for her to make it through the night.” As if on cue, the intercom screeched to life and said, “We’re ready for you.” The surgery floor always seems to be so full of life during the day, but at night, it almost seems haunted. There are empty beds, empty carts, and you can only hear your own breath and sometimes the hum of a rogue machine. We walked down the hall towards the OR. I had seen her work her magic before, but not on a case like this. She was usually bubbly and talkative as we strolled to the OR, but tonight she was quiet. She knew that the odds were not in her favor. She was the last chance to save this woman. The patient was moved into the room seamlessly. The gloves and gowns seemed to appear on the surgeon, like a quick costume change, and everything seemed to quicken. The surgeon strode over to the table and stepped up onto two step stools. As I stepped up to the table, my mind began to wander. I thought to myself that this could be my grandmother, or someone else’s. It is easier once the face is covered to not think of these more emotional details of the patient. It is easier to keep distance when they are just a case or just an anonymous patient on the table. Before I got too deep into these thoughts, the surgeon called for a #10 blade and traced it down the middle of the patient’s abdomen. The suction was shoved into the fresh wound as we went. Blood began to run down the sides of the drape. When we could finally see the abdomen open before us, there was dark red, firm blood pooling throughout. Everything and everyone was at the ready. Hands seemed to just know exactly where to go. Nothing was fumbled. There was a steadiness to the surgeon’s voice, with urgency but without harshness. The aneurysm of the vessel was hiding within the yellow clumps of fat. It stubbornly did not want to give away its position. The surgeon began to pack the abdomen with laparotomy pads. She was shoving them down into the crevices and cracks of the abdomen to soak up any extra bleeding. We would leave them there. She dug and dug for the stubborn aneurysm, and finally decided coming back was a better option. The patient would be closed another day, but for today, she would leave the operating room with a new vacuum-sealed abdomen. The surgeon asked for lab values. The anesthesiologist recited them to her, and I could see her begin to frown even from under the mask. They did not sound good, but we had done all we could do for the night. Hopefully she would make it through the night. We stepped out of the OR and peeled off our blood-covered gowns. I looked down and realized that blood covered my clogs because, as usual, I had forgotten to put on shoe covers. It was 3am. We agreed to meet back at 7am to round and check on the patient. I was exhausted. I was also worried that the patient would not make it to the morning. She was in a precarious state, and I was not sure if we could pull her back from that cliff edge. I came home and kicked off my clogs and fell asleep in my scrubs. The sleep came quickly, but my alarm came quicker. I was already tense about seeing the patient. I wandered through to the OR lounge where the surgeon was still staring at the CT from the night before and some new lab results. I could tell from her expression that it was not looking good. She didn’t turn to me when she said, “We’re taking her back to the OR.” She stood and quickly paced down the hall; I didn’t ask where we were going because I knew this was not the time for questions. Eventually, we ended up in the family room of the ICU. The family members were standing there clutching coffee and speaking in hushed whispers. They quieted more when we appeared. The surgeon said, “We are happy she made it through the night, but she is going to need another operation this morning to keep her alive. I cannot promise anything. Her chances are not good, but we will do the best we can.” Somehow, the family did not look surprised, or maybe they were still in a state of shock from the night before and hadn’t yet absorbed this new information. The surgeon began to assemble the team. She listed them like a batting order—her surgical partner, a hematologist, a critical care specialist, anesthesiologist, and a first assistant. The patient was full of tubes, hoses, and wires, so it was difficult to move her to the OR floor. We crammed into the elevator and hoped that nothing bad would happen on the way there. Once in the OR, there was a flurry of activity. Things were going to go quickly again. The critical nature was weighing heavily in the room, but everyone there knew that it was a Hail Mary, and this team was the final chance the woman had to live. There is nothing quite like a surgeon in a critical case. There is nothing wasted in their movements or words. The team worked like a machine. It was like everyone knew what the other would do before they did it. The wound vacuum came off, the staples were removed, the abdomen was opened again. It seemed as though time stood still. It was only 8am. “The floods is threat’ning, My very life today, Gimme, gimme shelter, Or I’m gonna fade away” wailed Mick Jagger. It sounded like someone had turned up the volume. I could see the surgeon clipping vessels and saving this woman on the table as the song seemed to get louder Two surgeons working together to fix this. Music makes the OR feel special, magical. There are sometimes indescribable moments in the OR that don’t seem quite real −a suspended disbelief, where miracles seem to appear out of the ether. I thought for a second, there is no way that she isn’t going to make it off the table, not with the feeling that was filling the room. The room collectively sighed as the surgeons began to navigate the patient back from the brink. The bleeding was controlled, and everything was working perfectly. Before I knew it, the case was over. The bubble of magic had burst, and the patient had survived another hour. As we all began to strip off our masks and gowns, someone pointed out that it was an all female team. There were leaders, but it was a group effort rather than a single person who saved this patient’s life, at least for a while longer. After the surgery, we continued to make rounds, but kept coming back to the patient. We kept wandering by her room to talk to her family and update ourselves on how she was doing. By the afternoon, she remained stable. She was not awake or out of the woods, but her lab values and vital signs were improving. This was my last day with the surgeon because I had to go back to my normal rotation Monday. I finally went home. I woke up Monday and started my first day of a pediatrics rotation. I kept thinking about the weekend patient, though, and I was worried. How was she doing? I was afraid to ask. I was afraid to hear that she had passed. I thought of texting the surgeon, but I did not want to bother her after an arduous weekend. That night, I heard my phone buzz, but I didn’t think much of it. I finally checked, and it was from the surgeon. My heart dropped into my toes. I was afraid to open it. I knew before reading it what it would most likely say. It said, “She went into pulseless electrical activity this afternoon, and we never got her back.” I responded that I was sorry, and I knew she had done all she possibly could. She had given it her all. She responded, “Thank you.” For one of my first times during third year, I felt like the physician had the same feelings about the patient’s death as I did. We were both hurting. I could tell she was grappling with what she could have done differently. She didn’t blame the other team members. She assumed full responsibility. Still, when I hear the song “Gimme Shelter” on the radio, I think of that patient, that night, and the magic of the operating room. Some nights all that is left is a Hail Mary for the patient, but sometimes, the miracles do happen, and sometimes the true miracle is keeping them alive long enough to say goodbye. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/VSAS_0449-copy-214x300.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. In July, she finished her third year of medical school and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. When she is not being a black cloud, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram [@alyssabrown1013](https://www.instagram.com/alyssabrown1013/) and Twitter [@Alyssa\_B\_MDPhD](https://twitter.com/Alyssa_B_MDPhD) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [Dear Pat responds to Not Over It Yet](https://blog.womensurgeons.org/not-over-it-yet/) **Published:** January 28, 2019 **Author:** Blog Team **Content:** Dear Pat, A patient that I had been following for several weeks died a few days ago, and I can’t seem to stop feeling upset about it. I talked about it with my colleague and he told me to “get over it”, and that “patients die, you’d better get used to it if you want to stay in this field.” Part of me thinks he’s right, but I am still struggling to get over this loss. Now I’m worried that if mention it to anyone else, I’ll be labeled as “weak” or “too sensitive”. How can I deal with these feelings without affecting the way people perceive me? Sincerely, ***Not Over It Yet*** Dear “Not Over it Yet,” I am so sorry about the death of your patient. A piece of advice I was given early in my career is that if it ever becomes easy to lose a patient, it’s probably time to take a break or find a new career. I still believe that is true. I know that you talked to one of your colleagues who didn’t provide an empathetic response. Is there someone else whom you trust within your program- either a peer or a senior resident- who you can buy a coffee in exchange for bending their ear about the case in particular, and how they manage patient deaths in general? Is there someone on faculty whom you think is a skilled listener? They might also be a resource. Grief can be complicated and sometimes peer support just isn’t enough. If you find that’s true, check with your program director or your GME office about Employee Assistance Programs. These programs often provide short-term support and counseling in a confidential manner. Most importantly, this is an opportunity for you to identify a support network and wellness activities that help to keep you grounded throughout your career. Those things are worth their weight in gold. Sincerely, ***Amalia Cochran, MD, FACS, FCCM*** ![](http://blog.womensurgeons.org/wp-content/uploads/2019/01/20180506_174814_11680.jpg)Dr. Cochran is board-certified in general surgery with a certificate of added qualifications in surgical critical care. Her clinical interests are in burns and frostbite and the use of telemedicine to deliver care in rural and frontier areas. She also has research interests in disruptive surgeon behavior and career development for women in academic surgery. She is a Past President of both the Association of Women Surgeons and the Association for Surgical Education. She is a self-described “single woman managed by three very indulged rescue animals.” Dr. Cochran earned her medical degree from Texas A&M University College of Medicine. She completed her general surgery training at the University of Utah, which was followed by a fellowship in burns and surgical critical care at UTMB/ Shriner’s- Galveston. She is currently Professor and Vice Chair of Education at The Ohio State University Department of Surgery. She began attending AWS Conferences as a resident, recognizing the networking opportunities afforded by the organization, and subsequently became active on the Academic Practice Committee. The focus of the AWS on the development of women as surgical leaders and as mentors aligns with her scholarly interests as well as her core values as a woman surgeon. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png) The Association of Women Surgeons (AWS) is excited to bring to you a resident and fellow focused blog titled, “Dear Pat”. “Dear Pat” answers questions about issues pertinent to surgical residents and fellows, such as navigating through residency, applying to fellowship, family planning, and handling difficult situations on the job. Questions may be submitted by residents and fellows anonymously and will be answered by [AWS council members](http://www.womensurgeons.org/page/Leadership). This monthly blog is published the fourth Sunday of each month. We want to hear from you, if you are interested in submitting your anonymous question, use this [link](https://www.surveymonkey.com/r/BSW2VR2). *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** DearPat **Tags:** AWSBlog, Dear Pat, residents, Women in Surgery --- ### [Lessons from her first year of practice: Navigating the first stage of a career in academic surgery](https://blog.womensurgeons.org/lessons-from-her-first-year-of-practice/) **Published:** February 2, 2019 **Author:** Blog Team **Content:** *Interview of Dr. Sook Hoang by Dr. Allison Martin* For years, I had drawn comfort from the simple act of being able to plan ahead for a stressful future life event, and I quickly figured out that the ability to mentally walk through an uncomfortable situation was a major stress reliever. I remember the first time I heard about mental practice as a method of preparing for surgery. [Studies](https://insights.ovid.com/pubmed?pmid=21245669) demonstrating that the simple act of [visualization](https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs.9657) ahead of a planned operation could improve performance seemed so practical and logical to me. Like many surgical residents before me, I have plenty of trepidation about my future career. *What kind of practice will I have? Will I get funding for research? Will I be able to find that perfect balance of personal and professional responsibilities? Who should a young surgeon turn to when she’s trying to plan out her next steps and transition to the next stage of a surgical career?* A young, successful attending who still remembers what it’s like to navigate that path is the perfect person for a surgical trainee to turn towards for this advice. Trying to visualize and map out the next steps of an academic surgical career starts with talking to someone who has done it before. Dr. Sook Hoang is in her second year as an attending at the University of Virginia. After having completed her general surgery training (University of Massachusetts) and fellowship training in colon and rectal surgery (Brown University), Dr. Hoang and her family migrated southward to start their lives and her surgical career in Charlottesville, Virginia. I sat down with Dr. Hoang to chat about transitioning from residency to fellowship to assistant professor status. With Dr. Hoang’s permission, some responses have been edited for brevity/space. **Q**: How has being young or female impacted your transition into practice? **A**: For any young surgeon, male or female, you have to remember, you’re not only being judged by your personality. You’re under a microscope and you have to remember how you portray yourself is extremely important. I sometimes felt like I had to look a certain way, but at the end of the day what mattered the most was establishing trust with the patient. You can become prone to internal feelings of inadequacy (imposter syndrome). Sometimes I think “you actually trust me?” But patients do and that gets easier with time and experience. **Q**: What’s been the toughest part of your first year of practice? **A**: Complications are beyond your control sometimes. How you deal with them is what matters the most. Ultimately as an attending you are responsible for everything that happens in and outside the operating room. One of the absolute hardest things was dealing with your first few complications. The feeling of being completely responsible for someone else’s well-being can be overwhelming as a new attending. Feelings of helplessness or lost sleep can really be alleviated by talking to your partners or someone in your life who understands and can relate and who you trust. **Q**: What makes a potential job attractive? **A**: Geographic area, lifestyle, support for research development, and supportive colleagues, among many factors. Your future partners are so important because they are your community. Work partners are so important. Having senior partners who can provide their opinion and support is invaluable. This partnership prevents you from feeling isolated. **Q**: What’s your best advice for a current surgical trainee preparing for the next step? **A**: As a resident, you see what your leaders (mentors) model. Take the good things and try to leave behind the less helpful behaviors. As a faculty member, you think through cases days in advance and plan ahead. You consider how all the parts have to work together smoothly to produce a good outcome. Be prepared. Start asking for things you want in advance (for example, specific suture, materials, intraoperative imaging/equipment). Most residents are already doing the preparation ahead of cases that lead to better performance in the OR. Even when you’re still in training, ask your attending in advance about patient positioning, suture choice, ports. We start that now. The practice of preparing in advance can start now, while you’re still in training. **Q**: How do you achieve your best work-life integration? **A**: One of the most important things is to have a good balance. You have to have a good and supportive partner in your personal life, too. You can’t settle for anything less than that. As a surgeon, your job is so important. One of my mentors told me “Being a surgeon is one of the most altruistic professions you can choose”. At the end of fellowship, I was advised to “preserve” myself. Take time for family and self-care. **Q**: How do you let things go? **A**: People are people. It’s so easy for us to treat our co-worker or patient as objects. It makes our jobs easier. I was fortunate enough to assist Dr. Hoang during her first surgery at our institution. Not only was it a great case, but it laid the groundwork for all of our interactions since then. Things I noted during that first operation were her confidence and poise, the ability to ask for what she needed, her respect for her nursing colleagues, and her patience with my developing laparoscopic surgical skill. In the end, it’s impossible to envision exactly what a future surgical career might hold. But my suggestion would be to observe your mentors: figure out which words and actions you would like to carry forward with you in your career, and which you might modify or leave behind altogether. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/alison-300x201.jpg)Allison Martin is a general surgery resident at the University of Virginia. After completing her undergraduate education at the University of Louisville, she pursued an MD at Vanderbilt School of Medicine and spent an additional year obtaining an MPH at the Harvard School of Public Health. During residency, she completed a two-year research fellowship in surgical oncology, including a year-long Fogarty fellowship in Rwanda. Her future plans include a career in surgical oncology and global surgery. She currently serves as the AWS Facebook Subcommittee Chair. You can find her on Twitter[ @globalsurgallie](https://twitter.com/globalsurgallie). ​ ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/Hong.jpg)Dr. Sook Hoang is a colorectal surgeon and Assistant Professor of Surgery at the University of Virginia. She completed her medical education at Pennsylvania State University and then her general surgery residency at the University of Massachusetts. She completed a fellowship in colon and rectal surgery at Brown University prior to her appointment at the University of Virginia in October 2017. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [One of These Things is Not Like the Other](https://blog.womensurgeons.org/one-of-these-things-is-not-like-the-other/) **Published:** February 6, 2019 **Author:** Blog Team **Content:** *By Susan Pitt* Every year, the Association of Women Surgeons co-hosts a luncheon at the annual Academic Surgical Congress (ASC) with the Society of Black Academic Surgeons (SBAS). The topic of this year’s luncheon that will take place in Houston, TX on Wednesday, February 6th, 2019 is “[*One of These Things is Not Like the Other – How to Manage Up, Down, and Across in a Multi-ethnic, Multi-gendered, and Multi-cultural Work Environment*](https://eventpilotadmin.com/web/page.php?page=Session&project=ASC19&id=20190033).” The luncheon is sponsored by SBAS and was organized by their representative Zara Cooper, MD, MSc ([https://eventpilotadmin.com/web/page.php?page=Session&project=ASC19&id=20190033](https://eventpilotadmin.com/web/page.php?page=Session&project=ASC19&id=20190033)). The session features several speakers and aims to have participants: - appreciate the perspectives of a number of leaders in academic surgery with respect to increasing diversity, equity and inclusion in academic surgery. - apply strategies for negotiating diverse working environments. - appreciate current approaches leaders in academic surgery are using *to foster diversity and inclusion in surgery*. The speakers and specific topics include: 1. Anne C. Mosenthal, MD – “Lessons and Observations of Being a Female Leader in Academic Surgery” 2. Jacob A. Greenberg, MD, EdM – “Training the Next Generation – How Can We Get This Right?” 3. Edward M. Barksdale, Jr., MD – “Treating Our Patients and Ourselves – Achieving Greater Inclusion and Equity in Academic Surgery” 4. Herbert Chen, MD – “Leveraging Social Networks and Professional Societies” As I prepare to attend the ASC meeting and co-chair this session with Dr. Cooper, I find myself reflecting on times when I personally experienced that “one of these things is not like the other.” The most obvious example from my own life was with my chief general surgery class at Washington University in St. Louis. I was the only woman in a class of 7 surgical residents. The classes above and below me had much more gender diversity, but in my class, I was the only woman…and I used that difference to my advantage. My leadership style and skills were a little different, yet complimentary to those of my male colleagues. These differences helped me be elected as the Resident Representative for the PGY1-4 classes. They also helped me become one of the Administrative Chief Residents. While being different can be uncomfortable, it can also be a major advantage. The advantages of diversity are increasingly recognized in business and in medicine. Several popular books are written on the topic, such as The Diversity Bonus: How Great Teams Pay Off in the Knowledge Economy by Scott E. Page or Inclusion: Diversity, The New Workplace & The Will To Change by Jennifer Brown. Just a quick search on Amazon.com reveals several reads. The benefits of having diverse ethnic, gender and cultural perspectives are many. For one, diverse teams are known to be more productive and perform better. Diversity among team members helps inspire creativity and drive innovation by increasing the knowledge and insight of a group. The group then can become a more competitive, profitable, and higher quality team. When an organization draws from a culturally diverse talent pool, it also maximizes its ability to attract and retain the best talent. Increasing diversity of thought and skill base also allows an organization to offer a broader and more adaptable range of products and services as well as offer greater opportunity for personal and professional growth. With all of these advantages to diversity, it only makes sense that all teams should strive to be diverse and inclusive. On Wednesday, February 6th, 2019, SBAS and the Association of Women Surgeons hope to show you how diversity is an advantage in surgery. The lineup of incredible speakers promises to prove the benefits of [“one of these things not looking like the other”](https://eventpilotadmin.com/web/page.php?page=Session&project=ASC19&id=20190033) and explore means for increasing diversity and inclusion. In the meantime, ask yourself, “How are you different? How are your differences an advantage? What can you offer your team?” *![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/Pitt.jpg)Susan C. Pitt, MD, MPHS is an Assistant Professor of Endocrine Surgery at the University of Wisconsin. Dr. Pitt serves at the Liaison to Association of Women Surgeons for the Association of Academic Surgery.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, mentorship **Tags:** #AcademicSurgicalCongress, womeninmedicine, womeninsurgery --- ### [Global Surgery: what is the surgeon’s role?](https://blog.womensurgeons.org/global-surgery-surgeons-role/) **Published:** February 10, 2019 **Author:** Blog Team **Content:** *By Gita Mody and Virginia Litle* According to the [Lancet’s Commission on Global Surgery](https://www.lancetglobalsurgery.org/), five billion people lack access to safe surgical care worldwide. This lack in healthcare equity exists despite the evidence that surgical procedures can be life-saving and cost-effective including in low-resource areas. The need for surgical involvement in the healthcare of developing areas is increasing due to the prevalence of surgically treated non-communicable diseases such as trauma and cancer. Major barriers to providing even simple surgical services include the lack of providers with surgical and anesthetic training, resources such as surgical sutures and instruments, and the ability of patients to access facilities with integrated surgical care. Availability of specialist surgeons in remote areas is extremely limited, leading to potential financial catastrophe for families needing to travel long distances and take time away from work to seek care in urban settings. Global surgery is typically thought of as the delivery of surgical and anesthetic care in low-resource settings. Humanitarian surgery is a term frequently applied to this effort as well. In response to these issues, many academic and professional surgical organizations, including the [American College of Surgeons](https://www.facs.org), have established internal platforms to leverage resources for the advancement of surgery globally. [Operation Giving Back (OGB)](https://www.facs.org/ogb) was established in 2004, with surgeon Kathleen Casey as the founding director and supported by the ACS leadership at the time, Drs. Andrew Warshaw and Robert Stephens with the mission “…to effectively meet the needs of the medically underserved.” The role of the surgeon can take many different forms depending on the specialty, the needs of local patients and providers, and the goals of partnerships behind the work. Outreach examples include mission trips by a variety of organizations. [Operation Smile](https://www.operationsmile.org/) offers repair of cleft lip. [Team Heart Rwanda](https://teamheart.org/) provides open heart surgery for rheumatic heart disease, and [CardioStart International](https://cardiostart.org/) has provided global volunteer cardiac care for over twenty years. In these missions, surgeons are brought in to provide specialized surgical care for common but serious clinical problems. There are the disaster relief groups including [Medecins Sans Frontieres](https://www.msf.org/) and the [American Red Cross](https://www.redcross.org/), which provide immediate, organized aid in times of natural disasters and infectious epidemics. Small groups of surgeons often rally their own trips in times of serious need, such as after hurricanes and earthquakes. Typically the smaller groups provide care under the umbrella of larger, more organized groups. Then there are the innovative physicians and scientists that provide education and conduct research on global health, like Paul Farmer and his colleagues at the nonprofit healthcare organization Partners In Health (@PIH), which supports fellowships for developing future “global surgeons”. Surgeons have unique skills to contribute to humanitarian medicine including technical skill, expertise in managing logistics, and experience with team-based care. There are many specialty-specific challenges, but a great deal of progress has been made and there are now many opportunities for surgeons from all backgrounds to participate in global surgery. Given the increasing interest of general and subspecialty surgeons to participate in global surgery, the AWS is hosting a tweet chat to discuss #GlobalSurgery. Join @womensurgeons with moderators Dr. Virginia Litle (@vlitlemd) and Dr. Gita Mody (@gitamody) for a tweetchat on February 18th at 8 pm Eastern Time by following #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo (@heatheryeomd) to know more. We will be discussing the following questions: 1. *How do you define #globalsurgery and/or humanitarian #surgery?* 2. Should surgeons in high-income countries be engaged globally to serve the medically underserved? 3. There are multiple challenges for surgeons to participate in humanitarian care outside of work, including time and financial constraints as wells as need for supportive professional partners. *How best can surgeons provide global surgical care?* 4. While often in an international setting, outreach also may be to local underserved or immigrant communities in the United States. *What are the obligations for surgeons to provide local humanitarian work?* 5. Due to the different requirements for surgical board certification, residents and fellows have different restraints on their opportunities to do #globalsurgery work. *Should we engage trainees (residents and fellows) in #globalsurgery and humanitarian #surgery efforts?* ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/Litle-2-e1549846682628.jpg) Dr. Virginia Litle (@vlitlemd) is Past President of Women in Thoracic Surgery and Professor of Surgery and Chief of Thoracic Surgery, Boston University Medical Center. Her global experience includes a clinical empowerment trip to the Solomon Islands to teach clinicians endoscopic skills and ongoing translational research efforts in India to screen for esophageal cancer. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/Mody-2-e1549846705652.jpg) Dr. Gita Mody (@gitamody) is an Assistant Professor of Surgery and the Director of Thoracic Surgical Oncology at the University of North Carolina. Her global experience includes clinical trials in India and Rwanda and surgical outcomes after thoracic surgery in Peru and Malawi. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat, resources, training **Tags:** AWS, AWSChat, Global Surgery, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Getting over the fear of trying something new: My journey into social media](https://blog.womensurgeons.org/getting-over-the-fear-of-trying/) **Published:** February 13, 2019 **Author:** Blog Team **Content:** *By: Lillian Erdahl* Social media is a part of my professional career and identity as a surgeon. Because of this, I spend a fair amount of time both informally and formally discussing professional social media with physicians and other healthcare workers. People view me as an expert and often seek my opinion on how and why to use social media in their careers. They turn to me for advice on how to receive information via various platforms as well as how to disseminate it. It turns out that in order to become an expert at something, you have start as a novice and remember that you never stop learning. Being a novice is a universal human experience. At some point we all had to learn basic things like how to eat or walk. Developing new skills requires taking chances and inevitably failing before we master them. From my experience as a surgery resident, I understand the fear of failing when learning new skills. I also know that I must be willing to get up and get back in the ring even after failing. My past experiences as a novice help me whenever I start something new. When I first embarked on learning to use social media professionally, I was unsure how to start. There were fewer resources ten years ago than there are today. My first professional social media education came during my graduate courses in Adult Education at the[ Penn State World Campus](https://www.worldcampus.psu.edu/degrees-and-certificates/adult-education-masters/courses). However, much of what I learned did not relate directly to the profession of medicine. I attended the Teaching and Learning with Technology Symposium in State College where danah boyd’s talk on social media inspired me. Seeing the possibilities for this new way of reaching a larger audience, I was interested but nervous about doing more. It took encouragement from someone else with vision, Dr. Rebecca Minter, to give me the push I needed to move forward with learning how social media could be utilized in healthcare. Lacking in knowledge and confidence, I spent much of my time observing and learning the culture of social media platforms used by others in healthcare like Deanna Attai and Diane Radford. Reading blogs, clicking through professional networking sites, and lurking on other platforms I learned a lot about medicine as well as the cultures of different social media sites. It is uncomfortable being a novice. Just like the first time I took a knife to the skin, posting on social media left me vulnerable to criticism for not meeting the expectations of those observing me. As a surgeon I know that many mistakes cannot be undone. The same is true when posting something on the internet where it can live on forever and be shared with anyone. As a novice, I made mistakes and was graciously aided by so many others who provided an example and gave me [tips and tricks for improving my success](http://blog.womensurgeons.org/awschat/social-media-presence/). It was well worth the journey which has led me to greater involvement in many organizations and professional networks. The next time that you are afraid to try something new, remember that every expert was once a novice. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/Erhdal-1-241x300.png)Lillian Erdahl, MD, FACS is an Assistant Professor of Surgery at the University of Iowa where she practices Breast and General Surgery. She is also Associate Program Director in General Surgery; head of the Iowa City VA Breast Clinic; Communications Director for @UIowa\_Surgery; and involved in curriculum development for medical students, residents, and fellows. Her research interests include breast cancer prevention and treatment, faculty development, and surgical education. Her work for gender equity in medicine includes involvement in the Association of Women Surgeons as co-chair of the Twitter subcommittee and the @PROWDWomen group. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice **Tags:** womeninmedicine, womeninsurgery --- ### [#HeForShe: A Call for Action](https://blog.womensurgeons.org/heforshe-a-call-for-action/) **Published:** February 20, 2019 **Author:** Blog Team **Content:** *by Apoorve Nayyar* “*With its unusually large proportion of highly educated and qualified women, medicine should be leading the way in gender equity. Leaders who have it within their power to address barriers to the advancement of women — and all underrepresented people — should behave ethically and resolve to act, expeditiously and with steadfastness*.” – **Dr. Julie K. Silver**, Associate Professor at Harvard Medical School & founder, [sheleadshealthcare.com ](https://www.google.com/url?q=http://sheleadshealthcare.com&sa=D&ust=1550678212362000&usg=AFQjCNGWgZ3I1um0rtZ0Ed3bvcT3QpyBHQ) “*I raise my voice – not so I can shout, but so that those without a voice can be heard. We cannot succeed when half of us are held back*.” – **Malala Yousafzai** In 1847, Dr. Elizabeth Blackwell became the first woman to be admitted to a medical school in the United States, after overcoming significant opposition. In 2017, nearly a century and a half later, more women than men were enrolled in medical schools in the U.S. for the first time in history. While we have made great strides in reducing the barriers to inclusion of women in medicine, true gender equity in healthcare remains elusive. [Study after study](https://www.doximity.com/careers/compensation_report) has demonstrated that women are paid less for equal work, promoted less often, are less likely to have their research funded and are more likely to have their [professional capabilities](https://web.stanford.edu/dept/radiology/cgi-bin/raddiversity/wp-content/uploads/2017/12/TheAbrasivenessTrap.pdf) undermined, compared to their men counterparts. A [recent report](https://news.aamc.org/press-releases/article/applicant-enrollment-2017/) by the [American Association of Medical Colleges (AAMC)](https://www.aamc.org/download/486590/data/supplementaltablec.pdf) showed that only 22 of the [369 surgery department chairs](https://www.womensurgeons.org/page/FemaleSurgeryChairs) were women (<6%). From differences in leadership to gaps in salaries, subtle sexist remarks to overt discrimination, bullying, and sexual harassment, the systemically biased culture continues to thrive, thwarting the progress towards complete social and economic gender equity in healthcare. The current status quo not only impedes the professional development of the women in surgery, but also discourages the next generation of well-qualified, extremely talented women from pursuing careers in surgery. While countless fierce and formidable women have paved the path towards gender equity, the majority of men have historically been mere spectators to the conversation of gender equity. #HeForShe is a call to action – a commitment from [men to join the conversation](http://blog.womensurgeons.org/gender-differences/why-i-joined-aws/), to be an ally and advocate with women to [end gender biases](https://www.ncbi.nlm.nih.gov/pubmed/26372589) and gender disparities. #HeForShe is an understanding that a fair, diverse and inclusive environment makes us all better, makes our teams better and ultimately makes patient care better. #HeForShe is the belief, that **together we can** achieve the goal of equity on all fronts within our lifetimes. What does it mean to be an ally? - **Ask**: It starts here. Check in with your friends, colleagues and co-workers about the challenges that they may be facing and how you can help eliminate those. Collaborate with your women colleagues to assist in gender parity efforts. - **Awareness:** Gender disparities have persisted for centuries, as it has been well documented in the literature. Make yourself aware of the gaps in parity in your profession and at your organization. Acknowledging the scope of the problem is the first step towards instituting a change. - **Recognize** any of your own implicit biases; awareness is the first step to eliminating these biases and ensuring that your actions and conversations are not influenced by them. We all have flaws; it’s the conscious effort to combat our flaws that makes us better. Check in on [implicit biases here](https://implicit.harvard.edu/implicit/education.html). - **Advocate** for implementation of policies that ensure equal rights, equal opportunities and fair treatment of everyone. If you see something amiss, speak up and advocate for what is right. - **Call out any sexist behaviors:** A few simple responses that can often help: - *“I’m sorry, can you please say that again?”* - *“Did you mean to say \_\_\_\_? I am sure you didn’t mean it this way, but it could be interpreted as \_\_\_\_\_”* - *“I am curious why you think that”* - *“Help me understand what you mean by that”* If someone repetitively engages in sexist dialogue, have a frank conversation with him/her and let them know it is NOT okay. - **Invite, Recommend, Amplify:** For any scientific meeting, panel, leadership position, award, there is always more than zero qualified women for the position – [the inexorable zero](https://www.ncbi.nlm.nih.gov/pubmed/28606837). If you are invited to be a part of a panel or a meeting that has all-male composition (i.e. manel), recommend women counterparts. Be mindful of gender ratios and ensure inclusivity. - **Remember, it is not about you:** Be humble, ask women how you can help in existing gender equity efforts. Refrain from speaking for women and don’t attempt to explain gender equity to women championing gender parity efforts. [Avoid ](http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199338764.001.0001/acprof-9780199338764-chapter-5)*the pedestal effect* (unearned praise, attention or escalation of men for combating unfair policies/behaviors against women). Be brave enough to acknowledge that it is not heroic to be fair and inclusive, to do something that a multitude of women have been working on for years; you are not special for doing the right thing. - **Provide a safe space** to talk, express thoughts and feelings as well as to share any unpleasant experiences. Provide resources and support to anyone that has been wronged; ensure their safety and assist in recourse as needed. - **Be an agent of change:** from the top down or from the bottom up, at every level you can. - **Model the right behavior:** It goes without saying that you should treat your colleagues with dignity and respect. Make no assumptions about the responsibilities women may want to take on. Be fair, be flexible. Communicate effectively to quell any inappropriate behavior. Allow women to clearly state their thoughts & opinions, without interruption. - **Don’t mansplain** (if you are unsure what mansplaining is, here is a brief lexicon of [behaviors to avoid](https://www.bmj.com/content/bmj/363/bmj.k5218.full.pdf). - [**Join** The Association of Women Surgeons!](https://www.womensurgeons.org/page/JoinAWS) Most of being a good male ally comes down to being a good human being. Am I a good ally? I don’t know the answer to that but I believe together we can be better. **Gender equity is a collective responsibility** – it is not a women’s issue; it is a human issue. Organizations where men also actively participate in gender diversity efforts [progress faster](https://www.bcg.com/publications/2017/people-organization-behavior-culture-five-ways-men-improve-gender-diversity-work.aspx) in achieving gender equity goals. #HeForShe is an advocate for equity, diversity and inclusion at all levels, someone who is not only mindful of gender disparities but also works persistently to eliminate them. Why be #HeForShe? Because simply put, it is the right thing to do. I am #HeForShe, are you? ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/apoorvenayyar.jpg)Apoorve Nayyar, MD is a breast surgery research fellow at University of North Carolina, Chapel Hill ([@UNCSurgery](https://twitter.com/UNCSurgery)). He is a proud member of the AWS, a proponent of #HeForShe in medicine and serves on the AWS Twitter subcommittee ([@womensurgeons](https://twitter.com/womensurgeons?lang=en)). Dr. Nayyar aspires to be a surgical oncologist; his research interests include healthcare disparities in cancer care and gender inequity in medicine. Outside of the hospital, he loves to travel and enjoys nature photography! You can find him on Instagram [@apoorvenayyar](https://www.instagram.com/apoorvenayyar/) and Twitter [@apoorvenayyar](https://twitter.com/apoorvenayyar) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy **Tags:** #HeForShe, AWSBlog, womeninmedicine, womeninsurgery --- ### [#DearPat turns one: a look at the past year](https://blog.womensurgeons.org/dearpat-turns-one/) **Published:** February 24, 2019 **Author:** Blog Team **Content:** It’s Dear Pat’s anniversary! This month marks the one-year anniversary of the #DearPat column, which was created in 2018 as a collaborative effort between the Association of Women Surgeons (AWS) Resident and Fellow Committee and the #AWSBlog committee. This column was designed as a forum for residents and fellows to share their experience as trainees, ask for advice from AWS leadership, and spark a conversation on the matters facing surgical trainees today. \#DearPat, is named after [**Dr. Patricia “Pat” Numann**](https://www.womensurgeons.org/page/PatriciaNumann) who founded the AWS in 1981 when she invited all the women surgeons she could find to breakfast at the October meeting of the American College of Surgeons (Read more about AWS history [here](https://www.womensurgeons.org/general/custom.asp?page=History)). From its inception AWS served as a place for women surgeons to share common experiences, interests and express their concerns. Over the years [Dr. Numann](https://twitter.com/PatNumannMD) has continued to provide advice and she continues to inspire our resident and fellow members with her stories and anecdotes of surgery. The #DearPat blog is a tribute to Dr. Numann’s legacy as evidenced by the numerous AWS Council members who volunteer their time to respond to our column and share their helpful advice to other women surgeons. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/IMG_4859-1024x580.jpg)Dr. Numman offers career advice to residents and fellows at the 2017 AWS Networking breakfast. During this past year we have covered topics such as applying to fellowship, [mentorship](http://blog.womensurgeons.org/residency/dearpat/missing-mentors/), [family planning](http://blog.womensurgeons.org/family-life/dear-pat-surgical-mom/), [work-life integration](http://blog.womensurgeons.org/family-life/dear-pat-mother/), teamwork, [implicit bias](http://blog.womensurgeons.org/residency/dearpat/please-call-me-doctor/), [how to have difficult conversations with colleagues](http://blog.womensurgeons.org/residency/dearpat/im-the-boss/), [dealing with grief](http://blog.womensurgeons.org/residency/dearpat/not-over-it-yet/), among others. This past year has been full of highlights. We are excited to see DearPat continue to grow. Thank you to the AWS leadership for your continued support, AWS members, especially the residents and fellows who continue to ask for DearPat advice. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-300x248.png)This recurring column is published on the fourth Sunday of each month. #DearPat answers questions about residency, fellowship, life after training, and focuses on issues pertinent to surgical trainees. Questions may be submitted anonymously and are answered by [AWS council members](https://www.womensurgeons.org/general/custom.asp?page=Leadership). We want to hear from you, if you are interested [submit your Dear Pat question here](https://www.surveymonkey.com/r/FTKCPVS). --- ![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/PMartinez-Picture-218x300.jpg) *Patricia Martinez Quinones is a general surgery resident at the Medical College of Georgia at Augusta University, and a doctoral candidate in Physiology. She plans to continue her career in academic trauma and critical care surgery. Patricia serves as the resident chair for the AWS Blog Committee and the Resident and Fellow Committee Vice-Chair. She is a doggy-mom and wife who is passionate about self-care, running, and healthy-living. You can find her on Twitter at* [***@PMartinezMD***](https://twitter.com/PMartinezMD)*.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** DearPat **Tags:** AWSBlog, Dear Pat, residents, Teamwork, Women in Surgery, WomenSurgeons, work-life balance --- ### [The Surgeon Informatician: Both Surgeon Scientist and Surgeon Advocate](https://blog.womensurgeons.org/the-surgeon-informatician/) **Published:** February 27, 2019 **Author:** Blog Team **Content:** *by Jane Zhao, MD, MS* Two years ago, I wrote a[ blog post](http://blog.womensurgeons.org/uncategorized/informatics-and-surgery/) about the benefits of informatics to surgeons. Shortly afterward, David Schneider wrote a similar article on the[ AAS blog](http://www.aasurg.org/blog/what-is-clinical-informatics/) describing clinical informatics. We had both independently chosen to take the path less traveled by pursuing postdoctoral training in clinical informatics, found ourselves highly grateful for the decision we had made, and wanted our colleagues in both informatics and surgery to understand why in our humblest of opinions the two should not be mutually exclusive. Clinical informatics has been around for quite some time, as early embracers[ Genevieve Melton-Meaux](https://www.advancessurgery.com/article/S0065-3411(10)00016-3/fulltext) and Gretchen Purcell Jackson, can attest to. The relatively recent and sharp rise of big data and artificial intelligence in healthcare has led to a critical mass of interest in clinical informatics; increasing numbers of health care institutions employ chief health information officers and physician champions of the electronic health record, and more and more physicians are exiting academia and private practice for industry. When the applications opened for hot topic proposals for the [14th Annual Academic Surgical Congress](https://eventpilotadmin.com/web/page.php?page=Session&project=ASC19&id=20190040) recently held in Houston, TX, I knew this was my moment to share my passion for clinical informatics with my surgical colleagues. Out of over 90 applications, mine titled “The Surgeon Informatician: Both Surgeon Scientist and Surgeon Advocate” was ultimately selected as a finalist. On the day of the hot topic, the ballroom was packed. Clearly there was interest in this topic from all levels of the surgical community. [David Schneider](https://twitter.com/dfs_77) began the panel discussion and introduced clinical informatics to the audience. [Raquel Forsythe](https://twitter.com/forsythe_raquel?lang=en) followed and explained the various pathways to becoming a surgeon informatician and highlighted the benefits and caveats of each pathway for surgical trainees. [Gretchen Purcell Jackson](https://twitter.com/pedssurgery?lang=en) spoke about her career as an academic informatician and her transition to industry. [Alexander Langerman](https://twitter.com/langermology) spoke about the role of informatics in the design and transformation of operating rooms into more patient- and surgeon-friendly working environments. Lastly, [Genevieve Melton-Meaux](https://twitter.com/MeltonMeaux) spoke about her role as a chief data and health informatics officer and how she on a daily basis leverage health informatics to improve care. The common thread in all the talks was that informatics opportunities are vast, with the potential to make a large impact on patient care. We live in an exciting yet confusing era of training and practice, and there is a real need for more surgeon informaticians to help us shift through all the data, figure out what is real versus what is #fakenews, navigate our relationship with industry, make empowered decisions when it comes to our different information systems and technologies, and at a higher level, drive policy changes. There is no better time than the present for surgeons to become involved in informatics. **![](http://blog.womensurgeons.org/wp-content/uploads/2019/02/Zhao-200x300.png)Jane Zhao,** MD, MS is a general surgery resident at the University at Buffalo, State University of New York. *S*he received her medical degree from McGovern Medical School, the University of Texas Health Science Center at Houston and her bachelor’s degree from Vanderbilt University. She was the founder and chair of the AWS Blog Subcommittee from 2013 to 2014 and a founding member of the AWS Social Media Subcommittee in 2013. She currently serves as the Resident and Associate Society Liaison for the American College of Surgeons Health Information Technology Committee. She is eligible for board certification in clinical informatics after she achieves board certification in general surgery. She can be followed on Twitter [@zhaomd](https://twitter.com/zhaomd). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events **Tags:** #surgeonscientist, AWSBlog, womeninmedicine, womeninsurgery --- ### [What I’ve learned in private practice](https://blog.womensurgeons.org/private-practice-2/) **Published:** March 6, 2019 **Author:** Blog Team **Content:** *By Emily Murphy* Full disclosure: I am a private practice surgeon in the truest sense of the term, I am a partner in a six-person group who provides care at a 545-bed hospital almost exclusively. Further disclosure, this was the job I always hoped I would have (in my hometown, with the opportunity to teach medical and physician’s assistant students, with a solid core of senior partners), so I am probably more than a little biased. But two years into practice, I have learned some things that are specific to my experience, but likely translate pretty broadly. 1. Introduce yourself to everyone (as “Dr. So-and-so”**) Playground rules apply to surgery too. Play nice in the sandbox. Interact pleasantly with others. Establish that you are Dr. So-and-so. And if it feels uncomfortable to call yourself doctor among peers, say your name and explain that you are a new surgeon with your group. It is easy to overcompensate for the personality traits that can be associated with “the female surgeon” and fall into the role of the sycophant, embracing those cool-mom-tropes of relaxed rules and neglected hierarchy. Don’t do it. Especially in the operating room, the surgeon is the boss. Sure, ask about people’s kids, pets or interests, establish whatever rapport fits with the relationship you hope to have, but your job is to keep a patient safe, and nothing should impede that. And similarly, you decide how you fit in the social nuances of the politicking of medicine. 2. Say “yes” (until it is time to say “no”)** Wouldn’t it be nice if patients showed up in your office fully worked up with the appropriate medical clearance and preoperative testing? If you have a particularly specialized practice that can be a harder ask than it might seem. The relationship between referring physician and surgeon should be pretty simple, at least from the referring physician’s perspective. First, a surgeon should have an office staff that is nice to patients. Second, a surgeon should be a competent proceduralist who provides timely care and communication. Third, a surgeon should make a referring physician’s life easier, not harder. Things we do to “help” sometimes don’t. Complex flow charts of the nuances of work up of disease processes with esoteric imaging and labs can make more work for those referring. Be available to patients and providers. Squeeze a case on at the end of a day or call someone directly with results. Little things make a big difference. Don’t jeopardize patient safety. It is never wrong to advocate for those who cannot advocate for themselves. 3. Know what your time is worth** Sometimes more money does mean more problems. I once calculated my resident salary to an hourly figure. I shouldn’t have done this. It made me sad. Like many young surgeons, the amount invested in my brain is far greater than the money invested in my bank. It can be tempting to pick up call and other cast offs from senior partners. There are always bills for a wedding or a car or a house, and I have felt this huge sense of being behind my peers (both medical and non-medical). But the money doesn’t matter if there’s not an outlet for it. Figure out what is fair by deciding what is important to you. If you want eight weeks of vacation and will settle for less money, state this. There are many resources that report average salaries, but that doesn’t give the complete picture of the job. 4. Eat what you kill** (but maybe don’t be an apex predator in the first few years) To “build” or “grow” a practice, one must start from one point and meet milestones to achieve another. The first months (and sometimes even years) of practice can have some pretty painful lulls. Watching partners with over-full clinics complain about how busy they are can be disheartening. But remember, everyone starts at pretty much the same point—excited for a lipoma consult. Most of us strive to be the best of the best, but remember a career is a marathon, not a sprint. And finding ways to diversify can help assuage burnout. 5. Look for mentorship opportunities** (see your world through someone else’s eyes) Personal and professional development takes external perspective. Often young surgeons think of mentorship as something they receive, but mentorship is a two-way-street. It’s easy to forget how much we have accomplished by the time we complete surgical training. We can get a little jaded about all of our struggles and forget the incredibly important work that we do. We literally help people and their families in ways that they cannot help themselves. The saying that when you teach, you learn twice is certainly also true. And investing in the development of those around us (whether it is teaching a surgical technologist about a case so he can better assist you or encouraging an ICU nurse to pursue a CRNA or letting a medical student throw her first stitch) provides some grounding among all of the things that we cannot control. 6. Have bad days** There are days when a hospitalist calls one too many times or a family member asks one too many questions, but the worst days are those with a complication. They can be devastating, not only to patients, but also to surgeons. Most of us went into medicine to help people, to fix them or make them better. Unfortunately, sometimes people get sick and sometimes they die. But unlike a patient or family that can grieve in the moment, we often have more patients and sometimes more bad news in the next room. We don’t always have the luxury of feeling things in the moment. And in practice I can’t stop at the gyro place around the corner for an eat-your-feelings session of falafel and baklava after work with my best friend, because we now live more than 1200 miles apart. We still run through cases on the phone, but it’s not the same without the humus. While there a struggles every day, not every day is a struggle. Most of the time, I think I have the best job in the whole world (and not just because I’m in private practice). It’s not the easiest. Or the cleanest. Or the most sophisticated. The hours aren’t great. And the stress is high. My senior partners don’t meet for cheap ethnic food, but they do provide a sounding board. But being a surgeon more often than not really helps people. Sometimes I even get to save a life. ![](http://blog.womensurgeons.org/wp-content/uploads/2019/03/Emily-1-215x300.png)Emily E. K. Murphy, MD is a private practice surgeon in Sioux Falls, SD. She is a Clinical Assistant Professor in the Department of Surgery at Sanford School of Medicine at the University of South Dakota. She completed her medical education at Sanford School of Medicine at the University of South Dakota. She was a general surgery resident at Christiana Care in Newark, Delaware. She has also completed a fellowship in endocrine surgery at the Medical College of Wisconsin in Milwaukee, Wisconsin. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, practice **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [You can’t sit with us! Surgeons as... Mean Girls?](https://blog.womensurgeons.org/you-cant-sit-with-us/) **Published:** March 11, 2019 **Author:** Blog Team **Content:** *By Kara Hessel* When I considered writing a blog post about bullying in surgery, I thought, “Sure I can do that.” Then, I sat down to write. Every snarky comment and eye roll that I’ve directed at a junior resident or medical student surfaced in my mind. I wondered whether I am the right person to be writing a blog post on bullying. As I reflect on my time in surgery, I have to admit that I have said and done things that could easily be interpreted as bullying. I come from a very benign surgical residency, particularly when you compare our interactions with staff to the “good old days.” The transgressions that can be described as potential bullying are nothing compared to the stories that my staff tell about their residency experiences. But when I read a recent article [in The Annals of Surgery](https://journals.lww.com/annalsofsurgery/Fulltext/2019/01000/Workplace_Bullying_Among_Surgeons_the_Perfect.11.aspx), I realized that what I see as normal surgeon behavior is viewed by the outside world and apparently many surgeons, as bullying. I have to admit that I instinctively reject this notion. M&M is definitely more malignant in some places than others, but attending surgeons repeatedly questioning residents in M&M or in the OR does not resonate as bullying with me. *Are my board examiners going to think of themselves as bullies if I become flustered and flounder during my oral exam*? *Are my patients’ families going to consider themselves bullies when they pepper me with questions about their family member?* *Is this really not just preparation for what we are to encounter as we gain more responsibility for our patient’s care?* *Are these valid arguments? Or is this culture so ingrained in me after 7 years of exposure to surgeons that I do not recognize it as abnormal behavior? Is there a more effective way of teaching?* I personally learn best when I am put on the spot. If I feel stupid after a presentation, I generally assume that I was underprepared and I often remember the clinical pearls that come from the exposure of my misconceptions better than any others. However, there are many people who do not learn well in this manner. When I am honest with myself, I can recognize that I do not necessarily adjust my style of “teaching” when the learner is clearly uncomfortable and not benefiting from our interaction. I still consider this “teaching”, but there are many who would consider that “bullying”. The conclusion I reach is that I need to make it a focus to provide feedback in a manner that is not only constructive in my mind, but also constructive in my junior resident or medical student’s mind. If they are not responding to the way that I am approaching an issue, perhaps their interpretation is not to blame and my approach is. Perhaps this is something that many surgeons could admit to themselves. The behaviors I have described above are potentially defensible. However, I have also witnessed overt bullying in the hospital from attending to attending, from attending to resident, from resident to nurse, and from nurse to resident. But most concerning to me is the bullying I have witnessed occurring among women. *Are we women not at enough of a disadvantage without belittling one another? Don’t we face enough challenges from inherent bias? Do we need to propagate the image of a bunch of gossiping high school girls who isolate and humiliate other individuals? Shouldn’t the goal be to lift and support one another?* *Why is it that out of all the “bullying” I have witnessed, the incidents that most readily come to mind were girl on girl crime?* I think we all have to ask ourselves the question and face the hard truth. Are you guilty of being a bully? And- if the honest answer is yes, what are you going to do to change it? *Join AWS (@womensurgeons) along with the authors of Workplace Bullying Among Surgeons – The Perfect Crime Drs. Amalia Cochran (@AmaliaCochranMD) and Kevin Pei (@kipsDS2010) for a tweetchat on March 18th at 8 pm Eastern Time to discuss #Bullying in the OR, surgery and medicine. Follow #AWSchat and @womensurgeons. If you haven’t participated in a tweetchat with us before, check out this* [*tutorial*](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) *written by Dr. Heather Yeo (@heatheryeomd) to know more.* ![](https://blog.womensurgeons.org/wp-content/uploads/2019/03/Hessel.png) Dr. Kara Hessel is a 5th year General Surgery resident at the University of Kansas. She is a graduate of Kansas City University of Medicine. She will move with her husband and daughter to Columbus, Ohio this summer to start fellowship in Vascular surgery at The Ohio State University. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #stopbullying, AWSChat, career development, training, Tweetchat, womeninmedicine, womeninsurgery --- ### [Save your rear](https://blog.womensurgeons.org/save-your-rear/) **Published:** March 14, 2019 **Author:** Blog Team **Content:** *By Anne Fabrizio* Buttocks. Butt. Bum. Booty. Badonkadonk. That’s just a few ways we refer to our bottoms. We speak freely about our rear ends when it comes to dancing or working out. In pop culture, we celebrate it. There are hundreds of songs dedicated to the exultation of the backside. However, when it comes to the health of our backsides, we’ve got some work to do. Despite the comfort we have singing songs about our butts, there remains social embarrassment discussing when things aren’t right. Too many times, I’ve seen people ignore symptoms and brush them aside. “I’ve just been a little constipated, it’s probably stress and bad diet.” “That blood in my stool? It’s probably just a hemorrhoid.” Sure, it could be those things, but we need to stop ignoring symptoms and make sure that people are aware that these could be signs of colorectal cancer. We also need to acknowledge the fact that many colorectal cancers are asymptomatic, which is why screening is so important. According to the CDC, colon cancer is the [third most common cancer](https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21551) in both men and women in the United States. It is the second leading cause of cancer-related death with approximately 50,000 Americans dying of colorectal cancer each year. Last year, the American Cancer Society updated its [guidelines](https://onlinelibrary.wiley.com/doi/abs/10.3322/caac.21457) for colorectal screening by changing the starting age from 50 to 45. These recommendations are based on the fact that despite the decline in the rate of colorectal cancer in older adults, incidence is increasing in young and middle-age populations. March is Colon Cancer Awareness Month. First established via presidential proclamation on February 29, 2000, the month is a celebration intended to increase awareness of colon cancer and colon cancer screening. This year, the Colorectal Cancer Alliance’s public awareness campaign is the “Don’t Assume” campaign, with the goal to “challenge assumptions and misconceptions about colorectal cancer.” One of the reasons I entered medicine was because I lost my grandmother to colon cancer. It’s not an uncommon story. We’ve all lost someone to colorectal cancer or know someone who has. And yet, less than 70% of adults in the United States aged 50-75 years are up-to-date with screening. There are [over 3 million people in the US](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf) alone that need to be screened. One quarter of the population has never been screened once. Screening saves lives. Let’s get out there and spread the word this month and every other month of the year. Colonoscopy is a safe and effective mean of identifying early lesions and preventing the development of cancer. Get screened. It could save your rear end or the rear end of someone you love. Because who doesn’t want to get back to enjoying a long life of celebratory songs about butts? ![](http://blog.womensurgeons.org/wp-content/uploads/2019/03/Anne-Fabrizio.jpg) Anne Fabrizio, MD is a fellow in colon and rectal surgery at [Brigham & Women’s Hospital](http://twitter.com/bwhsurg) in Boston, MA. She attended Rutgers New Jersey Medical School and went on to complete her general surgery residency at Medstar Georgetown University Hospital in Washington, DC. Her research interests include outcomes and the microbiome. You can find her on twitter [@annebchin.](http://twitter.com/annebchin) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons* **Categories:** awareness **Tags:** AWSBlog, cancer, Colorectal Cancer Awareness, fellowship, ILookLikeASurgeon --- ### [Practice Finances](https://blog.womensurgeons.org/practice-finances/) **Published:** March 28, 2019 **Author:** Blog Team **Content:** *By Feibi Zheng* For those in academic and/or employed practice, your practice finances can seem like a black box. Whether you are salaried, on a production model or a blend of both, I encourage you to pull back the layers and gain a basic understanding of how funds flow through your organization and into your practice. Some of you who are on a fixed salary model or who are paid on a wRVU only model may wonder why any of this should matter to you. I would reply with “no margin, no mission.” Your organization simply cannot pay you money it does not collect unless you are one of those rare individuals whose salary is supported by philanthropy. Ultimately, you are the only person who can make sure that you are being compensated fairly for your work. **Clinical Productivity Measures:** There are several measures institutions use to gauge/track clinical productivity among physicians/surgeons: **wRVU**: A standardized measure of effort. This is a common way for administrators to be able to compare clinical productivity within a department. There are several benchmarking organizations such as [MGMA](https://www.mgma.com/career-pathways/career-advancement/career-resources/salary-calculator), [AAMC](https://www.aamc.org/data/), [AMGA](https://www.amga.org/wcm/PI/wcm/PI/SAT/PhysComp/participate_comp18.aspx) which publish annual surveys regarding clinical productivity and associated total compensation, benefits, on-call pay, etc. Find out what survey your organization uses to benchmark. An administrator within your department or physician organization should also be able to give you data relevant to your speciality **Professional Charges**: The chargemaster price for a given service. For the most part, this number is totally meaningless. This is the price that an extremely wealthy individual without health insurance would pay for the surgeon’s fee. This is still a useful measure to compare productivity between surgeons within the same department who use the same chargemaster. **Professional Collections**: This is the top level revenue. This is the amount that is collected from patients and insurers on your behalf. This is arguably the number that matters the most in most organizations. In private practice, this is all of the income before you subtract the expenses. **How to interpret these metrics:**You should get a general sense of the ballpark collections/wRVU you are expected to generate and what surgeons in your division typically generate. Take a list of your most common procedures, by CPT code, and make sure that you actually collect what your “allowed” insurance negotiated rate states you should collect. In my first year of practice, I noticed that my collections/wRVU were substantially lower than what my insurer contracts allowed. Digging further into the situation, I discovered that there was a wide variation within our department on processes related to insurance verification and collection of co-pays, co-insurance and deductibles. There were practices where all co-pays, co-insurance and deductibles were fastidiously collected prior to surgery and practices where no attempt was made at collecting any patient responsibility prior to surgery. In the era of growing high deductible plans, this led to several situations where I was paid nothing for the surgery from the insurer and was expected to collect the entire professional fee from the patient after the surgery, which tends to be a futile proposition. **Clinical Productivity Bonus Models:** If you are exceptionally productive compared to your contract targets, you may have a productivity bonus embedded in your contract. The following are the most common types of models. Some organizations may use a blend of the following methods. **wRVU over threshold**: You are paid a fixed dollar amount per wRVU for any effort above a wRVU threshold. For example, your annual wRVU target is 6,700 and you generate 7,500 wRVUS. You are to be paid $50/wRVU. You would be paid a $40,000 bonus. This model is most favorable to practices where the payor mix is poor or unpredictable. For example, trauma and emergency general surgery surgeons typically fare best under this type of model. **Percentage** **of collections over threshold**: You are paid a percentage of all collections exceeding a certain threshold. For example, in one year, you generate $500,000 in revenue. Your collection target for the year is $400,000. Your percentage of collections over threshold is 50%. You would accrue a $50,000 bonus for the year. This model is best for surgeons who have a favorable payor mix of commercial insurance plans. **Revenue minus expense**: You are paid a bonus based on a percentage of net revenue minus expense. For example, your collections are $500,000/year. Your allocated overhead for your own salary/billing/support staff/malpractice/supplies $400,000. You are paid 50% of net cash revenue. Your bonus is $50,000. Again, this model is dependent on payor mix and how lean your organization runs. **Profit and Loss Statement:**This is a document that is produced monthly or quarterly that evaluates you or your section/division/group. Even though you may have little control or input on how the overhead is allocated as this will likely be pre-determined based on some formula your organization has developed, you should look over this statement to make sure that it is at least being allocated correctly according to the formula. For example, during my first year in practice, I was re-assigned an different administrative assistant. When I reviewed my P&L the next month, I noticed that my support staff expenses had jumped significantly. It turned out that while I had switched assistants, a portion of BOTH assistants’ salaries were accruing to my cost center. Now that you are familiar with these terms, I urge you to schedule a meeting with your administrator so that you can better understand your practice finances and how funds flow through your organization. ![](http://blog.womensurgeons.org/wp-content/uploads/2018/01/feibi.jpg) *Dr. Feibi Zheng is an endocrine surgeon at Houston Methodist Hospital in the Texas Medical Center and Assistant Professor of Surgery at Weill Cornell Medical College. She attended medical school at the University of California, San Diego. During her surgical residency training at Houston Methodist, she helped to establish the General Surgery Leadership and Health Care Administration Track, an 8 year program which blends clinical surgery training with practical experience in optimizing hospital systems for improved patient care and safety. She then completed her endocrine surgery fellowship at UCLA. In addition to her clinical practice, she is the Assistant Clinical Program Director of Surgical Quality and Population Health for Houston Methodist Hospital, where she is leading the development of a telemedicine program for surgical patients who live long distances from specialized centers of care. She also currently serves on the Committee for Perioperative Care of the American College of Surgeons which works to improve the quality of care for surgical patients across the country.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice **Tags:** AWSBlog, business, business of medicine, clinical practice, Negotiation Tips, Salary Negotiation, SurgTweeting --- ### [Dear Pat Responds to “In Need of Feedback”](https://blog.womensurgeons.org/dear-pat-need-feedback/) **Published:** March 31, 2019 **Author:** Blog Team **Content:** Dear Pat, I was scrubbed in a case in the OR last week and my attending seemed to be very upset with me. Nothing in particular had happened, and I couldn’t identify what the problem was. She and I have worked together several times before and have always had a good working relationship. Now several days have passed, and the situation hasn’t improved. How can I figure out where I went wrong so that I can improve our relationship and not make the same mistake again? Sincerely, **In Need of Feedback** Dear “In Need of Feedback” You did not indicate your year of training or the seniority of the attending however, I will assume that you are in the early years of training. My recommendation would be to ask the attending if you could make an appointment to review your performance. I would then ask her to identify your strengths & the areas in which you need to improve. Hopefully, the discussion will throw some light on the underlying problem. In the meantime, you could talk to your peers to see if they have also noticed a change. However, I would do this discreetly & only with the people you trust. If this is general change (and not just about you) then I would suggest that unless this is really bothering you, you just need to ignore it. If this is a general problem & it is bothering you (and your colleagues) to the extent that it impacts your training, I would approach the program director or the chair to express your concerns. If you are a chief resident and the attending is relatively junior then it could be acceptable to ask if there is something troubling her as you noticed a change in her demeanor in the OR. Make sure not to make this accusatory. I hope this helps! Sincerely, **Hilary Sanfey, MB, BCh, MHPE, FACS** --- ![](https://lh3.googleusercontent.com/JAW0WYcLiS9n3J1_CFQbkVKgiBCd0HwuTk-fSnsO2EpoRFIG5bMFVMQH5y71EH5r3W9CCN3Uv9P6gqbsx2fu8Yimx0WIcHokG13Fmrt4Jv88BdoxrVhFWx7lrHtSwzUsciuWvyLe) Dr. Sanfey is Professor of Surgery and Vice-chair for Surgical Education at Southern Illinois University and the Chair of the AWS Foundation. She graduated from Trinity College Dublin Medical School, underwent surgical training at RCSI and completed fellowships at Johns Hopkins University, at the University Hospital Clinic de Barcelona and at the University of Virginia. Dr. Sanfey practiced as a consultant transplant surgeon at the Royal Infirmary of Edinburgh and at the University of Virginia. Dr. Sanfey is a past president of the Association of Women Surgeons and past First Vice-president of the American College of Surgeons (ACS). She co-chairs the Steering Committee for the ACS Certificate in Applied Surgical Education Leadership program and is a founding member of the ACS Academy of Master Surgeons, a member of the American Surgical Association, and a Fellow *ad hominem* of the Royal College of Surgeons of Edinburgh. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/04/dear-pat-logo_FINAL-1024x847.png)*This recurring column is published on the fourth Sunday of each month. #DearPat answers questions about residency, fellowship, life after training, and focuses on issues pertinent to surgical trainees. Questions may be submitted anonymously and are answered by* [*AWS council members*](https://www.womensurgeons.org/general/custom.asp?page=Leadership)*. We want to hear from you, if you are interested* [*submit your Dear Pat question here*](https://www.surveymonkey.com/r/FTKCPVS)*.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** DearPat **Tags:** communication, Dear Pat, residency, residents, Teamwork, womeninsurgery, WomenSurgeons --- ### [Imposter Syndrome: The Dirty Little Secret of Successful Women (and men too)](https://blog.womensurgeons.org/imposter-syndrome/) **Published:** April 3, 2019 **Author:** Blog Team **Content:** *By Kandace McGuire* We were sitting in a bar in Center City, Philadelphia. My co-chief resident and I were being hosted by our attending (and mentor) to wings, beer, and life advice. After he taught us how to deglove a chicken wing for the most efficient gustatory experience, he declared, seemingly out of nowhere, “You know, so many of us think we are doing a horrible job at surgery and life and one day someone will expose us for the frauds we are”. My co-chief and I looked at each other and then back at him and exclaimed, “I thought I was the only one!!!” This was my first exposure to the concept of the Imposter Syndrome. Since then, I have come across many who suffer from it and many who write about it. Beyond that wing and beer-laden explanation, the technical definition of Imposter Syndrome is “a psychological pattern in which people doubt their accomplishments and have a persistent, often internalized fear of being exposed as a ‘fraud’.” It is characterized by the traits of perfectionism, overworking, undermining one’s own achievements, fear of failure and discountin[g p](https://www.sciencetheearth.com/uploads/2/4/6/5/24658156/2011_sakulku_the_impostor_phenomenon.pdf)raise. 1 It is common in the general population but incredibly prevalent in the field of medicine. Many have researched the topic in relationship to medical education, the most recent of which noted that those students most at risk for Imposter Syndrome had ‘Type A’ personalities, defined by very similar traits to those named above and by frequent co-existence of anxiety and/or [depression. ](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwiRhO7g2LThAhVl5oMKHe03C5EQFjAAegQIARAC&url=https%3A%2F%2Fwww.msjonline.org%2Findex.php%2Fijrms%2Farticle%2Fdownload%2F5360%2F4243&usg=AOvVaw1X_CuhBRTei2mLEADrzvyi)[2](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwiRhO7g2LThAhVl5oMKHe03C5EQFjAAegQIARAC&url=https%3A%2F%2Fwww.msjonline.org%2Findex.php%2Fijrms%2Farticle%2Fdownload%2F5360%2F4243&usg=AOvVaw1X_CuhBRTei2mLEADrzvyi) It is no surprise to me that women tend to suffer more with Imposter Syndrome than men. This has been noted not only in medicine, but also in the general population. In a survey of 3,000 adults in the United Kingdom two-thirds of women respondents noted feelings consistent with the syndrome in the past twelve months. Women were 18% more likely than their male counterparts to experience [Imposter Syndrome.](https://www.forbes.com/sites/karenhigginbottom/2018/07/29/two-thirds-of-women-in-uk-suffer-from-imposter-syndrome-at-work/#174085376ccf)[3](https://www.forbes.com/sites/karenhigginbottom/2018/07/29/two-thirds-of-women-in-uk-suffer-from-imposter-syndrome-at-work/#174085376ccf) Researchers have noted that, “… unlike men, who tend to own success as attributable to a quality inherent in themselves, women are more likely either to project the cause of success outward to an external cause (luck) or to a temporary internal quality (effort) that they do not equate with [inherent ability.” ](http://www.paulineroseclance.com/pdf/ip_high_achieving_women.pdf)[4](http://www.paulineroseclance.com/pdf/ip_high_achieving_women.pdf) So how do we overcome it? More so, how do we use it to our advantage? Some suggest honest feedback from people you trust and admire. Others suggest taking a moment to reflect on your accomplishments, maybe even writing them down or keeping a log, to have tangible proof of your [achievement. ](https://www.ncbi.nlm.nih.gov/pubmed/28742562)[5](https://www.ncbi.nlm.nih.gov/pubmed/28742562) For those who realize they are affected by Imposter Syndrome, I say to you: accept it, internalize it, and let it drive you, but be smarter than it. Never let it define you. You are worthy; you are intelligent, skilled and accomplished. Never forget that, but if you do, make sure you have people around you who will remind you of the fabulous and worthy success that you are. ![](https://blog.womensurgeons.org/wp-content/uploads/2019/04/McGuire_Kandace_4x6_suit-003.jpg)Kandace McGuire Kandace P. McGuire, MD, FACS is an Associate Professor of Surgery, the Chief of Breast Surgery and the Surgical Leader of the Multidisciplinary Breast Clinic at Virginia Commonwealth University in Richmond, VA. She is a great surgeon, researcher, administrator, mother, baker, and wing deglover. She has to tell herself this every day…because she still has Imposter Syndrome. *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice **Tags:** #womeninmedicine #womeninsurgery #residencyinterviews #AWSTweetChat #AWS #AssociationofWomenSurgeons --- ### [You Matched, Now What?](https://blog.womensurgeons.org/you-matched-now-what/) **Published:** April 8, 2019 **Author:** Blog Team **Content:** *By Camila Guetter* Congratulations! After years of preparation and a long interview trail, you have matched! And although this very important step is finally over, another even more crucial journey is about to begin: residency. And in that sense, many questions certainly arise, especially regarding intern year. If you haven’t done so yet, take advantage of the time you have left until the beginning of your intern year to celebrate and spend time with your family and friends. Be grateful for everyone who has been there for you and supported you through medical school. Also remember to thank you mentors and everyone that contributed somehow in getting you where you are today – be grateful and show recognition! In your first few days of residency, your hospital will likely hold formal orientation sessions on multiple aspects of the hospital and your department. But you might still have questions on how to become the best version of yourself as you train during residency. What materials should I read? How and when should I study while keeping good time management? What are good resources for improving my manual abilities and skills? Join the AWS National Medical Student Committee along with our moderators Drs. Beth Shaughnessy, Thomas Varghese and Lauren Nosanov for a tweetchat on April 15th at 8 pm Eastern Time. In the tweetchat we will approach questions about intern year in surgical residency, focusing on how to improve technical skills and technical knowledge as well as self-wellness. To participate, follow @womensurgeons, our moderators and medical students, and tag your tweets with the hashtags #AWSChat and #InternTips. If you haven’t participated in a tweetchat with us before, check out this [**tutorial**](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo (@heatheryeomd) to know more! **Tweetchat Moderators:** · **Dr. Elizabeth Shaughnessy ([@DrBethS1](https://twitter.com/DrBethS1))** – Surgical Oncologist, Professor of Surgery at the University of Cincinnati. Faculty Advisor for the AWS National Medical Student Committee. · **Dr. Thomas K. Varghese Jr. ([@TomVargheseJr](https://twitter.com/TomVargheseJr))** – Chief Value Officer at the Huntsman Cancer Institute, Head of the Section of General Thoracic Surgery, Program Director of the Cardiothoracic Surgery Fellowship at the University of Utah. · **Dr. Lauren Nosanov ([@laurenbnosanov](https://twitter.com/laurenbnosanov))** – Chair of the AWS National Resident and Fellow Committee, General Surgery Resident at MedStar Georgetown University Hospital-Washington Hospital Center, PGY4. **Medical Students Participants from the AWS National Medical Student Committee:** · **Faith Robertson** ([**@FaithCRobertson**](http://twitter.com/FaithCRobertson)) – Chair of the AWS National Medical Student Committee, MS4 at Harvard Medical School, Incoming Neurosurgery PGY1 at Massachusetts General Hospital. · **Ashley Choi** **([@AshleyYJChoi](https://twitter.com/AshleyYJChoi))** – Vice Chair of the AWS National Medical Student Committee, MS2 at Duke Medical School. · **Camila Guetter** ([**@camila\_guetter**](http://twitter.com/camila_guetter)) – Marketing and Communications Chair of the AWS National Medical Student Committee, MS6 at Universidade Federal do Paraná – Curitiba, Brazil. · **Uma Parikh ([@uma\_parikh](https://twitter.com/uma_parikh))** – Southwest Regional Representative of the AWS National Medical Student Committee, MS2 at Baylor College of Medicine. · **Elisa Atamian ([@ElisaAtamian](https://twitter.com/ElisaAtamian))** – South Regional Representative of the AWS National Medical Student Committee, MS3 at Tulane University School of Medicine. **Questions for the Tweetchat:** 1\. What are ways to improve surgical skills throughout intern year? 2\. What are ways to balance studying and being an intern? When is the best time to take step 3? 3\. What are good surgical resources to study and suggestions to get prepared before cases? 4\. What strategies can residents/programs employ to promote self-wellness during intern year and throughout training? ![](https://blog.womensurgeons.org/wp-content/uploads/2019/04/RAF1710-3450-683x1024.jpg) Camila is a sixth-year medical student at Federal University of Paraná in Curitiba, Brazil. In her third year of medical school, Camila was awarded a one-year scholarship to study Biomedical Sciences at the UCLA. Subsequently she worked as a research student at Beth Israel Deaconess Medical Center (Boston, MA) studying pancreatic cancer, hepatobiliary surgery outcomes, and patient education. Camila is passionate about pursuing a career in academic surgery and is very active in AWS. She is a member of the Publications Committee and currently serves as Medical Student Chair of the AWS Blog Subcommittee and Communications Chair of the National Medical Student Committee. You can find her on twitter at [@camila\_guetter](http://twitter.com/camila_guetter). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, intern year, match2019, residency, surgmatch, womeninsurgery, WomenSurgeons --- ### [The Give and Take of Surgery](https://blog.womensurgeons.org/give-take-surgery/) **Published:** April 11, 2019 **Author:** Blog Team **Content:** *By Simone Betchen* I recently applied to an executive MBA program and was asked the essay question based on Adam Grant’s groundbreaking TedTalk [“Are You a Giver or a Taker?](https://www.ted.com/talks/adam_grant_are_you_a_giver_or_a_taker)”. He describes three primary personality types in the workplace: givers, takers, and matchers. I was asked “based on your understanding of yourself and our program, **how do you intend to give and take as a student…?”** Takers in general as constantly tipping the scales in their own favor. They are out for themselves and see the world as an eat what you kill kind of place. Matchers have a great sense of fairness in a tit for tat system. Givers look to see what others need from them and often look out for the common good. Grant explains that in businesses, it’s the givers that end up on both ends of the spectrum as the most and least productive of employees. I sat down to think about how this applies to medicine and more specifically surgery. While as doctors and surgeons we all are extreme givers, aren’t we all takers too in the name of patient advocacy and care? How does one describe a surgeon’s life as a giver, taker, or matcher? I realized as I have moved through my medical training and my career as a neurosurgeon, that I have succeeded by toggling through all three types of interactions, giver, take, and matcher, on a macroscopic scale. In the beginning as a resident you are given an enormous list of tasks to complete. Getting patients ready for surgery, doing emergency room consults, drawing blood, ordering medication, and going to the operating room to help are only a few of the roles I learned to shift among on a daily, and often hourly basis, in a way that has the potential to make the difference of life or death. It meant navigating my way through the hospital dealing with patients, families, nurses, other doctors, and front desk staff. At every interaction, I have had to read the situation and decide how to best approach it. Sometimes as the taker I would allow another resident or specialist to take over. Sometimes as the giver I would do everything myself to get the patient safely to the operating room. Sometimes as the matcher I would call in a previous favor done. It taught me to be agile in my interactions and able to switch around my role given what the situation needs. Now as an attending, these lessons learned continue to be utilized every day. With all my patients, I have to gauge the interaction and make them feel comfortable in their decisions. Some patients clearly enjoy humor and others appreciate a more serious tone. Given my years of experience at different roles in the workplace, I have learned how to read the situation and adapt my role to what is necessary at the time to accomplish the best for the patients. In many ways, I see the role with the patient as a giver. We devote ourselves to doing what is best for each patient. On the flip side, we are often takers from the support staff around us. I often feel in the operating room like the ultimate taker, constantly asking others to do things specifically for me to carry out a successful operation. Being the taker has its consequences. Relationships with OR staff are often strained when one is always the taker. So I try to be mindful of giving something to those around me in the operating room. Adam Grant in his talk speaks of the 5-minute favor. Giving quick medical advice, listening to a problem, or hearing a story about their kids or latest trip often helps to nurture and balance the relationship with the staff around me. I found this exercise offered me insight and a useful explanation behind many of the things I’ve learned to do over the years. These are the same skills all of us have. For me, I learned them slowly over time. Maybe I would have learned them quicker had I the insight to look for these balances among co-workers. To be successful as a female surgeon, each of us has had to find our own rapport with those around us. The patients, their families, colleagues, nurses, and staff all view us in a unique way. Relationships amongst women surgeons with patients, staff, and co-workers can be hard to navigate. Maybe if we understood the different types around us and within ourselves, the path to a successful relationship would be more apparent. Everyday we take with some, match with some, and give to everyone. ![](http://blog.womensurgeons.org/wp-content/uploads/2016/11/Simone-Betchen-679x590.jpg) *Dr. Betchen is a board-certified neurosurgeon. She currently practices at Maimonides Medical Center in Brooklyn and is proud to have served the community there for a decade now. Dr. Betchen received her medical degree from Johns Hopkins Medical School. She did internship and neurosurgery residency at Mt. Sinai Hospital in New York City. After completing a neurosurgical oncology fellowship at Memorial Sloan-Kettering Cancer Center she made the big move south to Brooklyn where she now treats a wide variety of clinical problems in both the brain and spine including tumors, hydrocephalus, chiari malformation, herniated discs, and spinal stenosis. Her research interests are in clinical outcomes and quality of life with neurosurgical treatment. Outside of the hospital she is married with two children.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** academic practice, business of medicine, clinical practice, fellowship, ILookLikeASurgeon, Professional Development, residents, SurgTweeting --- ### [How soon is too soon?](https://blog.womensurgeons.org/how-soon-is-too-soon/) **Published:** April 17, 2019 **Author:** Blog Team **Content:** [“Fifty percent of physicians leave their first job within 5 years.”](https://www.prnewswire.com/news-releases/study-shows-first-job-after-medical-residency-often-doesnt-last-161949055.html) This statistic rang through my head as I sat looking at the computer screen. My mentor from fellowship had emailed me and asked me to come interview for a job. I was only 1.5 years into my first job. Was I really going to consider doing this? Was I going to become a statistic? While I was not actively looking for a job, if I was honest with myself I wasn’t happy at work. I had dreamed of being a burn surgeon and my current job was almost 50% trauma and emergency general surgery. Initially I had been happy to keep and develop my general surgery skills, but was beginning to feel I was not growing as much in my burn practice as I had hoped. However, my family was happy. Was I willing to move them again? I won’t bore you with all of the details, but I did eventually take the job after being at my first job for 2.5 years. Throughout this process I was very conflicted. I was excited. The new job was my dream job, the one I had wished for since I had decided to become a burn surgeon and it was not the type of job that came along very often. I was sad. I loved the people I worked with and I knew that I would miss many of them terribly. I was worried. I knew that there would be ramifications for my career, but how much would my career progress be hindered by changing jobs? I felt like a success and a failure all at the same time. But perhaps the worst thing, that no one who has gone through this tells you, was how completely and utterly alone I felt. People at work did not know what was going on for much of the process, and once they did know it was not really something I was comfortable talking about with them. My family was supportive and we spoke often of what the move would mean for the family, but we almost never spoke of my inner turmoil and feelings of doubt I experienced about the possibility of changing jobs. My new employer was excited for me to join them and this made it difficult for me to discuss my concerns with them. This was especially hard given that my new partners were my most trusted mentors. I did have a few friends I trusted to talk with, but I am sure they were sick of listening to me by the end of the process. I have been at my new job now for almost a year and a half, and I can tell you that it has been a wonderful move for me. My research is now progressing again and I have a lot more support for the studies I am conducting. Clinically, I am more fulfilled than before and I feel like I am where I was meant to be. That is not to say that there are not any issues. I am sure that I did lose at least a year of time progressing my career. Personally, the move has been harder on my family than I realized it would be and only now are they starting to regain the happiness they had prior to the move. So, my advice is don’t be afraid of becoming a statistic, it might be just the move that you need. It will be exciting, it will be sad, you will wonder if you are making a terrible mistake. Additionally, know that you are not alone, many of us have been through this before and can help you talk through the issues. ![](https://lh6.googleusercontent.com/WH18TWweZot-VL9XCrkXqTrzNak4nYAVR517Wu-Yfjb4XdAJ2pzWi9tNk7xuZlZr9mT6MpaQyTtPqRZp4604vZ7XuT6vL0EVkdXhwaNchBtpqRd4xaB_HX_FRjuME0tRbQRIv7xA) Kathleen Romanowski, MD, FACS is an Assistant Professor of Surgery at the University of California, Davis and Shriners Hospitals for Children Northern California in the Division of Burn Surgery. She attended the University of Chicago Pritzker School of Medicine and completed her general surgery residency at University of Chicago Medical Center. She did fellowships in Burn Surgery and Surgical Critical Care at University of California, Davis and Shriners Hospitals for Children Northern California. Kathleen is devoted to the care of the burn injured patient and studies disparities in care and predictors of outcomes in elderly burn patients. She is an active member of AWS and is a member of the AWS Communications Committee. You can find her on twitter at **[@KSRomanowski](https://twitter.com/ksromanowski?lang=en)**. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Becoming Human Again](https://blog.womensurgeons.org/becoming-human-again/) **Published:** April 24, 2019 **Author:** Blog Team **Content:** *By Susana Vargas-Pinto* Sign out. Rounds. Run the list. Check labs and images. Do the orders, start the notes and check my ‘to-do-list’ boxes for the day. Done! A series of events perfectly orchestrated during years to take care of our hospitalized patients and begin a new relationship with those coming in for their operations that day. As an intern I had my checkbox list to fill so I could make it to the OR on time. I thought of myself as the guardian of our floor patients and prided myself on “getting everything done” for the day. I spent countless hours with the electronic medical record (EMR) but not as much with our patients. A recent observational study using direct time-motion observations of interns from 6 mid-Atlantic internal medicine training programs, participants of the iCOMPARE cluster trial showed that first-year residents spend 10 hours over a 24 hr period on indirect patient care. Most of this time was spent working on EMR and multitasking. While surgical residency programs were not included in this subgroup analysis, and the study could not determine if this had a positive or negative effect, if you ask any surgical intern what do they dislike more about their job many will say the number of hours dedicated to EMR documentation and other aspects of indirect patient care. As a junior resident I devoted many hours to studying and learning the operations for the day, seeing all the consults and getting the patients ready for surgery so I could “earn” the privilege to do the case at my chief residents’ discretion. How irritating were the times when a chief will show up after I have been working hard and staff it with the attending physician and “take” the case from me… I certainly didn’t understand well their responsibilities at the time. Throughout the years, residency felt to me as a series of steps you methodically follow according to your post graduate year level, like a ritual or a standardized protocol to become an independent surgeon. Then, chief year happened. Neither Sabiston nor Cameron taught me how to run a service with different and at times very conflictive personalities. There was no chapter on paying attention to your interns, identify the areas where they struggle and come up with a plan to help them improve. Nor any guidance on how to organize the week so everyone can have a fair amount of operative time appropriate for their level, ensure no one breaks duty hours, and keep things going when someone gets sick or their children are sent unexpectedly home from daycare and the babysitter can’t make it. Having discussions with the attendings and consultants in regards to differences in patient management in a respectful way and to earn their trust while taking care of their patients was important to me. I began to see patients more as fellow humans whose fragility have placed them in my path rather than cases. They had a need and I had something to offer. I started to inquire more about their wishes, their understanding of the procedure they were about to undergo, and spent more hours on the phone with a family relative who was worried to death about their loved one and could not be there for them. My junior residents may continue to complain our morning rounds may take longer but I feel we need to listen more to the patients. Chief year has enriched my life in many ways which are not described in the textbook. In a sense, I feel I am becoming human again. In a sense, that passion I felt when I got my first white coat placed is growing back and I love it. ![](https://lh6.googleusercontent.com/TRaUarcjVjsScIVy8-cJcJKzmepIyrSQcWx-K-eeNu_O4bNve3Hebiy-Ofa4fVUWIFFkcj9MOKSXuyxiRmIQgnNn4d8QtRXgLPsIQrHpjyHQP935vJNaqY5tjVaG6yY0YFgwYLGP) Dr. Susana Vargas-Pinto was born and raised in Puerto Rico. She obtained a Bachelor’s Degree in Industrial Microbiology from the University of Puerto Rico at Mayagüez, Puerto Rico. She then earned her Medical Doctorate from Ponce Health Sciences University in Ponce, Puerto Rico. She is a Chief Resident at the General Surgery Residency Program at the University at Buffalo, in Buffalo, New York, and will train as an Endocrine Surgery Fellow at Yale University School of Medicine. She enjoys teaching and mentoring medical students. Dr. Vargas-Pinto is also a member of the Gold Humanism Honor Society, a wife and mother of a 3-year-old. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [Transitioning into an educator](https://blog.womensurgeons.org/transitioning-into-an-educator/) **Published:** May 1, 2019 **Author:** Blog Team **Content:** *By Madeline B. Torres* As a schoolkid, I associated July with hot Summer days at the pool with friends. Now, as I wrap up my research years at the National Cancer Institute, July reminds me of the transitions we experience in medicine every year. Each July, freshly minted interns start their journey into residency, and are not only tasked with the care of patients but also the education of medical students. Caring for patients can be daunting and overwhelming, yet extremely rewarding. As an intern, you will learn to place orders, do bedside procedures, and operate. You will be exhausted, and at times find yourself without the patience or desire to teach. However, I ask that you remember you were once a student, not too long ago. During times like that, think of the residents that made an impact in your education and the qualities that you treasured. Here are a few things I learned over the last few years: · **Set expectations**. Ask students what their expectations of the rotation are, similarly, share your expectations of them. This ensures their goals as learners and yours as the teacher are met. · **Set measurable goals.** Set daily or weekly learning goals, then follow up at the end of the day or week to check if the set goals were met. · **Provide autonomy.** Give the students level appropriate tasks. For example, they can help with the rounding list, dressing changes, patient walks, placing foley catheters and nasogastric tubes, suture, staple and/or drain removal. Giving the students tasks will teach them valuable skills, make them feel part of the team and help you assess their skill levels. · **Take advantage of small teaching moments.** One of my favorite residents, now a pediatric surgeon ([@citizensurgeon](https://twitter.com/citizensurgeon)) used to take every free available moment to teach and discuss – walking between cases, waiting for a patient to wake up, waiting for sign out. Take advantage of the few free minutes to talk about a topic, the care of a patient. Every minute counts and the students appreciate it, as I did. · **Provide feedback.** We all wish we received more real time feedback, so why not start doing this with your students? There are multiple ways to provide[ feedback](https://www.uab.edu/medicine/home/images/residents/cert/feedback.pdf). My personal preference is to provide feedback after a procedure or seeing a consult, perhaps at the end of the day or the week. I pick and set a non-threatening environment and tell the student I am about to give her/him feedback. Focus on the behavior and not the individual, provide suggestions to improve upon the behavior. · **Nurture**[ creativity**](https://blogs.scientificamerican.com/unofficial-prognosis/resident-as-teacher-how-to-nurture-strengths-in-medical-students/)**.** Remember that there is more than one way to do things, just because it isn’t your way, it doesn’t mean it’s wrong. Pay attention to your students train of thought and how they come to their conclusions rather than just the answer. · **Be kind.** Medical training is hard, there is no need to make it harder by being rude. · **Be inclusive.** Remember what it felt like not being acknowledged by the team in that one rotation? I do, don’t do that to your students. Make them feel welcomed, a part of the team. Include them during rounds, procedures, take them along to see a consult. · **Encourage wellness and self-care.** Physician burnout and suicide are on the rise, remember to take care of yourself and also remind your students to take meal breaks, keep doctor’s appointments and maintain a healthy lifestyle. As I prepare to go back as a mid-level resident, I look forward to working with students again and taking a more active role in the teaching of junior residents. Being an educator is a privilege, take advantage of the opportunity to train our next generation of physicians. And have fun along the way! ![](https://lh4.googleusercontent.com/oq4ygXm_D5k93fOheui74u8sfkCTCGhJRIJpTuiOBcm4Dd7SRpijAAKcTH1mELZmaJiee0bfsM5wVQPc5NiWSUATkCf5EPn3CN9fTL7j-GDUib3Dq1LKHC5CQ88DlvR0mgNfuQGd) Madeline B. Torres, M.D. is a general surgery resident at Penn State Milton S. Hershey Medical Center in Hershey, PA, currently finishing a research fellowship in surgical oncology at National Cancer Institute (NCI) in Bethesda, Maryland. Dr. Torres was born and raised in El Salvador. She immigrated to the United States with her mother and brother at the age of nine. She then went on to obtain her B.S. in chemistry from the University of Colorado at Denver and earned her medical degree from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors. Her academic interests include surgical education, surgical oncology, work-life balance, and encouraging women and minorities to pursue surgery and other careers in medicine. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** education --- ### [Waiting Your Turn](https://blog.womensurgeons.org/waiting-your-turn/) **Published:** May 8, 2019 **Author:** Blog Team **Content:** *By Alyssa Brown* I remember very clearly the first time I heard about [Match Day](http://www.nrmp.org/the-match-process-video/). We were sitting in the lecture hall, and we stopped lecture to watch the live stream of Match Day. This was almost four years ago now, and from that day forward, I started an anxious countdown to when I would experience it myself. I would be surrounded by my friends that I had met the first weeks of medical school, and we would all find out where we would be heading for residency. The type of residency and location of the residency on the card changed over the course of medical school, but the day-dreaming feeling never really stopped. As the years passed, I knew more and more people who were matching. There were ups and downs through this. I watched close friends above me struggle through not matching, and I watched some come to terms with not being where they wanted to be. Match Day became more real by the passing months with the looming applications to residency. Not to be cliché, but this is where I stopped and turned down the road less travelled. During my third year, I decided to apply to graduate school to train for a PhD in Biomedical Engineering and Physiology—a large departure from the wards and operating rooms that I was haunting during third year. I talked to my trusted advisor, a pediatric surgeon at my home institution, about this choice, and she encouraged it. I had always enjoyed research, and I thought a Ph.D. would be a wonderful choice, so that I could learn how to be a physician and scientist. I took the position in Rochester, Minnesota, very far away from my Louisville, Kentucky home. I left in July 2018, two days after taking my Step2 CK exam, and two days after finishing my pediatrics rotation. I was sad to leave, and the reality that I would be away from my friends during the last year of medical school set in. This year has been a hard transition for me. I am not an engineer by training, and I have struggled through the coursework and I miss the operating room. Most of all, I have struggled with missing my friends, the ones I spent the last three years of medical school with sharing all the highs and lows. I spent innumerable hours on the phone with them through the interview trail, and late nights helping to keep them awake on long drives back from interviews. I felt like I was at a least a small part of their journey. As match day inched closer though, I started to feel the familiar feelings of nervousness. I knew match day would come, but the day-dream now included me on the sideline, instead of opening an envelope alongside them. March 14, I arrived back in Louisville for my friend’s Match Day. We hunkered down in our favorite neighborhood bar to catch up before the big day. They were excited and nervous matching into pediatrics, internal medicine, psychiatry, pathology, and radiology. I had been on the phone with most of them on Monday for the moment that they knew they had matched, but not where yet. We woke up Friday nervous but excited. While I was glad to see them, I also started to get pangs of sadness that this was not my year. It stirred up questions about why I took the path that I am on. It stirred up guilt from thinking about myself on their day. As the hours drew closer to noon, I waited with them to open their envelope. Surrounded by my friends, it almost felt like watching a movie. I was there, but I was not participating in the day I had been thinking about for four years. They were all happy where they matched, and I was happy for them! It is amazing to see the envelopes open and the variety of reactions from the students matching. Even as the days have passed since then, I still have had a hard time coming to terms with the fact that my match day will not be the same as theirs. I will return for fourth year, to no friends that I have spent all my years of medical school with. It will just be me on that day in March hopefully opening an envelope that says I matched. I won’t have those friends that I love so dearly there. It seems arbitrary, but it has made me question whether I am on the appropriate path. *Was it the right decision to move towards getting a Ph.D.? Was it right to put my life on hold for three years before returning? Should I have just matched with my friends?* I will admit I do not have the answer to this. For others out there though, feeling this same way, your feelings are valid. My friend from home always likes to tell me to remember that my feet are on the ground, and that helps me to remember that I am here, and I am living my own journey. While the journey may not look the same, my goal of becoming a pediatric surgeon has not changed. Where I am going is just as important as the steps I am taking to get there. It is brave to take the road less traveled, but it can also get lonely. For those of you who did not match this year, I am truly sorry. This process is not easy or fair sometimes, and your heartbreak is real. I hope you know that you are not alone in this journey, and Match Day brings the best and the worst on the same day. Also know that taking care of yourself and your mental health is important during normal life and during stressful changes like this. You are not less of a person for needing help. To those who matched and to those who are graduating in the coming week, CONGRATULATIONS! Your late night, blood, sweat, and tears have gotten you to this point. I am sure you are nervous to start residency soon, but try to remember that we are rooting for you. Take care of yourselves, and cut yourself some slack sometimes. We couldn’t get through this process without each other. ![](https://lh3.googleusercontent.com/KL15baO-n9gmLweZ-AgyJhGrP8mB5KwPnk_ipLeusTQnaQ_o9DFipR8YT5rIbBdgB5Bi00Y5_xV4mnkaQW3hhqhaJmePXThe8gxUXfFSPg8tf3mlsM1GnnKB68Y8plFUmEvVNXPH) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. In July, she finished her third year of medical school and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. Whe she is not buried in lab work, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram [**@alyssabrown1013**](https://www.instagram.com/alyssabrown1013/) and Twitter [**@Alyssa\_B\_MDPhD**](https://twitter.com/Alyssa_B_MDPhD) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, self-care **Tags:** AWSBlog --- ### [Fostering International Collaborations: How Can We Become More Engaged?](https://blog.womensurgeons.org/international-collaborations/) **Published:** May 12, 2019 **Author:** Blog Team **Content:** *By Camila Guetter* Every day, universities and health centers across the globe lead independent successful initiatives in the field of medicine. These actions can often bring important changes to their community and sometimes even to their region. However, the truly large-scale changing actions are those that build on one another’s work, rather than duplicating efforts. Collaboration is what truly allows for the acceleration and development of shared knowledge and meaningful improvements in patient care across the globe. Creating networks for peer-to-peer support is crucial, and so is inspiring global action. Connecting with someone across the globe has never been as easy and fast as it is now. In that sense, the [Panamerican Trauma Society](http://www.panamtrauma.org/) (PTS) has been a leading organization in various international collaborations. PTS itself is well-established in most countries across North, Central and South America, and representatives of many of those nations are found in leadership positions among the many society’s committees. In addition, PTS leads international telemedicine grand rounds weekly, facilitates multi-centric international research projects, and engages members in global surgery efforts. Join the Association of Women Surgeons and the Panamerican Trauma Society, along with our moderators Drs. Tanya Zakrison ([@tzakrison](https://twitter.com/tzakrison)), Paula Ferrada ([@pferrada1](https://twitter.com/pferrada1)) and Gregory Peck ([@DrGregoryPeck](https://twitter.com/DrGregoryPeck)), for a tweetchat on May 20th at 8-9pm Eastern Time. In the chat we will discuss strategies on how to establish and maintain sustainable international collaborations in the clinical setting and in research. To participate, follow [@WomenSurgeons](https://twitter.com/WomenSurgeons), [@Panamtrauma](https://twitter.com/Panamtrauma) and our moderators, and tag your tweets with the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [**tutorial**](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo (@heatheryeomd) to learn more! This will be AWS’s first multilingual tweetchat (English, Spanish and Portuguese)! We are looking forward to discussing with and learning from people across the globe! The tweetchat will run from 8 to 9pm EST as usual, but given time zone differences between participants, we encourage you to participate for the following 48 hours if you are not available to join at that specific time. The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. **We will be discussing the following questions in the tweetchat:** 1\. What are effective ways to engage in international collaborations in the clinical setting? 2\. How can telemedicine contribute to fostering international collaborations in surgery? 3\. How can a society/association promote international collaborations in research? 4\. What is the role of international collaborations inside a society/association, and how can it be promoted in regional and national conferences? ![](https://lh5.googleusercontent.com/IyiUmFxNPcl6jD3_-_8Ui7aGWYQTPiZiSdLCb9e3Jjc-dZMRd6hsplLK7kv48Xxd0xI5Y0Z1kwG6mhBnh1oHd3phLfvCc2lajFJRilQYx5OhvVHDxx3JkMIzIEP_B3NhxJEakAJ0) ***Camila R. Guetter*** *is a sixth year medical student at Universidade Federal do Paraná and is originally from Curitiba, Brazil. In her third year of medical school, she was awarded a one-year scholarship to study Biomedical Sciences at UCLA. During her time in Los Angeles, she worked as a research student at the UCLA Translational Oncology Research Laboratories studying pancreatic cancer cell lines, and since then research has become one of her main interests. She later worked as a research student at Beth Israel Deaconess Medical Center in Boston, studying pancreatic surgery outcomes and patient education. She has also been a member of the Research and Education Committee of the Panamerican Trauma Society since 2017. Camila is passionate about pursuing a career in academic surgery and is very active in AWS. She is a member of the AWS Publications Committee and currently serves as the Medical Student Chair for the AWS Blog Committee and the Vice Chair for the AWS National Medical Student Committee. You can find her on twitter at* [***@camila\_guetter***](http://twitter.com/camila_guetter)*.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #AssociationofWomenSurgeons, AWSChat, collaboration, global action, Global Surgery, internationalcollaborations, Tweetchat --- ### [“Are you doing my surgery?”: Addressing Microaggressions in Surgery](https://blog.womensurgeons.org/microaggressions/) **Published:** May 16, 2019 **Author:** Blog Team **Content:** *By Eva M. Luo, MD, MBA and Rose L. Molina, MD, MPH* *“Lucy” is a new patient in the Gynecologic Oncology Clinic and she is visibly anxious. As you carefully explain your recommendation for surgery, the pathophysiology of ovarian cancer, expected postoperative course, potential complications and overall treatment trajectory, the tension eases as she gradually transfers her trust to you.* *This is a familiar exchange. Over ten years of practice, you have developed a confident demeanor that has allowed you to build this special relationship with your patients and their families.* *Just before you begin to review the consent form, Lucy asks tentatively, “I see you are in the same practice as Dr. Richard Smith. Are you doing my surgery?” You smile and say, “Yes.” In the back of your mind, you wonder why this question was asked.* The surgeon in this vignette is a black woman at a well known cancer institute who trained at prestigious institutions. *“Are you doing my surgery?”* While a seemingly innocuous question, it probes the intersectionality of multiple identities: race/ethnicity, gender, country of nativity, sexual orientation and any other aspect of an individual’s identity. The question exposes doubt between the patient and surgeon. This and other[ microaggressions](https://www.merriam-webster.com/dictionary/microaggression) impact relationships in clinical encounters and interactions in the workplace. Microaggressions can be particularly hurtful as female surgeons and surgeons of color may already feel the need to prove themselves as competent due to the cumulative impact of these insults. | **Definitions** | |---| | *microaggression*: a statement, action or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group (Merriam-Webster) | | *micro-affirmations:* apparently small acts, which are often ephemeral and hard-to-see, events that are public and private, often unconscious but very effective, which occur wherever people wish to help others to succeed ([Rowe](http://ombudsoffice.mit.edu/sites/default/files/documents/micro-affirm-ineq.pdf)) | --- It is no question that the face of surgery is changing. A workforce report compiled by the[ Association of American Medical College (AAMC) in 2018](https://www.aamc.org/data/workforce/reports/492560/1-3-chart.html) illustrates an increasing number of female physicians in all surgical specialties. The data about race paints a different picture. According to the[ AAMC’s 2014 Diversity in the Physician Workforce report](https://www.aamc.org/data/workforce/reports/439214/workforcediversity.html), out of the total active physicians in the U.S, only 4.1% were Black or African American, 4.4% were Hispanic or Latinx, 0.4% were American Indian or Alaska Native while 11.7% were Asian and 48.9% were White. The case for increasing diversity and inclusion in the physician workforce has been well described and promoted as a priority. While social media movements like #ILookLikeASurgeon have highlighted the changing face of surgery, there is a need for a deeper understanding of the lived experiences of physicians of color. In a[ qualitative study](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2703945) of 27 resident physicians who identified as underrepresented in medicine, three major themes emerged: a daily barrage of microaggressions and bias, being tasked as race/ethnicity ambassadors, and challenges negotiating professional and personal identities while being seen as “other.” **What are appropriate next steps to address microaggressions in surgery?** One strategy to address microaggressions between patients and surgeons is to simply repeat the offending statement. This gives both individuals the opportunity to acknowledge the microaggression and clarify intent. In the vignette above, one possible response is *“I am a surgeon.”* This would open the opportunity for the patient and surgeon to discuss any concerns about who will be performing the procedure and reestablish trust. [Premkumar, et al](https://www.ncbi.nlm.nih.gov/pubmed/30204690) outline strategies at various levels to develop a culture responsive to microaggressions. These include training in cultural humility and implicit bias through case discussions, encouraging faculty to lead “in the moment” debriefs when microaggressions occur, and creating a taskforce dedicated to developing institutional policies. Most importantly, at all levels, a chain of command for escalation should be formalized. While sensitization is important,[ Molina, et al](https://www.amjmed.com/article/S0002-9343(19)30137-8/fulltext) advocate creating a culture of *micro-affirmations*. Micro-affirmations (examples below) positively recognize, validate and ultimately empower individuals within a work environment. When micro-affirmations are intentionally used, individuals who feel marginalized are made to feel welcome, visible and capable. Department and institutional leaders are critical in role-modelling intentional micro-affirmations to foster a more inclusive environment. **Examples of Micro-affirmations (adapted from**[ Molina, et al**](https://www.amjmed.com/article/S0002-9343(19)30137-8/fulltext)**) | Appreciative inquiry | “Heard you had a busy clinic. Any interesting cases coming up?” | |---|---| | Recognition and validation of experiences and feelings | “I know that was a difficult interaction.” | | Reinforcing and rewarding positive behaviors | “Congratulations on the teaching award!” | | Intentional inclusion in professional settings (meetings, conferences, presentations) and information networks | “There is an upcoming prestigious meeting that I think you should attend. I’ll forward your name to the organizers.” | | Introducing team members by name and role | “This is Dr. \_\_, a resident working on your care team.” | | Diverse representation in public spaces | Departments or institutions should ensure that a diverse group of speakers are invited to present at Grand Rounds. | --- By encouraging micro-affirmations and addressing microaggressions, we will be able to support our colleagues while continuing to build a more inclusive work environment. Everyone has a role to play. References: 1\. Premkumar A, Whetstone S, Jackson AV. Beyond silence and inaction: Changing the response to experience of racism in the health care work force. Obstet Gynecol. 2018 Oct;132(4):820-827. 2\. Osseo-Asare A, Balasuriya L, Huot SJ, Keene D, Berg D, Nunez-Smith M, Genao I, Latimore D, Boatright D. Minority resident physicians’ view on the role of race/ethnicity in their training experiences in the workplace. JAMA Netw Open. 2018 Sep 7;1(5):e182723. 3\. AAMC 2018 Physician Specialty Data Report.[ https://www.aamc.org/data/workforce/reports/492536/2018-physician-specialty-data-report.html](https://www.aamc.org/data/workforce/reports/492536/2018-physician-specialty-data-report.html) Accessed April 29, 2019. 4\. Reede JY. A recurring theme: the need for minority physicians. Health AFF (Millwood). 2003 July-Aug;22(4):91-3. 5\. Axelrod DA, Goold SD. Maintaining trust in the surgeon-patient relationship: challenges for the new millennium. Arch Surg. 2000 Jan;135(1):55-61. 6\. Molina RL, Ricciotti H, Chie L, Luckett R, Wylie BJ, Woolcock E, Scott J. Creating a culture of micro-affirmations to overcome gender-based micro-inequities in academic medicine. Am J Med. 2019 Feb 2.[ https://doi.org/10.1016/j.amjmed.2019.01.028](https://doi.org/10.1016/j.amjmed.2019.01.028) --- ![](https://lh5.googleusercontent.com/wumE_2kmlDxGvGbbFsH83zKODnkpkaeIgqXpJ_DnEioun7T3WSJY9U6IZhWdzrPicDyZ5gJkx-e8YyI6MTJ6sRo1emEuqHK6rTTWyZPbuDVk48jYR2MJ1dHQzdk18KCQmtcJvIQO) Eva M. Luo MD, MBA is a Chief Resident of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center in Boston. She is creative problem solver passionate about improving the entire spectrum of women’s health. Her primary area of focus is in pregnancy care redesign, global health, and understanding how innovative models of care that arise from the entrepreneurship space can impact overall policy and systems of care. Twitter: @EvaMLuo --- ![](https://lh6.googleusercontent.com/-LZvQCkS5vjBSczej-PLcL2NCVjF3eU_TYkfTkJFkP3-11k_ZkCs3yMs6rc9kHqsi5sNdVUqjd2_IerBDk6H9rNHgoA6tDJ4FD5gR1_J98nwT7QgMf1NzqB4JCzr24BzxAZHGAXk) Rose L. Molina, MD, MPH is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. She works as a board-certified obstetrician-gynecologist at The Dimock Center, a federally qualified community health center in Roxbury, and Beth Israel Deaconess Medical Center. She is also the Faculty Director of the Medical Language Program at Harvard Medical School and the Director of the Obstetrics and Gynecology Diversity, Inclusion & Advocacy Committee at BIDMC. Twitter: @Rose\_L\_Molina --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* --- **Categories:** professionalism **Tags:** communication, microaggressions, Professional Development, residents, surgery, womeninsurgery --- ### [Should you get an MBA?](https://blog.womensurgeons.org/should-you-get-an-mba/) **Published:** May 22, 2019 **Author:** Blog Team **Content:** *By Heather Yeo* As I come to the end of my MBA and MS in Healthcare Leadership, I have spent a lot of time thinking about what these degrees mean to me and my career. The past two years have been very challenging, but they have also been very rewarding and expanded my worldview. As a physician and scientist, I think of myself as continually open to learning and gathering new ideas, and this program offered me the opportunity to strengthen areas of my own career and path. I have no doubt that having completed this program will help to push my career forward. I am often asked why I chose to pursue an MBA. There are many reasons and many skills that I hope to incorporate into my practice and career. **Why did I pursue a MBA?** 1. To get new skills in areas I thought that I lacked, for example accounting and finance. 2. To build and strengthen skills that I already have, for example improving my leadership/teambuilding skills.. 3. I want to be a healthcare leader and improve the care of my patients on a greater scale. 4. I wanted to set myself up for future leadership roles. **Why should you consider an MBA?** 1. Physician Leadership is Critical: Medicine is at a crossroads – shifting payment systems and evolving hospital structures are changing the structure of medicine – it is imperative that those with clinical experience are involved in the process. 2. Leading teams is critical in Medicine and Surgery. There are best practices for leading effective teams and skills that can be learned in order to be not only good, but great. Strategic thinking is important both in the OR and in the clinic. 3. An MBA is helpful for clinicians looking to improve their hospital systems, healthcare, and to become leaders both locally and nationally. **What did I learn from my MBA/MS program?** I learned many things during the program, from balance sheets to cash flows and contingency planning to project management, but there are a few key lessons that I think are worth sharing. 1. Leadership is much different from management. Both are important. You can be a good leader and a terrible manager. Or vice versa. But you can develop skills that help you improve at both! 2. Teams are key to success, but there must be someone to lead and bring things together. It is easy to “just do your part,” but harder to work together towards a larger goal. The best teams will work towards a common goal with an inspirational leader. 3. Everything is negotiable, know what you want and be creative with solutions. I used to be afraid to “negotiate”. Now I realize that negotiation is really about trying to understand what matters to different people and thinking how trades can be mutually beneficial for everyone. **How am I going to use these degrees?** 1. Skills that I gained from Operations Management and Advanced Strategic planning will help me be a better clinician. My team is constantly looking to improve patient care, and I am hoping to use some of these skills to make my office more efficient and forward-thinking regarding options for improving patient care. 2. As a researcher, understanding program management and finance will help me to make the most out of the grants that I receive. In addition, skills that I have learned about ways to develop and harness creativity to solve problems, will help me be a better academic surgeon. 3. I hope to continue to grow as a leader in my department. I now have a tool kit of resources that I can use to help do this, and have a better understanding of the science behind leading teams. **Is an MBA needed to be a leader?** No. Certainly there are many amazing surgeon leaders in our community without MBAs and much can be learned on the job. I don’t think an MBA is a necessary prerequisite to being a successful surgeon leader. However, I think there are certain skills that an MBA offers that can help us as physicians to think more strategically and creatively about how we do our jobs. I also think that an MBA offers the opportunity for us to be able to communicate with others who are running healthcare and puts us in a position to make change. There are many really great leadership programs for physicians and surgeons, these also have value. A few examples are: 1\. [ The ACS Surgeons as Leaders Course](https://www.facs.org/surgeonsasleaders) 2\. [ The SUS Leadership Agility Program](https://www.susweb.org/leadership-agility-program/) 3\. [ Executive Leadership in Academic Medicine (ELAM)](https://drexel.edu/medicine/academics/womens-health-and-leadership/elam/about-elam/) 4\. [ The AAMC offers several leadership courses](https://www.aamc.org/members/leadership/) The program that I did is the[ Cornell-Johnson Executive MBA/MS in Healthcare Leadership. ](https://www.johnson.cornell.edu/Programs/Executive-MBA-MS-in-Healthcare-Leadership) It was a 2 year part-time program aimed at physicians and healthcare professionals. Averaging every other weekend with 1-2 months off per summer and 2 “intense’ weeks per year. I won’t pretend it was easy. I didn’t take any time off, and in fact had a busier clinical volume compared to previous years. However, there are a number of different options. There are many different types of programs, part time, full time, online and in person. My program was entirely in person. If you are interested reach out and talk to the programs, ask about their experience working with surgeons. Some of the programs aimed at health care providers are listed below: [UNC](https://onlinedegree.uncw.edu/programs/emba-healthcare.aspx) [Denver](https://business.ucdenver.edu/mba/executive-mba-health-administration) [Duke](https://www.fuqua.duke.edu/programs/weekend-executive-mba) [Yale](https://som.yale.edu/programs/emba/curriculum/areas-focus/healthcare) [Wharton](https://hcmg.wharton.upenn.edu/programs/mba/) ![](https://lh6.googleusercontent.com/fvBTJXMWEPkQyrN-Vfp4rKwmE6po_lmT6ch49YER6aTqvjzJLWOc7pxQBhVofs1BnNpIar9Gj8EJTHSl0KTxs9s7hLQ5Ve9eNey8Ygxk6Dmo5IGUHfYFkHYdC3XVER5t_uiehtSF) Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College and Assistant Attending Surgeon at NewYork-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery, and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research and is focused on surgical outcomes and quality improvement in Gastrointestinal Cancer Surgery. She is particularly interested using mobile health apps to track patients in the post-operative period. She has completed a pilot study of an app developed in conjunction with Cornell Tech and is now enrolling to a randomized controlled trial. The app is aimed at decreasing length of stay, decreasing postoperative readmission by improving patient monitoring and complication management and improving return to functional status and overall well-being after surgery. Dr. Yeo has just completed an MBA/MS in Healthcare Leadership through the Johnson School of Business and Weill Cornell Medicine and is graduating in 3 weeks. You can find her on twitter at [@heatheryeomed](https://twitter.com/heatheryeomd). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [One step at a time](https://blog.womensurgeons.org/one-step-at-a-time/) **Published:** May 29, 2019 **Author:** Blog Team **Content:** *By Jaime D. Lewis* I am more than a surgeon. I am an educator, a wife, and a mother. And among other things, I am also a runner. I recently completed my first (yes, first, as I am now fully aware that there will be more) ultramarathon. It was a technical 50k over mountain biking trails, gravel paths, and rutted grassy knolls, up and down 4701 feet of elevation gain including two grueling climbs up “Big Ass Hill.” I hadn’t been able to eat any of my standard fare stocked in my pack after the first 15 miles, nearly tossed my cookies when I tried to put an M&M in mouth at mile 19, and praised the gods of the soft drink industry for the sweet sustaining nectar labeled Coke and Ginger Ale for the last 12 miles. My husband, son, and daughter hiked the last quarter mile with me. At that point, I could no longer run. I had acquired what I thought was an alien invader in my shoe but found out later was just a humongous blister that had developed on the bottom of my right foot after I had slid on a rock shearing off the top layer of skin some miles earlier as I tried to cheerily greet a hiker who flagged me down only to tell me that he thought I was WAY behind all of the others… Yet I crossed the finish line triumphant and smiling, with one hour to spare ahead of the 10 hour time limit. And the next day I signed up to do it again in a few short months. Over the last 20+ years I have run thousands of miles including many half marathons and a handful of marathons, sometimes with the rowdiest of company, occasionally with my dog, but many of those miles completed in solitude. I have run down my street, in my neighborhood, in neighboring and distant states, in deserts and rainforests, on mountains, under blistering suns and the darkest of nights, in rain, being pelted by hail, and with icicles freezing my eyelashes together. And I would not trade a single one of those moments for any other experience. I am finally starting to understand why I am compelled to run. Among them: 1\. Completing long distance runs is an affirmation of the awesomeness of the human body and mind. 2\. In running I experience FLOW – being fully immersed and engaged in a challenging activity that brings incredible satisfaction and healing. 3\. Participation provides me with access to a community of individuals who are similar minded but involved in a variety of occupations, which creates opportunities for learning and growth during our many hours on the trails. 4\. Running has taught me lessons in defeat and success, the value of hard work, and the necessities of coaching and rigor. 5\. Some of my closest relationships have developed while running. 6\. Running is my time to process, problem solve, forgive, forget, and release. Running rounds out who I am. It helps me to sit quietly with a raging women who has just been told she has breast cancer despite the fact that she has done all of the right things. It allows me to calmly guide my first year resident who tells me that ours is one or the first cases of her surgical internship. It reminds me to express gratitude to the staff who make my work possible. It lets me see the hearts and faces of my students and colleagues alike. It bolsters my ability to keep climbing despite the inevitable and painful falls. It allows me return to my family open to experience life with them, attempting to fully engage in the moments. Through running, I try encourage my children, my husband, my students, residents, and colleagues, and my patients to embrace the parts of themselves that feed and sustain who they are and who they will become. One step at a time. ![](https://lh6.googleusercontent.com/w2olWV7KgyavjJ6hRli5kT0KqAy3aoB7h2bgTkBH0Wwi7nWD_F7etPDoU6N7M6mfdD5cnZL3p-ZF2qx_gvltWukCentfLlpBhnwwpphW7MKIqEddggOYKDd5CLV4e-4Y9cgsmDE-) Jaime D. Lewis, MD, FACS, practices breast surgery at the University of Cincinnati College of Medicine in Cincinnati, Ohio where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Dr. Lewis is committed to improving wellness and professional development opportunities of the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys running and spending time with her family. You can find her on twitter at [@JaimeDLewisMD](https://twitter.com/JaimeDLewisMD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care **Tags:** #ultramarathon, AWSBlog, womeninmedicine, WomenSurgeons --- ### [Crisis Pregnancy Centers: Legal but Ethical?](https://blog.womensurgeons.org/crisis-pregnancy-centers-legal-but-ethical/) **Published:** June 2, 2019 **Author:** Blog Team **Content:** *By Nickey Jafari* Perhaps you have already heard of crisis pregnancy centers (CPCs). I see highway billboards for them on most of my long drives throughout the rural midwest. I recently received an email from a student interest group offering medical students to tour them. The first CPC opened in the 1960s, but they have since ballooned to far outnumber abortion clinics, and unlike abortion clinics, they can and often [receive public funding](https://www.npr.org/sections/health-shots/2015/03/09/391877614/states-fund-pregnancy-centers-that-discourage-abortion). CPCs present themselves to women as healthcare facilities, but they are often unlicensed and unregulated. Certain U.S. cities, like Austin and Baltimore, and states, like California, have attempted to combat this with their own measures, such as requiring unlicensed CPCs to simply disclose the fact that they are unlicensed, but a recent Supreme Court [ruled 5-4](https://www.pbs.org/newshour/nation/supreme-court-voids-part-of-crisis-pregnancy-center-law) that such laws infringe on First Amendment rights. Furthermore, we should be concerned that CPCs often share misleading or outright inaccurate medical information with women. For example, [one study](https://www.contraceptionjournal.org/article/S0010-7824(14)00565-4/abstract) of 254 websites referring to 348 CPCs found that 203 “provided at least one false or misleading piece of information”. These CPC websites often linked abortion to risks of breast cancer and/or future infertility, statements which are just not true – the American College of Obstetrics and Gynecologists also [denies](https://www.acog.org/Patients/FAQs/Induced-Abortion?IsMobileSet=false#health) these claims. [The Public Health Risks of Crisis Pregnancy Centers](https://onlinelibrary.wiley.com/doi/abs/10.1363/4420112) raises the concern that these centers “often provide inaccurate information that may delay or interfere with women’s access to abortion and contraceptive services, improperly influence women’s reproductive health decisions and potentially increase the number of unintended births.” The American Medical Association published an article in their Journal of Ethics – [Why Crisis Pregnancy Centers Are Legal But Unethical](https://journalofethics.ama-assn.org/article/why-crisis-pregnancy-centers-are-legal-unethical/2018-03), has the following conclusion: “Although crisis pregnancy centers enjoy First Amendment rights protections, their propagation of misinformation should be regarded as an ethical violation that undermines women’s health”. “[The V Word](https://itunes.apple.com/us/podcast/the-v-word/id1342089208?mt=2)” is a podcast on women’s health and reproductive policy issues by Drs. Jenn Conti and Erica Cahill. In episode 17, they discuss CPCs in length. It shocked me when they mentioned a CPC where ultrasound technicians tell a woman her pregnancy is much earlier than it actually is in hopes that she misses the abortion window. When it comes to ultrasounds, only a handful of states, like New Mexico and Oregon, currently mandate licensure of sonographers. This begs the question – who is regulating if CPC staff are qualified to be performing and interpreting diagnostic exams to unsuspecting women? The invitation from a medical student group to tour a CPC is what inspired me to write this piece because, as healthcare professionals, we have a lot of privilege and responsibility, and are hopefully trained to respect facts and evaluate issues as critically as possible. The intention of this post is not to change any opinions on abortion. This is an earnest effort to share salient truths about CPCs and raise some ethical questions to answer for yourself, no matter where you land on the abortion debate.We must ask ourselves if the ends here justify their means – is it okay for CPCs to not be truthful with women to achieve their political/ideological goals? Should unregulated organizations that are not held to any formal standard of care be able to present themselves as healthcare facilities or dispense medical information? ![](https://lh6.googleusercontent.com/Iattab1VWGbFSX71HIq3y9AInJxdDqmVDc5iH2gKwzGY9UFf6BYZ4uNAfCw-yIgJHjmhLS1tRVCpQJEwiudHIuvulpfQ8-Lifstha9BuZTh0-VYKVjF6hvPfI4Urpmjnvyk0fkOv) Nickey Jafari graduated with her medical degree from the University of Kansas. She also has her Master of Public Health from the Johns Hopkins Bloomberg School of Public Health. This summer, Nickey is starting her residency in Obstetrics and Gynecology at the University of Minnesota. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [Remember: You’re Strong enough!](https://blog.womensurgeons.org/remember-youre-strong-enough/) **Published:** June 5, 2019 **Author:** Blog Team **Content:** The AWS blog is thrilled to recognize the experience and accomplishments of women surgeons around the world. While women surgeons share many common experiences, we differ in our cultural norms, support for women in careers and expectations of women in society around the world. One of the goals of AWS is to support women internationally, and part of that recognition is to build cultural understanding and awareness of the barriers women face in countries outside the United States. We would like to congratulate Dr. Spinoit on her incredible accomplishment – recently becoming the first female professor of surgery in Belgium, and hope to see increasing numbers of women rising through academic and clinical ranks into leadership worldwide. *By Anne-Françoise Spinoit* I was born in a family where medicine, and especially surgery, was always present. Many family members are surgeons or perform medical-related jobs. As far back as I can remember, I told my parents I wanted to be a doctor. Many kids have a phase where they dream about being an astronaut, a firefighter, surgeon… My childhood dream never changed; I wanted to be a doctor like my grandfather and my uncle. They told me many times that it would not be easy, especially for a girl. It would be much easier to learn a job where I could have a more flexible schedule, where at least I would not have to work at night or during the week-ends. Yet, I kept on with my dream, year after year. In high school, I had great difficulty with chemistry, mathematics and physics. Many people told me that, given those subjects were essential for medicine, I’d better let go of my dream. However, I persisted, and I was accepted into and began medical school. And indeed, chemistry, physics, and those other subjects I still do not really see the utility for in medicine, became my nightmare. I was close to abandoning medical school a few times because I kept having bad scores in some classes in which the content was totally irrelevant to the daily clinical practice I have now. Each time I was close to abandoning, I remembered what my grandfather told me, “*If it’s your dream to become a doctor, you should do everything you can to make your dreams come true. Never quit before you have done all you could. Never quit because* ***you think*** *it is too difficult for you. Only quit when you’ve tried the hardest you can, as for that there is no shame.*” In those difficult moments, everyone needs to find his or her own way to overcome them. For me, it was with the help of Cher and Chumbawamba; I took a break and danced until exhaustion while listening to “Strong Enough” followed by “Thubtumping”. Only those two. I danced until I was physically exhausted, sweating, and needed a shower. After that, I was ready to begin working again. Today, I am a Professor of Urology in one of the largest University Hospitals in Belgium. I was very lucky to have family and friends who helped me become who I am today. I know they were very proud of me when I was appointed Professor, thereby becoming the first female professor in Urology in Belgium. I still sometimes need my two theme songs, as surgery never gets easy. The way to surgery is not easy for anyone, but gender biases make it even more difficult. The fact that it took until 2018 to have a female professor in Urology in Belgium is the best example. In many ways, Belgium is recognized as an open-minded country. Belgium was indeed the second country in the world (after the Netherlands) to legalize gay marriage in 2003. But still, many women in Belgium and in the rest of the world are struggling to build their way in surgery. And I have an important message for all those young women going through those struggles; remember, “You’re strong Enough”. “I get knocked down. But I get up again. And you’re never gonna keep me down.” ![](https://lh6.googleusercontent.com/mCqXPWtpNaXlwqIEG87h9e4h5kvbHIpklbeL3Be-qDhoQPI_zqpW57oTUzwaNjwPh5FrtoTRSJ8r1tUN2t9gorYG_R3hjSbzv_J7WXiQy1-p7M7z9UUD1TTQSqhpoD4eOjTOiXIX) Since October 2018, Anne-Françoise Spinoit is Professor in Pediatric Urology of the Department of Urology at the Ghent University Hospital, Ghent, Belgium. She is thereby the first female professor in Urology in Belgium. She is full staff member at Ghent University Hospital since 2013. She received her initial medical training at the Facultés Universitaires Notre-Dame de la Paix in Namur, Belgium, and in the Université Catholique de Louvain, Brussels, Belgium, and then her training in Urology initially in France and subsequently in the Ghent University Hospital. Anne-Françoise Spinoit’s fields of interest are congenital penile malformations and urogenital reconstruction in children, adolescents and adults. She has successfully defended a PhD thesis about it. She has developed the pediatric robotic program in Ghent University hospital, and is one of the European pioneers in robotic surgery in pediatric urology. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, gender differences, leadership, mentorship **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery --- ### [Dear Intern](https://blog.womensurgeons.org/dear-intern/) **Published:** June 9, 2019 **Author:** Blog Team **Content:** *By Melissa Herrin* When I first considered writing a blog titled #DearIntern, my instinct was that I should be the last person giving advice. Everyone around me seemed to be gliding through residency confidently and with capabilities I was lacking. However, it occurred to me that my struggles probably weren’t unique, and challenge begets learning and strength. Thus, I write this in hopes that my reflections can provide you the same. Dear Intern: You’re stronger than you think. You’re meant to be here, a surgeon. Remember that you earned your residency position by what many would classify as superhuman achievements. These sentences are easy to write, but they are very tough to remember and believe. That’s why I’m telling you now. My college rowing teammates and I would encourage each other through difficult workout intervals, “You can do anything for a minute.” This may sound irrelevant as shifts last hours and residency lasts years;by focusing on the note, the patient, the call shift in front of you, you may be astounded by what you can accomplish. Women tend to [underestimate their abilities and performance](https://www.americanjournalofsurgery.com/article/S0002-9610(05)00210-2/fulltext) (and consequently are [less likely to enter competitions](https://s3.wp.wsu.edu/uploads/sites/252/2014/10/EhrlingerDunning2003.pdf)). With encouragement, you can do hard things successfully, and you can be certain of that. Your [personal wellness and resilience](https://www.nytimes.com/2019/04/19/smarter-living/how-to-bounce-back-from-rejection.html?smid=nytcore-ios-share) necessitate that you continue to fire on all cylinders; that is, you need to nurture and rely on every component of yourself. Time out of the hospital is finite, but how you arrange it is limitless, and each of us has many selves beyond surgery. My husband (also a physician) and I are raising a teenager with activities and demands of his own. I didn’t ever want to miss a moment I could be watching or participating in his life. When I’m not in the hospital, I spend time with them or sleep. Two things in medical school that constituted important pieces of my happiness, running and working on advocacy and mentorship projects, all but disappeared from my life during intern year. I recently decided to train for a race, and embracing the intense pain to the finish line was like finding a part of myself that I had lost. I also became involved in our Women in Surgery Council and helped start a cardiothoracic surgery medical student interest group. Running in the race and belonging to these groups was like adding combustion from two additional cylinders to my engine. Finally, don’t hesitate to openly own and reflect on your mistakes and shortcomings (real or perceived). Being honest with others about my fears and difficulties emancipated many of my doubts. While my own imposter syndrome hasn’t been silenced, somehow it has become a source of motivation. By taking the risk of emotional exposure, you shall demonstrate you aren’t afraid of failure and show courage and a willingness for self-improvement. In doing so, you will exemplify an authentic teammate and leader, may inspire others to feel more at ease with the concept of imperfection, and form human connections within a demanding, competitive, and often isolating training environment. So have courage, cultivate what you love, model your strength by being vulnerable. And remember, we’re here to help you. Join @womensurgeons @AcademicSurgery @RASACS along with our moderators: Dr. David Harrington, president of the Association of Program Directors in Surgery, Dr. Crystal Johnson-Mann ([@CJMannMD](https://twitter.com/CJMannMD)) from University of Florida ([@UFSurgery](https://twitter.com/UFSurgery)) and Dr. Sophia McKinley ([@SophiaKMcKinley](https://twitter.com/SophiaKMcKinley)) for a tweetchat about Tips for Interns on June 17th at 8 pm Eastern Time by following #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. **We will be discussing the following questions in the tweetchat:** 1\. What are tips and tricks to survive intern year? 2\. What apps, resources, and textbooks are useful during intern year? 3\. What tips do you have to help with work-life integration? 4\. What is important to learn during your intern year? 5\. How did you find a good support system/mentorship/sponsorship? 6\. What can help make the transition from student to teacher? ![](https://lh4.googleusercontent.com/-Yu0X2mDuxmEIsMq2It4pIrbJsqVtxKaJhBmHRfJdKICKbN8qC9Q5TU6sCZcU3it7jcxmAzThCyS5IefTv74wHnfiXOp9M-0QyEOEy1PCudYzKUYvEGZLIwpeyq_uHGJEH1sSlRe) Melissa Herrin, MD is a 2nd year integrated cardiothoracic surgery resident at the University of Washington. She received her MD from Yale and spent an additional year of medical school funded by the Sarnoff Cardiovascular Research Foundation conducting pediatric cardiac surgery clinical outcomes research at Boston Children’s Hospital. Her husband is a primary care pediatrician, and they live in Seattle with their son David, 13, and two cats. Together they enjoy running, hiking/camping, and baseball. Her clinical and research interests include improving rates of assist device therapy and transplantation in underserved groups, expanded donor selection criteria, and mentorship of women interested in cardiothoracic surgery. You can find her on twitter at [@melissaaherrin](https://twitter.com/melissaaherrin). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** ILookLikeASurgeon, intern year, residency, surgicalresidency, training, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [The “Public Health Approach” – What Does It Mean?](https://blog.womensurgeons.org/public-health-approach/) **Published:** June 13, 2019 **Author:** Blog Team **Content:** ***By Stephanie Bonne*** Who remembers the public health class you took in medical school? More likely than not it was a pass/fail class, maybe a couple of credit hours, that was taught at 4pm on a Thursday. Do you remember what you learned? For those of us without formal training, like an MPH or similar degree, we might not be able to describe what it really means to “take a public health approach” to a problem. This has come to my attention recently in the corner of the world that I work. As a trauma surgeon interested in injury prevention, violence prevention and gun violence, my research and nonclinical interest lives in a highly charged political environment. I frequently hear politicians, advocates, and even peers calling for “us” (society) to take “a public health approach.” So what does that mean? If 20 people lock themselves in conference room until they figured out the public health approach, what exactly will they be doing? Fortunately, science and experience tell us what this means. Public health is a multidisciplinary, multifaceted field that includes health care, psychology, social systems, anthropology, policy and law just to name a few. The public health approach to any of the problems we see whether injury, cancer, infection or the numerous other surgical conditions is a 4-step process. 1\. **Surveillance.** No, this is not peering through people’s windows with binoculars to figure out who has a disease. We have to know how many people (and who) are affected by a problem before we can propose to fix it. Reliable data collection is of paramount importance. If we misrepresent or don’t understand who is at risk of a problem, we don’t know how to deploy prevention strategies to fix it. Imagine what would have happened if we knew colon cancer was a problem but didn’t know that it’s the population over 50 who is more frequently affected – colonoscopies for 15 year olds? 2\. **Identify risk factors.** Once we know who is affected, we need to know what makes those populations different. Is it age, race, sex, socioeconomic status, or access to a specific risk factor like an environmental agent or stressor? This is key to knowing how to mitigate the risk. 3\. **Develop and test prevention strategies.** Once we know who is at risk and why, we can seek to act upon risk factors that are modifiable. We may not be able to change sex or age, but we can change environmental factors, social factors, and, importantly, the social determinants of health that lead to disease. 4\. **Once we know what works, it has to be disseminated.** This is where policy can be especially important. Whether institutional, state, or national, creating policies that put prevention strategies in place and helping people understand why these policies are important will help ensure that prevention is applied across the population. A public health approach to any problem requires many stakeholders from many backgrounds to work together. Although the strategy may not always be perfectly clear, public health gives us a framework to solve really hard, really big problems in health care. This is what it will take to continue to further the agenda of creating health populations. ![](https://blog.womensurgeons.org/wp-content/uploads/2018/11/Bonne-1.jpg) *Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the American Association for the Surgery of Trauma, the ACS Committee on Trauma, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force, and is the surveillance core director of the New Jersey Center for FIrearm Injury Research at Rutgers University. Dr. Bonne is the current Communications Chair for the AWS, a co-editor for AJS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children. You can follow her on Twitter: @scrubbedin.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy **Tags:** Healthcare Disparities, public health, Women in Surgery, WomenSurgeons --- ### [Fail Better](https://blog.womensurgeons.org/fail-better/) **Published:** June 20, 2019 **Author:** Blog Team **Content:** *By Anne Mongiu* This unexpected invitation to write a post for AWS coincided with an equally unexpected phone call from my closest friend from medical school. She had resigned from her rather substantial clinical and academic appointments, and the conversation began with, “Anne, I’m a failure…”. I happen to have expertise in this area. My first memorable taste of failure came in the 6th grade. I scored 20 points lower than the 1200 needed on the SATs in order to spend the summer studying at Duke. I was devastated. As an only child of two first generation Americans with little education and no financial resources, academic excellence was my ticket to a different future. Up to that point, I had succeeded in school with little effort. But that failure marked the day that I began to truly study and prepare, knowing that my unseen competitors were formidable. The next 25 years were filled with innumerable hours of hard work and sacrifice. Scholarship to college, MSTP scholarship to earn my MD, PhD. I earned top marks, published papers, and ultimately fell in love with urology. I matched into an excellent residency in Boston and planned to become a leader in the field. Two years into my training, on a sunny Friday afternoon in May, I was diagnosed with stage II breast cancer. In an instant, my careful plans were rendered irrelevant. I took a leave of absence from training to get treatment – chemo, surgery, radiation, and more chemo. Months blurred and I lost my sense of self, and subsequently, my partner of more than a decade. Exhausted, nauseated, and bald, my self-worth reached its nadir, and I decided to formally resign from residency. My oncologist, an amazing woman and advocate, asked me to speak with the chair of surgery as I was finalizing my decision. Kind and soft-spoken, he asked me if I still saw myself as a surgeon. When I answered yes, he graciously adopted me into their program. What followed were the hardest six years of my life. Surgical residency is challenging by itself. Recovering from treatment and rebuilding my life in a new specialty was particularly grueling (even with phenomenal co-residents and faculty). I watched as the dreams of becoming a surgeon-scientist and department chair slipped from my grasp. Graduating from residency and fellowship, I smiled on the outside, but felt like an unmitigated failure to that younger version of myself on the inside. As an attending, I have finally found the time to breathe again, to have enough distance from the entire experience and to be able to reflect upon it properly. Amidst the failure, I see success. I found my way back to complex pelvic surgery via colorectal surgery. I have the unique insight that only comes from having been a cancer patient, which informs the way I care for my own patients today. I landed a wonderful job, with excellent residents and medical students that I hope I can mentor wisely. More recently, I was voted to take charge of resident research, and last month I sat down to write my first grant since graduate school. Our failures do not define us. They simply put detours in our path which invite us to try again. This time, I’ll fail better. *“Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.” Samuel Beckett* ![](https://lh5.googleusercontent.com/nw8Ds0SR7P3YA8GlVP7uKW9cZLTnds6yXnhm_JMX7hll3IELi-i3pkWeRlwWs8BZqlU8LNtMJx7l7Bey_VqJuouuy0l5F9xmF60xQPxCzbVbD85odqID2G5BOodhJk9EE3j30XXr) Dr. Mongiu is a board-certified general surgeon and fellowship trained Colon & Rectal surgeon (board certification underway) at Maimonides Medical Center in New York. She received her MD & PhD (in Cell & Molecular Biology) from Northwestern University. She went on to complete her general surgery training at Brigham & Women’s Hospital in Boston and her fellowship in Colon & Rectal Surgery at the University of Louisville. Her clinical interests are focused on colorectal oncology and the surgical management of IBD and pelvic floor disorders. Her research interests focus on robotic surgery education in general surgery residency and the role of the microbiome in combined pelvic floor disorders. She and her husband David live in New York City with their rather personable Weimaraner named Rashi. You can find her on twitter at [**@**akmongiu](https://twitter.com/akmongiu) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** career development, ILookLikeASurgeon, mentorship, residency, training, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Egg Freezing Facts for Female Physicians](https://blog.womensurgeons.org/egg-freezing-facts-for-female-physicians/) **Published:** June 27, 2019 **Author:** Blog Team **Content:** B*y Anu Kathiresan* As women in medicine, we are always focused on the next goal we need to achieve to advance our career. Though undergraduate education, medical school, residency, and fellowship, we are constantly striving to get the highest score, to maintain a high GPA, to publish papers, to get excellent letters of recommendation. The challenge that women physicians face is balancing these demands in the midst of our passing prime reproductive years. We plan a trajectory of our career from an early stage, sometimes as early as our undergraduate years. But do we have the same foresight about an equally important part of our life journey: planning for a family? Infertility affects 1 in 8 couples in the general population, however [infertility affects 1 in 4 women physicians](https://www.ncbi.nlm.nih.gov/pubmed/27347614). There is never a good time to have a family in our training years or in our early post-training years for that matter. But, if having biological children is important to us, this must be something we think about in advance. Here are some general infertility facts and statistics that are helpful to know: 1\) Each month, a young woman’s chances of conceiving is about 20-30%, assuming the woman has regular cycles and no known causes of infertility. This percentage starts to drop slightly at age 32, and more significantly at age 35. The chance of success declines with increasing age and increasing duration of time of trying to conceive without a successful pregnancy. 2\) We are born with a certain number of eggs, and this number declines with time. Women cannot regenerate eggs, while men can regenerate sperm. So once the pool of remaining eggs is low, there is nothing we can do to increase our remaining egg supply. 3\) As the female partner’s age increases, so does the chance of miscarriage. In our 20’s, the miscarriage rate is approximately 12-15%. Between ages 35-39, the miscarriage rate increases to approximately 20-30%. After age 40, the miscarriage rate approaches 50%. 4\) As females age, there is an increasing proportion of genetically abnormal eggs (from meiotic nondisjunction) leading to the observed decreased pregnancy rates and increasing miscarriage rates. These statistics can be sobering, especially as more professional women continue to delay starting their family whether it is by choice to pursue their career or if it is because they have not found the right partner. A [study](https://www.ncbi.nlm.nih.gov/pubmed/27347614) looking at childbearing patterns and decision-making among American physicians found that females doctors with infertility stated if they could go back and do things differently, some would have started a family earlier, gone into a different specialty, undergone treatments to preserve their fertility, and some would have not done anything differently. Knowing about fertility and timelines early is key, so that we can make decisions on what is right for each of us individually and so that we do not regret the choices we made later. Egg freezing is the process of cooling eggs to sub-zero temperatures to preserve reproductive potential. This technology may allow women to have the opportunity to have biological children later in life, but there are limitations. First, freezing eggs is not a guarantee for a biological child. It is an option that gives us some control over increasing the chances of having a biological child in our more advanced years, which we did not have before. The ideal number of eggs that a woman should consider freezing is dependent on many different factors: the woman’s age, her ovarian reserve, the number of children she wants to have, the likelihood of live birth that she is comfortable achieving, and the number of IVF cycles she would like to undergo. While more and more women are pursuing egg freezing, there still hasn’t been enough time to allow a significant proportion of these women to come back, thaw their eggs and attempt to have a child to provide better estimates of the success rates at various ages. Therefore, the data is limited on live birth rates per egg, especially in older women. With that caveat, there are a few [studies](https://www.ncbi.nlm.nih.gov/pubmed/26604065) reporting prediction models that can provide some guidance on the chances of having a live birth based on a woman’s age at time of egg retrieval and number of mature eggs cryopreserved. To briefly summarize the findings from the study by [Doyle JO et al.](https://www.ncbi.nlm.nih.gov/pubmed/26604065), freezing 15-20 mature eggs for women <38 years old gives them approximately 70-80% chance of at least 1 live birth. For women 38-40 years old, freezing 25-30 mature eggs gives them roughly a 65-75% chance of at least 1 live birth. Sometimes we can retrieve 10-15 eggs in women <38 years old from 1 IVF cycle, but sometimes it requires more than 1 cycle. The number of eggs retrieved from each IVF cycle is ultimately dependent on each individual woman’s circumstance: her age and her ovarian reserve, which is in large part genetically predetermined. Generally speaking, the younger a woman is, the better her chances at retrieving a larger number of better quality eggs with less IVF cycles. The disadvantage, however, to freezing eggs at a younger age is that the woman may not end up using these cryopreserved eggs. Conversely, the older the woman is, the more likely it is to undergo more IVF cycles in order to freeze more eggs of lower quality to achieve comparable pregnancy rates. Therefore, if a woman is considering egg freezing, a good time to start thinking about egg freezing is in between these two extremes in your early to mid-thirties (ie ages 32-37 years old). The process of egg freezing usually overall takes about 2 months to complete and involves 3 steps: 1) the workup, 2) ovarian stimulation, and 3) an egg retrieval. Step 1: You will see a Reproductive Endocrinology and Infertility (REI) Specialist. They will take a detailed history, do a physician exam, and perform a transvaginal ultrasound. They will also do an assessment of ovarian reserve (a term used to reflect remaining egg supply and fertility potential a woman has). There are 3 tests for ovarian reserve: 1) antral follicle count (AFC), 2) antimullerian hormone (AMH), and 3) day 3 FSH (follicle stimulating hormone). Once we have these test results, the REI will meet with you again to go over these values and expectations prior to undergoing stimulation. The patient will also meet with an IVF nurse to discuss a calendar and go over medication teaching. Step 2: Ovarian stimulation refers to stimulating the growth of ovarian follicles, which contain an immature egg within it. The process starts with either birth control pills for 2-3 weeks or estrogen for 1 week. This will help synchronize the follicles to grow together so we optimize the number of eggs we are able to retrieve. Then, a patient will undergo 10-12 days of injections to stimulate the ovarian follicles. Each day involves injecting 2-3 medications in the stomach or thigh subcutaneously. Some common side effects of the medication include: bloating, abdominal discomfort, sometimes mood swings, and local bruising at the injection site. During this time frame, patients will get bloodwork and transvaginal ultrasounds performed every 2-3 days, for a total of usually 4-5 visits. Once the follicles reach the appropriate size, the patient will do a trigger injection, which induces the final stages of egg maturation. The egg retrieval will then be scheduled 35-36 hours after the trigger. Step 3: The egg retrieval is a minor surgical procedure that is performed under conscious sedation. Under ultrasound guidance with a small needle and gentle vacuum suction, the follicles are drained of all the fluid within them. The procedure usually takes about 15-20 minutes. The fluid is then given to the embryologist who will look for the eggs in the fluid. They will then assess the eggs for maturity, and freeze all of the mature eggs. The most commonly performed type of freezing method is vitrification, a process using an ultra-rapid cooling technique to solidify the cell into a glass-like state. Compared to the previous slow freezing method, vitrification has been shown to decrease the formation of ice crystals (which can damage the egg) and has improved the overall success rates of freezing eggs. After the egg retrieval, some cramping and light bleeding are normal, but generally resolve quickly and patients are often feeling back to normal 1 to 2 days later. After the entire process is complete, patients will often meet with their REI again to review the outcome of the cycle. Based on the number of mature eggs frozen, we can assess if we met our goals with that cycle or see if another cycle is needed or desired. Fertility lasts for a finite period of time, so it’s important to prioritize thinking about it. Take control of the information available, learn about what advancing age does to fertility, check your ovarian reserve, learn about treatment options available, and make a plan that is right for you, just as you do with your career path. The ultimate plan may be to start a family earlier, to freeze eggs or embryos, or to not make any changes because we are comfortable with alternative means of having a family such as donor egg or adoption. Every woman has their own unique path to building a family. Ultimately, I would urge women physicians to make informed decisions early on regarding planning a future family, and not allow the passage of time to make the decision for you. ![](https://lh4.googleusercontent.com/18MmDApA2DWYLFBPxdFi-mCn6Yi6vG6rYCC5xxyRCX9XjekNMZs-HbjCIxw8rZBvJgNqbJMn9-13y6r1SE6_wcbw0u6-P5g_D_3ralbSI3-D0FSk0vIrFC2mYY3RmlbQvRPmmqZK) Dr. Anu Kathiresan is a board certified Reproductive Endocrinology and Infertility Specialist. She is Director of Fertility Preservation and Patient Education at the Center of Reproductive Medicine in Houston, Texas. Since moving to Houston, she was named a “Rising Star Super Doc” in 2018 and 2019. Her professional areas of interest include infertility, recurrent pregnancy loss, fertility preservation, in vitro fertilization, and PCOS. She is a native of Marietta, Georgia. Dr. Kathiresan obtained her Bachelor of Arts degree from Cornell University. She then returned to Georgia to attend the Medical College of Georgia where she earned her medical degree. She went on to complete her residency in Obstetrics and Gynecology at the University of Miami/ Jackson Memorial Hospital. She then completed her fellowship training in Reproductive Endocrinology and Infertility at the University of California, Los Angeles. Dr. Kathiresan’s goals are to provide compassionate and personalized care to her patients and help guide them to make the best treatment decisions for their individual needs. As director of Patient Education and a health literacy advocate, she also strives to provide understandable fertility education to both her patients in clinic and to a wider public audience with an ongoing fertility education video series called “Fertility Fridays.” Her videos are available at: [www.bit.do/anukathiresanmd](http://www.bit.do/anukathiresanmd). You can also follow her on Instagram [@anukathiresanmd](https://www.instagram.com/anukathiresanmd/?hl=en). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness **Tags:** #infertilitysucks, #medicine, AWSBlog, womeninmedicine, womeninsurgery --- ### [Racing back to work](https://blog.womensurgeons.org/racing-back-to-work/) **Published:** July 3, 2019 **Author:** Blog Team **Content:** *By Bethany Harvey* *But, what about FMLA?* That is the common response I receive when friends and family ask why I am working on formalizing a maternity/paternity leave and lactation guidelines for my residency program. Inspired by the work by Dr. Sarah Shubeck and Dr. Arielle Kanters at University of Michigan and with a now 55% female residency program; frequent AWS blogger and co-resident Dr. Jane Zhao and I decided that a formal policy was overdue. FMLA ([Family and Medical Leave Act](https://templatelab.com/family-and-medical-leave-act/)) entitles eligible employees of covered employers to take 12 weeks of unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Unfortunately, most surgical residents are unable to access even half of that time. A recent study by [Rangel et al.](https://www.ncbi.nlm.nih.gov/pubmed/29562068) surveyed 347 female surgeons who had had at least one pregnancy in residency to analyze factors associated with dissatisfaction. She found 6 major themes, and unsurprisingly to those who can associate with this, inadequate leave was one of the most reported factors. 86% of respondents had continue to work an unmodified schedule prior to giving birth, though nearly three-quarters of them were concerned that this negatively impacted their health or their growing child. Only 35% reported a formal maternity leave policy and the vast majority taking 6 weeks or less for maternity leave. Unsurprisingly, for those residents taking less than 6 weeks of leave, 72% described the leave duration as inadequate. Typically, residents have 4 weeks of vacation per year. Residents are also able to take up to 2 weeks of paid leave without affecting their standing with ABS between PGY1-3 and between PGY4-5; therefore, allowing residents to take a maximum of 6 weeks of leave in any given year. The ABS recently reformatted their published leave policies to clarify flexible training tracks, including extension of the chief year by the duration of leave taken. A study by [Lumpkin et al.](https://www.ncbi.nlm.nih.gov/pubmed/31048221) actually directly compared programs with stated residency leave policies to the 12-week leave in FMLA statues. They found that taking the full 12 weeks would result in a 1-year delay in board certification in 3 surgical subspecialties. Interestingly, while programs can utilize the ABS flexible leave policy, no programs were found to explicitly mention this policy. This is likely due to many programs being unsure of how to properly apply for this exception. In addition, ACGME does not require programs to offer these alternative pathways to new parents. Of these studies focused on maternity leave, none have yet to look at the broader category of maternity/paternity leave in the medical field. Initiating a clear policy across the board may help alleviate some of the tension that both female and male residents report surrounding their decision to take leave. Becoming a resident-parent is challenging and life changing regardless of gender. While male residents will never face all the same challenges as their female counterparts; picking rotations based on if they will be too pregnant to cover q3 trauma call or worry that their sleep deprived 4-week postpartum brain will alter their ability to clearly and succinctly relay their plan to the on-call attending, taking steps to make equitable leave policies available to all regardless of gender will ultimately benefit both groups. By implementing a new standardized policy in our program, we can begin to gather data which will hopefully support this assertion and add to the growing body of work in this field. ![](https://lh6.googleusercontent.com/k7XQP2bVTQj-oufa-SvX1kYMId_7l2v5bKfftDqUJlaaTMJ83qTDpRmM5yOwId2DM4hDOKbJ0fVgxSPkKRtXXDmA7SUCT6awZHTZECEDBHKNKNia41WoTBv7xAHHXaJnremvp6Uq) Bethany Wood Harvey, MD MHS is a 3rd year general surgery resident at the University at Buffalo. She received her MD from Tufts Medical School and her MHS from the Johns Hopkins Bloomberg School of Public Health. She lives with her husband, 2.5 kids and 2 dogs in Buffalo NY and plans on pursuing a Hospice and Palliative Care fellowship between PGY3-4 and a Surgical Oncology fellowship after graduation. You can find her on twitter at @bdwood62 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** parenting, practice **Tags:** #mothersinmedicine, AWSBlog, womeninmedicine, womeninsurgery --- ### [Latino Surgical Society’s 1st Surgical Symposium on Latino Health - Reflections on a Diverse Conference](https://blog.womensurgeons.org/latino-surgical-society/) **Published:** July 11, 2019 **Author:** Blog Team **Content:** *By Danilea M. Carmona Matos* Recently, I attended the [Latino Surgical Society](https://latinosurgicalsociety.org/)’s (LSS) 1st Surgical Symposium on Latino Health held in San Juan, Puerto Rico. I was delighted with the idea of going back home to an event led by a group of surgeons whom I have previously had the honor of meeting throughout different conferences (e.g. [Latino Medical Student Association](https://lmsa.site-ym.com/), [Academic Surgical Congress](https://academicsurgicalcongress.org/)). ![](https://lh4.googleusercontent.com/wkdT4OzoIHuWPq7QdkijDMtfCWi2ENsfYouTWLBAXopw-BsF6bQV-lnxQt2PjWlOFO6gu5ROCW_ULI01ONJicpSJvrvUm1EkupEHqxtMlt0pjL1HawlYamXWY5HBwlwkOLRCaMCj)Group Picture at LSS Surgical Symposium on Latino Health The symposium was very well-rounded with surgeons from mainland US and Puerto Rico sharing important knowledge on topics such as career development, surgical advancements, health policy and leadership in surgery. ***Career development*** tips and tricks surely are important for aspiring medical students, residents and young faculty as they try to navigate their road to success. What made the LSS’s take on this so special? ***“Latino students have the highest dropout rate from health care professions mainly due to economic constraints.” ~Dr. R. Rodríguez Mercado*** It was important to hear stories that really hit home, having prominent surgeons discuss their road to success and how to use adversity as a learning opportunity. Furthermore, we discussed ideas to improve the representation of minorities in health care through multilevel mentorship, scholarship, and coalitions. In addition, several programs were highlighted for physician development at all levels: from medical students up to faculty. ***Surgical advancements*** were shared by surgeons in various fields, such as cardiovascular, trauma and transplantation. The panelists made superb presentations outlining how surgical advancements have progressed – from the clinic to the battlefield. Each of them demonstrating that, when surgeons face a challenge, their spirit to “fix” things has only made these opportunities to develop new surgical techniques and equipment to address patient care. ***Health policy*** was eloquently addressed by surgeons and scientists who work to translate what we see in our community’s health via clinical data, scientific investigation or even times of disaster into areas for learning and improvement. Most importantly, it was impactful to see how these individuals advocated for health policy changes within their institutions, health coverage companies or even their state to address the disparity between health policy and reality. ***“I was able to accomplish this dream (PR Transplant Center) as a product of social conscience and commitment to healthcare through teamwork” ~Dr. E. Santiago Delpín*** Last but not least, ***leadership in surgery* was not only exemplified by the many individual successes that surgeon panelists had but also through their commitment to healthcare improvement. It was refreshing to learn how surgeons’ work can impact their communities, countries and even global health. In short, I look forward to future meetings and learning more about the amazing work these surgeons are carrying out! Dr Minerva Romero Arenas ([@minervies](https://twitter.com/minervies)), Dr Joseph Fernández Moure ([@JFernandezMDMS](https://twitter.com/JFernandezMDMS)), Dr Gezzer Ortega ([@DrGezzer](https://twitter.com/drgezzer)), and Dr Joseph López ([@drjoelopez](https://twitter.com/drjoelopez)) have become part of a list of surgeon role models, not only due to their success as academic surgeons, but also due to their commitment to address surgical disparities in the latino population and to promote the professional development of underrepresented minorities in medicine. ![](https://lh4.googleusercontent.com/QYDzrLWlfYgJ7psIOv6ZrTZDFu7aH9xEIVhsbbllAn8Bz_lOcDBUuPmxDWmyh9UcqwEFlgwtL2pGd7arEZAn6Bi1EnMGR2c0f61ryAq0zEkWDsKnlBoUXWxc2MN60brsDpGpPREu) Danilea M. Carmona Matos is third year medical student and current Howard Hughes Medical Institute Medical Research Fellow at the University of Alabama at Birmingham Department of Surgery. Her current work has looked into targeted therapies for neuroendocrine cancer treatments. Danilea is pursuing her medical degree at San Juan Bautista School of Medicine in Caguas, Puerto Rico. She has a Master’s in Medical Sciences from Ponce Health Sciences University in Ponce, Puerto Rico and a bachelor’s in Science in Biology with a minor in Italian Language and Culture from the University of Puerto Rico at Mayagüez, Puerto Rico. Danilea is a former teacher and aspires to be a physician scientist working translational cancer research, surgical education and mentorship. She has been actively involved at San Juan Bautista School of Medicine as a AAMC OSR, curriculum committee representative and served as president of the Latino Medical Association chapter in her school. In addition, she is an active member in various interest groups, pre-med student mentorship and community outreach activities. You can find her on twitter at [@danileacm](https://twitter.com/danileacm). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship, networking, professionalism, research **Tags:** #Latinosurgicalsociety, AWSBlog, surgery, womeninmedicine, womeninsurgery --- ### [From #MeToo to #TimesUp in Healthcare: The Dawn of A New Era](https://blog.womensurgeons.org/timesup-in-healthcare/) **Published:** July 14, 2019 **Author:** Blog Team **Content:** *By Apoorve Nayyar MBBS and Kristalyn K. Gallagher DO FACS FACOS* The #MeToo movement, with its growing visibility over the last year, has brought to the forefront the near ubiquitous prevalence of sexual harassment across industries, and healthcare is by no ways immune to inappropriate behavior. [The National Academies of Science, Engineering and Medicine (NASEM)](https://www.nap.edu/catalog/24994/sexual-harassment-of-women-climate-culture-and-consequences-in-academic) reported the prevalence of sexual harassment experienced by women in medicine to be highest within the STEM fields. For surgeons the [prevalence may be higher](https://www.medpagetoday.com/meetingcoverage/sts/77694), with [studies suggesting that 20%-60% of women](https://www.asc-abstracts.org/abs2019/85-01-national-evaluation-of-gender-discrimination-and-sexual-harassment-in-u-s-general-surgery-residency-programs/) [surgeons experience sexual harassment](https://www.asc-abstracts.org/abs2019/85-06-a-national-survey-of-sexual-harassment-among-surgeons/). On Twitter, the hashtag #MeTooMedicine resonated with [thousands of members of the healthcare workforce](https://www.washingtonpost.com/national/health-science/women-in-medicine-shout-metoo-about-sexual-harassment-at-work/2018/03/16/81673f82-0c37-11e8-8b0d-891602206fb7_story.html?noredirect=on&utm_term=.88163284291b), with physicians, trainees, nurses and ancillary staff all describing their personal experiences of sexual harassment. From lewd comments, inappropriate physical contact, and sexual advances to outright sexual assault, these accounts have shed a light on the dark underbelly of healthcare – existing for decades yet never addressed openly, leaving survivors to suffer alone in silence. The two words – **Me Too**, convey to every survivor that they are not alone in experiencing sexual misconduct, reflect a powerful yet infuriating state of affairs. The movement helps raise awareness about rampant sexual misconduct and yet it is an unfortunate realization that our current systems and policies have let sexual misconduct continue unchecked in our workplaces. Study after study has [demonstrated that fear of retribution](https://www.asc-abstracts.org/abs2019/85-06-a-national-survey-of-sexual-harassment-among-surgeons/) prevents the target from reporting sexual harassment to institutional authorities. The growing #MeToo movement has highlighted the lack of institutional policies with protective mechanisms for anyone reporting sexual harassment. Countless women in medicine have experienced sexual harassment at work, fueling the gender disparities and discriminatory behaviors that have persisted in healthcare. The NASEM report concluded that workplace sexual harassment significantly contributes to discriminatory patterns in healthcare, decreased work satisfaction, career opportunities & advancement, and ultimately attrition. Not only does this impact the target’s career trajectory but thwarts [scientific progress, medical innovation](https://www.nap.edu/catalog/24994/sexual-harassment-of-women-climate-culture-and-consequences-in-academic) and impacts [patient care](https://jamanetwork.com/journals/jamasurgery/article-abstract/2736337). The #MeToo movement also serves as a bridge from awareness to corrective action. It has brought the conversation of sexual harassment to the front and center of health policy making. The American Medical Association, at its [house of delegates meeting in June 2019](https://www.medpagetoday.com/meetingcoverage/ama/80360) vowed to adopt best policies for identifying and eliminating sexual harassment. The [Time’s Up Healthcare](https://www.timesuphealthcare.org/) (TUH) organization, launched in March 2019 aims to address sexual harassment in healthcare with improved awareness, research and advocacy for evidence-based policies with healthcare organizations to eliminate sexual harassment in healthcare. So far, thirty-five medical schools and healthcare organizations have committed as [TUH signatories](https://www.timesuphealthcare.org/signatories), pledging to end sexual harassment in the healthcare workplace. The [American Medical Women’s Association](https://www.amwa-doc.org/news/times-up-healthcare/) has also partnered with TUH to develop effective anti-harassment policies to create a safe and fair environment for everyone in healthcare. While these organizational efforts are an important part of the solution, it is incumbent upon every single one of us to foster an environment of safety and mutual respect in our healthcare workplaces. It is important for us to call out any inappropriate behavior; [bystanders can be very effective in curbing any sexual misconduct](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521419/). More importantly, bystanders can provide support to the target, acknowledge the behavior, and help report the incident (if the target desires to). The responsibility of corrective action and recourse should not only lie in the hands of the person experiencing the harassment. Movements like #MeToo and #TimesUp have facilitated an open and honest conversation about sexual harassment. Cultural change, along with effective policies for improved reporting mechanisms and due diligence will lay the framework for a safe environment for everyone. And while there have been some concerns by men about mentoring or working with women with concerns of false accusations, these are unfounded. According to the National Sexual Violence Resource center, [the rate of false reports lies between 2% to 10%](https://www.nsvrc.org/sites/default/files/Publications_NSVRC_Overview_False-Reporting.pdf). These movements are not intended to divide the genders, instead to raise awareness and bring everyone together towards solving a shared problem. Change is coming – sexual misconduct is no longer something that can be simply brushed off or pushed under the rug – it will be dealt with the seriousness it deserves. For far too long, far too many women have borne the brunt of sexual harassment at their workplace. This ends NOW. Join [@womensurgeons](https://twitter.com/WomenSurgeons) & [@AcademicSurgery](https://twitter.com/AcademicSurgery) along with our moderators: Dr. Lilian Erdahl ([@LillianErdahlMD](https://twitter.com/LillianErdahlMD)) and Dr. Arghavan Salles ([@arghavan\_salles](https://twitter.com/arghavan_salles))for a tweetchat discussing the effects of #MeToo and #TimesUp in healthcare on Monday July 15th at 8 pm Eastern Time by following #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following questions in the tweetchat: 1. What kind of discrimination is present in healthcare? Who is most vulnerable? 2. What can you do if you are experiencing discrimination? 3. Can the TUH initiative affect mentor-mentee relationships? How about co-worker relationships? 4. Have you seen an impact of TUH on medical education? Can you elaborate? 5. How can TUH have an impact on patient care? 6. Which aspects of medicine are most impacted by the TUH movement? ![](https://lh3.googleusercontent.com/onRCD-E9TlrELJKsEQkk_6pc6RTSsSAkXx3UpBNmPSJ3ov3kvBBbLk6sg-tL_dcXWspD8waqWlQwCyhV6CUrtgzA-7eARyvvKnGHkDxQZ3Bzx8mEz6CP5FlF4OddV3daOufTeRZj) Apoorve Nayyar, MBBS ([@apoorvenayyar](https://twitter.com/apoorvenayyar)) is a first-year general surgery resident at the University of Iowa Hospitals and Clinics ([UIowa\_Surgery](https://twitter.com/UIowa_Surgery)). He is a proud member of the AWS, a proponent of #HeForShe in healthcare and aspires to be a surgical oncologist. Dr. Nayyar’s research interests include disparities in cancer care and intersectional equity in healthcare. Kristalyn Gallagher, DO ([@DrK\_Gallagher](https://twitter.com/Dr_KGallagher)) is a surgical oncologist and Chief of breast surgery at the University of North Carolina, Chapel Hill ([@UNCSurgery](https://twitter.com/UNCSurgery)). Dr. Gallagher’s research interests include novel surgical techniques for breast cancer care and achieving equity in healthcare. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #metoo, #MeTooMedicine, #timesup, AWSChat, ILookLikeASurgeon, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Paging all interns - Tips for excelling during surgical intern year](https://blog.womensurgeons.org/paging-all-interns/) **Published:** July 17, 2019 **Author:** Blog Team **Content:** *By Mariela R. Martinez Rivera* ![](https://lh6.googleusercontent.com/x9yG_7SKzq_R5_HH3a0oTY1yFV3uGa8zBmmo4cCNNOU6zHSbsuRXPX_rkcsyp5w7YTCLL4IUEtzrISaZSEJIqcWVwDassm16GtoWfpSLb7d9gmFlHqyB83NUMJPDtNsfRrY2Awgd)Photo taken by me during my first month of intern year. July 1st is finally here and with it, the beginning of your surgical training. Now is when things get real! Last July 1st, was my first week of residency and I walked into the hospital for the first time eager to start this new stage in my life. Little did I know that soon I would be getting lost in the hospital floors, trying to decipher a new EMR system, and acknowledging that when nurses said: “Dr. Martinez” they were referring to me. The transition from medical student to physician happens exceedingly quickly and adapting to your n[ew role as a first year surgical resident can become challenging.](https://linkinghub.elsevier.com/retrieve/pii/S0002961011005836) Here are some tips to make the best out of your intern year: **1. Get to know the territory.** During the first year of surgical training, most of your time will be spent in the hospital. For you to become efficient navigating the hospital system, you first need to learn the infrastructure. Try to identify the key locations (and their phone extensions, if possible) such as: the operating rooms, radiology department, laboratory, pathology department, blood bank, etc. Knowing these key locations will be important for following up testing results and/or for managing urgent patient care needs. **2. Establish goals and expectations.** Goals. It is easy to become overwhelmed when patient load increases, workload is high, and the hours are long. Evidence shows that among the [factors that most affect intern confidence are high patient loads and long work hours](https://www.americanjournalofsurgery.com/article/S0002-9610(06)00640-4/fulltext). A good strategy that helped me manage daily setbacks was to develop short- and long- term goals. For example, a short term goal would be to have an inpatient discharge ready before noon and a long term goal would be to improve for example my knot tying skills. Focusing on goals keeps you motivated and focused on the task at hand. Expectations. Speak with residents who recently transitioned out of intern year and inquire about what specific roles/activities were expected from them. This will give you a general idea of what would also be expected from you as the new intern on the team. During the start of rotations, ask chief residents about what they expect from their junior residents. Inquire about senior residents’ experiences with attendings so that you can gain insight about them. Ask attendings directly what they expect from you while working with them. This will likely help establish good rapport with both attendings and senior residents. **3. Efficiency: Prioritize tasks and stay organized** Efficiency has been previously described among the [skills needed to become a “great” resident](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4092196/). To become an efficient resident, you will need to learn to prioritize and stay organized. Prioritizing is a skill that you will need to apply throughout your surgical training and ultimately your surgical career. For me, creating checklists with checkboxes helped ensure that all tasks were done in a timely manner for my patients. Initially I would directly ask seniors what tasks they believed should be prioritized until I was able to develop this prioritization skill myself. Ask senior residents to briefly explain their rationale so that you can gradually learn to prioritize tasks on your own. **4. Become an effective learner** As a resident, the time allocated for learning new concepts will be limited and likely diluted into the rest of your daily responsibilities. This means that you will have to make an effort to learn skills and concepts at a faster pace. Your learning will also mostly be self driven as you review anatomy and important concepts for procedures. A good strategy is to have an ABSITE review book to learn key concepts about topics. Also review your anatomy. Practice, practice, practice is the key. A good source of practice questions that can help solidify concepts learned are questions banks such as [SCORE](https://www.surgicalcore.org/) and [TrueLearn](https://truelearn.com/). **5. Interpersonal Skills** As a resident (and later on as an attending), interpersonal relationships are crucial for your work environment. Build strong relationships with your co-interns. You are all in this together and will likely need each other during this challenging year. Furthermore, create good relationships with support staff such as nurses, social workers, and consult services. Being mindful, respectful, and tactful with others will help you gain the trust of your colleagues. This will also help coordinate care for your patients. It goes without saying that people will be more happy to help someone they like than someone they dislike. Therefore, make allies…not enemies. The relationships you make (or don’t make) can truly make or break your first year as a resident. **6. Don’t forget about yourself** Taking care of yourself is highly important when you are in a constantly stressful environment like surgical training. Therefore, do not neglect your passions. Set time for them even if you can only do it occasionally. Find people who have similar interests to you and spend at least one day a week doing activities not related to surgery. Don’t forget to have fun, be patient and kind to yourself. Most importantly, enjoy the learning process and remind yourself that this process will pass. After all, you will only be a first year surgical resident once in your life. Welcome to the first year of your career as a surgeon, it’s your time to shine. Embrace it, you are now a future surgeon. ![](https://lh3.googleusercontent.com/mXJEMa870sJJ-HHBLbDaWTkBFNp7PjFIm3P3fd6UJmbpNmwZ7PyCRpIfBgVTDFkR-W16z7Jj9tm5L_xZC1-Tun3zc7F_u_1PEt0zdLc4BRsie5TYoMGU4rY9dNZLY9sKlUw0_QrV) Mariela R. Martinez Rivera is a Urology Resident in New York. During her medical training, Mariela became a recipient of the AMA Minority Scholar Award and was inducted as Junior Member of the Alpha Omega Alpha and Gold Humanism Honor Society. She studied Biology at University of Puerto Rico Mayaguez with research focus in Genetics and Admixture of the Puerto Rican population. Mariela also completed a Masters Degree in Human Genetics at the University of California-Los Angeles where she received the prestigious Eugene Cota Robles Fellowship and the NSF Graduate Research Fellowship. She graduated from Ponce Health Science University School of Medicine with honors. Her interests include urology, oncology, surgery, health disparities, health advocacy, non-profit leadership, genetics and molecular biology. A native from Puerto Rico, Mariela has spearheaded diverse initiatives to increase leadership and advocacy among Latinos throughout her involvement in the Latino Medical Student Association. She is also passionate about increasing the representation of women in medicine and in surgical fields. Mariela enjoys painting, photography, and singing. She also loves going to the beach and spending time with her family. You can follow Mariela’s path towards becoming a Urologic Surgeon on Instagram at @urochick and Twitter [@MartMari4460](https://twitter.com/MartMari4460). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** #AWSintern, AWS, womeninmedicine, womeninsurgery --- ### [Residents as Teachers: Shaping the Doctors of Tomorrow](https://blog.womensurgeons.org/residents-as-teachers/) **Published:** July 25, 2019 **Author:** Blog Team **Content:** *By Jane Zhao, MD, MS* It’s July, which means that around the country, it’s the beginning of the academic year for medical students and surgical residents. My brand new third year medical student finally became comfortable enough to confide in me, “I chose to rotate through surgery first to get it out of the way, and I’m enjoying this experience far more than I realized. I think I want to do surgery.” I will not lie. It’s a point of personal pride every time I have a student rotate through surgery with me and successfully convince him/her to legitimately consider pursuing surgery as a career. I sincerely believe that part of being excited about surgery is being involved. Part of being involved is being invited to participate. My favorite rotations as a medical student were the ones where I was included in the resident text thread or where I held the resident ascom. I may have been bone-weary on those service-heavy rotations but I was part of the team. My responsibilities ranged from following up on the lab value for Patient A to performing the rectal irrigations for Patient B. My involvement impacted the patient’s well-being. Now as a senior resident, I try to emulate this experience for my own medical students. I am a huge fan of how, in [2018](https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10412.pdf), the Centers for Medicare and Medicaid Services changed reimbursement policies to permit teaching faculty to verify medical student documentation–as opposed to having to re-document everything–to have the student note count in the medical chart. In fact, my co-residents have laughingly teased me about how championing the right for medical students to document under their own names and to receive credit in the medical chart for their hard work has become my soapbox over the past year. Truthfully, it’s critically important to include medical students as part of the medical team, more so than birddogging cases when they roll into the operating room or being able to answer pimp questions correctly. We as a medical establishment have a responsibility to prepare our students to become doctors, and that includes having them be ready on day one of being an intern: to be able to document appropriately and efficiently, perform simple procedures, start and end a conversation about something sensitive when time is short, and know how to be silent in a healing and respectful way. To be a good teacher is to do more than simply pile tasks onto students. It means that I have to follow through when I say I will do something and that I have to sacrifice time and energy that I could have used elsewhere. After I ask students to see, write up, and present their consults, I take the time to review their notes, perform edits, and then update them with the changes I made and provide reasons for why I made the changes that I did. I give feedback about what aspects of their presentation should have been bumped up in the first few seconds and which can be kept in reserve until asked. I ask my students to follow one to two patients daily and to write their notes. I edit them before I send them to the attending. When performing procedures like incisions and drainages in the emergency department, I go with them to gather supplies, hand them the scalpel, and then I talk them through the procedure. I try to remember to give positive reinforcement, but I am not above calling out individuals when expectations are not met. I try to tailor my teaching based on personality, and I find I have a lot of success with individuals on the quieter or shier end of the spectrum. Lastly, when the work is done, and all I have left is to tie up some loose ends, I show them that I respect their time to study for their shelf exam, and I send them home. I still remember how horrible waiting around and doing nothing feels like. Taking time to teach has eaten away a number of hours I could have used for sleep–especially during my rotations on q3day trauma call. However, it’s ultimately worth it when I think about how I am doing my part to shape better doctors for tomorrow and maybe even convert a handful here or there into pursuing surgery. Everyone has a different teaching style. Some are more Socratic. Some are more coach-like; others are more authoritative. I am heavily influenced by those who were great teachers to me. At the end of the day, I encourage everyone now and for the remainder of the academic year to be a little more patient, a little bit more optimistic, and remember that we all have much we can teach, whether it’s through our words or through our actions. To all my fellow residents, I implore you: reach into your own experiences, recall what it was like when you were trying to learn as a medical student, how your residents effectively taught you, and try to pay it forward as a resident-teacher by modeling that same behavior. ![](https://lh6.googleusercontent.com/ZFM0R3Vd4H9dqP_dZS8yAIZCVA3cU4WwzlZBg5osv_BHnBSfAWkyn2o7MLSbeVTzTRqbZoDPF9NxIMebueReZvZ0Cow2q5U8e9MY09Ve1m1VNWtSIZrBMxAjkg8tRiLHnQCZ6FyG) **Jane Zhao,** MD, MS is a general surgery resident with board eligibility in clinical informatics at the University at Buffalo, State University of New York. *S*he received her medical degree from McGovern Medical School, the University of Texas Health Science Center at Houston and her bachelor’s degree from Vanderbilt University. She was the founder and chair of the AWS Blog Subcommittee from 2013 to 2014 and a founding member of the AWS Social Media Subcommittee in 2013. She currently serves as the Resident and Associate Society Liaison for the American College of Surgeons Health Information Technology Committee. She has been recognized locally and nationally for her leadership, innovation, humanism, and role as an educator. She can be followed on Twitter [@zhaomd](https://twitter.com/zhaomd). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, residency **Tags:** education, ILookLikeASurgeon, residency, teaching, womeninmedicine, womeninsurgery --- ### [Egyptian Women in Surgery](https://blog.womensurgeons.org/egyptian-women-in-surgery/) **Published:** August 1, 2019 **Author:** Blog Team **Content:** *By Hadeer Nasr* An in-depth look into the history of ancient Egypt brings to light the certain fact that females can introduce themselves energetically even in a male dominated Kingdom. A few notable figures were honored by history as the first women in surgery. [Merit Ptah](https://en.wikipedia.org/wiki/Merit-Ptah), an Egyptian woman in Egypt’s second dynasty (2700 BCE) was described as “chief physician”. That title made her, not only a teacher and a supervisor, but also the king’s personal physician and surgeon. Furthermore, she is the earliest named woman in the history of science. Another woman named [Peseshet](https://ancientstandard.com/2011/03/16/the-female-physicians-of-ancient-egypt/) blossomed during the reign of the 4th and 5th dynasties. She became the most influential physician of the royal court near the Nile and was known as the main healer of the Kingdom. The ancient Egyptians attributed all their medical knowledge and advances to the lion goddess Sekhmet. Later on, at a time where[ ancient Greek](https://www.aoa.org.au/for-patients/articles-and-galleries/articles/the-surprising-history-of-women-in-surgery) democracy prohibited women from practicing medicine, Egypt represented a beacon for them where they travelled to Alexandria to study. Once qualified, they returned to practice in Athens as physicians, surgeons, obstetricians and gynecologists albeit occasionally disguised as men! Sailing through the lines of historical texts we find the twentieth century brought in a modern Egypt and a renewal of pioneering women. In 1922, a scholarship to study medicine in Britain was awarded to 6 female students among whom were Kawkab Hefny Nassef and Helena Sidarous. [Dr. Kawkab](https://womenofegyptmag.com/2019/03/08/download-your-free-copy-of-pearls-of-the-nile-the-pioneers/) became the first female surgeon and chief physician in Egypt and the first female physician to join the Medical Syndicate. She also founded the first nursing school. [Dr. Helena](http://copticmedical.com/dr-helena-sidarous/) worked at Kitchener hospital (today’s Shubra General Hospital), performing deliveries and surgical procedures. She was the first female Egyptian doctor to start her own private clinic. Her role was not only confined to surgical practice but she also participated in the National Struggle of the Egyptian Woman against the British occupation and joined the Coptic Charitable Society for social work which established the Coptic Hospital in Cairo. In the second half of the twentieth century, another notable figure[ Lafteya El Sabe’](https://womenofegyptmag.com/2019/03/08/download-your-free-copy-of-pearls-of-the-nile-the-pioneers/)a received a Ph.D. in Obstetrics and Gynecology and in Health Media from the UK in 1977. She was prominent in her field and worked for the Egyptian State Television. She broke new ground in medical media. She broadcast the first health program in Egypt and the Arab world and commenced public awareness advertisements on television. In recent times, the number of female surgeons has grown dramatically. According to the Egyptian Medical Syndicate there are 546 registered specialists, two thirds of them being general surgeons. Though this number is still limited compared to the number of male counterparts, the young generations of female medical students are inspired by the ancient Egypt history and the modern revolution to pursue a career in the different surgical specialties.They have much to look forward to during this growing and exciting time for women in surgery. *Acknowledgement: I would like to express my sincere gratitude to Dr. Aly Shalaby for revising this article and for his endless support.* ![](https://lh4.googleusercontent.com/ZlDHXoRWn1WTZ9qAAO_ORU5ROiudlvqa9QHHaRRQyLYTpomLRL8Lu2qwPsCQIKfvIyK41Zrlal6FRtXd68O0Tnqmme7YrPMDJY0TbNaWQ5E_vKupT5jA3X5CelyEV1TTVBDp4PUK) Hadeer Mohamed Nasr Eldin graduated from Cairo University School of Medicine in 2013. She worked as a Pediatric Surgery resident at Cairo University Specialized Pediatric Hospital since 2015. She then received her Master of Science degree in General Surgery from Cairo University School of Medicine in 2018 and became a Member of the Royal Colleges of Surgeons of Great Britain and Ireland in 2019. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** women **Tags:** #womeninsugery, AWSBlog, womeninmedicine --- ### [A Transplant Reflection](https://blog.womensurgeons.org/a-transplant-reflection/) **Published:** August 9, 2019 **Author:** Blog Team **Content:** *By Priya Suri* At first glance, he was a sinewy man—built long and hard. He was wheeled into the operating room (OR) intubated and eyes blinking. Was he blinded by the blaring white lights just like me? This was my first potential organ procurement. He was a “possible DCD,” meaning that if ventilator support was removed, the patient would likely progress to circulatory death. The head anesthesiologist had asked the resident if he had seen one of these before. He hadn’t and she remarked that it could be an emotionally taxing surgery to watch. The surgeons gowned up and left the room. It wasn’t our call to make if the patient died on the table—the ICU team would declare the time of death to ensure there was no conflict of interest. This was the first case where a patient entered the OR alive but if events were to progress as expected, he would leave dead. I wasn’t quite sure how to grapple with that fact. As future physicians, we are trained extensively on how to preserve life. My first instinct was to shy away from this procedure. I intellectually knew the bigger picture: we were helping someone who needed organs be able to receive life saving measures from a person who had no foreseeable quality of life ahead of him. However, physically seeing our organ donor and emotionally digesting the steps to come remained confusing and unsettling. His family had come to say goodbye. As per the family’s request, raging rock music greeted them in the OR to commemorate their loved one. The music didn’t seem to fit the solemn mood of the physicians and the staff. But it wasn’t meant for us. Nor was it meant to mourn the death of the patient, but rather it was meant to celebrate his life. The life support was removed, and as was predicted, the patient progressed to death. The family had five minutes to grieve with his body. A lifetime of memories had to be condensed into a few short minutes. The family was then escorted out and the surgeons took their places. We took a moment of silence to acknowledge his life. And we had begun. The sternum was cracked open and the abdominal contents splayed across the OR table. Every second could lead to organ damage; the surgeons could not afford to waste any time. I stood on the side watching the choreography between the lung and abdominal transplant teams working swiftly side by side. I was responsible to help close up the body after the organs had been removed. On his skin, a racist slogan had been emblazoned. What had initially been sadness at seeing his mutilated body turned quickly to anger and disgust, and just as quickly guilt. He died. Even though he believed in something I think is abhorrent, how could I be angry at him? I didn’t know what to think. What I had missed in his moment of silence was an explanation. His family had requested that the surgeons know that this tattoo wasn’t who he was. He had been in difficult life situations and he was forced to choose sides. He had struggled with opioid addiction and died by suicide. The explanation made me pause. I don’t know if he was a racist who disliked people of color. I don’t know if he despised the words displayed on his body. I don’t know if it really makes a difference. As future surgeons, we must be aware of our own biases and experiences that we bring. In that moment, I recognized my duty was not to judge–far from it. My duty was to continue to learn and understand. I was reminded that at the core of our commitment to service is a promise to treat patients with dignity and respect regardless of their beliefs. I will never fully know what he believed in his life, however, at that moment he was gifting me an incredible opportunity to learn, and I am grateful for that. What I do know is that this man is now gone. A man who was loved by his family. A man they had to watch struggle at the end. A man whose kidneys were going to a Latino gentleman in the OR next door. Perhaps it was fitting in a way; his final act would defy the words he had inked on his body. ![](https://lh4.googleusercontent.com/BA_mHSq7CLB9nzRb-3zAI8R07iUnhBTb8dBNf1pON18QheJUMMk3BT3ItFclSguTKTV-fmJ4-UYV_XXSGrHYthe0mqSdpAOjFiSRCO2YpIdyMs96PZGuXAmACJ-Pcf9DVjuPT63w) Priya Suri is a fourth year medical student at the University of Madison Wisconsin School of Medicine and Public Health. She was selected into their competitive urban health track: Training in Urban Medicine and Public Health (TRIUMPH) to complete her rotations in underserved neighborhoods in Milwaukee, WI and institute a community project. She is working with a local organization to design and implement a social justice curriculum for middle schoolers. She is excited to pursue a career in surgery and is currently creating a surgery advocacy elective for fellow students interested in merging these two interests. You can find her on twitter at @PriyaSuriMed. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** #AssociationofWomenSurgeons, AWSBlog, womeninmedicine, womeninsurgery --- ### [Implicit Bias: It’s Time to Be More Conscious about Our Unconscious Mind](https://blog.womensurgeons.org/implicit-bias-2/) **Published:** August 11, 2019 **Author:** Blog Team **Content:** Hope T. Jackson, MD *“Oh no sweetie, we are looking for actual physicians or nurses or some type of medical personnel. We don’t have time to talk to you.”* This was the [response](https://www.washingtonpost.com/news/morning-mix/wp/2016/10/14/blatant-discrimination-black-female-doctor-says-flight-crew-questioned-her-credentials-during-medical-emergency/?noredirect=on) [given](https://www.washingtonpost.com/national/health-science/tamika-cross-is-not-the-only-black-doctor-ignored-in-an-airplane-emergency/2016/10/20/3f59ac08-9544-11e6-bc79-af1cd3d2984b_story.html?noredirect=on) by a Delta Airlines flight crew member to Dr. Tamika Cross (a practicing Obstetrician & Gynecologist) after she answered the call for medical assistance on a Delta Airlines flight in 2016. Dr. Cross’ viral social media post detailing the encounter, the commentary that followed, and ultimately, the subsequent Delta policy change, serves as one large example of how implicit bias has recently come to the forefront of many conversations surrounding race, gender, sexual orientation and politics. A commonly accepted definition of [implicit bias](https://implicit.harvard.edu/implicit/) is an “*Unintentional bias that arises from attitudes or stereotypes. This bias (both favorable and unfavorable) can unconsciously affect our understanding, decision-making and behavior without realizing it.”* In 1998, researchers at Harvard University, University of Virginia, and the University of Washington created the [Implicit Association Test (IAT)](https://www.jointcommission.org/issues/article.aspx?Article=Lq3yj+0ZSfOIrnxvFnGhZb5Ox20QBCnbdRFHwXdrc9s=), a timed categorization exercise that measures implicit preferences by bypassing conscious processing. The overall goal of the project (which continues today in various forms) is to raise awareness and educate participants regarding their own personal biases. Between the initial study period of 1998 and 2006, [more than 4.5 million IAT tests](https://www.ncbi.nlm.nih.gov/pubmed/16004659) were completed on the IAT website. The project found that: *1.* *Implicit bias is pervasive* 2\. *People are often unaware of their implicit biases* *3.* *Implicit biases predict behavior* *4.* *People differ in levels of implicit bias* Many health care organizations have administered the IAT, and when applied to physicians, a significant [pro-white bias was identified](https://www.ncbi.nlm.nih.gov/pubmed/17594129). Implicit bias, however, is not just limited to race. For example, when the IAT was given to health professionals at an obesity conference, participants implicitly associated patients with [obesity with negative cultural stereotypes](https://www.ncbi.nlm.nih.gov/pubmed/12972672), such as “bad, stupid, lazy and worthless.” [Many](https://www.ncbi.nlm.nih.gov/pubmed/10749964) [studies](http://europepmc.org/abstract/med/8730135) [have shown](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337616/) that implicit gender bias among physicians may also unknowingly impact treatment decisions. Finally, implicit bias can also impact the organizational decision making that occurs in a healthcare setting. It can affect the hiring and promotion of staff, clinicians, and faculty. Each of these decisions can ultimately impact patient care. [These](https://www.ncbi.nlm.nih.gov/pubmed/31276177) [studies](https://www.ncbi.nlm.nih.gov/pubmed/27547105) [and](https://www.ncbi.nlm.nih.gov/pubmed/26469668) [more](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325336/) demonstrate that despite our best intentions, we are not immune to bias as we care for our patients and interact with colleagues. The implications of this have direct and potentially dangerous consequences for patient safety. Additional studies, focus groups and discussions are needed to more clearly understand the nuances of implicit bias and its implications for healthcare. But what can we do in the meantime? Awareness has been recognized as an [important first step](https://psycnet.apa.org/record/2002-18731-001) toward minimizing the effects of implicit bias. [Devine and colleagues](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603687/) describe six strategies to increase our own conscious awareness and reduce implicit bias: *1. Stereotype replacement* — Recognizing that a response is based on stereotype and consciously adjusting the response *2. Counter-stereotypic imaging* — Imagining the individual as the opposite of the stereotype 3\. In*dividuation* — Seeing the person as an individual rather than a stereotype (ie. learning about their personal history and the context that brought them for a patient visit) 4\. *Perspective taking* — Putting yourself in the other person’s shoes *5. Increasing opportunities for contact with individuals from different groups* — Expanding one’s network to include people of other racial and ethnic groups, gender identities, sexual orientation, etc *6. Partnership building* — Reframing the interaction with the patient as one between collaborating team members We all have biases, regardless of our gender, race, age, sexual orientation, academic background, or socioeconomic status. As we continue to examine and challenge our own thoughts, we should simultaneously amplify voices, projects and organizations that seek to help us reduce the impact of this universal healthcare issue. Join [@womensurgeons](https://twitter.com/WomenSurgeons) and [@SAGES\_Updates](https://twitter.com/SAGES_Updates) along with our moderators, Dr. Arghavan Salles ([@arghavan\_salles](https://twitter.com/arghavan_salles)) and Dr. Andrew Wright ([@andrewswright](https://twitter.com/andrewswright)), for a tweetchat about Implicit Bias on Monday August 19th at 8pm Eastern Time by following #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following questions in the tweetchat: 1. What is implicit bias? How does it differ from explicit bias? 2\. What are some examples of implicit bias experienced by physicians and other colleagues? 3\. What is the impact of implicit bias on physicians and other colleagues? 4\. What are some examples of how implicit bias affects patient care and outcomes? 5\. How can we facilitate a culture in medicine that constructively allows for identification of implicit bias? ![](https://lh3.googleusercontent.com/pLwl09O1Zk34fLvqJv58SUWgXWOZBbPRJ1a5PTjBs3ChyHtmqZ6GsUkK7CsmTf9cw86_EO9tNHVlTHoGPmOne_MBqHti2mEJFJPZ9vy2bcDZ3OoUP87fjNKBZj9WcEP3i7XNYV3Z) Hope Jackson, MD is an Assistant Professor at the George Washington University School of Medicine. Her clinical interests include bariatric surgery, flexible endoscopy and benign foregut disease. Her additional interests include graduate medical education, clinical outcomes research and medical communications. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, bias, Diversity, ILookLikeASurgeon, implicit bias, inclusion, Tweetchat, unconscious bias, womeninmedicine, womeninsurgery --- ### [Prosciutto](https://blog.womensurgeons.org/prosciutto/) **Published:** August 14, 2019 **Author:** Blog Team **Content:** *By Alyssa Brown* During third year of medical school, you collect many new numbers and contacts, and your phone’s contact list becomes filled with labels like “Bridgit OB resident,” “Bill RED medicine” and “Med Clinic Downtown.” The list goes on as you collect the numbers of clinics, social workers, residents, schedulers and physicians. You hoard these numbers in case you need them. Each number carries with it memories, and inevitably, some of them hold more meaning than others. Though you sometimes feel like you are just one in a long line of medical students that the residents and attendings see in a year, you sometimes feel genuinely useful or like you connected. Either way, each of these people shaped who you will become as a doctor. They are memories and experiences that made your third year what it was: learning, facing mortality and growing up. As cliché as it may sound, the small moments usually affect us more in the long run than the grand gestures or feelings of intense consternation. For me, one such moment occurred during my surgery clerkship.I had been invited to the General Surgery Journal Club. In the sweltering heat of a southern summer, I dressed as crisply as possible, not knowing what to expect. I had only been invited because another medical student had fallen ill. I arrived an hour early, afraid to be late for the meeting. Two other male medical students arrived shortly after. They were both sons of different surgeons in the community and seemed to know everyone at the meeting. The residents and attending physicians slowly trickled in, and the other two students greeted them accordingly as I stood there attempting introductions. Being the daughter of a railroad conductor and actuary, I felt so out of place. Everyone sat down to order, and a female intern sat down next to me at the large banquet table. I was poring over the menu, which was filled with items I had never heard of before. The two other medical students were on my opposite side, but even though they were my colleagues, I felt too embarrassed to ask them what prosciutto was. In hindsight, I had heard of it. I shouldn’t have been so nervous, but in the moment, I was frozen with anxiety. I didn’t want to order something and then not eat most of it. The server began making her way around the table taking orders, and I must have looked petrified as I frantically wondered what to do. After a few moments, I bashfully asked the female resident next to me, “What is prosciutto?” She leaned over and whispered, “It’s fancy bacon; you’ll like it.” After all of these years, I still remember this moment and still look up to that person. The rest of the night was much less memorable. I asked her eventually how intern year was, and she said that it wasn’t as terrible as everyone said it was. She showed me pictures of her dog, baked goods and cool surgeries. Although it was arguably a tiny moment in the course of a life or even an evening , it put me at ease and convinced me that maybe I did belong at that table. She was the kind of doctor I want to be. While there are phone numbers for those you wish to emulate, there are also numbers for attendings and residents whom you don’t want to be. You might eventually delete these numbers because they remind you of frustrating, demoralizing, or even appalling times. However, I sometimes keep these numbers as a reminder of what I don’t want to be. I don’t want to tell horror stories here; that is not my goal. I prefer to recount the beautiful moments of the hospital today: the girl who went home three days after her heart transplant, the candy off the secretary’s desk, the long stories with patients, the laughs shared with classmates and residents. There were many small moments along the way leading to surgery that brought joy to my life. A third-year medical student took the time during my first year to show me how to scrub. She gave me her number and told me to text her if I ever had questions about the surgery clerkship or medical school in general. It was the surgeon who — instead of yelling at me– taught me as we discussed our favorite Adele songs in the operating room. These moments have stuck with me, serving as reminders of what I want my future to be. I want to laugh with others. I want to support others. I want to be the kind of doctor who tells the clearly distressed student what prosciutto is. ![](https://lh5.googleusercontent.com/XyMsLiRFHzoKban0e-C0FCrPIyoWLSt_oNX2rwN5udq3oZ_Fy43antQP7ZX2S7YExR1zPOL7hipt3dX88FVa0LNRdfFeyCfF_q7xHipyLM0bW4EamUhsMl-4saRixgPkCRP2sQVz) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. Last July, she finished her third year of medical school and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. When she is not buried in lab work, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram [**@alyssabrown1013**](https://www.instagram.com/alyssabrown1013/) and Twitter [**@Alyssa\_B\_MDPhD**](https://twitter.com/Alyssa_B_MDPhD) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Diversity in Surgical Training - Redefining Mentorship](https://blog.womensurgeons.org/diversity-in-surgical-training-redefining-mentorship/) **Published:** August 23, 2019 **Author:** Blog Team **Content:** *By Ivy Godana* With the advent of social media and the internet, we are able to connect, inspire, and empower. And in this exists the perfect opportunity to broaden our definition of mentorship. One of the most remarkable opportunities for women surgeons is the global communities we have created such as [AWS](https://www.womensurgeons.org/default.aspx), [RCSI-WIS](https://www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/), [WISA](http://www.womeninsurgeryafrica.org/), and many more. Although we have come a long way, we continue to redefine and expand our individual and collective means of community. Mentorship is at the center of this community and diversity is a key part. Diversity is more than what we look like and our backgrounds. It is our most personal identity, our religious affiliations, our life experiences, our socioeconomic backgrounds, our opinions of the world, our outlook on matters of our society, our favorite hobbies, and more. Before we are healthcare providers, we are people. We meet to share and inspire as we work towards a common goal: to give our patients the best care possible. The more interactions we have, the more we meet our differences, the better we work as a team and, I believe, the better are our outcomes. Encouraging diversity in training and workspace is a great place to start. Diversity facilitates most importantly three opportunities. First, diversity brings new perspectives to the table. It asks and answers questions such as, how do we improve our reach as healthcare providers? It brings fresh ideas and innovative ways to accomplishing our goals. Secondly, and specifically on racial and religious lines, diversity matters to the patients. When a patient sees and identifies with a provider, there is a deeper element of trust and rapport built that is instinctual. All human beings do this subconsciously, as we feel connected to those who we believe to be similar to us. This is a natural part of human interaction. This matters because with established trust, patients are more likely to become a partner in their own journey to healing rather than passive players and this also impacts their outcomes. Of note, even in situations where patient and surgeon may not share any similarities, trust can be built with elements of compassion, patience, and kindness, as they are an integral part of any positive interaction. Last but not least, diversity inspires. To those young girls (and boys) who dream to become surgeons, and have the opportunity to see or meet someone who they can identify with, their dreams take shape and a seed is planted. It is the idea of, “if they can, so can I”. And in the eloquent words of actress Lupita Nyong’o – “ \[their\] dreams are valid”. That is our furthest reach in mentorship, collectively as surgeons, to inspire those that dream. One of the most remarkable aspects of diversity is that it enriches mentorship. As it does in bringing new perspectives to the table, diversity offers a lovely assortment of mentors we can all learn from. A surgeon who, having lived through economic hardship, may better understand how to meet patients experiencing economic hardships at their point of need. This understanding, and manner of practice can be taught. To the resident who witnesses something like this, they too can bring it into their forming practice of surgery. As the world is evolving, barriers are broken, and glass ceilings shattered by more women of all diverse backgrounds, our communities of practitioners ought to reflect that. In essence, diversity plays an important role between surgeons in practice, among surgical residents in training, between surgeons and patients, and in mentorship. So, as we begin to enrich our own practice and learning, we begin first with ourselves. I encourage you to open the gates of your mind, and welcome a mentor who may look, practice, worship, or think differently from you. There is always something to be learned by those who we think we may not necessarily identify with. And as we do so, this in turn brings together the wonderful art of the practice of surgery. And diversity adds a beautiful color to it. ![](https://lh5.googleusercontent.com/BgdpsBpvaWuCnTgCO-cvs5gAfZcKWf7hamAf-J0slaHE5nM6DnjWHnunUyi_Od8IMffsH8DHES9ApjZZwmorrsUy0hfAObKbHakMFXYQ1YPYULBqLNKX6MbCRhLBM9IePnplI8FA) Ivy Godana is currently a first year General Surgery Resident at McLaren Greater Lansing – MSU in Michigan. She completed her Medical School at ATSU-SOMA and Undergraduate studies at Baylor University where she majored in Biology, graduating with Honors. She is an immigrant,a dreamer, a huge fan of No. 11 and 15 blades, books, aphorisms, and wildlife conservation. She is interested in Global Surgery. Ivy is incredibly honored to be a part of the Association of Women Surgeons! You can find her on twitter at [@Dr\_Godana](https://twitter.com/Dr_Godana) and on instagram at @ivygodana. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** #Ioperatelikeagirl, #womeninsurg, AWSBlog, womeninmedicine, womeninsurgery --- ### [Setting an Intention](https://blog.womensurgeons.org/setting-an-intention/) **Published:** August 28, 2019 **Author:** Blog Team **Content:** *By Shree Agrawal* I am about two months into my intern year as a surgical resident. In anticipation of this transition, I have spent the last few months in nervous apprehension about the responsibilities of a surgical resident. As a medical student, I experienced small glimpses of practicing medicine when I was on acting internships and elective rotations. The activities on these rotations incorporated the most meaningful components of entering any subspecialty. Each rotation offered an opportunity to scrub into incredible cases, to have the luxury of time when speaking with patients, and being able to write notes and synthesize clinical pictures without the pressure of orders or an ever-beeping pager. The limitations of electronic medical systems and the legal liability of medical student autonomy translated to unfettered enjoyment of medicine. From witnessing residents above me, undoubtedly I expected intern year would be a different experience. With a new pager in hand, two new letters after my name and a rudimentary understanding of order sets and navigating an electronic medical system, I started internship year. It felt awkward introducing myself as Dr. Agrawal, feeling the full gravity my new title carried while still transitioning from the mindset of my past life as a medical student. At the end of a particularly terrible night on call, in which my pager was relentless, my patients weren’t doing as well as I had hoped, and I felt pulled in multiple directions at once, I remember getting into my car and sobbing on the drive home. I confided in my co-interns and felt less alone, less overwhelmed, knowing this experience was pervasive and would be both transient and common in the coming years. That night passed, and nights similar to that one started to feel slightly more manageable. However, I realize now more than ever how deliberate I have to be about practicing gratitude to remind myself of my motivation to be in this role. While I would like to think practicing gratitude is not a unique effort among trainees; however, in my new role as a resident, it required more energy than I anticipated. The motivation to enter this field became larger than the one-dimensional paragraph limited to a residency personal statement. I am more intentional about cherishing the one-on-one moments I have with my patients, maximizing the short time I can allot to each person. If ever there is an opportunity to go to the operating room, I try to replay the moments on the way home. When I see a friendly face – whether one of the nurses, chaplains, or my mentors, I savor a few extra moments to have a conversation, to feel supported and encouraged. Often I reflect on how incredible it is to work with the people around me. Even as the patients come and go, it is the co-residents and other care providers who make the steep learning curve worthwhile. To have the opportunity to connect with and care for my patients is humbling, especially when they refer to me as Dr. Agrawal. Realizing this keeps me grounded as I work towards becoming a surgeon. To any other interns who may be feeling a little isolated and who may be struggling to adjust, I hope you have a few moments to re-center and re-focus on the most meaningful parts of your day so that tomorrow feels a little better than today. ![](https://lh4.googleusercontent.com/x2De1mLl_AyCrut7aEk829aYMgwpQfKvtAA_NjEcqSw5hIitiFCFX0hifj5qOJyiFfnYuK2IYhydztPxZy8RiNJcbLi3ivnQN1AxxCC6OunlaVowF8YaiKvTnSIottWdFMMrWG5w) *Shree Agrawal is a urology resident at the Cleveland Clinic Glickman Urological and Kidney Institute. She completed her B.S. in biology degree and medical degree at Case Western Reserve University, as well as a clinical research fellowship in genitourinary reconstruction at the Cleveland Clinic. She is passionate about research surrounding patient decision-making and longitudinal patient care. She currently blogs for Doximity and the Association of Women Surgeons. In her free time, she enjoys practicing yoga, baking and cooking. You can follow her on Twitter:* [*@ShreeAgrawal21*](https://twitter.com/ShreeAgrawal21) *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** #Ioperatelikeagirl, AWSBlog, womeninmedicine, womeninsurgery --- ### [Ten Essential Lessons from a Senior Surgical Mentor](https://blog.womensurgeons.org/lessons-from-a-senior-surgical-mentor/) **Published:** September 5, 2019 **Author:** Blog Team **Content:** *By Jaime D. Lewis* One of the privileges that comes with working in academic medicine is caring for mentors and colleagues, those who make it their mission to pass along the wisdom and art of medicine. A recent experience caring for a mentor led me to reflect on lessons shared by this individual that have shaped my practice. 1. There’s a lot of data out there and it’s impossible to know it all. This is absolutely okay! There are >390,000 “breast cancer” articles in PubMed. **Learn to identify what may impact your practice, what is key for residents and medical students to know, and for patients to understand.** Be able to communicate this information such that others can understand your message. 2. **Know the history of the management of the disease process.** Be intimately familiar with the groundbreaking studies that have changed the course of clinical care. Question their ongoing validity as these questions will guide future advances. 3. While the results of clinical trials apply to “homogenous” groups of patients, each one of these patients is unique. **Get to know your patients and how their diagnosis impacts them personally.** Guide the course of care that is most appropriate for each individual. 4. **Treat and teach medical students and residents well.** They deserve the opportunity to learn, for each of us was once in their shoes. And one day they will be our referring physicians and then our own providers. 5. None of us is immune from disease and we too must be vigilant and advocates for our own health. **If something is wrong, seek care.** Each of us must be healthy and strong to serve our purposes. 6. No matter the circumstances, **celebrate life and living**. Perhaps do this with a going away party before undergoing bilateral mastectomies! 7. **There should be music in the operating room.** Music can elevate the spirits and mood of the room. It can bring energy to the process. The notes can calm the anxieties and frustrations. 8. **Hold your patient’s hand as they go to sleep** – it’s okay to be human. Your patient may not remember, but you will recall the tightness of their grip as they drift off knowing they have entrusted all of their care to you, their surgeon. 9. **Live to fight another day.** Not all of your battles must be won before sundown. 10. You must always have **hope**. Some days these lessons are easier to remember than others. Thank you to those who have taught and mentored me and helped me become the surgeon I am today. It is an honor and a privilege to now pass along your lessons. ![](https://lh5.googleusercontent.com/C7FOjlbD6YzM_lbM67EdvPP-Ec9tWdqcvFgoNqk_SZH1jlG-bEp8WOg3qJqc20wBbEuCwZ7r4JcXgSNe-6wNMawrJvsSc27stZkYALk75C6WbA5qBylbzNX_GVN7y1z4SEJpdEaF) Jaime D. Lewis, MD, FACS, practices breast surgery at the University of Cincinnati College of Medicine in Cincinnati, Ohio, where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Dr. Lewis is committed to improving wellness and professional development opportunities of the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys running and spending time with her family. You can find her on twitter at [**@JaimeDLewisMD**](https://twitter.com/JaimeDLewisMD). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Time Out: Optimizing Time Management as a Surgeon](https://blog.womensurgeons.org/optimizing-time-management/) **Published:** September 9, 2019 **Author:** Blog Team **Content:** *By Kimberly Hoang* *“I am going to take a course on time management…. just as soon as I can work it into my schedule”.* – Louis E. Boone As Mr. Boone and Einstein’s theory of relativity understand, time can be a tricky thing. It stands still when we are suffering through something we dislike, we lose it when we are doing something we enjoy, and there never seems to be enough of it. In an era of quantified metrics, time is also a measured commodity (in administrative speak: “time is money”). According to [Sinsky et al,](https://www.ncbi.nlm.nih.gov/pubmed/27595430) for every hour of patient care, a physician spends 2 hours doing paperwork. [Ardnt et al](http://www.annfammed.org/content/15/5/419.full) also reported 5.9 hours of a 11.4 hour workday is spent on the electronic health record. The AMA’s [2014 Work/Life Profiles of Today Report](https://www.ama-assn.org/practice-management/physician-health/how-many-hours-are-average-physician-workweek) that 25% of all physicians work 60-80 hours each week.When one reviews where our time is going, the numbers are disheartening. And female physicians experience unique systemic pressures in the realm of time management. In the [Physician Work Life Study](https://onlinelibrary.wiley.com/doi/full/10.1111/j.1525-1497.2000.im9908009.x), female physicians reported increased time pressure in ambulatory settings and feelings of less control at work, which was linked with burnout. Torn between clinical, operative, administrative, wellness, family, educational, and interpersonal duties, surgeons often feel as though there is not enough time. Laura Venderkam counters that we have, in fact,[ all the time we need](https://www.ted.com/talks/laura_vanderkam_how_to_gain_control_of_your_free_time?language=en) in our weekly 168 hours. By reframing our lives based on priorities rather than time units, Venderkam asserts that time will stretch to accommodate what we define as important. Rather than trying to “find” another five hours next week to write a grant, raise the task on your priority list. Conversely, when we do not have time for something, we do not prioritize the task or choose not to do it. Suddenly the narrative is switched. We are no longer victims of a limited commodity, but rather, in charge of when and how much energy we spend. Venderkam does not bother with small tips and tricks to shave minutes off the day. Instead schedule your week according to your priorities professionally, personally, and relationship-wise ahead of time, blocking off your priorities first. A big-picture mentality (write your successful performance review 1 year in advance) allows you to discover increments of wasted time for joy and personal well-being. Medical students, residents, fellows, and surgeons nationally across all subspecialities and level of professional experience are encouraged to find some time to weigh in. *Join* [*@womensurgeons*](https://twitter.com/WomenSurgeons) *with our moderators, Dr. Sasha Adams (*[*@SashaTrauma*](https://twitter.com/SashaTrauma)*) and Dr. Kimberly Hoang (*[*@KimberlyBHoang*](https://twitter.com/KimberlyBHoang)*), for a tweetchat about Time Management on Monday September 16th at 8pm Eastern Time by following #AWSchat. If you haven’t participated in a tweetchat with us before, check out this* [*tutorial*](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) *written by Dr. Heather Yeo (*[*@heatheryeomd*](https://twitter.com/heatheryeomd)*) to know more.* We will be discussing the following questions in the tweetchat: 1\. What are the areas you struggle with when it comes to managing your time as a surgeon? 2\. How do you decide which work tasks are lower on your priority list, and how do you ensure you do not spend too much time on these task? 3\. What tasks are worth delegating to others? How do you decide which tasks to delegate without jeopardizing outcomes/team morale? 4\. How does time management change during the transition from residency/fellowship to attending practice? Any tips for adjusting to this? 5\. How do you approach time management for self-care and personal/family life? ![](https://lh6.googleusercontent.com/Y9pIDz21nSfXojpqHNZRj-vC5PDYjC7H-6xDlDxxJaH4DLFVpKUC-nf9p-ZCYaPu002kCzC7exaHIcMrPwwo_zE-cTcs5Lgr4GCvW-x0vi246HQI54SXcybprvUrFbxkoJE8OLCW) Kimberly Hoang, MD is an Assistant Professor of Neurosurgery at Emory University Hospital and School of Medicine. Her clinical focus is in neurosurgical oncology, including the comprehensive management of malignant and benign tumors of the brain, spine and peripheral nerves. Her interests lie in device development and neurosurgical robotics. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, ILookLikeASurgeon, negotiating, surgery, time management, training, Tweetchat, womeninmedicine, womeninsurgery --- ### [A Stealth Misconception](https://blog.womensurgeons.org/a-stealth-misconception/) **Published:** September 13, 2019 **Author:** Blog Team **Content:** *By Monica Farrulla* Five years have elapsed since I took the Hippocratic oath and was bestowed the highly-coveted “MD” (Medical Doctorate) to follow my name. In these years of training I have experienced an almost-immeasurable number of emotions and I have pushed my body to its physical limits. The medical profession is relentless and there is never a paucity of sick patients in need of help. Through it all, in spite of the not-so-good days, I have come home feeling privileged and honored to have helped, and if lucky, to have cured someone in need. After all, helping other people was my reason for becoming a physician. The other day while casually perusing through my Facebook, I came across a post from a co-resident who was responding to an [article](https://www.nytimes.com/2019/08/21/upshot/medicine-family-friendly-profession-women.html) that spoke on the topic of medical profession and family planning. Intrigued by her strong reaction to this article, I decided to read it myself. In an instant, I comprehended her outrage as I found myself echoing her exact sentiments. In brief, the article suggests that electing medicine, in comparison to other professions, is the new gateway for women to have a profession and a family, as it demands less work hours and allows for more flexibility. Quite frankly, I was insulted by a multitude of statements and suppositions in this article, but I will address only three of these as they stood out the most. First, it states that women pick some subspecialties because they allow for flexibility, fewer work hours and more control of their schedule, whereas jobs in law and business have less of these advantages. I must respond that picking a specialty merely because of fewer work hours and improved control is not exclusive to medicine. Any professional can elect to quit and pursue an alternate profession that entails a better life style and less work hours. Someone that foregoes doing a specialty in oncology for geriatrics, as exemplified in the article, is merely quitting one job for another. The assumption implies that electing to pursue a career in medicine should not be about vocation or passion, but instead, should be based first and foremost on offered benefits. Second, it states that women are paid proportionately, which is a blatantly false statement. Even if the article was only speaking in context of hourly remuneration for so-called “shift work in medicine,” the pay gap between male and female physicians, as per a U.S. News report from 2018, is eighteen and thirty-six percent for general practitioners and specialty physicians, respectively. The fight for eliminating gender gaps in medicine is far from over. Third, the author implies that the increased number of women in medicine is due to closing gender gaps secondary to a move towards a shift-work model, which results in decreased schedule variability and increase in control. This asseveration probably proves to be the most egregious of all. I am presently in my sixth year of postdoctoral training and I can tell you for a fact that the female colleagues I have met in my ten years of medical training did not pick medicine because they viewed it as the professional means to a personal end. Quite the opposite, many of them were conflicted by the implications their professional life would have on their personal one. Having graduated from a medical class that was nearly fifty percent women and a surgical residency class that was one-hundred percent females, I can attest that the reason for more women in medicine is a mere reflection of changing times and not of closing gender gaps exclusive to medicine. Across the board, there are more women in the workforce today and in traditionally male-dominated fields than there were during my grandmother’s era. I would contend that the increasing proportion of female physicians with families has to do with an overall increase in the number of female physicians as well as a changing paradigm regarding social norms that expect only women to sacrifice professionally in order to stay home and raise the child/children. The journey towards becoming a physician is paved with arduous sacrifice and selfless endless hours of work. The years dedicated and debt incurred to achieve this honor and privilege is often overlooked by those far removed from the profession. This article reminded me how many misconceptions there exist about physicians, why I chose to be a surgeon and the sacrifices I had to make to get here. I believe medicine to be a profession that requires unending dedication and sacrifice because we are caring for a human being, whom irrespective of work hours and schedules, comes home with you at the end of the day. Shortchanging the lifelong oath we took when we became physicians and selling it as an easy option towards having a job and a family is upsetting and disrespectful. Women’s rights have come a long way, but the fight will need to continue until women in all professions are encouraged to pursue the career of their dreams without it being at the expense of their personal aspirations. ![Dr. Monica Llado-Farrulla](https://lh6.googleusercontent.com/GWLjXdUXn3SHiHAv4oxpEf_tF4N9uWlxNE-zVcDdg0xjiW2rl7wndDFgqEoCp-hRy3LA5tgh5QoVisDqJFbnsK_xTtr_vyRZPsXruJwm23-khrcqQ4ziI-3GiPGZ2b0-_8y-pO7w) Dr. Monica M. Llado-Farrulla recently started her plastic surgery training at the University of Pennsylvania after graduating from Tulane University’s general surgery program. She was born and raised in San Juan, Puerto Rico. Monica pursued her undergraduate studies at Boston College where she obtained a Bachelor’s in Biology and Chemistry. She subsequently returned to Puerto Rico to receive her MD from the University of Puerto Rico School of Medicine. Monica loves spending time with her pets, woodworking, car mechanics, and exploring new restaurants. You can find her on Twitter at [**@MFarrulla\_MD**](https://twitter.com/MFarrulla_MD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** gender differences **Tags:** bias, clinical practice, Gender Disparities, implicit bias, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [When the job of your dreams, isn’t.](https://blog.womensurgeons.org/when-the-job-of-your-dreams-isnt/) **Published:** September 19, 2019 **Author:** Blog Team **Content:** *By Melissa Alvarez-Downing* This time of year always brings me back to when I was starting a new job following fellowship training. After months of searching I’d found an opportunity close to home, with the promise of research and a busy clinical practice in my specialty. The opportunity was an ideal situation for me – or at least it seemed. However, several weeks after I started, a growing sense of apprehension slowly turned into a dreadful realization that my dream job, was in fact, not. While this was certainly not an overnight realization (I was there for nearly 4 years…), and hindsight is 20/20, there are three simple lessons I learned from that experience which I wish I had known beforehand. **Advocate for yourself….from the beginning.** We all are aware that women suffer from the “imposter syndrome” at a much higher rate than our equally trained male colleagues. However, countering that feeling isn’t only about knowing and believing you are more than qualified to be in a particular position. It’s also about advocating for yourself, establishing a presence and doing so in all instances from the very beginning. When I started my first job, I instinctively felt a need to fall in line, not speak up or cause any waves. Day after day, I arrived early, stayed late, and tirelessly worked alone on strategies to grow my practice. All the while, keeping my head down to avoid any disruption of the status quo or to come across as demanding, high maintenance, etc. One can imagine the shock I experienced when I was accused of not being available to cover my colleagues. Not only had I never said no to anything which was asked of me (resulting in an infinite list of useless ‘tasks’), but I had never actually been unavailable. Yet, I hadn’t established a significant presence in the practice and that made me a convenient target for criticism. Couple that with maternity leave and there wasn’t much else I could say. By the time I realized I was the only person who would be advocating for myself, my first year had passed and an undeserving perception about me had been formed. As a result, the many meetings I subsequently scheduled with leadership to establish a voice and express my concerns were answered with a lot of head nodding and followed by an equal amount of inactivity. Ultimately, I realized I should have approached my job as a sprint and leapt off the start line accelerating. Instead, I had approached it as a marathon, hanging with the pack and waiting to make a major move at the halfway mark. But by then it was too late. **Just because someone is in charge, doesn’t make them a leader for your success.** Don’t get me wrong, a lot of accomplished, well-respected people get put into well-deserved leadership positions based on their academic success. However, being in a leadership position does not necessarily mean those individuals have the skills, training or interest to help you advance your career. I experienced this the hard way at my first job. I was naively under the impression that working with a senior surgeon, who had obtained all of the accomplishments I aspired to, would translate into my success. Certainly, they’d want the same for me, right? The truth is, investing in someone’s career doesn’t happen by osmosis (I know this seems painfully obvious) and it takes a lot of time, commitment and energy to develop a junior faculty member. Not everyone is willing to adjust their schedule, campaign for you and include you on their projects to make that happen. Therefore, even if a new position has an assigned mentor or someone senior to help develop your practice, ensure they have the skillset and *time* necessary to invest in you. If not, seek out someone you identify with who does. This will ensure you don’t waste time with assumptions on your end (or theirs) about what your success looks like! **If things aren’t working, make a change.** Too often, particularly at the beginning of one’s career, there is a sense of wanting to stick it out to the very end, with hopes that ultimately, everything will work itself out. Queue the mantra, ‘there’s no such thing as a dream job.’ I think as a strong-willed, driven, committed person with a “never quit” attitude, it was hard for me to accept the realization that I needed to look for another job. I was not accustomed to giving up, having persevered through many obstacles in pursuit of a career in medicine. Yet, with all of the red flags present from the beginning, I should have questioned why I would want to stay. While making a change should be balanced with an attempt to ensure a situation is not irreconcilable, that is no reason to delay beginning the process for what your next career steps are. Waiting too long could mean losing an opportunity for something better. Just remember, every moment you are sitting in an unsupported position is lost time to advancing your career. And frankly, if there are that many red flags, why would you want to stay in the first place? In the end, the life lessons learned from my experience are simple – you are in charge of your own self-promotion, ensure you have the right mentors (coaches, advocates, etc.) in place to support your professional development and resist the temptation to settle – when the job of your dreams, isn’t. ![](https://lh3.googleusercontent.com/f6pwv_2_2EdDVd-K-qOI5MmNlY8wHJOqcG6xR_pPZVdyCvBxbw9hTH_UFTbJmRjV8P7r86cixBzbIRht5DXoobk0SciKthRdtyPtHXOHiMlbqb7J0cW4pbwiQu3-tWiq1vzOLIpm) Melissa M. Alvarez-Downing, MD, FACS, FASCRS is a well-supported and fortunate colorectal surgeon at Rutgers New Jersey Medical School, where she also serves as an Assistant Program Director for the general surgery residency. Having received a medical degree from Mount Sinai School of Medicine in New York, she underwent general surgery residency training at Saint Barnabas Medical Center and a clinical fellowship in colorectal surgery at Cleveland Clinic Florida. Her clinical interests include all aspects of benign and malignant colon and rectal diseases, colon cancer screening and implementation of enhanced recovery after surgery protocols. In her practice, Dr. Alvarez-Downing is committed to advocating for her mostly minority patient population by improving their experience and navigation through the healthcare system. She is actively involved in teaching and mentoring of medical students, residents and underserved Latinx students. She is a wife and proud mother to three young children. You can follow her on Twitter at [@AlvarezDowning](https://twitter.com/AlvarezDowning). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [The Off-Service Resident’s Guide to the Surgical Rotation](https://blog.womensurgeons.org/residents-guide-to-the-surgical-rotation/) **Published:** September 27, 2019 **Author:** Blog Team **Content:** *By Natalie Tully, MD, MPH* So, you find yourself a freshly minted doctor, headed off to Family Medicine, Urology, Radiology, or any other non-General Surgery residency, and yet here you sit stand through the 8th hour of a case that was posted as a 90 minute abdominal washout and wound vac exchange. How do you make time to study, and where do you even begin? Can you bathe in caffeine? Below are a few tips to help you navigate the weeks or months that you’ll be spending on service with us in surgery: 1\. Educational Resources a. Medical Knowledge: Remember-this isn’t your primary field, and everyone around you should be cognizant of that. You should look for resources that will help you to gain what you need from the rotation 1\. Quick Review: Fiser’s Review- Bullet points on major General Surgery Topics 2\. Deeper Dives: Cameron’s Current Surgical Therapy-Lighter on basic science than other textbooks, with more clinical focus. 3\. Try to get a few bonus points on rounds- Surgical Recall: Scattershooting pearls organized by subspecialty. ii. You don’t have to just read- [Behind the Knife’s](http://surgerypodcast.behindtheknife.org/) ABSITE reviews offer concise content that is pertinent to what can be expected of any resident to know or learn from General Surgery. Episodes are an hour or less and are available on a variety of platforms, including Spotify. b. Prep for the OR i. Zollinger’s Atlas of Surgical Operations-Short reviews of various surgeries with brief anatomy overview and operative indications. ii. Operative Dictations in General and Vascular Surgery- while this is intended as a guide to dictating various operations, it serves as a concise procedural guide that can be read prior to scrubbing in on a case to gain insight on the key steps and nuances of a procedure. 2\. Survival Tips a. Food & Drink: More than on other services, you may find it hard to find time to stop and eat/drink. Try to stock your white coat/bag/locker with nonperishable snacks that you can eat on the go. The last thing you want is to be unable to focus in a case because you’re severely hangry. Stay hydrated! It sounds so simple, but it’ll help keep you going through long days and combat lightheadedness in the OR. b. Self: Long hours and a stressful environment necessitate self care. Even though you may feel pressed for time, be sure to take even 10-20 minutes a day doing something that you enjoy. Ultimately, you’re a guest on our service, and having varied insight should ideally add to the educational experience for all team members, and improve patient care. Surgery is demanding, but be wary of letting yourself settle for a miserable experience-we do have fun sometimes *(typically scheduled for Wednesdays, 14:30-14:45)*. We’re glad to have you, and welcome to the jungle-for a few weeks, at least. What questions do you have for your time on surgery? Or what advice do you have to offer off-service residents? Answer in the comments section below! ![](https://lh5.googleusercontent.com/jOHkp2ofWo98XqxBwksmgMUqARP5Ezm93u8FOxH9s-iFmQQpOgIG8lF7hJn7Et4c-4n5zCRpukuttY6yV5EN1HRNy0276pu1ukS4Sl6O4Tzk7EuQ9FYAOoCyV2eKeWCVhHgTRcYR) *Natalie Tully is a General Surgery Intern at Texas Tech University Health Sciences Center in Lubbock, TX. She completed her B.S. in Human Biology at The University of Texas at Austin, and her M.D. and M.P.H. at Texas Tech University Health Sciences Center. She is cultivating her research interests, but would ultimately like to find ways to make her MD and MPH degrees intersect surrounding optimization of trauma systems and surgical education. In her free time, she enjoys running, barbecueing, and spending time with her dog, Sadie and fiance, Greg. Find her on Twitter:* [*@utully13*](https://twitter.com/utully13) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [An Incomplete Solution](https://blog.womensurgeons.org/an-incomplete-solution/) **Published:** October 2, 2019 **Author:** Blog Team **Content:** *By Elizabeth Lim* As a medical student and an aspiring surgeon, I enjoy when there is a definite solution or an answer to a problem. The level of satisfaction knowing that something is fixable is immense, especially when it comes to patient outcomes. The ability to help and provide care to a patient by resolving their health issues is one of the most rewarding feelings one can experience. However, I realize that is not always the case, whether it’s in surgery or any other specialty. During my very first rotation of third year of medical school, I quickly learned about the difficulty of incomplete solutions. One particular issue comes to mind-the issue of emergency dialysis in undocumented patients with end-stage renal disease (ESRD). This issue became a hot topic for me as it tends to spark a spectrum of emotions that ranges from anger to helplessness. I will never forget seeing patients come into the Emergency Department (ED) on the brink of death with severe electrolyte abnormalities, and all we could do was give them a few rounds of dialysis before sending them back home. The most difficult part was that we would discharge them despite being fully aware that they would be back in a couple of days or weeks. This wasn’t fixing the problem, it was putting a band aid over a gushing, open wound. However, in the majority of the states, relying on emergency dialysis is usually the only option available for undocumented immigrants with ESRD Even though [studies ](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2665387)have demonstrated that emergency dialysis compared to scheduled dialysis is associated with a higher mortality rate, higher hospital costs, and increased [emotional ](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2601078)distress for both the patients and the doctors who take care of them, state funding for scheduled dialysis for this population remains either very limited or nonexistent. Relying on emergency dialysis is a lose-lose situation, no matter the point of view. One of the most frustrating things about this situation is that there is a clear solution to the problem. In fact, a handful of states like California and Arizona have already taken action by redefining emergency care and extending state Medicaid funds to cover regular dialysis for undocumented immigrants. This issue, amongst many others, seems to be an uphill battle. But, as I leave this rotation and head into the next, I am reminded of the importance of patient advocacy, not only in the hospital but also in outside settings such as governmental instances. In addition, I am reminded that patient advocacy isn’t restricted to just one lane but can (and should) involve doctors, residents, and students from multiple specialties. Lastly, I am reminded that the mental and ethical challenges of incomplete solutions should inspire us to keep searching and fighting for a better answer, especially when they have the ability to evoke such strong emotions. ![](https://lh4.googleusercontent.com/pQKZsHeEzTc-Wmh8v_H_G2iVo_1-RRiSkU5I7piGfti2KOnx-syonccF3Ypsj8F7d9d0kl1hDjC2WTp06HyzKpqhEGFzvlZx2htU2Yre1ZK1Xb3C4CFaSfMoaOYIqB6S_-9G46P9) Elizabeth Lim received her B.S. in biology with a minor in French from Texas A&M University, and is currently a third year medical student at The University of Texas Rio Grande Valley School of Medicine. She has a passion for the surgical field, as well as for research. She is currently involved in research regarding endocrine surgery and diabetes. Elizabeth strongly believes in and tries to emphasize the importance of women working together to support each other, and will be the founder of the AWS chapter at her medical school. In her free time, she enjoys exploring new restaurants and cities, as well as spending time with her family and dog. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWSBlog, womeninsurgery --- ### [Fixing the Leaky Pipeline](https://blog.womensurgeons.org/fixing-the-leaky-pipeline/) **Published:** October 9, 2019 **Author:** Blog Team **Content:** *By Daisy Cruz* As a Latina in medicine, I am acutely aware of how many of the spaces I am occupying on a day-to-day basis have not been created for women who look like myself. I find ways to make myself present in a room, by questioning the status quo of how certain patients are being delivered care, be it by their race or socioeconomic status. This role has mostly been motivated through my own personal experiences as a Latina from South Central, Los Angeles. Thus, as I continue my aspirations in the surgical field, I have begun to realize the disappointing number of underrepresented minorities. This became obvious to me during my 3rd year of medical school, as I began to look for mentors. By finding these mentors it would enable me to feel more comfortable, sharing certain experiences with this individual, that others may not understand as well. They could enlighten me on how they overcame barriers on their way to becoming a surgeon. However, as I continued to look, mostly through residency websites and, Instagrams’ of female physicians, I couldn’t help but realize the continued lack of diversity in the surgical field. This March during the ACS conference for the Northern California Chapter, I was able to attend a workshop on diversity. I listened to Dr. Andre Campbell, trauma surgeon at UCSF, talk about the leaky pipeline. The pipeline, as he described it, was a descriptor of how we lost underrepresented minorities in medicine from kindergarten to medical school. Let me tell you, I heard about the leaky pipeline before, but this time, I realized as I sat in a room of mostly white male surgeons, with my 3 friends who also identified as URM, how lucky I was to have made it this far. Was it by chance? No! I think all three of us knew how hard we had worked just to sit in that room. All the people back home waiting for us to become surgeons and care for the individuals of our community. That is why I have and continue to make it my mission to mentor others and bring these conversations to the table. I have done it this year, by working with the amazing medical student board here at AWS. I helped to create a formal role in diversity and inclusion, so that we can continue to have these conversations of race and its role in the surgical field. [*Shaking up residency program admissions*](https://www.aamc.org/news-insights/insights/shaking-residency-program-admissions), a recent article published by AAMC, is a huge step forward. First and foremost, I want to acknowledge that this is the first time the program at the [University of Pennsylvania ](http://www.uphs.upenn.edu/surgery/Education/general_surgery/application_process.html) has an African-American program director in the history of the department. I’ll repeat that again for us to let it sink in, HISTORY of the program. Next, the program is beginning holistic review of its residency applicants. The training house staff is being trained on unconscious bias, and they have involved more reviewers in the application process, other than its program directors and other select staff. As an URM student/applicant, this is a huge deal. During the application process, you begin to think about your statistics and whether you’re competitive enough for these programs. The fact that a program is going out of their way to look for applicants who are URM is a step in the right direction. It means that we are working towards fixing this leaky pipeline. It means that as we increase the number of surgeons of color, we will also improve the surgical outcomes of our patients. I hope that other residency programs will begin to seek out more opportunities to increase the diversity of their program: be it with re-visit days for URM applicants, unconscious bias training for its house staff, or simply increasing its mentorship at its affiliated medical school. [The face of medicine is changing](https://blog.womensurgeons.org/women/the-changing-face-of-medicine/), and slowly, we are increasing the number of URM medical students, and our residency programs should begin to do the same. ![](https://lh6.googleusercontent.com/ncxlgM80jW_URgTqf1TX4wk-FIIeWZVwISTlINzLpCCkJR0_s4USC-2cCXLg7hrxKff58dRvXs98jA78f4luOU1GIn3rtOyZeFk9LF3LY9732SrE2JAIhVsErRos8Uvgyjjw0_bH) Daisy is currently a fourth year medical student at the University of California-Davis. Prior to medical school, she completed her undergraduate studies at UCR where she obtained a dual degree in Biological Sciences and Cell, Molecular and Developmental Biology. Following her undergraduate studies she worked at AltaMed Health Services in Los Angeles, as an AmeriCorp member for 2 years where she led a reproductive health clinic for teens and taught sexual education at local high schools. Her passions include working with the underserved Latino population, and increasing the diversity of underrepresented minorities in surgical specialities. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Dream Audaciously](https://blog.womensurgeons.org/dream-audaciously/) **Published:** October 17, 2019 **Author:** Blog Team **Content:** *By Sharon Stein* When did being ambitious become a bad thing? When I was growing up, my three favorite heroes were JFK, Martin Luther King and Mother Theresa. I remember my early reader book series that described their lives in 1st grader terms and wondering how a little kid like me could end up growing up to make a big difference in this world. I think that every kid in my 1st grade class wanted to be a president or an astronaut. We all dreamed that we could be anything that we wanted to be. Somewhere along the way it seems that we have been discouraged from big dreams. Being ambitious has somehow become a bad word. I don’t hear my daughter or her friends having these big goals, big audacious dreams, and it makes me sad because they may feel like having those big audacious dreams is just too much. Somehow, we are disdainful when someone wants to be a chief, chair, president, or save the world. We need all of those people, and we all need dreams. It is ok not to want to be president of the US, or AWS, or ACS. It is ok not to invent the latest surgical technique or rid the world of cancer, and it is ok not to reach your goals or decide that what you wanted 6 months ago, 6 years ago or 36 years ago isn’t what you want anymore. Your goals may change along the way. However, it is not ok to give up on having goals, being strategic, and being ambitious. This year’s AWS Conference in San Francisco is all about Sculpting our Future, as individuals, as women surgeons, and as professionals. Sculpting our Future means that we are in the driver’s seat. We can’t sit in the back seat and expect some Lyft driver to take us where we want to go. If we want to improve our profession, we are going to need to plot, negotiate, and plod in our fight to increase diversity within surgery. We are incredibly honored to have an all-star group of speakers coming to enlighten us about branding, visioning, dreaming, and designing our future. It won’t happen by osmosis; it will only happen as an active process. Many have said that improving as women isn’t enough, and that is certainly true. AWS isworking towards making differences within our profession – bringing up issues such as [pay](https://www.womensurgeons.org/page/SalaryStatement?) [parity,](https://www.womensurgeons.org/page/SalaryStatement?) sexual harassment, discrimination, and microaggression on a national level to ensure that these issues are part of the conversation within surgery. We also need to be ready as individuals. We need to dream audaciously, not just for ourselves but also for our profession. We need to work hard to make these dreams come true or forward our agendas. Join us at AWS, at [our conference](https://docs.google.com/document/d/1fNjdCX34sTwyZX9u8kqFJg1K1NZpi5C5daA6mX9a96E/edit) in San Francisco on Saturday October 26th at the Parc 55, at [our networking breakfast at Terra gallery](https://www.womensurgeons.org/page/SocialEvents) on Tuesday October 29th, or by renewing/completing your [membership application](http://www.womensurgeons.org/page/MemCategories). And dream audaciously. ![](https://lh5.googleusercontent.com/BXwZgxi0LeSctPpV5G5gnPBD4Vhvy3n89C4H6ntWThOz-4dsUfvu9wS8qMIOSZL4th11z_X6ls0kBYjKo538Hk9Ew2UZd3xyWKUZ25hkLGkSbmBdxLe6GwhTPZZziL_p4FcpR95P) Sharon L. Stein, MD, FACS, FASCRS, is a colorectal surgeon at University Cleveland Medical Center (UH) and Associate Professor, Surgery at Case Western Reserve University (CWRU) School of Medicine. She is also the Director of UH RISES: Research in Surgical Outcomes and Effectiveness Center. She was recently appointed at the Murdough Master Clinician in Colorectal Surgery for outstanding contributions to her patients and University. She is the President elect of the Association of Women Surgeons. You can find her on [twitter](https://twitter.com/slsteinmd1). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** leadership **Tags:** #DreamBig, AWSBlog, womeninmedicine --- ### [Leading by Example: Pioneering Women Chairs of Surgery in the Bay Area](https://blog.womensurgeons.org/leading-by-example/) **Published:** October 24, 2019 **Author:** Blog Team **Content:** *By Hillary Braun and Marissa Boeck* ![](https://lh5.googleusercontent.com/UxeKb9pCcKj0jOdrR-vLckQ414wXTyM7ogjR4rpcaSuJ9yrYUPCy3lD5MzspUIMDeDfqN05sFRduX4sVNZfvVpc9tMvX26QaTXjg7UtQqVyNpx0FyD8wo1BLwJv20kNdx1ApdDix)Dr. Nancy Ascher ![](https://lh6.googleusercontent.com/hbvGVgoFtvukucwX3aAmhHljdC6QEM8KpE9GZrg96yQjbB36_lPHs1fvHQYXMde7LyVDTeo-_t-HNVo5tAYTsBf9kGZr6bBMLO4ApxYFYbmXySNKvmjfr6nJefpx79Ukd_Kri7Iv)Dr. Diana Farmer![](https://lh5.googleusercontent.com/am9DdyvLZyQjX6xsSKMuGPsfUU8zp1Jkvug9Kd8j348dt2f6mz_LTFHcOTg1RE_gCPA6cXtpfFmsffiZgmyt-_Dsp_usCMKIe_RXxlIUz6D6Ll-IemngFPqq9xt0l1i9TwPKYbND)Dr. Mary Hawn ![](https://lh5.googleusercontent.com/FGIcmA4xqUZi1j5gv4C5HGEDSHs0qL0OCvJkkiDpUUQ7J-12-8f0aZPql53uqfhLtJu5Xlj2KzdQMPXR2BAVeLSuSQu6eKiDI0X6J7VS2G78H5GBbJY-RbSo1vEC8TdqD_iZh46s)Dr. Julie Ann SosaImpressively, Stanford University, University of California, Davis (UCD), and University of California, San Francisco (UCSF) all currently have female chairs of surgery. These three women make up 14% of the[ 21 female surgery chairs present nationwide](https://www.womensurgeons.org/page/FemaleSurgeryChairs). As the Bay Area prepares to host the annual meetings of both the[ Association of Women Surgeons](https://www.womensurgeons.org/) (AWS) and the[ American College of Surgeons](https://www.facs.org/) (ACS) at the end of October, there seems to be no better time than now to honor and highlight this powerful trio of American surgeons who are breaking barriers and advancing the surgical leadership landscape. The story of women in surgical leadership in the Bay Area begins with[ Dr. Nancy Ascher](https://transplant.surgery.ucsf.edu/meet-the-team/transplant-surgeons/nancy-l-ascher,-md,-phd.aspx), who became Chair of Surgery at UCSF in 1999, making her one of just four female chairs in the United States at the time. A world-renowned transplant surgeon, revered for her sharp clinical acumen and technical prowess in the operating room, Dr. Ascher led UCSF by example from 1999-2016. During this time, she also grew the Department into an oasis for female surgeons, with women currently representing more than 30% of the faculty and over 50% of the trainees in the surgical residency. In 2018,[ Dr. Julie Ann Sosa](https://surgery.ucsf.edu/faculty/general-surgery/julie-ann-sosa,-md,-ma,-facs.aspx) became Chair of Surgery at UCSF, making her the first woman to succeed another female chair of surgery in the country. She joined the local company of[ Dr. Diana Farmer](https://health.ucdavis.edu/publish/facultybio/surgery/faculty/1577), Chair of Surgery at UCD since 2011, and[ Dr. Mary Hawn](https://profiles.stanford.edu/mary-hawn), who was named Chair of Surgery at Stanford in 2015. Dr. Sosa is an endocrine surgeon who trained at Johns Hopkins University and the University of Oxford, and came to UCSF from Duke, where she was Chief of Endocrine Surgery and Leader of the Endocrine Neoplasia Diseases Group, as well as Director of the Surgical Center for Outcomes Research. Dr. Farmer is a pediatric surgeon who was Chief of Pediatric Surgery at UCSF before beginning her tenure as Chair at UCD. Dr. Hawn is a minimally invasive foregut surgeon who trained at the University of Michigan and came to Stanford after nearly 14 years at the University of Alabama, Birmingham. To gain insight into their successes and challenges, we asked each of these remarkable women two questions: **1)** **What was the most significant challenge you faced on your path to becoming a chair of surgery and how did you overcome this?** **DF:** *“The hardest part of becoming a chair at UC Davis was leaving UCSF which had been my surgical home for so long. The good news has been that I am still able to serve the UC system and have maintained many friendships and collaborations with colleagues at UCSF. UC Health is at its strongest when working together.”* **MH:** *“My husband is an otolaryngologist and we began our academic careers at the same time. As we both became more successful and advanced in our fields, we each had individual opportunities to consider, but it was a challenge to find opportunities for both of us. We were also incredibly happy in our positions and our community. When the opportunities came along at Stanford, it was not an easy choice. It took a lot of negotiations, not only between us, but also our 14- and 16-year-old kids. We leaned on many friends, colleagues and mentors to help us think through our decisions and give us guidance on the transition. Having a network of friends and mentors is incredibly important as leadership can be lonely.”* **JAS:** *“We all know the adage “don’t judge a book by its cover”, yet we still do so, often. I am a woman, 5’5″ tall, thin, and younger appearing than stated age. My youthful look has been an impediment, frequently being misjudged up front as a proxy for potential inexperience. I have had interviewers look incredulously at my C.V. and then back at me, as if they were trying to reconcile their own unconscious bias with the evidence presented before them. I do realize that (particularly) women in our society are very much judged by their appearance, and so much emphasis is placed on making sure we “look the part”, “fit in”, and conform to societal norms. As a chair, I am now much more aware of my own biases, actively trying to avoid making assumptions about people based on cues such as looks, dress, mannerisms, accents. etc. We all have implicit biases, but making concerted efforts to bring these to the forefront and recognize them intentionally, is the first step towards conquering them.”* **2)** **Since becoming a chair of surgery, what one or two tasks are you most proud of accomplishing?** **DF:** *“Being chair of the department of surgery is one of the most fabulous jobs I can imagine. For me, it was an opportunity to take an educationally exceptional department and transform it into a multidisciplinary specialty, high-tech, complex surgical department. It’s been fun to bring a new level of skill to the Sacramento region. One of the great advantages of having a health system at UC Davis is leveraging the resources of the Davis campus. The veterinary school, the school of engineering and bioengineering, the public policy institute, all the many areas of expertise leveraging them in the service of human health. We have opportunities here at UC Davis Health that are unparalleled and have impact for vast reaches of inland California.”* **MH:** *“A. Creating a health services research center to nurture and support the research of our faculty and trainees and* *B. Enhancing the culture of inclusion by creating several vice-chair leadership roles for the department to carry forward our important missions of research, education and clinical care as well as prioritizing diversity, inclusion and wellness”* **JAS:** *“My proudest accomplishments over the last year and a half (Has it been that long? Time flies when you are having fun!) have been building an organismal rather than hierarchical structure in the department. We are empowering and developing faculty into leaders in an open way, establishing inaugural vice-chairs and new surgical divisions, assigning terms and stewardship reviews, providing coaching for our new faculty leaders and ongoing skill-building opportunities for all. We are creating a culture of transparency and equity around salaries, promotions, career opportunities, and issues of diversity, equity, and inclusion.”* Particularly over the past 20 years, women have continued to gain power and momentum in surgical fields, which is exemplified by this incredible culture of leadership in the Bay Area. As we come together at the end of the month to share our scientific discoveries and connect with colleagues from across the country through the ACS and AWS meetings, we hope these stories will serve as a reminder that, as women in surgery today, we are truly standing on the shoulders of giants. ![](https://lh6.googleusercontent.com/nWoTMS03oAU36cEQHg2HZ70pgJsWPrww7eztfYzk8siLjMZJasJ2-wy-TZqG97juhjZ5Y1l9NDtAJTRDh7KAknTbhaICLjxKlmFdjKz4dVJ1mhqCoehh7K3GliRxoe6ih1DJ25uw) Hillary J. Braun MD is a fourth year general surgery resident at the University of California, San Francisco (UCSF) who is currently a research resident in the Division of Transplantation. She is a graduate of Stanford University and UCSF Medical School. Dr. Braun plans to pursue an abdominal transplant fellowship following completion of her training in general surgery. She is interested in living donor liver transplantation, liver allocation policy, and liver regeneration. Dr. Braun is also a member of the UCSF Muriel Steele Society Council, serving on both the Programming and Medical Student Committees. ![](https://lh3.googleusercontent.com/CmbXBY23KoDxWD16lom060fzk4P_fKqNVfT33nlS8nnhiI04Dzq4M0Ph2StoVskSzb0uTePJ7sUw4JKaUByP_5w97t4g3RLBO7tx9-B_oEqtVM1xGqq02MXRH55Wf6NCdLfKKnpo) Marissa A. Boeck MD, MPH is a Clinical Instructor and second-year trauma fellow at Zuckerberg San Francisco General Hospital/University of California San Francisco (UCSF). She is a graduate of the City University of New York Macaulay Honors College at Hunter College and Weill Cornell Medical College. Marissa completed her general surgical residency training at NewYork-Presbyterian Hospital/Columbia. She is passionate about diversity in the surgical workforce, the power of social media in medicine, and global public health, especially as it relates to injury prevention, emergency response, and trauma and surgical system strengthening in low-resource settings. She is also a member of the inaugural UCSF Muriel Steele Society Council, serving on both the Communications and Programming Committees, whose mission is to inspire, support, and promote women surgeons so they can thrive at all stages of their careers. You can find her on Twitter at [@KickAsana](https://twitter.com/KickAsana). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** #AWS19, AWSBlog, womeninmedicine, womeninsurgery --- ### [My First AWS Meeting](https://blog.womensurgeons.org/my-first-aws-meeting/) **Published:** November 1, 2019 **Author:** Blog Team **Content:** By Kristin Rojas Annual medical conferences are not only an opportunity to stay up-to-date with developments in your prospective field, but also a convenient way to catch up with inspirational friends and colleagues. The [Association of Women Surgeons](http://womensurgeons.org) (AWS) Meeting in San Francisco this past weekend was no exception. With a theme of “Sculpting our Future”, it was full of sessions led by dynamic, inspirational women in surgery sharing personal experiences and insightful career mentorship. There were a wide range of attendees: from established faculty and past Presidents of the American College of Surgeons to fellows, residents, medical school and even high school students. The day began with inspirational words by AWS President Dr. [Sharon Stein](http://twitter.com/slsteinmd1), followed by Dr. [Carla Pugh](http://twitter.com/carlapughMDPhD), who shared her own journey sculpting her brand. She encouraged us to listen to those that introduce you, even if the introduction is incorrect, as your brand is what people say about you when you aren’t in the room. She shared with us how her own brand needed “chiseling”, and that when even your biggest supporters ask painful questions…don’t kill the messenger. A panel of four surgeons followed, sharing valuable insight into their own career paths. Dr. [Dana Telem](http://twitter.com/danatelem) encouraged the audience to follow their heart, while Dr. [Maya Babu](http://twitter.com/mayababuMD) described the potential benefits of a more fluid market in medicine in a world where we might be more comfortable with risk. Dr. Karen Brasel described how writing a vision statement for her desired position helped her shape her own career. Dr. [Julie Ann Sosa ](http://www.twitter.com/jasosaMD)shared that her own path was not the straightest line, but that we can learn from inefficiencies. ![](https://lh6.googleusercontent.com/LYCAxgR_DwvAg1UvCkNk-oQOai_IPb7Hv-HB_d2LfG9c3hufIWP6YVWxFgzKwpJJNiE5w43Q1MW4_5oclMkmFSLV9XG8Nb_2j5_5C_AyInempBeSVRXOpBs2H-v4HulNRrGrCoUV) Dr. Julie Freischlag ([@jfreischlag)](http://www.twitter.com/jfreischlag) provided the audience with strategies for addressing microaggressions in a tactful way.I personally had the opportunity to share the stage with two other [@womensurgeons](http://twitter.com/womensurgeons) researchers, Dr. Laura [Rosenberger ](http://www.twitter.com/rosenbergerMD)from Duke University and Dr. Alicia Mohr from University of Florida. Presenting our opioid-sparing initiatives from Maimonides Medical Center in front of so many game-changing surgeons that I admire, topped only by being voted “Best Paper” by my peers, was the highlight of my year. The day finished with a collection of S.H.E. Talks, where the safe space created throughout the day fostered an environment of diversity, equity, and inclusion. The inspirational day left attendees with a better understanding of where we have been and where we are going, and the future of women surgeons is bright. ![](https://lh6.googleusercontent.com/XdYbvvmme-fI_m8f0lRT-Hq5apa8vKy69AojnHc08onK05obnhS5TmzE9alUp2zjhdSvHe-EG0SjfekKtw1XGHePK-oIZiy0TDRVzANCPqAR1cgJ3i61CKSw95HERFQZwhTukIhL) Dr. Kristin Rojas is a fellowship-trained breast and gynecologic surgeon at Maimonides Medical Center in Brooklyn, New York. Originally from Texas, she attended the University of Texas Southwestern Medical School in Dallas, completed residency at Brown University, and later the Society of Surgical Oncology Breast Fellowship at Brooklyn Breast Program of Maimonides. Her research interests include studying the implementation of opioid-minimization ERAS protocols, along with cancer survivorship and sexual health during and after treatment. You can find her on Instagram and Twitter [@kristinrojasmd](http://twitter.com/kristinrojasmd). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** #HeForShe, AWS2019, ILookLikeASurgeon, medstudents, WomenSurgeons --- ### [SUCCESSFUL GRANT APPLICATION WRITING II](https://blog.womensurgeons.org/grant-application-ii/) **Published:** November 11, 2019 **Author:** Blog Team **Content:** *By Luz Maria Rodríguez* *This is the Part II of the **Grant Writing** series published on* [*Jan 14, 2019*](https://blog.womensurgeons.org/research/grant-application/)*.* Funding for research grants is made available by various institutions to help research efforts made by individuals, universities and other groups. Research can encompass many subjects such as literature, basic and social sciences & technology. To succeed, the physician-scientist needs to think about diversification and flexibility in their interests, developing multidisciplinary and multi-institutional projects. As a result, he or she can therefore engage a broader base of stakeholders that includes patients, colleagues or other populations of interest in another country or continent. Research funding comes from three major sources – Government (via agencies, universities, institutions), Corporations such as subspecialty societyand Private foundations given directly to the individual or via institutional funds. The key to obtaining any funding, no matter what the source, is a well-formulated grant proposal. A review of opportunities to develop and hone their grant-writing skills is provided below and can be reviewed in detail in the previous blog article of this series, published in [Jan 14, 2019](https://blog.womensurgeons.org/research/grant-application/). Federal funding for scientific research is an important cornerstone of societal progress, economy, sustainability, health and well-being. A nation’s scientific knowledge, competitiveness, and contributions ultimately can be measured by the amount and type of funding provided for research. Accordingly, governments prioritize meritorious and strategic distribution of public funding in support of the best science, often in accordance with other national goals to promote diversity and regional wealth distribution. This article will discuss the various research grants at the NIH which is the model used by others when discussing grant types. The Information is publicly available at <https://grants.nih.gov/grants/oer.htm> , but I decided to dissect out and highlight those areas that are directly pertinent for “busy” investigators such as surgeons. **Grant Process Overview** Repetition is the key to learning: this [link](https://grants.nih.gov/grants/grants_process.htm), [video](https://www.youtube.com/watch?v=rNwsg_PR90w) and the PDF Grant Process Overview emphasize the importance of the Grant Process. ![](https://blog.womensurgeons.org/wp-content/uploads/2019/11/image-845x1024.png)Source: [https://grants.nih.gov/grants/grants\_process.htm](https://grants.nih.gov/grants/grants_process.htm) **Type of Grant Programs at the NIH** [https://grants.nih.gov/grants/funding/funding\_program.htm](https://grants.nih.gov/grants/funding/funding_program.htm) **Research Grants:** 1\. The following represent frequently used research grant programs. A [comprehensive list of all activity codes](https://grants.nih.gov/grants/funding/ac_search_results.htm) is also available. Important: NIH Institutes and Centers (ICs) may vary in the way they use activity codes; not all ICs accept applications for all types of grant programs, or they apply specialized eligibility criteria. Look closely at funding opportunity announcements (FOAs) to determine which ICs participate and the specifics of eligibility. **2.** **Prototype Grants Funding by the NIH** - [Research Grants](https://grants.nih.gov/grants/funding/funding_program.htm#RSeries) **(R series)** - [Career Development Awards](https://grants.nih.gov/training/careerdevelopmentawards.htm) **(K series)** - [Research Training and Fellowships](https://grants.nih.gov/training/nrsa.htm) **(T & F series)** - [Program Project/Center Grants](https://grants.nih.gov/grants/funding/funding_program.htm#PSeries) **(P series)** - [Resource Grants](https://grants.nih.gov/grants/funding/funding_program.htm#Resource) **(various series)** - [Trans-NIH Programs](https://grants.nih.gov/grants/funding/funding_program.htm#Trans) - [Inactive Programs (Archive)](https://grants.nih.gov/grants/funding/funding_program.htm#Inactive) **3. Grants based on Training Level: Click at the far right under *Color Code Boxes*** [https://grants.nih.gov/grants/funding/funding\_program.htm](https://grants.nih.gov/grants/funding/funding_program.htm) **4.** **Abbreviations to know:** [https://grants.nih.gov/grants/policy/nihgps/html5/section\_1/1.1\_abbreviations.htm](https://grants.nih.gov/grants/policy/nihgps/html5/section_1/1.1_abbreviations.htm) **5. Grant Summary:** [https://grants.nih.gov/grants/funding/funding\_program.htm](https://grants.nih.gov/grants/funding/funding_program.htm) ![](https://blog.womensurgeons.org/wp-content/uploads/2019/11/Screen-Shot-2019-11-11-at-11.05.10-AM-1024x439.png)Reference: [https://grants.nih.gov/grants/funding/funding\_program.htm](https://grants.nih.gov/grants/funding/funding_program.htm)Additional resources [NIH Grant Writing Workshops in 2019](https://regionalseminars.od.nih.gov/baltimore2019/welcome) [NIH Faculty Sponsored Grant Writing 2019](https://www.sbas.net/annual-meeting/#register) [Grant Writing for Success NIH by Dr. Paula Stricklan](https://www.youtube.com/watch?v=EX4gO69AGo0) [The Grant Application Writer’s Workbook, 2018, ](http://www.grantcentral.com/workbooks/national-institutes-of-health/)Russell & Morrison **The Elements of Style, 4th ed**. By Strunk & White [Successful Grant Application Writing](https://blog.womensurgeons.org/research/grant-application/) Join [@womensurgeons](https://twitter.com/WomenSurgeons) along with our moderators, Dr. Carrie Sims ([@carriesims20](https://twitter.com/carriesims20)) and Dr. Genevieve Boland ([@gmboland](https://twitter.com/gmboland)), for a tweetchat about Grant Writing (Part II) on Monday November 18th at 8pm Eastern Time. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. **We will be discussing the following questions in the tweetchat:** 1. What are some features of a successful grant application? 2. What are the reviewers looking for? Does this vary based upon the type of grant? 3. What are some resources for beginners? 4. What are important things to know about the grant review process? 5. Who should you include on your grant? How can you find mentorship/collaboration? 6. What are the most common pitfalls to avoid when writing a grant application? ![](https://lh4.googleusercontent.com/N3TpBJuQ4GzkTNfmKfLQjMgKRfReL4y9ErckB347im60pkPm5tH6m86emIftYLeyl9JOKWwuU_u7JherLyDevylNGOriNKtorHC34cZjMgdX8staZtHO_WMRlaAOyLakRO4N_SrD) Dr. Luz María Rodriguez is a dual fellowship trained surgical oncologist and colorectal surgeon. She works at the National Cancer Institute (NCI) Division of Cancer Prevention (DCP). Prior to joining the DCP she spent nearly a decade as a translational physician-scientist in the Genetics Branch at the NCI. Her lab studied genome-wide gene expression profiles in colonic mucosa of populations at risk. This expression profiling created a foundation for biomarkers of early colon cancer detection and prevention. She developed a Clinical Cancer Genetics Program devoted to risk surveillance, assessment, genetic testing, counseling, prevention and targeted intervention for individuals at increased risk for specific cancers. At DCP, Dr. Rodriguez supports ongoing clinical trial efforts of the NCI Division of Cancer Prevention Early Phase 0-II prevention trials through protocol development, scientific review, strategic planning. DCP’s early phase clinical trials fill the void between preclinical studies and Phase III. The Early Phase trials places emphasis on intervention effects on at-risk tissue-intensive tissue collections (e.g. biopsies), invasive biomarker monitoring. Dr. Rodriguez oversees chemopreventive and treatment trials in organ sites such as the liver, pancreas, stomach, and colon using study agents such as vaccines, and drug agents such as Simvastatin, Berberine, Curcumin, Metformin, Erlotinib and Aspirin. She also serves as a consultant nationally and internationally with various scientific and clinical groups with special focus on high risk cancer families, cancer immunoprevention and health disparity with the hope of narrowing the gap in cancer intervention. Dr. Rodriguez is a senior faculty and surgeon at the Uniformed Services University of the Health Sciences (USUH) and Walter Reed National Military Medical Center (WRNMMC) serving domestic and foreign military families in the area of GI diseases, pelvic floor disorders, soft tissue sarcoma, breast and anorectal diseases. She also trains medical students, residents and fellows in surgery, oncology and cancer prevention. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* --- **Categories:** AWSchat **Tags:** academic practice, academic surgery, AWSChat, funding, grant writing, ILookLikeASurgeon, physician scientist, research, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Bad Mentors](https://blog.womensurgeons.org/bad-mentors/) **Published:** November 14, 2019 **Author:** Blog Team **Content:** *By Carolina Torres Perez-Iglesias* Throughout our lives we meet amazing people that connect with us in meaningful, unexpected ways. They are able to transform our previous ideas into new and exciting aspirations. Medical school and residency are certainly no exception to this, especially in an era when comprehensive feedback is encouraged and sometimes even mandated. We aim for valid and well-reasoned opinions that allow us to continue improving and bring us closer to our goals. Yet we don’t always find this. Frequently, we encounter a different kind of mentor. The kind who miserably fails to empathize with our beliefs and tries to force their perspectives into our plans, leaving us feeling frustrated and confused. However, it is through these experiences that we can also learn how to acknowledge negative perceptions and use these to reshape our confidence. This is why we need the bad mentors. By the time I completed my medical studies in Latin America, I had encountered a fair number of similar unpleasant interactions. At that time, most positions of authority were occupied by men, and the gender gap between female and male physicians was just starting to change. I received many unwanted sexist opinions regarding the role of women in surgery and I was expected to be intimidated by a career that many considered “unsuitable for a girl” and a “waste of years and resources”. These so-called mentors believed they had the ultimate prediction about my life as a surgeon and a woman, condemn the possibility of a successful work-life balance. I wasn’t being judged by my abilities or my knowledge but primarily by my gender, which made me feel uncertain and anxious regarding my future plans. Thankfully, I realized that my approval-seeking behavior was not allowing me to assimilate these negative comments correctly. During these years, I also met incredible role models that supported me in pursuing a surgical career abroad and continued to teach me how to transform negative criticism and harmful stereotypes into incentives to prove the doubters wrong. Medicine is a field that demands we engage in continuous learning and we must also learn to find value in our interactions with others, both positive and negative ones. Confronting differing ideas is the exposure therapy we need to make us feel more comfortable with our own fears and goals. The motivation to stay committed to a task will grow as a result of the intensity of our desire to achieve that goal and the expectations that we create for ourselves. Negative feedback is not harmful when we use it to reinforce our passion and keep us on track with our actions. Positive mentoring helps reassure us to continue our hard work and keep aiming high, but negative mentoring is indispensable to challenge our expectations and goals. The self-improvement circle can only be completed when we find that balance. ![](https://lh5.googleusercontent.com/1_tO9063K4HWglSwZAldaZ35LgFU7spx_-Ptr6fyrnUcbAR64rI9i_rMvgZh9Vdrb9kSb0OQ_3weqY8dmHps6xRAvN5XjhcS3cJusbfEHjMjG4JVsbs02sW9qMCNmxCLWYotkVgs) Carolina Torres Perez-Iglesias MD is a General Surgery resident at Boston Medical Center. She is originally from Lima, Perú, where she completed medical school at the Universidad Peruana Cayetano Heredia. She is invested in pursuing an academic career in surgery with a specific interest in global health and finding a work-life balance between surgery, gardening, pet-parenting, cooking and her early modern art affection. You can find her on Twitter [@cucuTPI](https://twitter.com/cucuTPI). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [The A-Ha Moment](https://blog.womensurgeons.org/the-a-ha-moment/) **Published:** November 21, 2019 **Author:** Blog Team **Content:** *By Alyssa Brown* It started snowing this weekend, and it is the first snow of the year. I was staring out the window dreading the next six months of winter. I was also trying to think of something to write this piece on. I’ve covered [patients](https://blog.womensurgeons.org/medical-students/black-clouds/)’ [deaths](https://blog.womensurgeons.org/medical-students/gimme-shelter/), [prosciutto](https://blog.womensurgeons.org/mentorship/prosciutto/), and [watching match day](https://blog.womensurgeons.org/medical-students/waiting-your-turn/). Usually, I have something smoldering in the back of my mind that I want to write, but this time, I had nothing. It finally hit me as I was watching the snow falling. As I watched the snow tumble and swirl past my desk, I flashed back to a time during third year when I was standing outside at 5am watching the snow fall. I am sitting 647 miles and almost two years from that time and place now. It was a moment that shouldn’t have been that important in the grand scheme of things, but it was the day that clarified my path. Third year of medical school is what I dreamed about during first and second year. I couldn’t wait to see patients and “practice medicine.” In reality, third year is a lot harder than I thought it would be. There are sweet patients, whose names, faces, and stories I still remember, countless hours writing notes, chart checking, and gathering records from outside hospitals, sore feet before I learned about compression socks, miraculous surgeries, and miracles that never came. In short, I grew up during third year. I had done my surgery rotation in the fall, and I loved it. I came off that rotation though feeling beat up. The attending on my rural rotation had been incredibly demanding, and it made me question if I was good enough to pursue surgery. No matter what I did, it never seemed right or good enough in his eyes. It may have just been him being tough on me, but honestly, it wore me down. I loved being in the operating room and the patients were the cherry on top, but he made me waiver in my belief in myself. I lost my confidence. To be fair, we had an incredibly tough eight weeks, whatever could go wrong with patients did, and we had a long hard streak of “bad” call nights and tough cases. He operated like a graceful amazing machine, but often, nothing would have been enough to save them. It was neither of our faults, but I was physically, emotionally, and mentally worn out by the end of this rotation. At the start of third year, I thought it would come down to a decision between surgery or obstetrics and gynecology. My friends had all put their money on obstetrics and gynecology. I started my obstetrics and gynecology on benign gynecological surgery on New Year’s Day. I had a team that worked like clockwork. They integrated me very quickly in the OR. By the end of the first day, I was getting to hold the camera during laparoscopic hysterectomies and suture closed the laparoscope holes. It was an incredibly busy service, but I enjoyed it. I loved the opportunity to learn in what felt like a safe environment. They encouraged me to ask questions and to do and learn. After two weeks on benign gynecology, I was sold. I loved working in women’s health, and I loved the team I was working with for those two weeks. Following that, I had a fairly uneventful weeks of obstetrics and gynecology clinic, which I have to admit, was a little boring. The patients were great, but I didn’t get to do much more besides finding fetal heart beats. My last two weeks were spent on the Labor and Delivery Floor. I liked labor and delivery, but I missed being in surgical cases. I found caesarean sections much more fun than vaginal deliveries. Looking back, it should have been clear which direction I would eventually go, but I was enjoying my time. It finally crystalized was the final night of my Labor and Delivery Rotation. It was the night of the 2018 Super Bowl. I had been on night shift for a week, and I had made it to the last night. I only had to make it through until 7am, and I would be done with labor and delivery. As an aside, I loved working at night. It was weirdly calming to me. I focused better, and I felt more productive working all night and sleeping all day. To break my sleeping during the day habit, I decided to shadow my surgical mentor in pediatric surgery in the daytime after I was released from Labor and Delivery at 7am. Was this a faulty plan? Probably, but my sleep deprived brain thought it would be a fantastic way to reset my internal clock. That night shift was fun, and one of my favorite clinic patients came in for a vaginal delivery. She started pushing at kick-off of the Super Bowl, and she delivered a healthy boy right before the halftime show started; she really wanted to see Justin Timberlake perform. The rest of the night passed with patients coming in from the Emergency Department, but nothing major occurred. I had become very comfortable with the obstetrics and gynecology teams, residents, and patients, so I was sad to change rotations. I changed out of my scrubs and bid the labor and delivery floor goodbye. The sun was still not up when I slid through the doors to the main hospital to walk the four short blocks to the children’s hospital. I had not seen the outside world since the previous afternoon, so I did not notice it had started snowing that night, which is a rarity in the south. That early in the morning, even around the hospital, it is eerily quiet. There are not many cars heading to park, people milling around, or patients and family members smoking cigarettes outside the doors. It was just me on the sidewalk. I didn’t see anyone else on my walk to the Children’s Hospital. It was peaceful and beautiful. The streetlights caught the falling snow. The entire world looked like a snow globe, as the snow danced and spun in the yellow light of the street lamp. A strange calm hugged me and held me tight, as I stood transfixed watching the snow. It was pure magic. I thought of a song lyric from a long time ago that I loved, “The smell of hospitals in winter/ And the feeling that it’s all a lot of oysters, but no pearls” from [Long December](https://www.youtube.com/watch?v=1D5PtyrewSs) by Counting Crows. It is a sad song, if you know it. I always liked that line though because I understood the feeling of constantly going through things looking for the pearl but never finding it. For a split second under those street lights, the world stopped spinning, and everything felt right. I am rarely calm, but in that moment, I just knew that it was okay if I didn’t find the pearl. I was waiting for a big a-ha moment that would never come, and I finally knew it was okay that it wouldn’t. I had been waiting all of third year for the big a-ha moment that would come sweep me off my feet and tell me what I wanted to do for the rest of my life. I had seen it for others. I had seen people have torrid love affairs with specialties, the surprise love of something they never considered, or the slow burn of the thing they always knew they loved. I hated when people would say that “when you know you know.” I felt happy working with patients. I felt happy with good mentors and teachers. I knew there were rotations that I didn’t love, but it was hard to feel that decisiveness that I was going to pick something to love for the rest of my life. I had shadowed hundreds of hours during my first and second year of medical school and hundreds before medical school to try to make sure I didn’t miss some hidden specialty that I would regret not exploring. At the end of one day, and the beginning of another, in that still dark, quiet morning, I knew that was the day I would decide. I think shear exhaustion brings a beautiful focused clarity to some decisions in life. I had been to the eighth floor of the children’s’ hospital countless times. I could find my mentor with my eyes closed. She always sat in the PACU. I found her easily and quickly fell into step behind her. I knew my day was going to start with a curt catch-up of our lives, but we would easily fall into talk of surgery and patients. She didn’t know that I had been on labor and delivery the night before with no sleep. I fell into the all too easy rhythm of scrubbing in with her and watching her incredibly deft and elegant movements in the operating room. I would be lying if I said I remembered the cases that day. All I remember is that the decision had never been clearer to me. I had felt comfortable on my OB/Gyn rotation, and I am sure I would love being part of an OB/Gyn residency. What I loved most about that rotation though was the surgery. At the end of that day, after 24 hours of being awake, I knew what I wanted, I knew where I belonged. I belonged in the OR with my mentor. I belonged in surgery. I know the path will not be easy, and I don’t expect it to be. I suspect that some days will be miserable, and it will drive me to the brink. At the core of things though, I don’t think I would be happy not doing surgery. I don’t always believe in miracles, but I do believe that sometimes, the path becomes clear, and you finally catch a glimpse of what you knew all along. For some, it will be a big wondrous a-ha, a big pearl, while for many of you, like me, it will be the knowledge that you knew all along, many oysters. It is okay to take your time. It is okay to not know. Deep down, I think I always knew I wanted to be a surgeon, it just took a cold, snowy morning to solidify that in my mind. ![](https://blog.womensurgeons.org/wp-content/uploads/2019/11/VSAS_0449-copy-214x300.jpg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. When she is not buried in lab work, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram [**@alyssabrown1013**](https://www.instagram.com/alyssabrown1013/) and Twitter [**@Alyssa\_B\_MDPhD**](https://twitter.com/Alyssa_B_MDPhD) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Making It Work](https://blog.womensurgeons.org/making-it-work/) **Published:** November 27, 2019 **Author:** Blog Team **Content:** *By Joy Alvarado* It’s not on everyone’s mind as they contemplate going into a surgical residency, but it was on my mind: Could I handle the physical challenges of this new diagnosis under the ergonomic pressures of being a surgeon? How would my coworkers perceive me when they find out about my new diagnosis? Will they become angry when I take time off to heal? Would they think it irresponsible that during my general surgery residency … I chose to become pregnant? As an older-than-average female medical student who desires children one day, these questions are very important as I contemplate my future in medicine. On the one hand, there are my imagined challenges to being pregnant during general surgery training that are associated with the condition itself: the extra exhaustion I’ll feel while carrying an extra 20 pounds during long cases, the inability to run to the bathroom when I get an unexpected kick to my bladder in the OR, or the hormone-induced nausea and vomiting I’ll experience while trying to complete a 48-hour shift. On the other hand, I’ve learned about the very real challenges that being pregnant can bring to residency programs: absences that have to be covered when I am having morning sickness or going to obstetrics appointments, and OR accommodations that have to be made around my protruding belly. What about the potential resentment that can build when coworkers take on more cases or codes because I physically cannot run as fast or stand as long? When would I arrange make-up rotations for the lost training during maternity leave? As we strive to increase the number of women in surgery, it’s clear that we have to consider these challenges in our recruitment process. A 2018 study by [Rangel et al.](https://www.ncbi.nlm.nih.gov/pubmed/29562068) surveyed 347 general surgery residents who had been pregnant during residency. Their average age was 30.5 years, and all of them completed residency in 2007 or later. Only 34.9% of them stated that their programs had established maternity leave policies, and 72% perceived the duration of their maternity leave to be inadequate. 63.6% were concerned that their work schedule adversely affected their health or the health of their unborn child. Nearly 40% reported that they strongly considered leaving surgical residency, and nearly 30% indicated they would discourage female medical students from a surgical career, “specifically because of the difficulties of balancing pregnancy and motherhood with training.” One piece of advice I received from many surgeons, male and female, is that, “There is no perfect time to have a baby. If you want a baby, just have it. There will always be challenges. But, you can make it work.” This idea to “make it work” might be the same mantra that everyone recites in handling pregnancy or children, no matter the career or lack thereof. Many women surgeons are turning to technologies like egg-freezing in order to extend their window of optimum fertility for a few more years. In doing so, they can decrease the complications associated with advanced maternal age should they wait until residency is over before attempting pregnancy. However, this option is not easy, nor is it guaranteed. Dr. Arghavan Salles, surgeon and writer for the AWS Blog explains the ups and downs of her own egg-freezing journey in a piece called, [*Peri-Menopause*](https://blog.womensurgeons.org/family-life/peri-menopause/). If I waited until residency was over, I would be approaching 40 years of age before having my first child. We can all agree that pregnancy is not easy. It affects nearly every aspect of life, and undoubtedly influences the male/female ratios in many professions. As a woman medical student in her 30s who desires a family one day, I would be remiss to not consider the challenges of being a pregnant resident in my specialty choice. And while there is something appealing in the challenge of “making it work,” we have to take these factors into consideration as we continue our efforts to increase the number of women in surgery. ![](https://blog.womensurgeons.org/wp-content/uploads/2019/11/Joy-Alvarado.png) Joy Alvarado holds a Bachelors of Arts in English from the University of Texas at Austin and a Masters of Health Science from Johns Hopkins Bloomberg School of Public Health. She is a fourth year medical student at the University of Texas Rio Grande Valley School of Medicine. She is also a 2nd Lieutenant in the US Army, and founder of the UTRGV SOM Student-Run Clinic. She is passionate about alleviating health disparities, and is an avid oil/acrylic painter. See her work at [www.joyalvarado.art](http://www.joyalvarado.art). Twitter handle: [@thejoyalvarado](https://twitter.com/thejoyalvarado) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness **Tags:** ILookLikeASurgeon, pregnancy, residency, surgeon mom, surgeon parenting, surgery, womeninsurgery --- ### [Why you should consider basic science or translational research](https://blog.womensurgeons.org/why-you-should-consider-research/) **Published:** December 4, 2019 **Author:** Blog Team **Content:** By Gillian Goddard, MD My path has deviated significantly from what I envisioned when I started medical school. I would never have anticipated that future me would join a basic science lab during residency, commit another 2-3 years to training, and *actually* enjoy it. As with anything, there are times when research can be frustrating – especially when an experiment does not work and sends you back to the drawing board. However, the knowledge, skills, and mentorship that I have gained during my time in a basic science lab are invaluable and will help guide me through my future career, academic, or otherwise. For those considering whether or not to take dedicated research time, what type of research to pursue, or those who think I’m crazy for choosing basic science research, here is what it has taught me. 1. ***The foundation to think critically.*** Research teaches you to question EVERYTHING. Spending time with our PhD colleagues in the lab and designing/planning experiments has taught me to approach problems using a hypothesis-driven method. It has also allowed me to become more comfortable critically assessing everything from study design to journal articles to clinical decision making. 2. ***How to learn from failure.*** For the majority of medical trainees who go from college to medical school to residency, experiencing failure, is unfamiliar and possibly debilitating. Basic science research will teach you that failing is a part of learning. While hard and frustrating at times, various projects not working for XX reason has helped me to obtain a growth mindset. Nothing is fixed and one can always be better. 3. ***The importance of multi-disciplinary and multi-institutional work.*** Every single person looks at your project with a slightly different lens based on their background and training. It gives you new insight (even if it’s hard to hear sometimes). I have learned time and time again that collaboration is truly the key to success. This tenet directly translates to clinical care as everyone (nurse, registered dietitian, concerned family member) comes to the table with a different area of expertise. Only by working together can we deliver the best patient care possible. 4. ***Improved technical skills.*** Initially, I didn’t think of my time in the lab as a way to increase my technical skills; however, after learning how to do ileocecal resections with 9-0 suture on mice, I now think otherwise. Many surgical basic science labs have the opportunity to operate for their animal models, and you should take it! 5. ***The challenge of implementation and the importance of sustainability.*** Before starting my prospective translational study, I had no idea how hard it was to implement something within the context of patient care. The actual execution of any translational project (no matter how small) takes time, persistence, and (wo)man-power. I have learned that a lot of projects worth doing take time, which in some instances means multiple years and way longer than any of us will ever spend in research during our training. If a project that you are working on won’t be finished by the time you need to return to residency, you will be the one responsible for figuring out who will and can help once you resume your clinical responsibilities. Without placing mechanisms of sustainability in place, your hard work (and PI’s funding) will be wasted. 6. ***Significance of mentorship, sponsorship, & connections***. In research, we have the opportunity to work with individuals from different fields and ways of thinking. The surgeons, neonatologists, and PhDs whom I have met and worked with while in research have all guided my academic and personal growth in different ways. Beyond simple guidance, this experience taught me the importance of having both a mentor and sponsor to guide my development and advocate for my advancement. Learning and growing through basic science and translational research has been rewarding in a way I never could have imagined. Maybe now you can. ![](https://blog.womensurgeons.org/wp-content/uploads/2019/12/gillian-1.png) Gillian Goddard, MD graduated from McGovern Medical School, The University of Texas Health Science Center at Houston. She then completed two years of general surgery residency and is currently a research fellow at Cincinnati Children’s Hospital Medical Center. Her main research projects focus on further delineating the interactions between the microbiome and bile acid metabolism that are occurring in the context of intestinal adaptation. Other research interests include gastroschisis, and necrotizing enterocolitis. In her free time, she enjoys trying out new coffee shops and figure skating. **Categories:** research **Tags:** #womeninresearch, AWSBlog, womeninmedicine, womeninsurgery --- ### [At the Intersection of Race, Gender, and Surgery](https://blog.womensurgeons.org/the-intersection-of-race-gender-and-surgery/) **Published:** December 12, 2019 **Author:** Blog Team **Content:** *By Valeria S.M. Valbuena* In 1989, American Civil Rights Lawyer Kimberlé Williams Crenshaw published her now essential critical race theory piece entitled [“Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics.”](https://chicagounbound.uchicago.edu/cgi/viewcontent.cgi?article=1052&context=uclf) In this paper, Crenshaw elegantly dissected the institutions of race and gender as individual pillars upon which part of the experience of Black Women in America is constructed. Race and gender, however, could not be effectively used on their own to fully describe or understand what the collective experience of living as a Black Woman is truly like. Nowadays, intersectionality is a household term used to describe the communion of any two identities. Intersectional feminism belongs to Black Women and their unique stories and challenges, and it’s been adopted to aid in the understanding of similar issues for other groups. In the world of medicine, intersectionality often translates into being a physician member of more than one marginalized group. Minority women and Women of Color (WOC) carry a precarious existence in modern academic surgery. We live in the tenuous area where our powerful, diverse,dominant identity carries the painful tax of fulfilling a job classically held by White men. Success for a minority woman surgeon is defined by the same metrics used for the rest of our colleagues, but getting there is often much more difficult. Key milestones such as college and medical school admissions, residency match, early career awards, and high-level sponsorship are deeply influenced by both our identity and the ones of the mentors and friends we lean on to carry our careers forward. Race and gender synchronicity have long been shown to play a key role in productive early mentoring relationships. Without many WOC in surgery leadership, minority women surgeons rarely have the opportunity to benefit from these spontaneous connections. Some of the challenges faced by surgeons and trainees who are WOC fall grossly in the realm of gender discrimination. We share the struggle of a profound lack of equal compensation, comprehensive maternity leave policies, rampant sexual harassment, and stunted career advancement. This keeps women of all backgrounds from reaching their full potential. However, it would be naive to ignore the key role that race brings to the table when it comes to describing lack of access to [equitable](https://jamanetwork.com/journals/jama/fullarticle/184622) [advancement](http://vivo.med.cornell.edu/display/pubid77956214416). There are many opportunities within our field that are more accessible to White women. A strict feminist take on key issues, such as the pay gap, can often disregard the racial component of the intersectional experience and leave WOC disenfranchised. More importantly, the educational advantage that comes with being a physician often does not translate into a new social status once the white coat comes off. Social pressures, while always inherent to some extent, are very different outside the hospital for women surgeons of different races. I will always be an immigrant Afro-Latina when I interact with the world outside of work, and these interactions change my disposition on a daily basis. Given these barriers, the question stands: how can we make surgery and surgical training equitable for minority women? I believe advocacy and ally-ship begins with obtaining profound knowledge of each other’s experiences. As a mentor or sponsor of a minority woman surgeon or trainee, maintaining open routes of conversation is key to creating trust. Honest acknowledgement of the unique challenges we face everyday can be particularly helpful for trainees who find ourselves pressed by both the new and escalating expectations of our jobs as surgeons-in-training, while still rising above the historic external pressures of racism and sexism. Navigating a world that still displays such a visceral push-back against women leading is difficult, but it is opening avenues for self-discovery for all the members of our surgical community. While we work actively on making the future of women happen, let us remain connected and supportive of each other, being mindful of our differences and biases but also committing ourselves to planting the seeds of lasting change. Please join [@womensurgeons](https://twitter.com/WomenSurgeons) along with our moderators, Dr. Yewande Alimi ([@yalimi](https://twitter.com/yalimi)), Dr. Laurie Punch ([@laurie\_punch](https://twitter.com/laurie_punch)) and Dr. Patricia Martinez Quinones ([@PMartinezMD](https://twitter.com/PMartinezMD)) for this tweetchat on Monday December 16th at 8pm Eastern Time. The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. The questions we will be discussing are below. Some of the questions are featured from our followers on Twitter about questions they would like to see answered regarding this topic: 1. What is intersectional feminism and what are ways to promote those values in daily life? 2. It used to be much harder to find your “people”. How have you managed to create your “village” of support in this day and age? [@leahbackhusmd](https://twitter.com/leahbackhusmd?lang=en) 3. How do we retain talent in surgery when so many women feel alienated? [@linamacarmona](https://twitter.com/linamacarmona) 4. What kind of support can we provide as peers? Is labeling ourselves as a “minority” perpetuating intersectionality? [@civo05](https://twitter.com/civo05?lang=en) 5. Beyond race and gender – how do we as a surgical society support our LGBTQIA surgeons and trainees of all races/ethnicities? ![](https://blog.womensurgeons.org/wp-content/uploads/2019/12/Valeria.png) Dr. Valeria Valbuena is a third year General Surgery resident at the University of Michigan. Originally from Colombia, Valeria completed her undergraduate education starting in her local community college. She obtained a B.A in Biochemistry from the New College of Florida and her medical degree from the University of Illinois at Chicago where she was an active member and leader of the Latino Medical Student Association. Valeria’s research interests include workforce diversity with a focus on medicine and surgery, healthcare disparities, community-based interventions to increase access to safe surgery, and organ donation and transplantation in minority populations. You can find her on twitter at [@v\_valbuen](https://twitter.com/v_valbuen). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #AWSTweetChat, womeninmedicine, womeninsurgery --- ### [Finding Your Tribe](https://blog.womensurgeons.org/finding-your-tribe/) **Published:** December 19, 2019 **Author:** Blog Team **Content:** *By Feibi Zheng* When I had my first child three years ago, one of my co-residents added me on Facebook to Physician Mom’s Group (PMG) and a dear friend that I met through the Resident and Associate Society Education Committee (ACS-RAS) added me to Surgeon Moms Group and Dr. Milk. During the past three years, these groups have been both a professional and personal helpline for me. Whenever I have a question about finances, daycare, or clogged milk ducts, I have an army of women who willingly share their advice and experience in a safe, (mostly) judgment-free environment. When I moved back to Houston to start my first job after training, I relied on my local PMG group for networking and practice building. My local group hosts several in-person events each year. Through these events, I met women endocrinologists, all in private practice, who form a substantial portion of my referral base in endocrine surgery. I have leveraged this network for many other aspects of my life as well. One day last winter, I woke up with terrible shoulder pain. I could barely lift up my right arm; a terrible conundrum for a surgeon. I posted a message on my local group and within minutes, an orthopedic surgeon called my cell phone and set me up with an appointment for that afternoon. Last week, I bought a new car. Where was the dealership where I got the best deal? The one where the manager was the brother of a physician mom. On the academic development front, I have benefited from participating in these groups as well. I have met collaborators and sponsors. In one recent example, a surgeon mom (who I have yet to meet in real life) nominated me to be a guest editor for an upcoming issue of the Surgical Clinics of North America on Patient Safety. I have also seen women help place members of the group on panels and nominate others as grand rounds speakers. Lastly, these groups have served as a safe space where we can celebrate successes and commiserate on the daily struggles of being a physician/surgeon mom. This shared experience has allowed me to feel less conflicted and more confident. I now understand that it’s normal to feel that you are not a perfect parent, a perfect clinician or a perfect academic but somehow your kids will still grow up to be just fine. What to do if you’re not a mom? There are multiple online groups for women physicians with or without children (Women in Surgery Facebook Group), subspeciality groups (Young Endocrine Surgeons), physicians interested in side gigs (Physician Side Gigs), finance (Married to Medicine Finance), decorating (Physician Moms DIY Home Decor and Design), travel (Mama Docs Travel). Find your tribe, engage and thrive. ![](https://blog.womensurgeons.org/wp-content/uploads/2018/01/feibi.jpg)Dr. Feibi Zheng is an endocrine surgeon at Houston Methodist Hospital in the Texas Medical Center and Assistant Professor of Surgery at Weill Cornell Medical College. She attended medical school at the University of California, San Diego. During her surgical residency training at Houston Methodist, she helped to establish the General Surgery Leadership and Health Care Administration Track, an 8 year program which blends clinical surgery training with practical experience in optimizing hospital systems for improved patient care and safety. She then completed her endocrine surgery fellowship at UCLA. In addition to her clinical practice, she is the Assistant Clinical Program Director of Surgical Quality and Population Health for Houston Methodist Hospital, where she is leading the development of a telemedicine program for surgical patients who live long distances from specialized centers of care. She also currently serves on the Committee for Perioperative Care of the American College of Surgeons which works to improve the quality of care for surgical patients across the country. You can find her on twitter at [@FeibiZheng](https://twitter.com/FeibiZheng). --- **Categories:** Uncategorized --- ### [Another Year with COVID](https://blog.womensurgeons.org/another-year-with-covid/) **Published:** January 13, 2022 **Author:** Blog Team **Content:** *By Kathleen Skipton Romanowski, MD, MAS, FACS* A little over a year ago, I sat down to write a blog piece for the Association of Women Surgeon (AWS) Blog that was to be published on [December 24th](https://blog.womensurgeons.org/family-life/but-what-about-christmas/). It was a lighthearted blog piece about how to handle the holidays when you are a parent and a surgeon. As I wrote it, I *was* joyful. I was writing about a topic I am passionate about (integrating my life as a surgeon and a mother) and on top of that my mood was buoyed with the thought that I had just received my first dose of the COVID vaccine. I naively thought that this was the beginning of the end and that maybe by the 2021 holiday season, we would be back to normal. Oh, how wrong I was! For me, 2021 and the ebbing and flowing of the pandemic has been a struggle. In many ways, this year of ups and downs was harder for me than the initial months of fear. I am a burn surgeon, so in my clinical world, I am very used to having to deal with uncertainty and wait for patients to make progress towards healing. I am used to patients making progress and then having setbacks and eventually making progress towards healing again. I should have been well-suited to deal with the ever-changing COVID situation, but I did not handle it well and struggled to find motivation to accomplish things beyond my clinical tasks. Throughout these long, hard months, the AWS blog was one of my constants each week. Truly, my purpose in writing this piece is as a thank you to everyone involved with the blog for being my lifeline during this rough year. I have been a part of the Association of Women Surgeons blog team for a little over 2 years. As the Faculty Chair of the Blog Subcommittee, I have the distinct privilege of working with an amazing group of women and men to bring you this blog every week. This group of surgeons, residents, and medical students are truly wonderful. They are so dedicated to editing and posting this blog each week and are a joy to work with and to know. Leading this group, I have also had the opportunity to read most of the blog pieces that we have published. It is your stories and determination that helped me push through when I was struggling. Through the blog, I have learned about the lives and experiences of some wonderful women surgeons. Our authors inspire me with their experiences, and commitment to the field of surgery. I am also fortified by the grace with which they handle the challenges that are placed in front of them. I am so proud of the willingness of the authors to guide those who are less experienced than them through the process of becoming a surgeon. All the blog authors and the blog committee were my weekly reminder of what was right with the world and our profession. I am so proud to have spent this year with you all and I look forward to the future. Wishing you all a healthy and happy 2022! ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/Romanowski-Blog.png)Kathleen Romanowski, MD, FACS is an Associate Professor of Surgery at the University of California, Davis and Shriners Hospitals for Children Northern California in the Division of Burn Surgery. She attended the University of Chicago Pritzker School of Medicine and completed her general surgery residency at University of Chicago Medical Center. She did fellowships in Burn Surgery and Surgical Critical Care at University of California, Davis and Shriners Hospitals for Children Northern California. Kathleen is devoted to the care of the burn injured patient and studies disparities in care and predictors of outcomes in elderly burn patients. She is an active member of AWS and is a member of the AWS Communications Committee. You can find her on twitter at @KSRomanowski. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** AWSBlog --- ### [Nothing to Prove: Supporting Each Other as Female Surgeons](https://blog.womensurgeons.org/nothing-to-prove-supporting-each-other-as-female-surgeons/) **Published:** January 20, 2022 **Author:** Blog Team **Content:** By Meredith Taylor, MD One of the most difficult aspects of surgical training is taking critical feedback, synthesizing it, improving from it, and—most importantly—not taking it personally. In my second week as co-senior in the surgical intensive care unit, I have been challenged immensely by the patient care, acuity of problems, and rapid decision making it takes to keep everyone safe. With COVID-19 cases on the rise amongst our faculty, staff, and residents, our teams are a little smaller, and my team is currently a group of all female residents and fellows of mixed disciplines. My co-senior is a brilliant cardiothoracic surgery resident who can probably get central access in someone without blood vessels, and the first year is an orthopedic surgeon who is already adept at spotting fractures in any plain film, at any angle. Our fellow can operate and make clinical decisions without hesitation, and her compassion for patients is unrelenting even when she’s inundated with responsibility. Sounds like the people you want taking care of you when you’re critically ill, right? They’re great teammates, even better people, and I’m embarrassed to admit, they intimidate me. Regardless of how kind or understanding they are when I make a mistake or ask for help, I always feel like I have something to prove, or that I need to work harder to earn their respect. It occurred to me I almost never feel this way amidst my male peers and colleagues. While it is likely my personal insecurity fueling my need to measure up and make my worth apparent, I imagine other female surgeons may feel similarly when contemplating the skills and accomplishments of their colleagues. It is important to remember all of us are exceptional, talented, and we are on the same team. Those before us have fought through blatant and institutional discrimination, lack of role models, and countless, “No’s,” so we can exist in a medical community that now boasts all-female surgical teams. We are not each other’s competition, rather, we are the inspiration and strength the other needs to continue improving personally and professionally. Admiring the talent of my teammates and focusing on how they’ve helped me grow in two short weeks has eased my ego burden and allowed me to embrace the awesome nature of our team. While I still cuss when I strike out with an art line or need something pointed out to me on a CT scan, I no longer have paralyzing embarrassment or feel like I need to hide my deficits to prove I’m worthy of their respect. To quote Brene Brown, “I am not here to be right. I am here to get it right.” It is a new year, and it is time to pause and appreciate the female leaders that surround us, work with us, and inspire us to take care of our patients by being the best surgeons possible. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/AWS-Meredith.png)Dr. Meredith Taylor is originally from Medina, OH. She earned her undergraduate degree from the University of Dayton and her medical degree from the University of Cincinnati College of Medicine. She is currently a second year general surgery resident at the Medical University of South Carolina in Charleston. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [The Size of my Scrubs](https://blog.womensurgeons.org/the-size-of-my-scrubs/) **Published:** January 26, 2022 **Author:** Blog Team **Content:** *By Alyssa Brown* Blue, white, red, yellow, pink, and brown. These are the colors of the ties and the strip of fabric around the scrub pants and scrub tops. Maybe it sounds dramatic, but it always felt like a Scarlet Letter to me. The colors indicate the size of the scrubs. My friends always complained about not being able to find smalls and mediums, and I would shrink back a little more. At the start of medical school, I would squeeze into the red top and red pants. These were the larges. It was so easy to see who was smaller or larger than you because of this. I felt uncomfortable because I knew how many other people were smaller than me. I was worried they were judging this too. I had spent years growing up uncomfortable. The southern term for it is being big boned, and everyone in my family is big boned. On the golf team in college, I was used to having to order the biggest size on the team, and it made me uncomfortable. It was slightly illogical because I was also the tallest and strongest on the team, but it was ingrained in me to feel uncomfortable with my size. Maybe I overthink it, and no one else cares what size of scrubs I am wearing, but I noticed. By the end of third year, I started wearing yellow bottom scrubs (XL) and red tops. The irregular eating in the hospital led me to increase in size. Also, I was tired of squeezing into the smaller bottoms. My friends did not have this problem. They often lost weight throughout medical school. They ate less and less because of stress, while I ate more. During my third year, I started feeling more and more uncomfortable with comments that people made to patients and to me about weight. I can’t count the times that people commented on how the patients should just lose weight and how they could just eat less. They would call them obese or fatties, but I knew how much they weighed and knew it was close to my own weight. I was acutely aware of the struggles of trying to lose weight. Sometimes it is not as easy or simple as just losing weight. One situation stuck out to me. I was stretching my calves after a long case, and I asked the other student with me if his calves were stiff too. He responded that mine were probably just sore because I was fat. I didn’t know what to say. I just turned around and left the operating room. I never said anything to him about it. I just ignored the fact that he said it. I should not have. It wasn’t fair for him to say it. My calves were stiff because of the long operation, not because of my weight. It confirmed my fears that everyone was judging me for my size. When I came back for fourth year, I moved into pink top scrubs and pink bottoms (XXL). I knew I had gained weight, and this was just another reminder. I have worried on the interview trail this year about being judged for being bigger. I don’t often see people that are my size. I almost always see thinner students. I worry that it is an unspoken thing that I will be judged on, which is supported by data in studies of[ graduate school admissions](https://pubmed.ncbi.nlm.nih.gov/23784894/) and[ radiology interview invites](https://pubmed.ncbi.nlm.nih.gov/31149924/). I worry the people interviewing me will view me as lacking discipline for being overweight or that I am unfit to be a surgeon because of it. Despite the fact that I am strong. I get around the hospital just fine. I take care of the patients like everyone else. I do not want to be judged for my appearance, even though I know I will inevitably be. I’ll try to focus less on the color of scrubs I fit into. I realize they are just scrubs, and their size does not indicate anything about who I am as a person or the surgeon I will become. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/Alyssa_Brown_HeadShot-731x1024.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is in her fourth year of medical school back at Louisville and is in the application cycle for general surgery residency. Her thesis research is on diaphragm muscle mitochondrial function and morphology, which she will defend in March. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram [@Alyssa\_b\_futuremdphd](https://www.instagram.com/alyssa_b_futuremdphd/?hl=en) and on Twitter [@Alyssa\_B\_MDPhD](https://twitter.com/Alyssa_B_MDPhD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** #AssociationofWomenSurgeons, AWSBlog, womeninmedicine, womeninsurgery --- ### [Writing a Blog Piece for AWS](https://blog.womensurgeons.org/writing-a-blog-piece-for-aws/) **Published:** February 3, 2022 **Author:** Blog Team **Content:** By Alyssa Brown I blame Camila Guetter for my involvement with the Association of Women Surgeon’s Blog. Well, blame is too strong of a word. I should say I am lucky that Camila Guetter told me that the AWS blog was looking for new team members. This was back in 2018. I was finishing my third year, taking Step 2, and planning to move to Rochester, MN for my PhD. I had applied to be the Social Media representative of the AWS Medical Student Division, but I did not receive the position. She mentioned that the AWS Blog team needed some new members, so I jumped at the chance. I wanted to be more involved with AWS nationally. Third year of medical school had been difficult between surviving a tough surgery rotation, applying to a PhD program, and being a black cloud on every service. I had found solace in the blog pieces I read on a weekly basis about women’s experiences in surgery. Now that it’s 2022, I realize it has been almost four years. Over those four years, I have had the pleasure of writing thirteen pieces for the blog. I had to go back and count because I didn’t believe the number. When I started in 2018, I never would have guessed that I would write this many. I never thought I would enjoy writing blog pieces. I started writing one day in third year because I wanted to just get a patient’s story down. My hands flew across my keyboard at home – I had been bursting trying to keep the story inside. I had struggled with the feelings I had over the death of this patient. I wished so many things had gone differently, and I wished the outcome had been different. When I was done typing this story, I just sat there. I felt like a little bit of the weight had been lifted off my shoulders. I had been able to write what I was feeling and how I was feeling. It was coping, and I was learning how to cope. This became [my first piece for the blog](https://blog.womensurgeons.org/medical-students/black-clouds/). Over the next four years, I wrote 12 other pieces (linked at the end). Sometimes they were about patients and hospital situations;others were just about feelings I was having. I found that I could channel what I was feeling and sorting through in my head into a document. It gave me the space to reflect on my journey and think through both the negatives and positives. It helped me capture some of my best and worst memories. I have never been one to journal, and I still don’t, but having the space to write about the things I am thinking and feeling has been cathartic. Being part of the team has also allowed me to read pieces written by women across the world. That is the beauty of the blog: everyone brings their own stories. Also, I have gotten to meet and work with some of the best women. I am lucky to know and work with them. They are a constant in my life. A lot has changed since 2018, but the AWS Blog has helped me grow. I can’t wait to spend more years working with the blog team. [The Size of my Scrubs](https://blog.womensurgeons.org/medical-students/the-size-of-my-scrubs/) [Coming Home](https://blog.womensurgeons.org/medical-students/coming-home/) [How was your Day?](https://blog.womensurgeons.org/reflection/how-was-your-day/) [Infertility and Pregnancy in Women Surgeons](https://blog.womensurgeons.org/family-life/infertility-and-pregnancy-in-women-surgeons-taking-action-to-create-a-welcoming-practice-environment-for-women-surgeons/) [The Facade We Keep](https://blog.womensurgeons.org/self-care/the-facade-we-keep-masking-mental-health/) [Picking Between Surgical Specialities as a Medical Student](https://blog.womensurgeons.org/medical-students/picking-between-surgical-specialties-as-a-medical-student/) [The Distance Between Two Worlds](https://blog.womensurgeons.org/medical-students/the-distance-between-two-worlds/) [Confessions of Ill-Equipped Third Year Medical Student](https://blog.womensurgeons.org/medical-students/confessions-of-an-ill-equipped-third-year-medical-student/) [A-Ha Moment](https://blog.womensurgeons.org/medical-students/the-a-ha-moment/) [Prosciutto](https://blog.womensurgeons.org/mentorship/prosciutto/) [Waiting Your Turn](https://blog.womensurgeons.org/medical-students/waiting-your-turn/) [Gimme Shelter](https://blog.womensurgeons.org/medical-students/gimme-shelter/) [Black Clouds](https://blog.womensurgeons.org/medical-students/black-clouds/) ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/headshot_5x7_0449-731x1024.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is in her fourth year of medical school back at Louisville and is in the application cycle for general surgery residency. Her thesis research is on diaphragm muscle mitochondrial function and morphology, which she will defend in March. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram [@Alyssa\_b\_futuremdphd](https://www.instagram.com/alyssa_b_futuremdphd/?hl=en) and on Twitter [@Alyssa\_B\_MDPhD](https://twitter.com/Alyssa_B_MDPhD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWSBlog, womeninmedicine --- ### [“Dear Intern”, welcome to residency!](https://blog.womensurgeons.org/welcome-to-residency/) **Published:** June 20, 2022 **Author:** Blog Team **Content:** *By Camila R. Guetter* Dear soon-to-be interns, congratulations on finishing medical school and welcome to residency! You are about to embark upon a very challenging but rewarding journey. In residency you will create lifelong friendships. You will also learn how to excel as a surgeon, a leader, a mentee, a mentor, an educator, and a surgeon-scientist. We all know how transition times can be tough and how they can bring a lot of anxiety, just like when you went from college to medical school, or from your pre-clinical years to clerkship years in medical school. You are here though, which means you have all it needs to succeed! A lot of the anxiety in this transition time comes from uncertainty on what to expect and what will be expected from you. Main questions new interns have include how to best organize your time, how to study during residency, how to maintain work-life integration and wellness, and how to succeed as an intern overall. To answer these and any other questions, residents from the AWS Resident and Fellow Committee and the RAS-ACS are organizing a tweetchat to share our experiences and help you get ready to get started. Please join us on Monday, June 20th, 2022, 8-9 PM EST, for an AWS TweetChat on tips to survive (and thrive!) during your intern year. The chat will be moderated by members of the Association of Women Surgeons ([AWS](https://twitter.com/WomenSurgeons)) Resident and Fellow Committee, and the Resident and Associate Society of the American College of Surgeons ([RAS-ACS](https://twitter.com/RASACS)). Moderators: - **Camila R. Guetter** ([@camila\_guetter](https://twitter.com/camila_guetter)): Rising PGY-2 General Surgery resident at Beth Israel Deaconess Medical Center/Harvard Medical School - **Shan Lansing** ([@ShanSLansing](https://twitter.com/ShanSLansing)): Rising PGY-2 General Surgery resident at Oregon Health & Science University - **Brianna Spencer** ([@brianna59213847](https://twitter.com/Brianna59213847)): Rising second year research fellow at University of Michigan. Previously completed PGY 3 General Surgery at Penn State. - **Rashi Singh** ([@Rashi2S](https://twitter.com/Rashi2S)): Rising PGY4 General Surgery resident at University Hospitals/Case Western Reserve University - **Brittany Johnson** ([@brittljohn](https://twitter.com/brittljohn)): Rising PGY-5 General Surgery resident at UMMC, Future Pediatric Surgery Fellow at University of Michigan/Mott Children’s The tweetchat questions will be posted directly from the [@WomenSurgeons](https://twitter.com/WomenSurgeons) Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this [tutorial](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__http%3A%2F%2Fblog.womensurgeons.org%2Fmedical-students%2Fbeyond-the-basics-of-tweeting%2F__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UH7HLDER%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=KfiBo6A70VlffaJp8Mn9kz12YBY7SF2igEx%2F8dbTeRs%3D&reserved=0) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following questions during our tweet chat: 1. Staying organized is key during residency. What are some tips on how to stay organized with your daily tasks and workflow? 2. It’s easy to get busy and forget to take care of yourself as an intern. What are some tips on how to take care of your physical and mental health during residency? 3. Depending on the program/especially you are on, you may have annual exams to take. How can you find time to study during residency? 4. How can you find mentors during residency? 5. What is something you wish you knew before you became an intern? Last but not least, remember that you are not alone! All residents (in your program and elsewhere) were interns once, so don’t hesitate to ask for help and advice when you need it. AWS and ACS are great platforms for meeting people (mentors and friends) that can help you through this journey as well. We can’t wait to see what the future holds for each one of you and to see you shine as residents! ![](https://blog.womensurgeons.org/wp-content/uploads/2022/06/DSC_2250-754x1024.jpg) **Camila R. Guetter, MD MPH**, is a rising PGY-2 General Surgery resident at Beth Israel Deaconess Medical Center/Harvard Medical School. Born and raised in Brazil, she graduated medical school from the Federal University of Parana in Curitiba, Brazil. She obtained a Masters in Public Health at Johns Hopkins Bloomberg School of Public Health before starting residency. She has been a proud and active member of AWS since 2015. In her free time she enjoys playing tennis, traveling, and spending time with her intern class! --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, dear intern, intern, mentorship, residency, residents, surgery, Tweetchat, womeninsurgery, WomenSurgeons --- ### [Pancreatic Cancer Blog](https://blog.womensurgeons.org/pancreatic-cancer-blog/) **Published:** February 27, 2023 **Author:** Blog Team **Content:** Interview by: Dr. Rachana Punukollu In November 2022, I had the opportunity to shadow Dr. Chawla, a hepatopancreatobiliary surgical oncologist. I rotated on his Surgical Oncology service at Northwestern Central Dupage Hospital for a month. Since then, Dr. Chawla has been a great mentor and source of support. I learnt a great deal of background on pancreatic cancer from his teaching in the OR and in the clinic. During my time on the service, I interacted with patients and their families who were affected by pancreatic cancer, and this sparked my interest in the disease. As I delved deeper into the statistics surrounding the pancreatic cancer and its dismal outcomes, I became increasingly motivated to raise awareness about its significance. Therefore, I decided to interview Dr. Chawla to gain a better understanding of pancreatic cancer and to help educate others about its importance. Introduction: ![](https://blog.womensurgeons.org/wp-content/uploads/2023/02/Chawla.png)Dr. Akhil Chawla is a Hepatopancreatobiliary and Gastrointestinal Surgical Oncologist at Northwestern Medicine, Chicago, Illinois. He received his undergraduate degree in Bachelor of Science and graduated medical school from University of Cincinnati. He completed his General Surgery residency training from Case Western Reserve University. He completed a two-year National Institutes of Health funded research fellowship focusing on solid tumor immunology at MD Anderson Cancer Center. He completed his clinical fellowship in the Harvard Combined Complex Surgical Oncology Fellowship Program at Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Massachusetts General Hospital. He is director of the Northwestern Medicine Surgical Oncology Tumor Bank, Biorepository and Translational Research Laboratory in the West Region. He is a transitional researcher and Principal investigator of multiple oncology related clinical trials within Northwestern Medicine as well as nationally with a focus on pancreatic cancer. 1. What made you choose General Surgery during medical school? I liked the aspect of being able to critically think, spend time in the operating room, utilize my technical skills, and think not just about the disease process, but being able to simultaneously act on them. There’s a great deal of gratification in watching a patient clinically improve just a few days after an operation after coming to the hospital very ill. I love spending time in the operating room; it is the one place where I can be completely focused on what I am working on without any outside distractors. I also love to teach in the operating room, which attracted me early on. 1. What drew you to pursue a career in Surgical oncology? During my time as a junior resident, I found myself spending a great deal of time with the families of patients afflicted with cancer. I was really interested in explaining the disease process in detail and discussing the rationale for surgery. Though it was challenging to deliver tough news, I found this experience gratifying. During my time in the basic science oncology lab at MD Anderson, I realized surgical oncology has a little bit of everything – the ability to spend time with patients, do complex technically challenging operations and to scientifically investigate ways to enhance care and outcomes for the patients. As a senior resident, I spent a long days performing hepatobiliary and pancreatic surgery in the operating room. Working in these complex operations was highly intriguing to me; I then knew that this would be a great field for me. 1. You are a high volume pancreatic cancer surgeon with a research interest towards pancreatic cancer. What sparked your interest in this area? Pancreatic cancer is a very challenging malignancy to treat. It requires a great deal of persistence and expertise in the operating room. It is a very humbling disease, which propels me to work harder as an investigator and as a surgeon, pushing me to do better every day. Pancreatic cancer is the third most common cause of cancer death in the United States and is expected to be the second most common cause by 2030. This is because we don’t have adequate treatments, with a limited understanding of why some patients respond well to treatments while others don’t. That’s what my research really focuses on. Some of the treatment strategies that have shown promise in other malignancies have not really panned out in pancreatic cancer. Trying to understand why all those limitations exist is very interesting to me. I also enjoy the multi-modality treatments that are available and feel that there’s great opportunity within this cancer. 1. Can you elaborate on your research in pancreatic cancer and how it will impact the treatment of pancreatic cancer? My primary areas of investigational focus are clinical trials, liquid biopsy, response assessment of cytotoxic and immune systemic therapies. My goals are to find ways to individualize therapies afflicted with pancreatic cancer. We are starting to gain a better understanding of molecular subtypes in pancreatic cancer as well as circulating biomarkers, which are areas I focus on with my research. I hope to be able to move the needle in terms of being able to change the way we think about pancreatic cancer treatment and systemic therapies. 1. Pancreatic cancer is one of the leading causes of cancer deaths in the United States with low five year survival rates. How can we improve these statistics? There are usually two groups of patients. One group that has potentially curative disease with localized pancreatic cancer. The other group is patients that present late with metastatic disease. - For the first group, we need to increase the number of patients that ultimately have long-term survival (>5 years) by individualizing therapies to enhance sensitivity to systemic therapies. - For the latter subgroup of patients with metastatic disease, we need better methods of earlier detection, by using circulating biomarkers and screening patients that have a higher risk based on family history, germline mutations, other clinical and demographic factors which would enable us to identify pancreatic cancer sooner. The primary challenge in the early diagnosis pancreatic cancer is its asymptomatic nature and its late presentation which makes it difficult to cure. Being able to identify those patients earlier, puts them in a potentially curative setting (the first subgroup I mentioned), hence improving the survival rates. 1. Is pancreatic cancer research appropriately funded, compared to the other areas in oncology? I think we’re starting to catch up a little bit. The challenge lies in the fact that the preclinical data is very difficult to obtain for pancreatic cancer. Larger grant agencies would like to see strong data before they’re able to fund larger studies. There are only a finite number of patients that are diagnosed with pancreatic cancer, and it’s very difficult to get tissue particularly in the preoperative setting. Most centers do not have a research process in place to obtain additional tissue from the primary tumor at diagnosis. But, I do think that there has been an increased emphasis on pancreatic cancer over the last 5 to 10 years and an increased level of funding available for pancreatic cancer research is encouraging. 1. Do you have any advice for med students or residents who are interested in the field of surgical oncology or pancreatic cancer? Surgical oncology is a field where you have the ability to utilize your technical skills in the operating room, use your thought process to treat cancer patients in the clinic, and also maximize your ability to scientifically approach the challenges with scientific investigation. I think much of the research that I have done in my early career has really focused on ideas that I have had based on learning from others in the field, then forming my own hypothesis and thoughts on how to investigate the question at hand. It’s certainly a very challenging field – the patients, the anatomy, the disease biology. So it’s very important to be broad-minded and be able to come at it from different angles. With regards to pancreatic cancer research, there’s so much new momentum that has changed the field in the last 10 years. When I began studying circulating tumor DNA (ctDNA) in pancreatic cancer 2 – 3 years ago, some told me pancreatic cancer does not shed ctDNA. But now the question has become which assay should we use to gain the best sensitivity to detect the ctDNA, because we now know it certainly sheds, even in early stages. So don’t believe everything you hear, it further, and find ways to dispel those beliefs. Because, in reality, they may not be true. There’s probably more to the story. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/02/Punukollu.Rachana.jpg)Rachana Punukollu is originally from India. She graduated medical school from Konaseema Institute of Medical Sciences, India. She is currently a Research Scholar at Mayo Clinic, Arizona in the Division of Transplant Surgery. Rachana is deeply passionate about General Surgery and its subspecialties. She is looking forward to pursuing her residency training in General Surgery in the United States. **Categories:** awareness --- ### [Creating an Inclusive Surgical Community: Association of Out Surgeons & Allies](https://blog.womensurgeons.org/creating-an-inclusive-surgical-community-association-of-out-surgeons-allies/) **Published:** March 16, 2023 **Author:** Blog Team **Content:** When I was asked to write a piece describing who the Association of Out Surgeons & Allies (AOSA https://www.outsurgeons.org/) is for the Association of Women Surgeons (AWS) blog, I paused. I hesitated because the answer seemed so simple, but complex. Members of AOSA are your: fellow surgeons, patients, mothers, fathers, sisters, brothers, and friends. We represent an often overlooked minority group that faces discrimination for our lesbian, gay, bisexual, transgender, queer (LGBTQ+) identities but also cumulatively experience gender discrimination, sexual harassment and encounter unique vulnerabilities within healthcare. Many of us belong to more than one marginalized group, and most have encountered discrimination throughout our lives, during surgical training, and in our careers. The AOSA is a group of LGBTQ+ surgeons and LGBTQ+ allies of our community, who are connected to support one another and to try to close the existing knowledge and discrimination gap. The need for such an organization has been apparent for years but even today some of our members feel a strong need for anonymity. In 1998 one of the first surveys of physician attitudes toward gay and lesbian medical students, house officers, and colleagues was published and it revealed the difficulties such individuals faced within healthcare.1 One-thousand-forty-five practicing physicians in New Mexico were polled and found that 16.2% were opposed to gay and lesbians seeking training in surgery and 10.1% objected to OB/Gyn training.1 It wasn’t until 2014 that surgery residents were surveyed about their attitudes and perceptions of sexual orientation during the training experience2. Of the 388 general surgery residents studied, 11% identified as LGBTQ, but 1/3 kept their sexual orientation secret during residency. The same study reported that more than half of LGTBQ+ residents reported witnessing or experiencing homophobic remarks during their training, that 54% concealed their sexual orientation from attendings, and 42% were uncomfortable bringing their spouse/partner to departmental events.2 Workplace and training discrimination are not the only problems faced by LGBTQ+ surgeons. In the same year of 1998 that the first survey of physician attitudes was published, the horrific anti-gay hate crimes occurred in Laramie, Wyoming, the most notable being the assault and murder of Matthew Shepard. Violent anti-gay crimes increased over the next ten years until 2009, when the Matthew Shepard and James Byrd Jr. Hate Crimes Prevention Act was passed in order to limit biased crimes directed at the LGBTQ+ community. It was only 8 years ago, in 2015, that the US Supreme Court ruled that the Constitution guaranteed the right to same-sex marriage, thus opening the door of opportunity for the LGBTQ+ community to advocate for equality. In 2021, nearly 5.6% of the overall US population identified as members of the LGBTQ+ community, with a much greater proportion among generation Z (15.9%) and Millennials (9.1%).3 While the numbers in the US grow, surgery has maintained a conservative culture and work environment, thus driving many to continue to conceal their sexuality. A survey distributed in 2019 to 6381 general surgery residents taking the American Board of Surgery In-service Examination showed that 305 respondents (4.8%) identified as LGBTQ+. Of the 305 LGBTQ+ participants, 191 (62.6%) identified as gay or lesbian, 98 (32.1%) as bisexual, 15 (4.9%) as other sexual orientation, and 16 (5.3%) as transgender or other gender identity. Highlights from this study showed the greatest prevalence of LGBTQ+ residents were in the Northeast and the West. These surgery residents also reported experiencing greater mistreatment and discrimination based on gender, gender identity, or sexual orientation, as well as harassment and bullying, with the highest incidence being noted by female residents.4 Although statistics like the 2020 census suggest we are taking steps forward, the pendulum has recently swung in the other direction. Violence towards the LGBTQ+ community continues to increase. During 2022, more than 240 anti-LGBTQ+ bills were filed nationwide. Today, a total of 413 anti-LGBTQ+ bills exist, and while many will not pass into law, they pose harm to persons of all ages. The need for our organization is apparent and undoubtedly long overdue. We founded AOSA to be a place of acceptance that fosters open communication and learning while providing education and collaboration to promote inclusion among students, residents and attendings. Surgery needed to have a welcoming place where surgeons could be themselves and AOSA is that place for LGBTQ+ surgeons and allies. We are confident that the AOSA community will find innovative ways to educate and support the surgical community and work towards achieving a safer, more inclusive, society. (https://www.outsurgeons.org/join-aosa) ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/AOSA-300x221.jpg) References 1. Ramos M.M., Tellez C.M., Palley T.B., Umland B.E., Skipper B.J.: Attitudes of physicians practicing in New Mexico toward gay men and lesbians in the profession. Acad Med 1998; 73: pp. 436-438. 2. Lee K.P., Kelz R.R., Dubé B., Morris J.B.: Attitude and perceptions of the other underrepresented minority in surgery. J Surg Educ 2014; 71: pp. e47-e52. 3. LGBT identification rises to 5.6% in latest U.S estimate. GALLUP®[ https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx](https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx) 4. Heiderscheit E.A., Schlick C.J.R., Ellis R.J., et. al.: Experiences of LGBTQ+ residents in US general surgery training programs. JAMA Surg 2022; 157: pp. 23-32. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/moren.Alexis-blog-235x300.png)Dr. Moren is a Trauma, Critical Care & Acute Care Surgeon at Salem Health in Salem, Oregon and an Assistant Professor of Surgery at Oregon Health & Science University. Dr. Moren received her fellowship training in Trauma & Critical Care at the University of Pennsylvania. She completed her General Surgery Residency at Oregon Health & Science University and received her MD/MPH from St. George’s University in Grenada, West Indies. Her interests include Violence and Injury Prevention, Trauma Informed Care, massive transfusion, global health and creating a more equitable and inclusive environment in the surgical setting. She enjoys traveling and learning about other cultures as she strives to understand health disparities throughout the world. She is a founding member of the Association for Out Surgeon’s and Allies. When not working she spends her time exploring the outdoors with her family of 3 kids, 4 dogs and a cat. **Categories:** advocacy, awareness, diversity and inclusion, leadership, resources, Underrepresented in medicine, women --- ### [Reflections and Advice from a Former Preliminary Surgery Resident](https://blog.womensurgeons.org/reflections-and-advice-from-a-former-preliminary-surgery-resident/) **Published:** March 19, 2023 **Author:** Blog Team **Content:** by Justine Broecker, MD Now that it’s post-match day, a day of celebration for many, I wanted to write a blog post focused on people who may or may not have felt as celebratory—specifically those who didn’t match into categorical surgery programs—as someone who similarly did not match into a categorical position. First of all, even though you may feel like you failed, perhaps for the first time in your life, let me assure you that you are NOT a failure. And, even though challenges are ahead, being a preliminary surgery resident is just the beginning and does not mean you can’t succeed. I wanted to write this post for several reasons—to acknowledge the challenges preliminary surgery residents face, to offer some advice as someone who has now successfully completed general surgery training, and to shed light on how the general surgery community can and should do more to support preliminary surgery residents. As a disclaimer, my experiences are uniquely my own and I do not pretend to entirely represent the wide range of preliminary surgery residents who have had their own unique experiences that may share some similarities with mine, but likely differ in many ways as well. For instance, I know that my friends who are foreign medical graduates (FMG) experienced unique challenges that I myself cannot speak to. However, based on my own experience and conversations with colleagues as well as reading published literature, there are shared experiences that can be improved upon. Preliminary surgery residency—non-designated surgery residency for 1-2 years without the guarantee of completion of residency for board certification—possesses a controversial reputation within surgical training as it has both been described as a “golden opportunity” and a “dead end.”1 Non-designated preliminary surgery residency developed in response to the end of the previous pyramidal system of surgical training in 1996.2 Non-designated positions became critically important to upholding duty hour restrictions as well as filling open categorical positions secondary to attrition, research and/or other reasons for extended leave of absence among categorical surgery residents.2 As a result, preliminary surgery residents clearly play an important role in helping surgery residency programs function, and although such a relationship has the potential to be mutually beneficial, the power imbalance—which exists for all residents, but is amplified for preliminary surgery residents—creates the potential for inequality, and even abuse. Not surprisingly, perhaps, little is known about the preliminary experience, and more information is needed to address existing challenges. In the sparse literature that does exist on this topic, one report found that compared to categorical general surgery residents, non-designated preliminary surgery residents are often older, male and international medical graduates (IMG).3 Another single institutional survey suggested that preliminary surgery residents were in need of more support, in particular mentoring.4 Mentors—whether other surgery residents, especially those who had been prior preliminary surgery residents, or attendings I came into contact with—were extremely important in helping me navigate the unique challenges of preliminary surgery residency. There were so many unique concerns I had to consider as a prelim—how do I stand out on service as a junior resident? Should I reapply to the match or apply directly to open PGY-2/PGY-3 categorical positions? There are no easy or right answers to these questions, but it is helpful to get other, often more experienced, insight as you make these difficult decisions. Feedback and mentorship are critical during residency, but even more so as a prelim. As you apply for promotion at your own institution, or others, you will need other people to advocate for and recommend you. I struggled to ask for this direct feedback and support; in hindsight, I was only hurting myself. In particular, my program director was extremely important in helping me eventually achieve a categorical position. Although monitoring and applying through the APDS for positions is necessary, often some positions are word of mouth, and, therefore, maintaining close contact with your program director is necessary. I also recommend being as direct and honest as possible with your program director. This can at times be uncomfortable again given the power imbalance and the possibility you may want to stay or leave your preliminary institution. In my experience, where and when a categorical position may become available is unpredictable and the process of placing preliminary surgery residents in those categorical positions is complex and rarely transparent. It is therefore in your best interest to be as direct as possible, as early as possible, in asking whether you will be offered a position at your institution, and, at the same time, to actively seek out and pursue other options as well, and to remain open-minded and adaptable. Data regarding the experience of preliminary surgery residents compared to categorical surgery residents is lacking but suggests that disparities exist. One survey reported that preliminary surgery residents were less likely to be satisfied with their operative experience and “the costs of training.”3 At my preliminary institution, preliminary and categorical surgery residents completed the same rotations—which is not always the case everywhere—and I was told we were “the same.” However, there were instances that I did not feel the same. For instance, although it was very common for preliminary surgery residents to pursue research prior to being offered a categorical position, such research often took place in limited, specific labs within our institution. I remember being ecstatic to be accepted to an external fellowship during my second year only to be discouraged from pursuing it and later disappointed when I ultimately could not pursue the fellowship. Residency limits all residents’ freedom, but, as a prelim, I felt even more powerless not only because of the nature of my position but also to advocate for myself for fear of retribution. Perhaps the extent of this fear was unfounded, but without an anonymous mechanism in place, I didn’t feel comfortable, given my vulnerable and unstable position, being honest or entitled to expect or even ask for anything. Given how little is known about the professional experience of preliminary residents, not unsurprisingly, even less is known about the personal struggles faced. One institutional survey highlighted the “stress” felt.4 As for myself, I experienced a range of emotions the months and even years after I didn’t match into a categorical general surgery residency position: shock, confusion, frustration, anger, resentment, envy, shame, loneliness, powerlessness, anxiety, stress, grief, defeat, self-comparison and self-doubt, burnout. I was certainly fortunate that there were many people who were supportive of me during this time who did their best to try to help me manage these emotions while I also dealt with the very real stresses of pursuing surgical residency while also worrying about where, when and if I might complete it. I sought professional counseling during intern year only to become frustrated and give up after only a couple of sessions were nearly impossible to coordinate with my busy schedule and I felt ultimately unhelpful. I did not feel the few therapists I did manage to find time to see really understood my situation as a surgical resident, let alone the added challenges of a preliminary position, to be able to really help me. Many of these similar emotions, shared amongst many residents, have continued to occasionally trouble me as a categorical resident and surgeon, but I have identified better ways to manage them. Although maintaining positive wellbeing is challenging for any resident, my advice is to as best you can identify ways to protect your self-care and to prepare for, acknowledge and address in particular new mental and emotional stresses that may for the first time present themselves during residency, as residency presents new stresses not previously encountered, especially as a prelim. In hindsight, there were some perhaps potentially self-inflicted reasons I didn’t match—I didn’t “interview well,” I was choosy about where I wanted to spend five+ years of my life, I wanted to be close to family and friends—but, like much in life, the match is unpredictable and cannot be fully understood or controlled, and there was perhaps an element of “bad luck.” Conversely, I was very fortunate and lucky to obtain my categorical position as many qualified and excellent preliminary surgery residents do not. “Success” following preliminary surgery residency is unclear, potentially debatable and rarely defined in the literature by preliminary surgery residents themselves. Based on available literature, the majority of preliminary surgery residents appear to be able to successfully obtain categorical positions within the US graduate medical system—although success rate differs between institutions—and, roughly one third of preliminary surgery residents eventually obtain a categorical general surgery position.3,5-9 Residents who obtained a categorical general surgery position were more likely to have completed a preliminary PGY-2 year, demonstrate higher ABSITE scores, be US medical graduates, belong to a race other than black or Hispanic, and be younger.3,5 After I obtained my categorical position, I expected life to be much easier. I had “succeeded.” I did not anticipate that the transition was perhaps in some ways even more difficult than my preliminary years. Transitioning programs mid-residency is challenging—you become an outsider who enters a new, strange environment, but at a potentially senior level. Therefore, you are expected to meet the expectations of having completed years you have completed elsewhere that inevitably were different, and, therefore, pose gaps compared to the experience of your peers. Achieving operative autonomy is challenging for any resident; it was especially challenging at a program where no one knew or trusted me. And, again, although I was very fortunate to have extremely supportive mentors at my new institution, I was the first prelim to transfer and succeed at my level at my new institution, and I struggled to navigate these unique challenges. This brings me to my next piece of advice which is I think you have to accept that as a preliminary surgery resident you have to sometimes work harder compared to your categorical counterparts to reach the same goal. But, hard work alone is not enough, and you have to know and be able to ask for help from the right people when you need it. As I reflect on my experience as a preliminary surgery resident and the transitions and adaptations I have had to make in order to succeed, although I would not recommend being a preliminary over a categorical resident to anyone, I do acknowledge the strengths the experience provided me: capacity to work hard, adaptability, resilience, compassion, empathy, self-reflection and awareness. Residency is designed to change people from student to surgeon and we learn many of these and other skills in the process in order to succeed. But, given the nature of preliminary surgery residency, fair or not, more is ultimately required and expected of you to succeed. There is limited data on what programs can do to improve the wellbeing and/or success of preliminary surgery residents; however, certain program characteristics and interventions appear to enhance preliminary surgery resident success. Larger programs with dedicated faculty researchers, defined mentorship curriculums and an additional PGY-2 year appear to enhance preliminary surgery resident successful placement in particular in categorical surgical positions.2,10,11 From my own experience, I believe additional programs should be offered to support and protect preliminary surgery residents: national standards and expectations that additional support be provided by surgery programs and national organizations for preliminary surgery residents, an anonymous mechanism to provide feedback and advocate for oneself during residency, and a national mentorship program consisting of prior successful preliminary surgery residents to not only offer guidance during the preliminary residency years but also during a potential transition to a categorical position especially at a different institution. More data is needed to define the preliminary experience and to define individual success as it will likely vary individually and potentially evolve over the course of residency. Such knowledge is essential to supporting and empowering preliminary surgery residents. Although the match and obtaining success as a preliminary surgery resident can be—like many things in life—beyond our control even with the best intentions, I believe we can and should explore how to improve the preliminary experience as part of a growing movement to make surgical training more equitable and diverse. 1. Christein JD, Cook JK, Enger TM, Farley DR. Preliminary general surgery residents: indentured servitude or golden opportunity? *Curr Surg*. Jan-Feb 2006;63(1):85-9. doi:10.1016/j.cursur.2005.10.001 2. Sarosi GA, Jr., Silver MA, Ben-David K, Behrns KE. Training outcomes of preliminary surgical residents in a university and Veterans Affairs surgical residency. *JAMA Surg*. Nov 2014;149(11):1127-32. doi:10.1001/jamasurg.2014.2054 3. Sullivan MC, Yeo H, Roman SA, Jones AT, Bell RH, Jr., Sosa JA. Discrepancies in training satisfaction and program completion among 2662 categorical and preliminary general surgery residents. *Ann Surg*. Jun 2013;257(6):1174-80. doi:10.1097/SLA.0b013e3182718ef1 4. Rajesh A, Asaad M, Chandra A, et al. What Do Former Residents Say About Their Nondesignated Preliminary Year? A Survey of Prelims’ Experiences in a General Surgery Residency Program. *J Surg Educ*. Mar – Apr 2020;77(2):281-290. doi:10.1016/j.jsurg.2019.10.003 5. Rajesh A, Asaad M, Chandra A, McKenzie TJ, Farley DR. Outcomes of non-designated preliminary general surgery interns: A 25-year Mayo Clinic experience. *Surgery*. Feb 2020;167(2):314-320. doi:10.1016/j.surg.2019.09.013 6. Montero P, Powell R, Travis CM, Nehler MR. Selection, mentorship, and subsequent placement of preliminary residents without a designated categorical position in an academic general surgery residency program. *J Surg Educ*. Nov-Dec 2012;69(6):785-91. doi:10.1016/j.jsurg.2012.04.009 7. Pezzi CM, Leibrandt TJ, Augustine RT, et al. Nondesignated preliminary residents in general surgery: 25-year outcomes. *Am J Surg*. Aug 2011;202(2):233-6. doi:10.1016/j.amjsurg.2010.06.033 8. Yoo PS, Kozol R, Reilly P, et al. AVAS Best Clinical Resident Award (Tied): fate of non-designated preliminary general surgery residents seeking a categorical residency position. *Am J Surg*. Nov 2009;198(5):593-5. doi:10.1016/j.amjsurg.2009.07.024 9. Ahmad R, Mullen JT. Career outcomes of nondesignated preliminary general surgery residents at an academic surgical program. *J Surg Educ*. Nov-Dec 2013;70(6):690-5. doi:10.1016/j.jsurg.2013.09.004 10. Rawlings A, Doty J, Frevert A, Quick J. Finding Them a Spot: A Successful Preliminary Match Curriculum. *J Surg Educ*. Nov 2018;75(6):e78-e84. doi:10.1016/j.jsurg.2018.09.011 11. Ritter KA, Anand RJ, Beard K, et al. Impact of Surgery Program Characteristics on Fate of Non-designated Preliminary Surgery Interns. *J Surg Educ*. Nov – Dec 2020;77(6):e11-e19. doi:10.1016/j.jsurg.2020.06.001 ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/Broecker.Justine-119x150.png)Justine Broecker is a surgical critical care fellow at UTSW. @jasb805 **Categories:** advocacy, awareness, career development, current events, education, medical students, professionalism, residency, Underrepresented in medicine, women --- ### [Welcome to the New AWS Blog & Tips for Surviving Your Surgery Clerkship](https://blog.womensurgeons.org/welcome-to-the-new-aws-blog-tips-for-surviving-your-surgery-clerkship/) **Published:** May 20, 2013 **Author:** Blog Team **Content:** We’re proud to share the launch of the AWS blog with you, and hope that this will provide a new resource for you. We’ll be posting at least once a week, trying to spark a conversation with you–usually about a topic that relates directly to being a woman surgeon, but also about things that relate to life in the modern day. Mostly, we do want this to be a place for conversation, for thought, for discussion, and we look forward to getting to know you better through that dialogue. If you have a topic of interest you would like to see us address, please let us know. Those of us writing for the blog and the leadership of the AWS are interested in creating a community space, and to do that, we need to hear your voice. Welcome! Amalia Cochran, MD, FACS, FCCM Secretary, Association of Women Surgeons **Surviving Your Surgery Clerkship**by Lauren B. Nosanov I was asked to help compile some words of advice for students entering their third year of medical school, specifically addressing tips for surviving the surgery clerkship. Surgery was my first rotation of my third year, and by far my favorite. That said, I know that many students do not enjoy it nearly as much, and experience a great deal of anxiety thinking about it. As such, I have decided to share here those pointers which I thought would be universally applicable. **General Pointers** - Be excited about the OR! - Surgeons love the OR and they want you to also, even though they accept that most rotating students will not end up applying to a surgical field. Don’t shirk your duties outside of the OR, but do your best to spend as much time observing and participating in operations as you can. - Learn the basics of the OR: - how to scrub (you will be taught this at the beginning of the clerkship – pay attention, sterile technique is important!) - how to not accidentally scrub yourself out (few things raise the ire of an attending / resident as much as a med student who scratches their nose and then contaminates the surgical field!) - what is sterile in the OR and therefore should be avoided when not scrubbed (pretty much everything draped in blue is a good rule of thumb) - where to stand and observe to have a good view but not be in the way (when in doubt, ask) - Anatomy, anatomy, anatomy. - This is 90% of what you will be pimped on, and good knowledge of relevant anatomy makes it much easier to figure out what is going on in the OR. Go back and review the relevant parts of your notes from first and second year lectures and labs. Make sure you know what cases your team will be doing if at all possible and study up the night before. - Learn to tie and to suture ASAP. - Students who can demonstrate these abilities are more likely to be allowed to do things in the OR other than retract. Take advantage of the surgical skill center and the amazing people who work there and practice, practice, practice. - Be confident. - Surgeons tend to be straightforward and sometimes even a bit impatient. When you present, speak up, speak clearly and most importantly, speak concisely. This will earn you respect, and in turn you are more likely to receive more teaching, more opportunities to see and do cool procedures, and (of course) a better grade. - Help your team by becoming a walking cabinet – you will be thanked endlessly time saved and hassle avoided. At a minimum, consider carrying (in white coat pockets or a bag): - radiology order forms - sliding scale forms - trauma forms - suture removal kits - staplers - suture - sterile gloves in your size and your resident’s size - sterile saline - syringes - marking pens - kerlix - 4x4s - tape - extra copies of the team’s patient list - Be gracious when you are allowed to close at the end of a case. This educational opportunity comes at a cost to everyone else (mostly in the form of time, as you are inevitably slower than your resident closing or stapling). Your appreciation to the OR support staff and your residents will not go unnoticed, and you will likely find that you are given opportunities to close more often. - When on call, don’t forget to pack: - lots of healthy snacks you can carry in your white coat pocket (think string cheese, ziplocs with nuts, granola bars, bananas, PBJ) – eat when you can to keep your energy up! - deodorant, toothbrush and toothpaste, washcloth, extra glasses / contact lenses – anything that will help you stay feeling clean and refreshed - cell phone charger (nothing worse than being 20 hours in to your shift and realizing your phone is dead) - books / study materials for potential down time - Don’t tolerate abuse and mistreatment, but try to have a thick skin. Remember that surgery is stressful, and that the well-being of the patient comes before your feelings. That said, if you feel your are being mistreated, speak to whoever is in charge of your clerkship and report – keeping your mouth shut won’t help you or your fellow students. **Study Resources** - NMS Surgery Casebook: great for learning how to assess and manage surgical patients - NMS Surgery: fantastic, concise bullet-pointed information about common surgical conditions; helpful for reading up on your patients’ diagnoses each night - [Pestana Review](http://shortwhitecoats.com/2011/carlos-pestana-surgery-review-notes): case-based review, this is the Surgery equivalent of Goljan Path (very valuable!) - Surgical Recall: nice coverage of basics of surviving a surgical clerkship; best resource for commonly asked pimping questions (and answers!) - Surgery Blueprints: Clinical Cases; a lot like Case Files but more true to the types of questions asked on the Shelf - [Access Surgery](http://accesssurgery.com/): great website for reviewing basics of surgical cases and conditions – load on the computers in the OR immediately prior to a case for last-minute review; requires a subscription (many medical schools provide students with access) - As with all clerkships, Pretest, First Aid and Case Files may come in handy depending on student preference Cross-posted on November 1, 2012 at [metamorphosistomd.blogspot.com](http://metamorphosistomd.blogspot.com/) **What resources did YOU use to prepare for your surgery clerkship? What other general pointers do you have for students who wish to excel during their third year?** **Share your thoughts in the comments! Let us know what else you would like to see featured on the blog!**\~~~ *Lauren Nosanov is a fourth year medical student at the University of Southern California Keck School of Medicine. She has spent the last year as a Dean’s Research Scholar, dedicating her time to clinical research in the field of Trauma and Critical Care. Having loved surgery from the very beginning, she is excited to embark upon the process of applying to General Surgery residency this fall. She is passionate about issues surrounding surgical education, mentorship and finding a balance between motherhood and medicine. Outside of medicine she enjoys practicing Taekwondo and spending time with her husband and son.* **Categories:** medical students, training --- ### [Disparities](https://blog.womensurgeons.org/disparities/) **Published:** June 11, 2013 **Author:** Blog Team **Content:** by Marie Crandall, MD, MPH, FACS **Poverty** Living in Detroit as a child, I learned that if your water got turned off, you just went down to the city Water Board, paid $10, and got your water turned back on. When I started high school in the early 1980s, our family moved to Northern Michigan. It was there I met folks who didn’t have running water. I have countless memories of stumbling out past snow-covered woodpiles to drafty outhouses, then pumping ice cold water over my hands before returning to not terribly public health-focused high school parties. Seeing both urban and rural poverty and the ensuing late-diagnoses of cancer, alcohol-induced car crashes, and gunshot wounds that ruined lives absolutely influenced the course of my life and my career. The crushing effects of poverty are pervasive and have a tremendous impact on health disparities, as income and race have been found to predict outcomes in nearly every kind of illness, from trauma to appendicitis to cancer, though we are only just beginning to understand the mechanisms. However, programs that improve housing stability and access to healthcare and healthy food choices have been shown to improve ALL health outcomes for children, underscoring the principles of the social determinants of health. If we can address some of the nutrition, education, and health issues of children living in poverty, we may be able to narrow the gap of subsequent health outcomes disparities. Likewise, if issues of homelessness and substance abuse could be more comprehensively addressed, there is evidence to suggest that Emergency Room visits and healthcare expenditures can be reduced. **Trauma** Injury is the leading cause of death of all Americans ages one through 45. Gunshot wounds take the lives of 30,000 Americans every year. There is an epidemic of violence and endemic acceptability of violence in our communities with African American and Latino youth suffering a disproportionate amount of gun violence in the United States. Simply providing excellent trauma care is not enough. Programs like CeaseFire/CureViolence in Chicago and Safe Streets in Baltimore are necessary adjuncts to address the underlying root causes of handgun violence. Ensuring safe access to schools, improving educational and earning potential for underprivileged youth, and teaching conflict resolution skills as alternatives to violence are essential to preventing the loss of life that takes such a heavy toll on our disadvantaged communities. Fear of flying is one of the most common phobias in America, affecting nearly 40 million people. Yet if you ask any group of people if they know someone who has been killed in a commercial aviation crash, almost no one will raise their hand. However, most people have no fear at all of getting behind the wheel of a car, even when intoxicated, though nearly 30% of Americans have lost someone in a motor vehicle crash. However, there are things you can do to make your ride safer, like wearing a seatbelt, which reduces the risk of death for a similar velocity crash by up to 80%. Many researchers have found that people of color are less likely to use a seatbelt; this disparity is completely eliminated in states with primary seatbelt laws. These data suggest that primary prevention can be effective in some cases to decrease racial disparities in health outcomes. **Upshot** So, what does all this mean? I believe that by recognizing the disparities around you, affecting your families, friends, and communities, and by striving consistently to acknowledge and eliminate them, you will be a better clinician and global citizen. Your role may include public health work, competent clinical care, health policy, and/or advocacy. But a holistic worldview, with an understanding of the social determinants of health that affect all of us, is essential to the comprehensive care of your patients. **What health disparities have you witnessed in your community or during your travels? What efforts have you made (or wish to make) to transform the world into a better, healthier place? Leave your comments below!** \~~~ [![](%5Bsiteurl%5D/wp-content/uploads/2013/08/Crandall-252C-MD-252C-Marie-2010-NMFF.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/08/Crandall-252C-MD-252C-Marie-2010-NMFF.jpg)*Marie Crandall, MD, MPH, FACS is an Associate Professor of Surgery and Preventive Medicine in the Division of Trauma and Critical Care at Northwestern University Feinberg School of Medicine. She is originally from Detroit, MI, a product of Head Start and local public schools. Dr. Crandall obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley in 1991, and completed her M.D. in 1996 at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001, and in 2003, completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA. During her fellowship, she obtained a Masters in Public Health from the University of Washington. Dr. Crandall performs emergency general and trauma surgery, staffs the SICU, and is an active health services researcher. Dr. Crandall loves travel, triathlons, hiking, and is a passionate animal rights activist; you can follow her on Twitter [@vegansurgeon](http://twitter.com/vegansurgeon).* **Categories:** Uncategorized --- ### [Green Solutions for the OR - 2013 Contest](https://blog.womensurgeons.org/green-solutions-for-the-or-2013-contest/) **Published:** June 13, 2013 **Author:** Blog Team **Content:** [![](%5Bsiteurl%5D/wp-content/uploads/2013/06/globe.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/06/globe.jpg) **The [Association of Women Surgeons](https://www.womensurgeons.org/), in partnership with [Practice Greenhealth](https://practicegreenhealth.org/), Invites Entries for the** **2013 Competition: Green Solutions for the Operating Room** This contest is designed to facilitate discourse between students, residents and perioperative faculty and staff about ideas that demonstrate environmental responsibility in the operating room through reduction of energy use, preservation of natural resources and/or effective waste management. DEADLINE IS AUGUST 4th, 2013. **Contest Description:** To enroll in this contest, please submit an innovative solution that has been or can be implemented in the operating room to protect, restore, and/or preserve the environment. Your idea can incorporate one or more of the following: energy efficiency, pollution prevention, preservation of natural resources and/or waste management. This idea can be in the form of a proposal (has not yet been implemented) or a summary of a project that has already been initiated. Entries will be judged on originality, feasibility and potential impact. **Prizes:** Recognition, two $200 monetary prizes and a complimentary registration to the 2013 AWS Conference will be awarded to the top two submissions. The first place submission will also receive free admission to the Greening the OR® workshop at the 2014 Practice Greenhealth [CleanMed Conference](http://www.cleanmed.org/) ([www.cleanmed.org](http://www.cleanmed.org/)). Winning submissions will also be posted on the AWS Website if the submission is free of copyright restrictions. **Inspiration:** Check out Practice Greenhealth’s [Greening the OR®](https://practicegreenhealth.org/initiatives/greening-operating-room) Initiative website to jumpstart your ideas (<https://practicegreenhealth.org/initiatives/greening-operating-room>) [![](%5Bsiteurl%5D/wp-content/uploads/2013/06/greening-the-or.png)](%5Bsiteurl%5D/wp-content/uploads/2013/06/greening-the-or.png) **Who can participate: The contest is open to **all** students, residents, physicians, nurses, and allied health professionals involved in the care of patients in the perioperative setting. **How to Enter: Gather your best ideas, prepare a document, and submit! Please include the following sections in your submission: · Title and Author(s) (including affiliations) · Description of targeted problem · Proposed solution: include information about general budget, personnel required, need for training if applicable, etc.) · Anticipated outcome and method for measuring the outcome · Figures and photos optional · Please specify if the submission is free of copyright restrictions. Submission Guidelines: · Limit the entire submission to **500 words or less** (excluding the title and authors). · The **file name** should be your last name followed by your first name (i.e. “SmithJohn”). · Save the file as a WORD document · Send the document as an attachment by e-mail to the [AWS Greener OR Contest](mailto:AWSgreenerORcontest@gmail.com) address –<AWSgreenerORcontest@gmail.com>. **Receipt of your submission will be confirmed by email.** · **Submissions must be received no later than 5:00 PM EST Sunday, August 4, 2013.** **Notification: Contest winners will be notified by September 1, 2013. All entries will be compiled and shared during the 2013 Association of Women’s Surgeons Annual Fall Conference in Washington DC on Sunday, October 6, 2013 (held prior to the American College of Surgeons Clinical Congress). **Questions?** Please do not hesitate to contact us at <AWSgreenerORcontest@gmail.com>. [![](%5Bsiteurl%5D/wp-content/uploads/2013/06/AWS-logo-131x150.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/06/AWS-logo-131x150.jpg) [![](http://blog.womensurgeons.org/wp-content/uploads/2013/06/10683299-practice-greenhealth.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/06/10683299-practice-greenhealth.jpg) **Categories:** Uncategorized --- ### [Internship: Ready, Set, Go!](https://blog.womensurgeons.org/internship-ready-set-go/) **Published:** June 21, 2013 **Author:** Blog Team **Content:** by Callie Thompson, M.D. Congratulations to all of you newly minted Doctors of Medicine! It is almost time to start your internships! You are probably trying to imagine what it will be like, and you are probably excited, nervous, scared, and maybe even a little nauseous. This transition from medical student to doctor will be a big adjustment. But don’t worry, you really can (and will) do this. I will start with a few general tips for how to succeed in your internship and then finish with some more specific tips that you will hopefully find helpful. 1\. **The patient comes first.** Always. They are your North Star. When you lose your way, ask yourself “What is best for my patient?” and do that. 2\. **Be the doctor.** I know, this one seems obvious, but you just graduated 3 weeks ago and now someone is calling you “Dr. So-and-so” and you feel both scared and like a total fraud almost all of the time. However, your patients and your team still depend on you. You are their “Dr. So-and-so” and you need to act like it. Have assessments, have plans and be willing and able to explain your reasoning for them. And don’t forget to introduce yourself as “Dr. (YOUR LAST NAME HERE)”–you earned it. 3\. **Always worry, but never worry alone.** If you load that proverbial boat early, at least you won’t sink alone. If someone on the floor is going south, assess them and then let your senior resident know. Immediately. No one expects you to be perfect; you will be learning and improving for the rest of your life, but we do expect that you will not keep secrets from us. 4\. **Never lie.** Not to your seniors, not to your attending, and not to the patient. I know that these people will be looking at you and wanting to hear “good news” but your only job is to be honest, to tell them the truth. Trust is what your relationships with these people is built on; lying, even once, can permanently damage that relationship and worst of all, put the patient at risk. 5\. **Utilize the nurses, but don’t let them use you.** The nurses can and will be your best friends. They have experience, and they can teach you infinite amounts. If they call and tell you someone is sick, listen to them. Don’t let your ego get in the way. Everyone is on the patient’s team. The flip side of this is that some people will take advantage of your “newness” and they will ask you to do things that seem wrong to you. If that is the case, don’t do it. Politely tell them that you need to check with your senior, and check with your senior. No one should get offended by that, as long as you remain polite and respectful. 6\. **Ask your senior residents and attendings for their expectations of you.** There is nothing worse than finding out that you are falling short of expectations that you didn’t know existed. Asking for expectations up front will lessen their potential frustrations, and yours. 7\. **Ask for feedback from your seniors and attendings.** Don’t wait for the end of a rotation to get an evaluation. That leaves you no opportunity to fix things and get better. Ask for feedback in the middle of your rotation (a great time for this is when you are finishing up a case) and then they will know that you were interested in improvement, and they will be able to recognize when you have improved. And for the interns who are parents: 8\. **Set goals for yourself and your family.** Make promises to yourself and your family about when you will study and prepare for your patients and when you will just be present for them. This is going to be an especially big period of adjustment for you, your partner, and your child(ren), but you’ll get through it. Have patience with yourself and with them. Now for a few specifics… **Must-use Websites & Apps:** 1\. [NCCN Guidelines](http://www.nccn.org/clinical.asp). The absolute best resource for guidelines for treatment of cancers. This site will help you immensely in clinic–and they have an app. 2\. Up-to-date. Obviously. 3\. Epocrates. Again, obviously. 4\. ACGME case log mobile app. Immediately enter all of your cases after you complete them. Seriously, don’t let them stack up. I had to enter an entire year’s worth at one point, and it was obnoxious. Open the ACGME case log site on your iPhone (*if you know how to do this on a non-Apple product please weigh-in in the comments below*), click the rectangle with an arrow icon on the bottom of the page, and then click “add to home screen.” 5\. [Twitter](http://twitter.com/). Join twitter, follow people and organizations that you are interested in, and just watch. I have read more journal articles in the two months since joining twitter than I have in the prior two years. I recommend the Association of Women Surgeons, American College of Surgeons, Journal of Trauma, Annals of Surgery, NEJM, JAMA, and Journal of Burn Care and Research, but there are many more. 6\. DrawMD apps. A perfect way to explain an operation to a patient. 7\. Other useful (but potentially costly) resources include the SCORE curriculum (this will be an institutional license, so your program may not have it), the Gray’s anatomy app, and SESAP 14. 8\. Useful books (I like e-books because they are easier to carry around): Greenfield’s Surgery, Zollinger’s Atlas of Surgical Operations, and Operative Dictations in General and Vascular Surgery. **Organizing Your Day:** Pre-rounding, rounding, clinic, OR, afternoon rounding, sign-out. The schedule probably hasn’t changed too much from medical school, except that you will be the one in charge of getting things done while still being in clinic and in the OR. Multi-tasking and triaging will be vitally important, but they can’t really be taught. They are best observed and then applied in a trial and error manner until you find a method that works for you. I will give you this tip: discharge your patients before doing anything else (unless the something else is urgent). With computerized order entry, a lot of the discharge orders can be done the night before. This is also true for the discharge summary. The big question is, what should you do when you get home from work? You should NOT start working again immediately. You should NOT study or read for the next day’s cases. You SHOULD sit down and relax. Take a few moments for yourself. Eat some dinner. Maybe have a glass of wine. If you have a significant other or kids, spend time with them–see above. If you don’t, make some plans with friends (co-residents make great friends) or give your family a call. Then, set a time (maybe 1-2 hours after you get home) to study, prepare for the next day, and/or check in on your patients. **What You Should Know for Every Case/Procedure You Do:** Prior to scrubbing in to a case or performing a procedure you need to know… 1\. Your patient’s history (including being familiar with their imaging) 2\. The indications for the operation 3\. The steps of the operation (including the anatomy) 4\. The pitfalls for those steps 5\. The general perioperative management You may not be asked anything during the case but you should know these things all the same. If you have a question or can’t see during the case, ask politely if it would be a good time to ask a question or for you to take a closer look. Be okay if the answer is no because the patient comes first. At the end of every case, talk with the senior resident and attending about the perioperative plan for the patient. You should know the plan for every drain/line, diet, pain management, and wound care. You should also know the criteria for discharge. (Hint: if you do this, you will almost always have an acceptable plan for the patient on morning rounds.) Best of luck to all of you and congratulations, again! **For those of you who have already completed internship or at the tail-end of your intern year, do you have any additional tips or advice? What helped you out most during your first year as a new surgeon-in-training? Let us know in the comments below!** *\~~~* *Callie is a resident in general surgery at the University of Washington. She will be entering her fourth clinical year at the end of June 2013 after completing a two year research fellowship. Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.* **Categories:** residency, training --- ### [Policy & Advocacy Corner: A Day on Capitol Hill](https://blog.womensurgeons.org/policy-advocacy-corner-a-day-on-capitol-hill/) **Published:** July 4, 2013 **Author:** Blog Team **Content:** **Happy Independence Day to our US readers! As a special holiday treat, today’s blog post features an article from our members-only newsletter: *AWS Connections*. Enjoy!** **My Day on the Hill** by Leigh Neumayer MD, FACS In April 2013 I participated for the first time in one of the ACS Advocacy Summits in Washington, DC. Now I will admit, this was not something that was on my bucket list, but as a leader in the ACS, I was strongly encouraged to attend. In retrospect, I wish I would have started attending these summits years ago. Clearly the surgeons who had done this before were way more comfortable and polished in this role than I was. That being said, even if I was the only surgeon from my state there, I am confident the ACS Washington office would have prepared me well to fly solo. After some prep work, reviewing the issues and with talks from some elected officials and their staff, we headed to Capitol Hill. What struck me initially was the sheer volume of U.S. citizens (usually in groups with nametags identifying the sponsoring organization) who were wandering the hallways of the Senate and Congressional office buildings with us. If we aren’t there presenting our concerns and viewpoints, our elected officials’ schedules will clearly be completely filled with other groups. Having not voted for several of the Utah delegation, it felt a bit weird visiting their offices. I had to remind myself that despite their party affiliation or who they defeated, these individuals (all men in the case of Utah) are now in Washington representing all of Utah, regardless of party. We had specific issues we were to review in each senator’s/congressman’s office. The Boston marathon bombings occurred the day before our visit, making funding for trauma systems an easy opening issue. From there we (my colleagues Dr. Amalia Cochran and Dr. Mark Savarise, both veterans in advocacy efforts) were able to cover a couple other issues. For each issue we had talking points and had made a plan about who was going to take the lead for each meeting. [![](http://blog.womensurgeons.org/wp-content/uploads/2013/07/AdvocacyDay.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/07/AdvocacyDay.jpg)While we met with staff for the majority of the Utah senators and representatives, one of our senators was able to drop in at the end of the meeting and we were meeting with one of the representative’s chief-of-staff in his office when he came by to pick up the rest of his lunch. We were given important tips along the way, like asking the staff of one representative to take us on a tour and the staff of another to deliver us underground from one building to another. Overall, it was a great experience, one that I hope becomes habit for me. We live in a great country, and should take advantage of the privileges that are afforded us by citizenship, which includes making our voices heard in a constructive manner to those who can make a difference on a national level. \~~~ **Categories:** advocacy --- ### [Surgeon Preference and Music in the Operating Room: a Randomized, Controlled Trial](https://blog.womensurgeons.org/surgeon-preference-and-music-in-the-operating-room-a-randomized-controlled-trial/) **Published:** August 27, 2013 **Author:** Blog Team **Content:** by Marie Crandall, MD, MPH, FACS **Background:** Music in the operating room has been studied fairly extensively, mostly in the context of ambient music used to decrease anesthetic requirements during surgery. However, very little has been written about musical preferences of the operating surgeon, which is arguably very important, as “ambient” music often translates into that irritating New Age music which meanders aimlessly, relying heavily on woodwinds and bird tweets, and defies all rhythm or syncopation. Still, apparently it’s very helpful to patients who are not actively driven to poke their eyes out with stray syringes of propofol having to listen to that nonsense. **Methods:** The authors (A.K.A. me) decided to conduct a randomized, controlled trial of surgeon-directed music in the operating room (OR). Except that randomization is sort of painful, in that there has to be blinding, measurement of covariates, and I really only had a week. So, instead, I performed a population-based survey, by sending out an email and posting a Facebook notice querying surgeons about their OR musical preferences. I guess one could quibble about the “population-based” aspects, as I mostly just emailed the cool women surgeons whose email addresses were in my Outlook contacts, and well, I suppose my Facebook friends are not exactly a random sample of American surgeons. Oh, yeah, and I only asked women. Just because. But I digress. Four questions were asked, “1. Do you listen to music in the OR?, 2. Is it your music?, 3. Do you let residents pick the music?, and 4. What do you listen to?” (yes, I know I ended the question with a preposition, but remember this is a population-based survey, and EVERYONE does it, ok I’ll change it. See **Table 1** below). **Results:** Seventeen attending women surgeons responded to the survey (100% response). Nearly all respondents listen to music in the OR. Most bring their own music, but some attendings allow the residents, nurses, and anesthesiologists to choose music. A theme emerged that many surgeons will turn off the music when a patient is unstable. Those who always listen to their own music were fairly vehement about it. Otherwise, musical preferences are all over the map and completely contradictory to each other, defying any kind of theme analysis. And some people listen to really terrible music, as you can see for yourself in **Table 1** below. **Table 1:** **Survey of badass\* attending surgeon musical preferences** | Question | N (%) | Comments | |---|---|---| | 1. Music in OR? Yes No | 16 (94%) 1 (6%) | “If it’s an unstable patient, I turn the music off,” “Occasionally it’s distracting when I have to make sure anesthesia is not slipping some pressors in the IV,” “Will turn tunes on when out of the danger zone,” “No music allowed. Focused concentration mandatory” | | 2. Your music? Yes No | 10 (59%) 7 (41%) | “Really? That’s the absolute best thing about being an attending, choosing the OR music. That and wearing pajamas every day to work.” | | 3. Let residents pick music? Yes No | 12 (71%) 5 (29%) | “NEVER,” “Yes, unless it sucks” | | 4. Musical choices? Neurosurgery resident playlist; Pandora, dance music (all decades); “Mostly alt country/Americana with a little Southern rock thrown in; Drive-By Truckers for nec fasc”, “Washed Out, Wye Oak, Beach House, Sharon Van Etten, Wild Nothing, Iron & Wine, Silent Years, Alela Diane, Army Navy”; ‘80s, upbeat dance music, “My Sharona”; “Top 40 radio, classic rock, top 40, jazz, classical”; “Electronica is my office default, but it’s not appropriate in the OR”; contemporary pop; “OR specific playlists with Pink, Indigo Girls, Patrice Pike, Bonnie Raitt, Tim McGraw, Lady Antebellum, Shawn Colvin, The Rescues, just to name a few”; Indian and American club music; “I use Pandora; liver transplants get 80s pop or Vanilla Ice mix, liver resections get Abba or Pink”, “my iPod (all decades)”; “A mix on Pandora, what it is depends a bit on the case and time of day, one of our night scrub techs is a huge Disney fan so we tend to play Disney Pandora and have a name that tune session” ; “My music is the best. I have everything from Metallica to Otis Taylor to Agent Orange to Santana. If you hate the current song, wait til the next one.” *Pertinent negatives: no country (x2), no musicals, no rap, no metal, no Britney Spears, no Taylor Swift, no Justin Bieber, no smooth jazz* | \*badass (adj). Used to describe all study participants; indicates clarity of mind, a humorous disposition, and excellence in the field of surgery **Conclusions:** My first conclusion is that most of us are united in turning off the music to enhance concentration, consistent with previously published research. Second, in this non-randomized, uncontrolled, not remotely population-based survey of experts in the field of surgery, there is a wide variety of music played in the OR. And, finally, the near-unanimous agreement that the best music to be heard in any OR anywhere is that of Marie Crandall, MD, MPH, FACS. **What music do you like to play in the OR?** **Let us know in the comments below.** \~~~ [![](%5Bsiteurl%5D/wp-content/uploads/2013/08/Crandall-252C-MD-252C-Marie-2010-NMFF.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/08/Crandall-252C-MD-252C-Marie-2010-NMFF.jpg) *Marie Crandall, MD, MPH, FACS is an Associate Professor of Surgery and Preventive Medicine in the Division of Trauma and Critical Care at Northwestern University Feinberg School of Medicine. She is originally from Detroit, MI, a product of Head Start and local public schools. Dr. Crandall obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley in 1991, and completed her M.D. in 1996 at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001, and in 2003, completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA. During her fellowship, she obtained a Masters in Public Health from the University of Washington. Dr. Crandall performs emergency general and trauma surgery, staffs the SICU, and is an active health services researcher. Dr. Crandall loves travel, triathlons, hiking, and is a passionate animal rights activist; you can follow her on Twitter [@vegansurgeon.](http://twitter.com/vegansurgeon)* **Categories:** Uncategorized --- ### [Lean In: Book Review & Discussion (Part Two)](https://blog.womensurgeons.org/lean-in-book-review-discussion-part-two/) **Published:** October 1, 2013 **Author:** Blog Team **Content:** [](%5Bsiteurl%5D/wp-content/uploads/2013/10/SophiaKimMcKinley.jpg) by Sophia Kim McKinley, Callie Thompson, MD, and Minerva Romero Arenas, MD, MPH **Chapter 4: It’s a Jungle Gym, not a Ladder (*Sophia*)** Sandberg reveals that she did not have a master plan at the outset or her career. Instead, she took opportunities as they arose or created her own opportunities. Again, business is a different context than surgery, in which the progression up the totem pole happens in a very particular and prescribed order. Still, there are elements of uncertainty, risk, and surprise when making decisions about a career in medicine. Even as a 4th year medical student, I can describe junctions and branch points in my medical career where, instead of taking the safe or planned route, I pursued something else and wound up in a wonderful situation. I entered a lottery to be one of a dozen students in a novel, integrated third year and found myself having yearlong relationships with patients. It was there that I abandoned my plan of becoming a dermatologist in the operating room of a surgeon who would become one of my greatest mentors. And because of the effect of this new rotation system, I developed an interest in surgical education and ended up taking a year off to complete a Master of Education. It’s easy to look at someone successful or admirable and imagine him or her climbing a ladder straight to that position. Long-term goal setting and planning are critical to achieving ambition dreams, but Sandberg reminds her readers that there is likely more to the story, including a willingness to pursue unanticipated opportunities because of the potential for growth, whether that be taking a job in a new part of the country, starting a new research project, or taking on additional responsibilities in one’s current practice setting. ***Have you taken alternative routes in your career?*** **Chapter 5: Are you my mentor? (*Minerva*)** “*It should be a badge of honor for men to sponsor women.*” This chapter is full of practical advice that can easily be applied into any field, and in my opinion, can help both the mentee and the mentor. Through anecdotes of Sandberg’s own mentors and the people she has mentored herself (whether officially or not), her message becomes clear: mentoring relationships have to develop naturally and grow. As such, having ground rules for these relationships is important. Things to consider: 1. Be mindful of the mentor’s time – mentees cannot expect to spend hours of a mentor’s time each week. As Sandberg points out “That’s not a mentor – that’s a therapist.” In my personal experience, setting up short meetings of 15-20 minutes with focused questions or goals are more effective for both the mentor and mentee. On a similar note, Sandberg suggests avoiding complaining “excessively” to a mentor and instead, ask for specific advice about how to move forward. 2. Strangers can be mentors – Just do not seek a mentor by asking a stranger cold-turkey “Can you be my mentor?” Successful mentees have approached Sandberg in a different form – a simple introduction with a well-thought out question. These individuals sparked her interest through their own success and she eventually filled that mentor role. 3. “Excel and you will get a mentor” – In surgery, strangers are frequently referred to each other by a common colleague or friend. This is how I landed with my current research mentor. The key is engaging potential mentors so they may take an interest in you and your success (via your CV or a strong referral) and following through afterwards with hard work (the mentoring relationship will naturally develop through your hard work). In my own experience, it is important to have more than one mentor, something Sandberg alludes to through various anecdotes. For example, I have surgical mentors to whom I can turn to for various aspects of my career: my clinical concerns, career advice, and even task or situation-specific guidance. I have mentors to whom I can turn to for support and life advice. I also have some informal mentors with whom I interact on a less frequent basis (often by email or occasional text messages or calls). The importance of mentors in surgery (as in other fields) is obvious and many employers and medical organizations, including AWS, have launched their own mentorship programs. Interestingly, Sandberg points out that “official mentorship programs are not sufficient by themselves and work best when combined with other kinds of development and training.” ***What has your own mentorship experience been like? Have you been a part of an organized mentorship program?*** If you have not downloaded the AWS Pocket Mentor you may do so [here](https://www.womensurgeons.org/aws-pocket-mentor-now-available-as-e-book/). You can also read our [AWS blog post](https://www.womensurgeons.org/blogger-q-a-advice-passed-down-from-our-mentors/) for good advice passed down from our mentors. **Chapter 6: Seek and speak your truth (*Minerva*)** In closing the chapter, Sandberg writes one of the sentences that made me think a lot about my own experience in surgery- “And maybe the compassion and sensitivity that have historically held some women back will make them more natural leaders in the future.” What I took away from this chapter really was a lesson in effective communication and leadership. By this point in the book it is no doubt that Sandberg has research to back up the inescapable fact that gender strongly influences others’ perceptions of a person. In fact, gender strongly influences our own perceptions of ourselves. Sandberg laments that women hesitate to provide honest feedback, lest they be labeled as whiners or avoid discussing their children at work lest their priorities be questioned. Instead she advocates for honesty and a shift in leadership that strives for “authenticity over perfection.” I have seen both types of leaders and struggled with the qualities I want to emulate. Slowly I have realized that some situations will call for a different kind of leader in order to be effective. For example, I know a leader who is generally regarded as someone who has high expectations, demands perfection, and may not be the easiest person to please. While this style may aggravate colleagues and subordinates in many situations, in surgery this type of leadership is essential when dealing with decisions that carry serious consequences such as life or death. Ultimately, more diversity in the workforce will translate to changes in leadership and eventually, I hope more equitable roles in the workforce. ***Have you ever felt like you could not voice concerns out of fear that you may be labeled as a complainer or not a team-player?*** **Chapter 7: Don’t leave before you leave (*Minerva*)** Sandberg points out that many women start to end their career before even getting out of the workforce. In an extreme example, Sandberg notes a young employee who worried about raising children before even being in a relationship, pregnant, or anywhere near having to worry about career-personal life balance. She raises a valid point that instead of holding themselves back from success due to being unable to meet demands later – women should aim for success and adjust or scale back as needed later when their success will lend them much more flexibility. When I read this chapter I immediately thought of one surgery mentor. Having seen many intelligent, bright, and technically gifted female residents quit surgery for their families, he would frequently warn me not to quit surgery “because you want to have kids.” Most of the time I thought he was kidding with me, but in retrospect I feel lucky that someone saw enough promise in me and cared enough to open up a sincerely dialogue with me about career planning. I must admit that I am guilty of nearly doing this to myself. While I had mentally prepared to make sacrifices for my career, during medical school I realistically started to consider how much of my life I would let my career consume. After my clinical rotations I was convinced in my heart that I wanted to do surgery, but all the warning alarms in my mind were going off. I am thankful that I had the sense to call one of my mentors (and a voice of reason) to help me think through this seemingly enormous decision. “Why not?” she asked during that call –I had no answer –and with that simple question she helped me realized that only I could hold myself back from a fulfilling career in surgery. ***Do women really leave before they leave?*** ***We value your opinion. Chime in on the comments below, and be sure to check back tomorrow as we continue our discussion in Part Three. Yesterday’s discussion can be found [here](https://www.womensurgeons.org/lean-in-book-review-discussion-part-one/).*** **\~~~** [![](%5Bsiteurl%5D/wp-content/uploads/2013/10/SophiaKimMcKinley.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/10/SophiaKimMcKinley.jpg)*Sophia Kim McKinley is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia will be applying for general surgery residency during the 2014 Match cycle.* [![](%5Bsiteurl%5D/wp-content/uploads/2013/12/Thompson.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/12/Thompson.jpg) *Dr. Callie Thompson is a resident in general surgery at the University of Washington. She recently completed a two year research fellowship and is now in her fourth clinical year. Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.* *[![](%5Bsiteurl%5D/wp-content/uploads/2013/10/MRomeroArenas.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/10/MRomeroArenas.jpg) 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.* **Categories:** Uncategorized --- ### [Lean In: Book Review & Discussion (Part Three)](https://blog.womensurgeons.org/lean-in-book-review-discussion-part-three/) **Published:** October 2, 2013 **Author:** Blog Team **Content:** by Sophia Kim McKinley, Callie Thompson, MD, and Minerva Romero Arenas, MD, MPH **Chapter 8: Make your partner a real partner (*Callie*)** By nature, women are charged with carrying the child, birthing the child, and feeding the child (if one so chooses), resulting in an uneven distribution of work between a couple from conception. This chapter discusses some of the author’s personal struggles with being a new parent and the division of labor and responsibility in her relationship. Data show that in heterosexual couples, when both work outside the home, the women does 30-40% more of the childcare and housework, and as recently as 2009, only 9% of dual-earner marriages said they split the work evenly. As a surgeon, I would suggest that this needs to be acknowledged and discussed prior to starting a family with a spouse/significant other. When a couple is discussing having children, there can be a lot of debate and negotiations about the vision for that child with regard to religion, discipline, schooling, extracurricular activities, and on and on. One thing should not be a negotiation; both parents must contribute equally to the care and development of the child, and if that is not okay with your partner, I strongly suggest reconsidering him for that role. This does not mean that each task needs to be done by each parent equally, just that the division of labor overall needs to be as close to 50/50 as possible. If you feed the child, your partner can bathe the child, and if you clean the dishes after dinner, your partner can vacuum the floor, etc . . . . If that was it, things would be easy, but you also have to deal with society. You have to realize that society is going to set out to make your male partner feel emasculated because he is sharing household and child-rearing tasks with you. Believe it or not, even in 2013, men are still harassed for staying at home with their kids. Lighthearted comments and snide remarks can be hurtful to our male partners. The easiest way to counteract those actions is to let them know how appreciated they are, not because they are doing things FOR you but because they are doing them WITH you. Society will also try to make you feel badly for working outside of the home. People will tell you how wonderful it is or how lucky you are that your husband “watches” your kids for you. When this takes place, you should feel free to inform these people that the father of your children is fathering them. Nothing more, nothing less. But overall, my best advice is to ignore, ignore, ignore. If it works for you and your family, the rest does not really matter. ***Do you have a family? Is your partner in medicine or surgery? Are couples in similar fields more likely to succeed or fail?*** **Chapter 9: The myth of doing it all (*Callie*)** In this chapter, “having it all” is called “the greatest trap ever set for women,” “antiquated rhetoric,” “a myth,” and a “recipe for disappointment.” I think we can all agree that this phrase should leave the vocabulary of our society and never return. Sandberg quotes some amazing women in this chapter: Gloria Steinem, Nora Ephron, Tina Fey. All of it is to say that being a working parent is hard work, and it doesn’t always (read: almost never) go according to plan, but the best way to manage is to cut yourself some slack, be willing to compromise, be honest with yourself about your own goals/desires, and be willing to change the plan. Admittedly, some of these things are much easier to do in other lines of work and at different points in our surgical careers. For instance, it would be great to be able to work the hours that worked best for my family, but those aren’t the hours that are best for my patients, my attendings, my co-residents, or my hospital system, so as a resident, I work the hours I work, and when it comes time to choose a job, I may want to take that into consideration in my choice. Another important point is that we need to manage our guilt. This is a hard one because, no matter how many times you hear people say that your kid(s) will be okay even though you don’t stay home with them, the one time someone insinuates the opposite, it will stick with you and that one thought can fester and cause a lot of damage to your psyche. However, as lovers of science and evidence-based practice, we should rely on the data. As the author points out, data show that kids who are cared for by their mom vs. those also cared for by others develop the same, build the same relationships, and still bond with their moms. Also, having an involved dad, a mom who gives you independence, and parents with emotional intimacy are much more influential on a child’s development than having their mom care for them exclusively. ***Full disclosure:*** despite this data, I still feel guilty quite frequently. I was irrationally crushed just last week when we missed my son’s 12 -month check-up because my husband and I both forgot. Other than reminding myself that the kid is fine, the appointment was rescheduled, and nothing bad actually happened because of this. Conclusion? I do not have a good solution to these thoughts. ***How do you “do it all?” Is it really a myth?*** **Chapter 10: Let’s Start Talking About It (*Sophia*)** Sandberg encourages a conversation about the influence of gender in the workplace—the whole point of her book is to start talking about it. I’ve heard from more senior women in surgery that the attitude in the past has been one of “play along to get along.” That is, you don’t bring up the fact that you are a woman because you don’t want to bring any more attention to your obvious minority identity. While “play along to get along” may be useful for an individual to minimize any associated penalty for being a woman, Sandberg would challenge this strategy as one that would win in the long run. She encourages naming hidden biases and the micro-aggressions against women as a way to move forward toward gender equality. Once, when I told a faculty member that I was going into general surgery, the first thing she said was “Are you planning on having children?” I highly doubt she would have asked the same question to a male medical student, which means that my gender was a strong determinant in her attitude toward my chosen career. I shared her comments with other faculty as a way to shed light on the ways in which women who pursue surgery continue to be treated differently, even by other women. Knowing precisely how and when to raise the topic of gender requires thoughtfulness and discretion, but I am hoping that forums such as the AWS Blog will continue the conversation about gender and surgery in a way that is rigorous yet respectful. ***Have you encountered gender discrimination in or out of surgery? How have you addressed it?*** **Chapter 11: Working together towards equality (*Callie*)** “Today, despite all of the gains we have made, neither men nor women have real choice. Until women have supportive employers and colleagues as well as partners who share family responsibilities, they don’t have real choice.” This is where the AWS and each of us at our institutions across the country can make a big impact. We can be those colleagues and mentors. We can encourage our fellow women surgeons to make their partners real partners. We can speak out when we see or hear a male medical student or resident praised for their outgoing spirit while a female who behaves the same is chastised for her aggressiveness. If we do not point out the inequities of such thoughts and perceptions, they will never end. As Deborah Gruenfeld is quoted to have said, “Working together, we are fifty percent of the population and therefore have real power.” ***How can we move toward equality? How can we engage the men in these initiatives?*** **Let’s Keep Talking** **We have truly enjoyed reading and discussing our thoughts on this book and the parallels drawn in the surgical world. Please join our discussion below and share your input on how we can improve personally, as a discipline, and as leaders.** ***Part One of the discussion can be found [here](https://www.womensurgeons.org/lean-in-book-review-discussion-part-one/). Part Two, [here](https://www.womensurgeons.org/lean-in-book-review-discussion-part-two/).*** ***\~~~*** [](http://3.bp.blogspot.com/-Z6jU-VltDP8/UkcwrWDSMjI/AAAAAAAAAB4/ed83tCNu2R4/s1600/SophiaKimMcKinley.jpg) [![](%5Bsiteurl%5D/wp-content/uploads/2013/11/SophiaKimMcKinley.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/11/SophiaKimMcKinley.jpg) **Sophia Kim McKinley is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia will be applying for general surgery residency during the 2014 Match cycle.** [![](%5Bsiteurl%5D/wp-content/uploads/2013/12/Thompson.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/12/Thompson.jpg) *Dr. Callie Thompson is a resident in general surgery at the University of Washington. She recently completed a two year research fellowship and is now in her fourth clinical year. Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.* [![](http://blog.womensurgeons.org/wp-content/uploads/2014/03/MRomeroArenas.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/10/MRomeroArenas.jpg) *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.* [](http://1.bp.blogspot.com/-Z6jU-VltDP8/UkcwrWDSMjI/AAAAAAAAAB0/QVmKXHqVRos/s1600/SophiaKimMcKinley.jpg) **Categories:** advocacy, career development, gender differences, leadership, women --- ### [Early Lessons in Leadership](https://blog.womensurgeons.org/early-lessons-in-leadership/) **Published:** November 20, 2013 **Author:** Blog Team **Content:** by Sophia K. McKinley **Do you consider yourself a leader?** For most of medical school, I did not consider myself a leader. To me, leaders were people with big personalities and big visions, the kind of individuals who could inspire passion in large crowds or start political movements. I was a quiet-voiced student at the bottom of medicine’s hierarchy – surely not a leader, and in no position to lead. My perspective on leadership changed dramatically while spending a year as a Zuckerman Fellow at the Center for Public Leadership at the Harvard Kennedy School. Every week I participated in three hours of leadership training in the form of small-group seminars with prominent individuals, workshops on practical skills such as public speaking and negotiating, and personal development sessions. Whenever anyone asks me what I learned over the course of the year-long leadership curriculum, I always identify the same three take-aways: **1. Leaders are made, not born** I used to think some people were leaders and others weren’t. Now, I see leadership as a skill that can be cultivated, practiced, and improved. This shift in attitude has meant that even when I don’t feel as if I am a leader, I still see myself as someone who can learn to become a leader. And, I am now on the lookout for opportunities to practice leading and to gain skills as part of a lifelong process of becoming an increasingly skilled leader. I expect surgery residency will be full of opportunities to practice leadership skills. Oral presentations will be public speaking practice, and overnight call will serve as an exercise in prioritization and time management. Leaders need excellent interpersonal and teamwork skills even in tense situations—where better to deliberately develop these abilities than the operating room? No one expects newly graduated medical students to show up to intern year as fully formed surgeons. I now know it is just as unrealistic to expect myself to be a fully formed leader. **2. Self-understanding matters** Leadership is about influencing other people. In order to do this better, I realized I first needed to understand myself and my own behaviors. Through a variety of assessments including emotional intelligence evaluation and a 360 feedback process, I gained a greater understanding of how my actions were influencing those around me. For example, I learned that I often concede what I want in order to avoid negotiation. But in surgery, being a leader often means effectively advocating for patients in difficult situations. Awareness of my tendency not to press my agenda means that in future conflicts, I can reflect on whether I am being assertive enough, or whether I am failing to identify collaborative, “win-win” solutions that satisfy all parties including myself. I now know that a key to my future success as a leader will be improving my negotiation skills. Yet gaining self-understanding isn’t just about identifying weakness—it’s also about understanding strengths. Nearly all of the individuals who provided me with feedback during my 360 evaluation commented on my written communication skills. I know that for me to be the most effective leader possible, I should capitalize on my ability to influence others through writing. **3. Leadership happens at all levels** Finally, I no longer believe that leadership is solely the purview of those at the top. While leadership manifests itself differently at different levels within an organization, individuals at every position in a hierarchy can exhibit leadership. One of the most common definitions of leadership is acting in a way that enlists the support of others towards the accomplishment of a common goal. A title that indicates authority or power is not necessary to engage in leadership of this kind. Think of a situation during medical school, residency, or beyond in which a group of individuals at the same level were given a task or assignment. Even without adopting formal roles or titles, some individuals functioned as group leaders because their behaviors influenced others towards superior performance in task completion. And probably everyone has been on a medical team in which the individual who did the most to improve group performance was not the team’s most senior member. As I enter intern year and beyond, I hope to be the kind of resident who exhibits leadership by influencing others to better achieve common goals. What I do to exhibit leadership may change as I rise through surgery’s ranks, but no matter what level I am, there will be opportunities to function as a leader, even if that means leading by example to peers and more junior trainees. Not everyone has the experience of participating in a formal leadership curriculum across a year, but everyone can reflect and seek feedback to gain better self-understanding of leadership strengths and weaknesses. We can all seek opportunities that will develop particular leadership skills, and we can consciously practice leadership in the setting and position we currently work and learn. Hopefully, when asked “Do you consider yourself a leader,” more women surgeons will affirm, as I do now: ***“I am a leader.”*** ***\~~~*** [![](%5Bsiteurl%5D/wp-content/uploads/2013/11/SophiaKimMcKinley.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/11/SophiaKimMcKinley.jpg) *Sophia is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education, and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia is currently interviewing for general surgery residency during the 2014 Match cycle.* **Categories:** Uncategorized --- ### [Sexism & Surgery](https://blog.womensurgeons.org/sexism-surgery/) **Published:** December 12, 2013 **Author:** Blog Team **Content:** by Amalia Cochran, MD, MA, FACS, FCCM How many of you saw this great piece from Emily Graslie a couple of weeks ago? I loved this video for a couple of reasons. One is obvious if you are familiar with her work- Emily’s video series from The Brain Scoop is a terrific, user-friendly approach to science. The other was that I honestly empathized with the comments that Emily included in her video, as I suspect many of us do, and I loved her approach to dealing with sexism and science. She’s no-nonsense about it and addresses the issue head on. I thought back to my first encounter with sexism in medicine, going back to high school. Our family’s physician, upon being told that I was leaving for college at the end of my junior year under an early admission program with intent of going to medical school, simply commented, “Well, I guess it’s okay for women to be physicians these days.” No, he wasn’t joking. No, he never treated me again (nor my mother). I’ll admit- this was almost 30 years ago, and with the entry of more women into medical school many things have changed. Or have they? Plenty of research shows that female medical students often experience gender discrimination, and that this occurs most commonly on their surgical clerkships. [Women medical students are more likely to experience gender discrimination during their surgical clerkship than are their male counterparts](http://www.ncbi.nlm.nih.gov/pubmed/15972188) and [are more likely to perceive sex discrimination, typically from male attendings and male residents](http://www.ncbi.nlm.nih.gov/pubmed/16618901). My [own recent work](http://www.ncbi.nlm.nih.gov/pubmed/23414631) has shown that female surgeons and residents are more concerned about the presence of sex discrimination in the workplace than are their male colleagues, and that they perceive this discrimination as a barrier to advancement in academic surgery. Clearly this problem isn’t just one of the 1980s; it persists in modern-day medicine. Stories of incidents can be gathered easily enough from many sources; in one night on Twitter I was able to acquire stories ranging from colleagues or patients refusing to address a woman physician as “Doctor” to women being told they are “too nice” to be a surgeon, or being told that they are allowed to do more in the OR because of their looks. While the overt sexism remains, many institutions are starting to consider the role of “implicit bias,” those subtle behaviors and actions that manage to undermine the leadership and credibility of any minority group. Yes, women surgeons are still a minority group. So back to where we started, with Emily Graslie’s video. We have a problem still, and what we need is a solution. We can start by speaking up when we hear sexist comments- particularly those of us who are a little more senior and have less to lose than our younger colleagues. We can also work within our institutions to increase awareness of implicit bias in hopes that this will have a durable impact. And, as Emily Graslie stated, “We need to make sure we’re making it possible for people of all genders to feel acknowledged for their contributions and not feel held back by something as arbitrary as their genetics or appearance.” *How have you experienced sexism? And, perhaps more importantly, how have you dealt with it when you have either experienced it or witnessed it?* *This post was* **originally* published on Dr. Cochran’s blog, [Life in the Wild West](http://www.amaliacochranmd.com/sexism-and-surgery-starting-off-with-a-bang/).* \~~~ [![](%5Bsiteurl%5D/wp-content/uploads/2013/12/AmaliaCochran.jpeg)](%5Bsiteurl%5D/wp-content/uploads/2013/12/AmaliaCochran.jpeg) *Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah. She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah. Her research interests lie in surgical education and in clinical outcomes in burns. She is Vice President of the Association of Women Surgeons. Follow her on [Twitter](https://twitter.com/AmaliaCochranMD). Visit her [blog](http://www.amaliacochranmd.com/).* **Categories:** Uncategorized --- ### [Finding Strength in Setbacks](https://blog.womensurgeons.org/finding-strength-in-setbacks/) **Published:** January 3, 2014 **Author:** Blog Team **Content:** by Jane Zhao Two months ago, I read a great book, and I’ve been raving about it ever since to whoever will listen. [*David and Goliath: Underdogs, Misfits, and the Art of Battling Giants*](http://www.ted.com/talks/malcolm_gladwell_the_unheard_story_of_david_and_goliath.html) by Malcolm Gladwell is a book that stays true to form to Gladwell’s other works. In it, Gladwell challenges readers to look beyond conventional wisdom to reevaluate the way we look at setbacks. The nonfiction book begins with a vignette from the biblical passage of David and Goliath. Historically, David has always been painted as the underdog and Goliath the giant. But based on what criterion? The fact that David is of significantly smaller stature? *Pfft*. According to Gladwell, David wasn’t such a weakling. In fact, he had numerous other qualities that made him just as formidable (if not more so) than Goliath. [](http://www.blogger.com/) [](http://www.blogger.com/) Gladwell writes early on in the book: *“There is a set of advantages that have to do with material resources, and there is a set that have to do with the* absence *of material resources—and the reason underdogs win as often as they do is that the latter is sometimes every bit the equal of the former.* “For some reason, this is a very difficult lesson for us to learn. We have, I think, a very rigid and limited definition of what an advantage is. We think of things as helpful that actually aren’t and think of other things as unhelpful that in reality leave us stronger and wiser.” As I read, I thought bemusedly how his words could be applied to setbacks faced by women in surgery. How often have I heard of the challenges faced by my predecessors described as blessings in disguise? Based on his writing, Gladwell probably wouldn’t think of that analogy as far-fetched at all. So I came up with some examples of surgeons whose pasts as underdogs and misfits shaped them into amazing role models. - In the 1970s, women were discriminated against from receiving credit in their own name at banks, and if these women were married, they were told to use their husband’s name on the checking account. Finally, in response to the refusal of service, a number of women banded together and formed the first ever [women’s bank](http://www.sandiegoreader.com/news/2011/feb/02/cover-well-behaved-women-history/?page=3&). [Dr. Anita Figueredo](http://www.scripps.org/news_items/3616-in-memory-of-san-diego-icon-dr-anita-figueredo) was one of them. During the creation of the bank, these women received derision and dismissal from many of their peers. But after the bank’s successful launch, banks all around (even the ones that had previously refused them service) began to open up “women’s departments” and “women’s divisions.” Lessons learned: when these women didn’t feel welcome, they decided that instead of trying to fit in, they’d start from scratch elsewhere. As a result, they each became successful entrepreneurs with leverage of their own right in the banking community. - Dr. Frances Conley never really considered herself the victim of sexual harassment. Anytime an off-color joke was directed her way, she’d fire off a snappy retort, and that’d be the end of that. She built an incredibly successful career as a neurosurgeon at one of the most prominent academic institutions in the country. She kept her head down and didn’t rock the boat. But then came an incident of misogyny that she simply couldn’t ignore, and she publicly resigned from her tenured position in protest. Her office and lab were ransacked; she was vilified by the media and many of her peers. Thanks to her efforts, numerous medical schools, universities, hospitals, and research labs created or updated their policies regarding sexual harassment. When she finally performed the unsavory deed of “rocking the boat” that she’d spent so long trying to avoid, she became recognized and respected as a [leader brave enough to speak the unspeakable](http://news.stanford.edu/stanfordtoday/ed/9709/9709fea201.shtml). - Dr. Linda Brodsky serendipitously discovered in 1997 during a residency program review that a recently hired male faculty member in her department with lesser qualifications, responsibilities, and seniority was being compensated by her university at twice her state salary. Upon further investigation, she discovered that this was not an isolated incident. [After more than two years of trying to resolve her gender and pay concerns internally, she resorted to filing charges of discrimination by her two employers](http://www.lindabrodskymd.com/press/resolution.html). As a consequence, she lost her job. She’s since spoken publicly about the innumerable times she became wracked with guilt over putting her family through the tortuous process. Often, she’d lose sight of the light at the end of the tunnel and question whether she’d made the right choice by filing a lawsuit. After ten long years, the lawsuits were finally settled. Because of that grueling period in her life, she is significantly wiser about the laws regarding fair gender compensation, and she has become a fearless leader in the global community by advocating for others who are now in similar situations. - And lastly, an orthopedic surgeon I know was teased and called “Token” by her co-residents all throughout residency because she was the token woman their program had taken in that year to meet its quota for diversity and inclusion. Being called by a nickname she hated irked her to no end, but that experience made her aware of just how damaging and alienating such taunts, however slight, can be over time. As a result, she is an infinitely more sensitive caretaker and teacher than she would have been otherwise. The incidents suffered by these women were awful. They faced difficulties because they were different. The silver lining to all of this is that we wouldn’t know about any of these women and their heroic contributions to society if they hadn’t been pushed to the brink and been forced by their situations to find the inner courage to implement change when change was needed. [Globally, women and underrepresented minorities still have a ways to go before full equality is met.](https://www.womensurgeons.org/sexism-surgery/) It’s a new year though, and with that as reason enough to celebrate, I’d like to raise a toast to the tremendous progress we’ve made as a society, all thanks to the efforts of underdogs and misfits who saw setbacks not as obstacles that blocked their paths but as walls to be climbed over. Happy 2014. Oh, and make sure to read *David and Goliath: Underdogs, Misfits, and the Art of Battling Giants* by Malcolm Gladwell. It’s a good book. **Do you have an experience where being an outsider made you a stronger individual? Share your story with us in the comments below.** \~~~ [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/JZhao.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/JZhao.jpg) *Jane Zhao is a fourth year medical student at the University of Texas Medical School at Houston. She completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award. Her interests include healthcare social media, quality improvement, and public health from a surgical perspective. She chairs the AWS blog subcommittee and can be followed on [Twitter](http://www.twitter.com/jzhao3). She is in the process of interviewing for General Surgery residency for the 2014 Match.* **Categories:** Uncategorized --- ### [Creating your own academic timeline](https://blog.womensurgeons.org/creating-your-own-academic-timeline/) **Published:** January 9, 2014 **Author:** Blog Team **Content:** by Christina Cellini, MD, FACS, FASCRS This topic came to me during a grand rounds given by a well-known surgeon in his mid-career – henceforth will be referred to as “WKS”. I had just returned from my second three-month maternity leave in two years and was looking forward to hearing about what advice he had to give. That morning WKS gave a talk about how he advanced academically starting from residency to his early attending years that eventually led to his promotion to associate professor. His talk was very informative, and he made a really big deal about being present for your family while trying to achieve your goals. All in all it was a thoughtful presentation. However a few things caught my attention and highlighted how everyone’s situation is unique. One piece of advice given was that one should constantly “be writing papers” and even to “get up at 4 am before work” to write in order to fulfill that goal. 4am??? I thought back to what I was doing at four A.M. that morning. Oh right… I was nursing an infant. I’m certain that’s not something that ever stood in his way of writing papers. Oh well, no time for paper writing this morning. Maybe tomorrow. His next piece of advice was to take advantage of all the wonderful scholarships and traveling opportunities that are catered towards young attendings under the age of 45 . He showed lovely pictures of him and his family frolicking around a foreign country that was many time zones away. I thought- wow! I didn’t know about these awards. I should think of putting something together. Then I thought of the logistics- I don’t think I’ll be able to leave my tiny children away for that amount of time. And since these days I need to plan about an hour in advance to take both kids out to a trip to Target…. maybe in about 5-7 more years. But then I’ll be too old for these scholarships! Finally he mentioned being involved in society meetings and to bring family along so that you can take advantages of the opportunities there while your spouse and kids go and do fun things in the area. See- you can work and spend time with your family as well! I thought- that might be doable. I did have to skip the last 2 of my society meetings because I was either too pregnant to fly safely or did not have the resources to travel with an infant. Let me ask my husband how he’d feel about watching the girls in a strange place for a week while I do my surgery thing. I texted him- I got back “absolutely not”. Apparently dealing with two cranky, nap-less, off schedule children by himself while I do my own thing most of the day was not my husband’s idea of “family fun”. He encouraged me to go alone. Now don’t get me wrong- my husband is awesome and takes care of the lion’s share of child rearing and is supportive of my career- but I couldn’t blame him for not wanting to sign up for that. WKS had a number of great ideas that worked for him to achieve academic success so quickly in his career. I am certain there are many young surgeons – both men and women- who can achieve that as well. However, WKS had a personal situation that allowed him to flourish early on. He was able to follow the typical academic timeline that usually consists of publishing 2-3 papers/year, obtaining some sort of early career development grant or funding in the first 5 years as a means for future funding, active involvement in the ACS and specialty societies – all in addition to growing one’s clinical practice at the expected pace. With this timeline one can usually expect promotion to associate professor within five years or so. I know that I will not be able to keep up with that timeline. My path to promotion will likely take a few (or more) years longer than others. Occasionally I get antsy about it when I perceive that my peers are advancing faster than me or that I am in some way “behind”. However, I have been lucky to have colleagues and mentors that understand my need to slow down for my family and are supportive of an “extended” academic timeline to academic advancement. Now, if you can breastfeed and write scientific papers at the same time go for it! If not, I suggest the following: 1\) Take some time to really think about what your future academic goals are. Make them very discrete, not ambiguous. Also, take the time to write them down. 2\) Prioritize the goals and create a timeline to go with them. Give some real thought as to how you might go about achieving these goals. Again, the more specific you are, the more likely you are to realize them. 3\) Share your academic timeline with a more senior colleague or mentor. Doing so may help you identify potential opportunities or pitfalls in your strategy that you may not have considered. As always AWS members are available to help- and have likely been in your shoes at one time or another! 4\) Periodically look back on what you have written and adjust as necessary. Do not feel bad or guilty if it takes longer than you thought. Try not to fall into the “keeping up with the Jones’s” trap that can be prevalent in surgery (I know I have on more than one occasion). Take the time to write down and reflect on everything that you have accomplished up to that point. Remember no accomplishment is too small! As long as you remember what’s important to you and keep your eye on the prize you will no doubt be able to balance your personal and professional life and accomplish what you have set out to do. **Readers, how have you adjusted your own professional timeline to achieve both personal and professional goals in a reasonable manner? Share your thoughts below.** \~~~ [![](http://blog.womensurgeons.org/wp-content/uploads/2014/01/Cellini-Christina-MD-suit-4x6-300-print.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/01/Cellini-Christina-MD-suit-4x6-300-print.jpg)*Dr. Christina Cellini is an Assistant Professor of Surgery and Oncology at the University of Rochester Medical Center in the Division of Colorectal Surgery. After obtaining her undergraduate and medical school degrees at Cornell University she trained in general surgery at the NewYork Presbyterian Hospital-Weill Cornell Medical Center. Following residency, she completed a fellowship in Colorectal Surgery at Washington University in St. Louis. She recently completed a Masters in Medical Management at the Simon School of Business at the University of Rochester. She lives in Webster, NY with her husband and 2 children and enjoys running and snowshoeing in her free time. Dr. Cellini serves on the AWS communication committee.* **Categories:** career development, education, family life, gender differences, parenting, professionalism, self-care, women --- ### [Negotiation, like tying surgical knots, is a learned skill.](https://blog.womensurgeons.org/negotiation-like-tying-surgical-knots-is-a-learned-skill/) **Published:** January 16, 2014 **Author:** Blog Team **Content:** by Carol EH Scott-Conner, MD, PhD, MBA Endocrine and Breast Oncology Surgeon Professor of Surgery – Surgical Oncology and Endocrine Surgery University of Iowa Carver College of Medicine What image does the word “negotiation” bring to your mind? Do you think of a buyer and a seller haggling in some bazaar? Do you cringe, remembering a time when you had to go to your supervisor with a request for resources (and maybe got turned down)? Perhaps you envision a mother trying to get a toddler to do something. Do you think of bribery? Of weakness? Of strength? Of imbalance of power? We negotiate all the time, in matters large and small. Negotiation, like tying surgical knots, is a *learned skill*. And that means that you can learn how to do it, just like you learned how to tie a secure knot (even though you had been tying your own shoelaces for decades). Negotiation involves give and take between two parties. Give and take implies that each party has something to gain and something to lose. A successful negotiation satisfies both; there is a sense of balance. In *Women Don’t Ask*, Babcock and Laschever argue that many women are averse to negotiation. They give numerous examples and quantitate the way in which women sacrifice as much as half a million dollars over their working lives by neglecting to negotiate effectively for their first job. The damage extends far beyond monetary compensation. Failure to negotiate may hamper your ability to succeed, if you “low-ball” the resources and/or support needed to achieve a needed goal. Suppose, for a moment, that you have been asked to take on a major responsibility such as becoming a Division Director. It’s a huge honor. You’ve actually wanted this job for quite some time. The moment has come, and you are in the office of your Department Chair. You’re quite excited, and yet afraid, somehow, that the offer will be withdrawn if you are too demanding. You will need to negotiate for: a raise (commensurate with your additional resources), some protected time for the administrative functions, administrative support, a commitment to recruit and grow your division, resources for your division (such as clinic space, operating room time, research support). How should you proceed? First of all, **prepare ahead of time**. You wouldn’t go into the operating room without preparation. Don’t assume for a moment that you can just “wing it”. 1. **Do your research.** Get as much information about the division as you can. Hopefully you have been doing this along as you prepared to move into an opportunity like this. Basic statistic such as volume and trends in clinic visits, diagnoses, patient satisfaction, surgical cases, complications, length of stay, salaries, size of division relative to other academic medical centers are easily obtained if you dig around a bit. 2. **Do a basic SWOT analysis.** What are the division’s strengths, weaknesses, opportunities, and threats? How can you build on strengths, expand into opportunities, correct weaknesses and avoid threats? 3. **Put your findings into the** **broader context** of the Department and the hospital (or university) in which you work. 4. **What are your priorities and goals for your own career?** How will this position advance your career? How will it complicate your life? Next, take this information and **make it into a concise set of needs/wants** and rationale for each. Rank these. Consider a menu of options. Consider how factors are interrelated; for example, if growth is a priority for this division, then recruitment will require a commitment for additional clinic space and operating room time. Remember that the negotiation process involves give and take. Additional operating time may simply not be feasible at this point, but analysis might reveal that another division is about to lose personnel, or that some surgeons will be moving their practice to an Ambulatory Surgery Center. You may be able to get a commitment to get newly freed up time in the Main OR or to move a significant fraction of your division’s cases to the ASC. **Rehearse your negotiation** with a trusted and experienced person. A network of mentors around the country, including friends in other disciplines, can be invaluable. You might (rightly!) not feel comfortable doing this with a colleague in your own department, or even a colleague at a different university. Seek someone with experience in another discipline if necessary. Use your spouse or partner. Go through the discussion. Have your partner throw objections at you. Use the mirror if you have to. Practice countering objections, resistance, even hostility. **Keep a collaborative focus**. Both you and the person you are negotiating with want the division to thrive. If the other person does *not*, you may want to switch jobs or consider turning it down. Think about the priority of this particular division within the larger organizational structure. How does this division affect the whole? Do you provide a crucial service that no one else can do (for example, pediatric surgery) or do you overlap with other divisions (for example colorectal surgery overlaps with MIS, surgical oncology, and GI surgery)? **Lose the emotion.** The best advice I ever got about negotiation was to think in these terms: “I care, but not *too* much” about the outcome. Don’t personalize it. This is not about friendship, or individual worth. This is about what you can do for the organization and what you need to have to do the job. **Get some distance**, if you need to. If all else fails, make a graceful exit and return to continue the negotiation after you have both cooled off and reconsidered. **Remember the value that you bring to the organization.** This is about maximizing that value, and continuing to contribute. Let’s take a simpler example. You need better nursing support in clinic. You suspect that the male physicians are assigned more nursing support because they need to be chaperoned when they examine a female patient. You feel that you need to be chaperoned as well, but that your needs are ignored. Go through the same steps outlined above. Collect the data. Come up with a menu of options. Perhaps you can shift clinic days/times to a less busy slot. Perhaps the problem is that you are in clinic when a particularly busy and demanding male surgeon is also there, and he is sucking up all the resources. Options include tackling the issue head-on or switching. The truth is that you are constantly negotiating. Shall we have dinner at home or eat out? Should we go to a basketball game or a concert? Does my case go first in our shared OR, or does yours? Will you add this procedure on to your full schedule to accommodate my patient? Once you become aware of how pervasive negotiation is, you will find numerous lesser-stakes opportunities to practice. This practice makes you ready for the high-stakes discussions. **What if you are the person in power?** Make sure that all the facts are available. Have a menu of options to achieve a shared vision. Don’t take advantage of a naïve junior surgeon. If you feel that the person with whom you are negotiating is naïve, ask them to take some time to look at the data and come back to you with a list of needs. This is not only the right thing to do, it gives both of you a greater probability of success. In 1995, I became the second woman in American surgery to Chair an academic department at a medical school. Every year, I would met with each faculty member to discuss salaries. The men came in with demands that were often outrageous, but they were usually also armed with data. Too many of the women came in and began the discussion by saying, “the money isn’t important.” I think that women don’t generally go into surgery without a strong sense of vocation. Money doesn’t taint that vocation, it is a just reward for what you do. It is how people measure success. When I went to Scotland decades ago to meet with a textbook coauthor, I learned the phrase “good value for money.” It can mean a lot of things, but at the most basic it means that it is okay to spend more money if you get higher quality. You provide “good value for money” every day. Don’t hesitate to make sure you are appropriately rewarded and empowered with the resources you need. **The “c” word**. I don’t consider myself a crier. However, when I was young, difficult negotiation, one-on-one, with a supervisor used to bring me to the verge of tears. In informal discussion with other women, I know that this is not a rare problem. The remainder of the session would spiral out of my control as I focused on keeping my emotions in check. We all know that crying on the job is almost never a good idea, particularly when you are up against a male surgeon. I learned not to cry, and you can too. Incidentally, this is not just a female problem. Men cry, too. Rehearsal will help desensitize you. Taking the emotion out is easier if you think of it as an analytic problem rather than an interpersonal one. If all else fails, make a graceful exit and return in the near future with better armor! **Suggested Readings:** Babcock L, Laschever S. *[Women Don’t Ask](http://www.amazon.com/Women-Dont-Ask-Negotiation-Strategies/dp/0553383876)*, Bantam books, 2007. *Get this book and read it!* Negotiation. Wikipaedia. [http://en.wikipedia.org/wiki/Negotiation accessed January 2014](http://en.wikipedia.org/wiki/Negotiation%20accessed%20January%202014). *This is a very concise and nice guide to negotiation. It identifies three classic styles.* **Categories:** Uncategorized --- ### [What I learned about negotiation while getting ready for my first job interview.](https://blog.womensurgeons.org/what-i-learned-about-negotiation-while-getting-ready-for-my-first-job-interview/) **Published:** January 17, 2014 **Author:** Blog Team **Content:** by Kaitlyn Kelly, MD Assistant Professor of Surgery UC San Diego, Division of Surgical Oncology I recently made the transition from fellow to attending. As I was getting ready for my first job interview, I realized that I knew nothing about negotiating. Several friends and mentors asked me what I was planning to ask for and I didn’t know. I also felt very anxious about that thought of asking for any more than what was being offered to me. It just is not in my nature. Then a mentor suggested that I read, *Women Don’t Ask*, by Linda Babcock and Sara Laschever. I bought the book the next day and read it on the flight to my interview. It was very eye-opening for me because it made me realize that I was not alone. It explained that many women have trouble negotiating and provided an in-depth discussion of personal and social reasons for why that is. The book went on to explain how to effectively ask for what you need in an effective, yet polite, way. I felt much more comfortable and better equipped for my interviews after reading it. Another thing I learned as the process went on is that at many academic institutions, the salary for an assistant clinical professor is a set rate and is not considered negotiable. It is important to find out what the standard / acceptable salary is in one’s field and in the geographic region where one is applying. This information is published yearly in the AAMC Report on Medical School Faculty Salaries. Even in cases where starting salary is “non-negotiable”, there are many other things that one can still negotiate for in the academic practice setting. These include office space, a computer, a window in one’s office, tuition for courses and career development opportunities, travel funding, phone expenses, parking, etc. After the interview process is complete, you receive a letter stating the terms of the position and the salary. If you accept the position and terms, you sign and return the letter. This letter is your final opportunity to negotiate. You may respond and ask that it be amended prior to signing. It is important to make sure you are complete when responding and that you ask for all modifications that you want. I have heard of a situation where an applicant went back and forth several times with the letter and ultimately, the offer was taken away. To summarize, I recommend the following tips when entering the job negotiation process: 1. Read the books: *[Women Don’t Ask](http://www.amazon.com/Women-Dont-Ask-Negotiation-Strategies/dp/0553383876)*, and the *AAMC Report on Medical School Faculty Salaries*. 2. Be organized. Know what salary is reasonable to ask for, and know what non-salary items are important to you that you want to ask for. 3. And be confident. Know what you have to offer the institution where you are interviewing. Good luck! **Categories:** Uncategorized --- ### [Join our team](https://blog.womensurgeons.org/join-our-team/) **Published:** January 23, 2014 **Author:** Blog Team **Content:** Surgeons, residents, med students: Looking for a leadership opportunity? Get involved with the Association of Women Surgeons through social media! We need tweeters, bloggers, and Facebook fanatics to join our communications team and help make a difference! Contact <info@womensurgeons.org> for more information. **Categories:** Uncategorized --- ### [Green Solutions for the Operating Room](https://blog.womensurgeons.org/green-solutions-for-the-operating-room/) **Published:** January 27, 2014 **Author:** Blog Team **Content:** *In 2013, the Association of Women Surgeons sponsored its second* [*Green Solutions for the Operating Room Contest*](https://www.womensurgeons.org/green-solutions-for-the-or-2013-contest/) *in a partnership with* [*Practice Greenhealth*](https://practicegreenhealth.org/)*. We received many innovative and creative approaches to reducing the environmental impact of the operating room. Today we are featuring a submission from Michelle Hoadley, a 4th year medical student at William Carey University College of Osteopathic Medicine. Many thanks to Michelle and the rest of the contest participants!* **The Use of Steam in Preoperative Preparation of the Operating Room** Michelle Hoadley I became interested in “going green” because it is my parents business. My parents started up their own company that specializes in commissioning and green building services. Because I have worked many summers at my parent’s office, I have gotten an inside look at the green building process. As a result, I began to see things differently and developed a keen eye for evaluating how to make things more environmentally friendly. I also learned that making things environmentally friendly often times involves small changes or changing things most people do not even think about. One of these things includes the way we clean. Most disinfecting agents carry high levels of Volatile Organic Compounds, aka VOC’s. VOC’s are of particular concern because they are a source of indoor air pollution and are known to cause a variety of health issues with exposure. However, as I began my rotations during 3rd year I noticed that these same harmful chemicals were being used to in not just cleaning the hospital, but also in cleaning the operating room. Eliminating the toxic chemical exposures in the hospital and the OR is important to the health of everyone involved, from physicians to staff and even patients. So I started to evaluate the best way to clean the OR without unnecessary VOC exposure. The cleaning method would also have to be affordable and easily implementable into a small hospital as well as large university hospital. What came to mind is steam cleaning—maybe because I recently purchased one for my home and absolutely love how easy it is to use. Cleaning with steam at home also means I minimize the level of VOC’s my family is exposed to. Why not transfer how I clean my home to how we clean the operating room? Especially since steam is far superior in disinfecting and sterilizing then most of those toxic chemicals currently being used. I also incorporated into my steam cleaning proposal a method to the cleaning process. This method includes cleaning top to bottom and then back wall to the door, which would reduce contamination. In order to improve the disinfecting capabilities even more as well as improve efficiency, one could add a microfiber cloth attachment to the steam cleaning process. In conclusion, using steam cleaning in the operating room as well as the hospital in general would eliminate the high levels of VOC’s produced by the toxic disinfecting cleaners in current use. As a result, the indoor air quality would improve. With an improvement in the indoor air quality the health risks associated with the now eliminated toxic fumes would also improve. It’s a win-win situation. To take this one step further, paints, floor waxes, and other sources of high VOC release compounds should be switched to low or no VOC alternatives. We often overlook the pollution caused by our everyday chemicals and cleaners, as well as dismiss the health risks associated to their exposure, which includes respiratory issues and even cancer. It is because VOC exposure is so easy to overlook that I wanted to write about it and bring its health risks to the attention of others by submitting my proposal to the “Greening the OR” competition. \~~~ [![](http://blog.womensurgeons.org/wp-content/uploads/2014/01/Michelle-Hoadley.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/01/Michelle-Hoadley.jpg)*Michelle Hoadley is a 4th year medical student at William Carey University College of Osteopathic Medicine. She holds a Bachelor of Arts from Mercer University in women and gender studies with a minor in chemistry. Michelle also holds a Master’s of Science from Mississippi College in biomedical science. Michelle is a current member of the Association of Women Surgeons, has held leadership positions in the Student Osteopathic Medical Association, and is an active instructor in WCUCOM’s suture clinic.* **Categories:** Uncategorized --- ### [Respect](https://blog.womensurgeons.org/respect/) **Published:** January 29, 2014 **Author:** Blog Team **Content:** by Erin W. Gilbert, MD “Your job gives you authority. Your behavior gives you respect.” —*Irwin Federman, general partner at U.S. Venture Partners*Throughout my surgical training I blindly accepted that having grey hair (and experience) equaled garnering respect as a surgeon. Now that I am junior faculty at an academic institution (and beginning to grey myself), I’m wondering if there is more to the story. There is a noticeable difference in how residents treat me as compared to how they treat the Department Chair- which is of course OK by me, but I have begun wondering how can I ensure that I will achieve and more importantly maintain the same level of respect? As a medical student at LSU in New Orleans, we followed a very hierarchical system where the intern was the boss of the students, the junior was the boss of the intern and so on. It seemed to me in this system that the doctor’s role dictated the level of respect they earned from the team, but just because you follow someone’s orders does not mean you respect them. Other misconceptions I have had include believing respect comes from being a good dresser, having large muscles or simply being intimidating in some way. Now that I have matured a bit I am learning that people may admire good looks, muscles, or a power suit, but this does not translate into respect. Federman’s quote alludes to the real heart of the story. Think about people in your life you respect; who you would follow into battle without question, who you try to emulate… they are kind, generous, caring, and fair. They treat all of those around them with respect – from the hospital CEO to housekeeping staff – without question and without needing a reason to show respect. They value others’ efforts and *acknowledge them*; they listen, and they are always sincere. I may just be figuring this out for myself now, but thanks to my upbringing, I know that treating all people with respect is the expectation not the exception- I just didn’t realize how much it could influence how others treat me. **Readers, think back to the role models in your life. What behaviors of theirs did you respect? Share with us in the comments below.** **\~~~** [![](http://blog.womensurgeons.org/wp-content/uploads/2014/01/Erin-Gilbert.png)](%5Bsiteurl%5D/wp-content/uploads/2014/01/Erin-Gilbert.png) *Erin Gilbert is an Assistant Professor at Oregon Health & Sciences University in Portland where she is a member of the Knight Cancer Institute. She received her medical degree from LSU in New Orleans and completed her general surgery residency at the University of Washington in Seattle. She was fellowship trained in Minimally Invasive Surgery at OHSU and specializes in the surgical management of pancreatic disease.* **Categories:** career development, leadership, professionalism --- ### [Green Solutions for the OR - Part 2](https://blog.womensurgeons.org/green-solutions-for-the-or-part-2/) **Published:** February 11, 2014 **Author:** Blog Team **Content:** *In 2013, the Association of Women Surgeons sponsored its second [Green Solutions for the Operating RoomContest](https://www.womensurgeons.org/green-solutions-for-the-or-2013-contest/)* *in a partnership with* [*Practice Greenhealth*](https://practicegreenhealth.org/)*. We received many innovative and creative approaches to reducing the environmental impact of the operating room. Today we are featuring a submission from Hena Ahmed, a 2nd year medical student at Harvard Medical School. Hena’s submission describing her [OR RecylingProject ](http://mghorrecycling.wix.com/orrecycling) won second place in the contest. Congratulations, Hena!* **Innovation in Practicing Cost-Saving Health Care** Using technology to reduce health care waste and deliver supplies to resource poor communities by Hena Ahmed A plastic bottle can sit unchanged in a landfill for decades. The same is true for single-use plastic devices in operating rooms. Consider the trajectory of equipment in today’s operating rooms: many of these devices are opened as part of surgical kits but not always used. Due to current hospital policies, these items are discarded after each procedure, perfectly intact. A discarded suture kit could sit in a landfill for decades, or be used to repair a wound in a low-income community. As a first year medical student, I became interested in the intersection between resource recovery, global health delivery, and health care expenditure. In an era of rapidly rising health care costs, I developed an interest in finding a win-win-win solution for recovering and redirecting materials in hospital operating rooms while supporting health care delivery in resource poor settings. This resulted in the creation of the Medical Resource Delivery Project at Harvard Medical School. With experience as an undergraduate in collecting supplies for global health projects, I found that a bottleneck for global health delivery often occurs at the level of resource and medication procurement to support projects abroad. Through my interaction with physicians interested in global health, I discovered a demand in other countries for recoverable resources from health care settings in the U.S. Operating rooms are one of the main sources of hospital expenditure and waste generation. Despite efforts to reduce resource usage, operating rooms have limited data-driven assessments of their daily energy and equipment usage. Evaluation of these practices rests on yearly assessments. However, real-time data collection using mobile technology can improve practice and reduce waste. Recovery programs currently in place, including at MGH and through nonprofits such as Remedy Inc, and the Afya Foundation, do not generate resources in a sustainable manner. These programs also have minimal tracking of their supply collection and shipping to other organizations. I developed a mobile application that would allow us to track recoverable materials from operating rooms. The purpose of the application is to use quick-response codes, similar to barcodes but customizable to individual items, linked with cloud-storage spreadsheets powered through Google Docs. The items that are collected are then shipped to nonprofit organizations. The application not only eliminates the need for manual tracking of supplies, but also allows us to understand the monetary value of the supplies being discarded and recovered. On a daily basis, surgical departments would be able to track both their resource consumption and their waste generation, while also tracking materials that are available for recovery. Hospital administrators would find this data invaluable as they work to target hospital costs that do not directly impact patient care and outcomes. So how exactly does this application work? (Figure 1). **Figure 1. Process of Operating Room Resource Recovery**[![](%5Bsiteurl%5D/wp-content/uploads/2014/02/hena-5.png)](%5Bsiteurl%5D/wp-content/uploads/2014/02/hena-5.png) In just two years and in only two operating rooms, the application found more than $31,000 of materials that were recoverable from procedures in the obstetrics and gynecology floors at Massachusetts General Hospital (Figure 2). **Figure 2. Materials Recovered in Operating Rooms ($)** [![](http://blog.womensurgeons.org/wp-content/uploads/2014/02/hena-3.png)](%5Bsiteurl%5D/wp-content/uploads/2014/02/hena-3.png) The findings were documented and presented at the 2013 Association of Women Surgeons Conference in Washington, D.C. The project was also recognized with an award in the Green Solutions for the Operating Room Contest. The application continues to generate interest among the environmentally conscious surgeons, and our group recently partnered with UCSF School of Medicine and the Cleveland Clinic to implement the technology in their operating rooms. Future goals of the project include expanding to other operating rooms in MGH as well as other hospitals around the country, and partnering with nonprofit organizations to create sustainable delivery programs. Ultimately, limiting waste is a key goal of operating rooms and hospitals across the country, and by implementing technology that allows for real-time evaluation and data collection, we can ultimately improve health care practice while simultaneously supporting health care delivery in global health settings. **About the author:** **Categories:** Uncategorized --- ### [Blogger Q&A: Why AWS?](https://blog.womensurgeons.org/blogger-qa-why-aws/) **Published:** February 18, 2014 **Author:** Blog Team **Content:** **Brittany Bankhead-Kendall, MD**: Camaraderie and advice from women in the same boat as I! As women surgeons we are in a very unique situation and it’s so beneficial to have others who have walked before you and have practical advice and inspiration to offer. **Christina Cellini, MD**: I originally joined AWS to take advantage of the excellent research funding opportunities that are offered. I have benefited from remaining a member by being inspired by other members who are able to balance work and family and are open and realistic about the many challenges we face in our field. **Amalia Cochran, MD**: I joined AWS as a resident when I realized the networking benefits that membership provided. I attended my first AWS meeting in Chicago and still remember being very impressed with this roomful of women surgeons (because, quite frankly, we had 3 women surgeons on faculty where I was a resident, and had no women surgeons on faculty where I went to med school). It was an exciting prospect for me! As an AWS member, I have benefitted from precisely those networking opportunities. I’ve received some great advice on wisdom over the years from women who are senior to me and I’ve had the opportunity to mentor women who are junior to me. One of the important lessons I’ve learned is that of shared experiences and what we can learn from each other; while we often have a tendency to think that a challenge is unique to each of us as individuals, more often than not someone else has been through something similar and is eager to share what they did right and what they did wrong. **Erin Gilbert, MD**: I joined as a medical student because I was concerned about being a woman surgeon in a predominantly male field (at the time!) **Celeste Hollands, MD**: I joined the AWS in order to apply for the AWS Ethicon grant. Receiving that grant funding launched my academic career. The personal and professional relationships I have developed as a result of becoming involved in the AWS have guided and supported my career and afforded me the opportunity to lead with a group of women I am proud to share my personal and professional journey with. **Bharti Jasra, MD**: I was introduced to AWS by my mentor Dr Janet Tuttle-Newhall. She not only introduced me to it but also paid for my membership. Since then I had the opportunity to not only meet and get inspired by great women surgeons but also network with fellow residents and students. Overall it has been a great experience and I would like to continue to work for this organization after completing residency this year. **Sophia Kim McKinley**: I joined AWS on a lark – I had just developed an interest in surgery and wanted to see what kind of resources there were for students going into surgery. I did a quick internet search for “Women in Surgery” and that is how I found out about AWS! I was so pleased to discover the electronic version of the Pocket Mentor as well as information about the annual AWS meeting. At that time, none of my friends were planning on going into general surgery, so it was a great comfort to find an organization committed to the flourishing of women like myself. I wanted career resources, the opportunity to network with like-minded individuals, and perhaps even some mentoring. AWS membership has given me all of these things and more, including the chance to contribute to the organization’s mission through participating on the medical student committee and writing for the wonderful AWS Blog. When more junior medical students approach me about resources for medical students interested in surgery, I always point to AWS! **Lauren Nosanov**: I initially was introduced to the AWS through one of our newer female surgeons. I was immediately impressed by the incredible level of professional success represented by the AWS membership. Through my involvement with social media and the Communications Committee, I have come to be better acquainted with a number of members and organization leaders. Each of these women continually impresses me and inspires me, and serves as a reminder of the person and surgeon I want to become. I am grateful for both the friendships and mentorships that have emerged, and expect to be involved for many years to come. **Minerva Romero-Arenas, MD**: I joined the AWS to find a support network and mentors in surgery who are open to discussing ways in which women can become leaders in our field. I have truly enjoyed the initiatives from the Association for education, networking, and scholarship. **Mona Singh**: I joined AWS at the end of my third year of medical school, shortly after I realized I wanted to be a surgeon. I wanted to get to know, learn from, and be part of an inclusive community of women surgeons at various levels in their career and representing diverse surgical specialties, practices, and perspectives. I was looking for inspirational and grounded mentors and role models, as well as a community where I would be welcome to contribute and grow as a surgeon-in-training. I renew my AWS membership because I have truly found both in this association. **Callie Thompson, MD**: I joined because I wanted to connect with more female surgeons. I am surrounding by amazing role models and mentors and I wanted to seek out a greater community of women in surgery. I would say that I have not taken advantage of even 10% of what AWS has to offer but I have received wonderful advice and support from the online community and I look forward to experiencing more in the future. **Jessica Wilson**: I study medicine in a country where doctors regularly imply (or sometimes just state outright) that I can’t/shouldn’t be a surgeon because I am female- that perhaps I should become a pediatrician or a family physician, because those careers are better suited to the demands of womanhood. I joined AWS to learn more about the profession of surgery, to make connections with other surgeons, and to be a part of an encouraging community. **Jane Zhao**: At the time I joined, I was involved in the creation of a women in surgery lecture series at my school, and Dr. Lillian Kao suggested that I check out the AWS. Dr. Rosemary Kozar provided extra incentive by offering to sponsor my first year’s membership. I can’t thank my lucky stars enough that I joined. Since that time, I have forged some truly wonderful friendships and have been blessed to work with extremely talented and open-minded individuals to introduce new initiatives such as social media to the surgical community. I plan on renewing my AWS membership annually for the indefinite future, and I am excited to continue making meaningful contributions to the community via the AWS. ***Why did YOU join the Association of Women Surgeons? Share with us in the comments below.*** **Categories:** networking --- ### [OH No—Money!](https://blog.womensurgeons.org/oh-no-money/) **Published:** February 18, 2014 **Author:** Blog Team **Content:** By Janet Meller, MD, FACS On March 29, 2013, the New York Times published an article entitled *[Money Advice for Doctors and Lawyers and the Rest of Us](http://www.nytimes.com/2013/03/30/your-money/money-advice-for-doctors-and-lawyers.html)* by Paul Sullivan. It echoed a very familiar theme, that physicians are not good at finances. In particular, we do not know how to save and we do not know how to invest. We come out of our residencies and are faced with decisions that we have little experience or knowledge to make. This includes negotiating a salary and benefits package, managing a business (for those going into private practice), and managing a private income that increases dramatically after years of struggle. Women, in particular, are at a disadvantage because we are historically poor negotiators. I learned this first hand, joining an academic practice only to discover that my associate (male) was earning more than I even though we did the same work and I was also the clerkship director. It took several years to rectify this problem and would have been easier to fix at the start. Furthermore, we are much more likely to have a duel income and a spouse that also has an agenda. Most consistently, the most important thing that we can do is to get help and not try to manage everything ourselves—that includes a trustworthy, experienced financial planner and a lawyer (as much as we don’t like the “l” word) for contract negotiations and estate planning (not the same person). Lastly, if it feels unfair, speak up! Planning for the future is also paramount. We need to save for our retirement which seems far away, saving for our kids to go to college so that they aren’t burdened by debt, and planning for catastrophic illnesses or other events. The smartest thing I did was to start saving for my kids as soon as they were born by opening accounts and putting money aside every month, more than you think you need to. Now, I have put three variously through college, grad school and medical school. They are all debt free. I didn’t start maxing out my retirement accounts early enough, though, and now that I am getting close to that age, I am having to work hard at saving. The recommendation is that you have 10 x your yearly salary ( at the age of retirement) saved to preserve your lifestyle. It is easier to do if you start early! Janet Meller, MD, FACS is an associate professor of pediatric surgery at Texas Tech University Health Sciences Center School of Medicine at Amarillo. **Categories:** Uncategorized --- ### [Financial Planning for Young Physicians](https://blog.womensurgeons.org/financial-planning-for-young-physicians/) **Published:** February 18, 2014 **Author:** Blog Team **Content:** By Christina Cellini, MD, FACS, FASCRS Financial planning is something that gets overlooked during medical school and residency (likely because you probably don’t have much of it!). Before you know it you are an attending and making a real salary for the first time and its imperative to learn how to spend and invest wisely. I reached out to my personal accountant Paul Visca, CPA in Rochester NY, as to what is advice he would give to young professionals. Here are his pearls of wisdom: 1. Save for retirement. Begin as early as possible. Take full advantage of a company’s retirement plans. The earlier you start the more time will be available to take advantage of compounding. Money doubles every 7 years at 10%. 2. Take control of your finances through self-education. Read investing literature as much as possible. Learn the basics. The biggest hurdle I’ve seen is a complete lack of knowing investment “jargon.” Even if you hire a financial planner, knowing the terminology is powerful. 3. Start saving for kids college early. Again the power of compounding comes into play here. 529 plans are great vehicles for this. 4. Live below your means!! Especially if debt is involved. Save monthly. 5. Books to read to help achieve these goals – I particularly like books by John Bogle (founder of Vanguard Funds). I would also add to hire an accountant to help you with your tax returns if you don’t already do so. These get significantly more complicated to do once you are in a higher tax bracket and things like houses, cars, spouses and kids are involved. The small price tag of doing so significantly pays off in terms of what you end up paying the government otherwise. Finally, below are two articles that are found on the web that detail some of these points. [Financial Planning for Young Physicians (PartOne)](http://www.physicianspractice.com/blog/financial-planning-young-physicians-part-one) by Dave Denniston, CFA [Financial Planning for Young Physicians (PartTwo)](http://www.physicianspractice.com/login?referrer=http%3A//www.physicianspractice.com%2Ffinancial-planning-young-physicians-part-two) by Dave Denniston, CFA Both can be accessed for free online, but registration to the site is required. *Dr. Christina Cellini is an Assistant Professor of Surgery and Oncology at the University of Rochester Medical Center in the Division of Colorectal Surgery. **Categories:** Uncategorized --- ### [Changing the paradigm](https://blog.womensurgeons.org/changing-the-paradigm/) **Published:** March 13, 2014 **Author:** Blog Team **Content:** by Robert Swendiman Whether I am at Grand Rounds, a department meeting, or the American College of Surgeons Clinical Congress, it is often like looking into a mirror. I cannot help noticing the abundance of white men – especially at “the top.” While I meet numerous female and minority surgical residents and junior faculty, most of the chairs, program directors, and full professors are men. Outside of the medical profession, surgery has an “old boys club” reputation. But I come from a [school of leadership](http://www.centerforpublicleadership.org/) where difference and diversity are more than just opportunities for social progress – they are *requirements*. So I was disappointed when I perceived the stereotype affirmed. The more I look around, the more men I see. Constant inquiry (or “quality assessment and quality improvement” in medical terminology) is an important component of leadership. Without it, we fail to analyze, understand, and improve the systems in which we are a part. Thus, I began my investigation, and what I found was shocking. Despite the increasing number of women entering general surgery residency programs – from 10% in 1980 to 36% in 2011 – as of last year, women only represent 9% of all full professors, 17% of associate professors, and 25% of assistant professors in surgery. 1, 2 While these numbers are obviously disproportionate, what is perhaps more concerning is that they also remain stagnate. *In the last 15 years, these percentages have not changed*. 3 Despite the fact that men and women enter academic medicine at equal rates, the rate promotion is uneven. 4-6 Though men and women start at similar ages, the mean age of attaining “Professor” status in approximately five years younger for men. 4 “Even after adjusting for number of publications, amount of grant support, tenure versus other career track, number of hours worked, and specialty, women \[remain\] substantially less likely than men to be promoted.” 4 Thus, female surgeons remain impressively underrepresented in the ranks of surgical faculty at 21% of the workforce (the average across all medical departments is 37%). 2 Of all academic departments in the basic and clinical sciences, surgery ranks second to last in percentage of total female faculty members (orthopedics, 15%). 2 However, in other specialties, women hold more than half of all faculty positions (obstetrics and gynecology, pediatrics, and public health and preventive medicine). 2 The famous surgeon, Dr. William Halsted, once quipped that the issue with surgeons taking call every other night was that residents would miss half of the cases. In the same manner, when we exclude 51% of the population from top leadership positions, we are missing out on half of the talent. If fewer than 10% of professors of surgery are women – and that figure has not changed in more than a decade – I wonder, “Is our academic community really moving surgery forward?” Fellow colleague, Sophia McKinley, wrote about her own [early lessons in leadership](https://www.womensurgeons.org/early-lessons-in-leadership/). She states, “Individuals at every position in a hierarchy can exhibit leadership.” I agree, and I see this lack of diversity as an urgent opportunity for real-time leadership at every level. As a white male, I think it is my job to participate in changing this paradigm – chipping away at the explicit and implicit barriers that male surgeons still espouse in surgery, advocating for and leveraging diversity, and staying curious about surgery’s present and future challenges. As an inspiring academic surgeon, this also meant research, which is why I joined a multi-institutional team from UNC, Harvard, and Stanford to better understand how we can change the status quo. I know it’s not enough, and change will not happen overnight, but doing nothing is not a viable option. I was often asked on the interview trail, “Can an intern or a medical student really be a leader?” This is the answer I give them. ***\~~~*** **References** 1\. [Cochran A](http://www.ncbi.nlm.nih.gov/pubmed?term=Cochran%20A%5BAuthor%5D&cauthor=true&cauthor_uid=23716118), [Freischlag JA](http://www.ncbi.nlm.nih.gov/pubmed?term=Freischlag%20JA%5BAuthor%5D&cauthor=true&cauthor_uid=23716118), [Numann P](http://www.ncbi.nlm.nih.gov/pubmed?term=Numann%20P%5BAuthor%5D&cauthor=true&cauthor_uid=23716118). Women, surgery, and leadership: where we have been, where we are, where we are going. JAMA Surg 2013;148(4):312-3. 2\. Association of American Medical Colleges. “Women in Academic Medicine and Science: Statistics and Benchmarking Report 2011-2012.” Table 3: Distribution of full-time faculty by department, rank, and gender, 2012. < <https://members.aamc.org/eweb/upload/Women%20in%20U%20S%20%20Academic%20Medicine%20Statistics%20and%20Benchmarking%20Report%202011-20123.pdf>>. Accessed November 6, 2013. 3\. [Sexton KW](http://www.ncbi.nlm.nih.gov/pubmed?term=Sexton%20KW%5BAuthor%5D&cauthor=true&cauthor_uid=22208838), [Hocking KM](http://www.ncbi.nlm.nih.gov/pubmed?term=Hocking%20KM%5BAuthor%5D&cauthor=true&cauthor_uid=22208838), [Wise E](http://www.ncbi.nlm.nih.gov/pubmed?term=Wise%20E%5BAuthor%5D&cauthor=true&cauthor_uid=22208838), et al. Women in academic surgery: the pipeline is busted. J Surg Educ 2012;69(1):84-90. 4\. Zhuge Y, Kaufman J, Simeone DM et al. Is there still a glass ceiling for women in academic surgery? Ann Surg 2011;253:637–643. 5\. Schroen AT, Brownstein MR, Sheldon GF. Women in academic general surgery. Acad Med 2004;79:310 6\. Buckley LM, Sanders K, Shih M, et al. Obstacles to promotion? Values of women faculty about career success and recognition. Acad Med 2000;75:283-8. ***\~~~*** [![](https://images-blogger-opensocial.googleusercontent.com/gadgets/proxy?url=http%3A%2F%2F4.bp.blogspot.com%2F-fJaikUzVdHc%2FUwLG2q-xHoI%2FAAAAAAAAAIA%2FRjhnQBbNm8c%2Fs1600%2FSwendiman.jpg&container=blogger&gadget=a&rewriteMime=image%2F%2A)](http://4.bp.blogspot.com/-fJaikUzVdHc/UwLG2q-xHoI/AAAAAAAAAIA/RjhnQBbNm8c/s1600/Swendiman.jpg)*Robert Swendiman is a dual-degree M.D./M.P.P student at UNC School of Medicine and the Harvard Kennedy School of Government. He spent his time at Harvard as a Dubin Fellow for Emerging Leaders at the Center for Public Leadership, researching how leadership principles can be applied to medical education. Robert is participating in the 2014 Match cycle, and is interested in pediatric surgery.* ![](https://mail.google.com/mail/u/0/images/cleardot.gif) **Categories:** Uncategorized --- ### [Green Solutions for the Operating Room: Remanufacturing of Single Use Devices](https://blog.womensurgeons.org/green-solutions-for-the-operating-room-remanufacturing-of-single-use-devices/) **Published:** March 25, 2014 **Author:** Blog Team **Content:** *In 2013, the Association of Women Surgeons sponsored its second* [*Green Solutions for the Operating Room Contest*](https://www.womensurgeons.org/green-solutions-for-the-or-2013-contest/) *in a partnership with* [*Practice Greenhealth*](https://practicegreenhealth.org/)*. We received many innovative and creative approaches to reducing the environmental impact of the operating room. Today we are featuring a submission from Titi Adegboyega, a 4th year medical student at Gundersen Health System in La Crosse, WI. Congratulations, Titi!* Green Solutions for the Operating Room: Remanufacturing of Single Use Devices Gundersen Health System, La Crosse, WI By Titi Adegboyega My interest in medicine has been deeply rooted in my passion for global health. As I go through my training, I always ask myself what obstacles I would face if I plan to execute the same treatment plan I just provided a patient in Wisconsin to a similar patient in a rural town in Nigeria. Specifically, I consider how performing surgery here in the United States can be very different from doing surgery in a developing country. The limited resources in these areas sometimes preclude the use of laparoscopy and expensive devices like staplers and vessel sealing devices. In addition to the cost of securing these instruments, the one-time use makes them a deterrent to in light of limited funds. Innovations to recycle these devices are one way to make these expensive devices cost effective. Single Use devices (SUD) are commonly used in the operating room. With growing number of minimally invasive procedures, the use of SUD such as laparoscopic trocars has also grown. Likewise, there has been a surge in use of the LigaSure and Harmonic, both SUDs utilized in many surgical procedures for vessel sealing and dissection. For over ten years, Gundersen Health System (GHS) has been participating in remanufacturing of single use devices. The list of the most common devices remanufactured a listed in table 1. In other to reduce waste, GHS recycles 95% of SUD although only about 2% is actually remanufactured and packaged for reuse based on the Food and Drug Administration guidelines. The recycled products are diverted away from the regulated medical waste stream which results in ‘waste savings’. The process of recycling involves placing items for recycling in clearly labeled teal Stryker containers in each operating room. These items are sent to one of the two processing plants in the US (Arizona and Florida). Items are then sorted for recycling versus remanufacturing. There is no additional cost of recycling to GHS and no additional personnel required as SUD are placed in the recycle bins immediately after surgery by the OR staff. The safety of utilization of SUD is a potential concern for both patients and healthcare organizations. The department of infection control and infectious diseases is engaged in the remanufacturing process and each remanufactured device is inspected multiple times in the cleaning, sterilization and repackaging process to insure quality and safety. The average cost of medical waste disposal is $0.50 per pound. In 2013 alone, GHS has recycled 7,843 pounds, resulting in a waste savings of $3,924. GHS has also saved $161, 360 this year alone from reusing of SUD (figure 1). The cost savings attained from recycling SUD makes it more suitable for low resource environments and is one of many innovative ways to bridge the difference in surgical care globally. I hope to incorporate this in my career in global surgery to maximize the limited resources available to care for patients. | **Table 1: Remanufactured OR products** | |---| | Arthroscopic Shavers / Burs | | Burrs / Bits / Blades | | Cardiac Stabilization | | Compression Device – Pairs | | EP Catheters & Cables | | Endoscopic Trocars | | External Fixation | | Ligasures | | Opened & Unused / Expired | | Suture Passers | | Tourniquet Cuffs | | Ultrasonic Scalpels | **Figure 1: 2013 Monthly savings on utilization of remanufactured Single Use Devices** [![](http://1.bp.blogspot.com/-AdQ48Tgw0DI/Uy91YBainNI/AAAAAAAAA74/yRW2v8g4nes/s1600/titi+figure.png)](http://1.bp.blogspot.com/-AdQ48Tgw0DI/Uy91YBainNI/AAAAAAAAA74/yRW2v8g4nes/s1600/titi+figure.png) \~~~~~~ [![](http://1.bp.blogspot.com/-J8yZB1XCXfE/Uy92B2TcgVI/AAAAAAAAA8A/IN1erPkNFcY/s1600/titi.jpg)](http://1.bp.blogspot.com/-J8yZB1XCXfE/Uy92B2TcgVI/AAAAAAAAA8A/IN1erPkNFcY/s1600/titi.jpg) Titi Adegbboyega is a fourth year surgery resident at Gundersen Health System in La Crosse, WI. She completed medical school at the University of Minnesota and is interested in global surgery. ![](file:///C:/Users/Sophia/AppData/Local/Temp/msohtmlclip1/01/clip_image002.png) **Categories:** Uncategorized --- ### [Changing Gender Paradigms](https://blog.womensurgeons.org/changing-gender-paradigms/) **Published:** March 27, 2014 **Author:** Blog Team **Content:** *Original blog post by Dr. Paula Ferrada (February 22, 2014) can be found on [OnSurg’s blog](http://onsurg.com/28359/).* While reading an innocuous[ post regarding dating female doctors](http://heelskicksscalpel.wordpress.com/2014/02/15/top-7-reasons-you-should-datemarry-a-female-physician-or-surgeon/), I came across a comment that immediately unleashed a visceral response: an MD implying that medical education is wasted on women. His argument is as follows: Medical education is expensive and supported by federal and state tax money, both at the university level and at teaching hospitals, and apparently more women than men choose to work part time. In this doctor’s view, ***women who work full time are part-time wives and mothers, and women who work part-time are a waste of money and education***. [](http://onsurg.com/wp-content/uploads/2014/02/Screen-Shot-2014-02-22-at-9.19.58-AM.jpg) How *not* to have a visceral reaction to a statement like this…. I am a foreign graduate, and it took a lot of clinical and academic effort to find and hold a position in surgical training. Following that, I finished two fellowships and I still work full time (trauma surgeons’ hours). I have a four-year-old child, and I am married. I LOVE my job, I love being a mother and a wife, and not for a second of my life have I ever considered that I am doing *anything* part time. This is not only about the terrible discrimination and stereotypical definition of roles; the core of the problem runs deeper. Parenting is not the unique responsibility of females, neither is being a good partner in any relationship (wife, husband, friend, sister, etc.). For some reason, the “ideal***”*** family picture still contains a woman dressed in pink, holding the complete responsibility of managing a house, cooking and raising children, while the guy works late hours, earns the bacon, and is completely unaware of his children’s education and family’s emotional needs; it is not only NOT ideal, but not compatible with the reality of gender roles in 2014. Until **ALL** of us**,** males and females, recognize the change in gender paradigms, we will not see a change in our culture. The best advice that a mentor once gave me, “be excellent.” I took it to heart: in my world, that translates into being an excellent mother, wife, friend, surgeon, teacher, partner… just being excellent. To become our best selves, we need infrastructures that understand and support our need for growth, not only as doctors, but as humans. Male and female residents, fellows and faculty, need more support to fulfill their obligations at home, while maintaining a full clinical workload. Until each hospital/training program makes an effort to provide working parents with child care that can be open at “surgeon friendly” hours; until husbands and wives understand that building a home is a partnership that requires equal distribution of work; until both men **AND** women find a way of supporting each other, rather than pressurizing one another into thinking that working full time means being an incompetent parent, until then, there will be women “quitting their day jobs,” and as the poisonous blogger who inspired this option stated, “wasting tax payers dollars.” It is encouraging to see a new generation of women and men, progressive thinkers who know that we can do anything, and sometimes even everything. So it is up to us. Unless there are people like us who purposely want to make a difference, nothing will change. It just won’t. *Dr. Paula Ferrada is an Assistant Professor of Surgery at Virginia Commonwealth University and the incoming president of the Virginia Chapter of AWS.* **Categories:** Uncategorized --- ### ["You've matched to a Preliminary position."](https://blog.womensurgeons.org/youve-matched-to-a-preliminary-position/) **Published:** March 28, 2014 **Author:** Blog Team **Content:** *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](https://www.womensurgeons.org/unconventional-our-couples-match-story/), 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. \~~~ [![](http://blog.womensurgeons.org/wp-content/uploads/2014/03/00-Brittany-Bankhead-Kendall.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/03/00-Brittany-Bankhead-Kendall.jpg) *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.* **Categories:** medical students, residency, training --- ### [A place of our own](https://blog.womensurgeons.org/a-place-of-our-own/) **Published:** April 2, 2014 **Author:** Blog Team **Content:** *by Amalia Cochran, MD* Apparently there are a number of men who, upon hearing about a women surgeon’s activity will state, “We don’t get to have a men in surgery group!” This statement is both true and untrue. While it would probably be considered politically incorrect to have a formal “men in surgery organization”, it can easily be argued that academic surgery remains the “men in surgery” club. Between 2001 and 2011, the number of [women in surgery residencies increased from 24% to 37%](https://www.aamc.org/download/305520/data/2012_table2.pdf) of trainees, breaking that 33% number often associated with achieving “critical mass” for any non-majority group. However, in the [ranks of academic surgery in 2012,](https://www.aamc.org/download/305522/data/2012_table3.pdf) women constituted 21% of surgery faculty, and women are apparently stalled as 9% of full professors in surgery. This paucity of women in academic surgery does matter, both in terms of availability of role models for our residents and students, and in terms of how women are seen and perceived in academic surgery. If you were to ask most (if not all) of my male colleagues if they have walked into a room at a surgical meeting and felt out of place, the vast majority would tell you no, and many would look at you like you were crazy for asking. In contrast, I know experientially from speaking to many of my female colleagues that we’ve walked into any number of surgical settings and felt fairly certain we didn’t belong there. My first experience of this nature came during my fourth year of medical school while on the interview trail- I was one of 40 interviewees at a program that shall remain unnamed on a given date, and I was the only woman in the interview group. While I knew I deserved the interview, I inferred that being a resident there had the potential for me to have to fight lots of battles that involved being judged not on my work, but on my gender. I didn’t have an interest in that. I still occasionally make jokes about it when I find myself seated in a room of surgeons in which I am the only woman- and yes, this does still happen in 2014. My support for and involvement in organizations like the [Association of Women Surgeons](https://www.womensurgeons.org/home/index.asp), is predicated on this idea that as women we do need a place where we are exclusively looked at for our body of work and where we aren’t judged for being any of the stereotypes associated with single/ married/ divorced/ childless/ childed women surgeons. For me, and for many others, it’s been a “safe” environment to expand our leadership skills and to experiment with authentic engagement with colleagues. My experience [in a social sorority in college](http://www.alphadeltapi.org/default.asp) was similar, in terms of it being a place where my leadership skills were cultivated and I learned to collaborate with people who were very different from I. While I recognize that many horror stories exist about the collegiate Greek system, I remain [passionate about the benefits of sorority life](http://www.pursuantmedia.com/alphadeltapi/loyallyyours/1212a.htm) when it’s done “right.” Would I have the leadership and team skills that I have today without Alpha Delta Pi and without the Association of Women Surgeons? Maybe. Would I be where I am in my career without the support of some wonderful men who focused on who I was as a student, then as a surgeon? Absolutely not. Did opportunities in these women’s-only organizations change my life for the better? No doubt, and I am absolutely certain that they helped make me into who I am today. For me, and for many women leaders in varied professions (particularly historically male professions), this idea of having a “place of our own” is critical to our professional and personal development. This post originally appeared March 11, 2014 on Dr. Cochran’s blog *[Life in the Wild West](http://www.amaliacochranmd.com/a-place-of-our-own/)* \~~~ [![](http://blog.womensurgeons.org/wp-content/uploads/2014/04/AmaliaCochran.jpeg)](%5Bsiteurl%5D/wp-content/uploads/2014/04/AmaliaCochran.jpeg)*Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah. She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah. Her research interests lie in surgical education and in clinical outcomes in burns. She is completing her term as Vice President for the Association of Women Surgeons.* **Categories:** advocacy --- ### [Can we have an AWS Visiting Professor every year?](https://blog.womensurgeons.org/can-we-have-an-aws-visiting-professor-every-year/) **Published:** April 7, 2014 **Author:** Blog Team **Content:** Submitted by: Dr. Jane Wey CCF Chair of Surgery: Dr. Matt Walsh **Summary of Visit** **AWS Kim Ephgrave Visiting Professor Dr. Tuttle-Newhall** **Cleveland Clinic** **March 4-5, 2014** Dr. Tuttle-Newhall arrived on March 4, 2014 for her visit hosted by the Cleveland Clinic. In the afternoon, she presented on “[Challenges for Women in Academic Medicine](https://www.womensurgeons.org/challenges-for-women-in-academic-medicine-and-the-question-of-leadership/)” to a group of 25 residents and staff from across the Cleveland Clinic campus, hosted by the Women’s Professional Staff Association (WPSA). This was followed by a reception and a lively question/answer session. She also had a chance to review the 2013 WPSA Annual Report, documenting accomplishments by the Cleveland Clinic women staff and ongoing initiatives. The staff in attendance included those practicing in surgery, gynecology, emergency medicine, and various other surgical and medical subspecialists. Dialogues included those addressing Dr. Tuttle-Newhall’s past experiences and her insights and advice for trainees and other staff. Several people requested that she share her slideset so that those unable to attend the event could still benefit from her insights. Dr. Tuttle-Newhall was then the guest of honor at a dinner hosted by the Women’s Professional Staff Association, attended by selected women surgical residents, surgical staff (including a former co-resident of Dr. Tuttle-Newhall’s), and the WPSA president, Dr. Margaret McKenzie (gynecology). Again conversation was lively, ranging from casual conversation about life experiences to more serious discussions about women in academic/medical leadership and collaborative efforts between women’s organizations. On March 5, Dr. Tuttle-Newhall presented Grand Rounds on “Quality, Data, and Transparency: The New Era of Healthcare” to over 100 staff and trainees of the Digestive Disease Institute, where she was introduced by Dr. Dympna Kelly, a senior transplant surgeon and professional associate of Dr. Tuttle-Newhall’s . This was a well-attended event, which again generated an animated question/answer session. Following Grand Rounds, Dr. Tuttle-Newhall met with a group of approximately 60 residents and fellows. The group consisted of general surgery residents, abdominal transplant fellows, liver transplant fellows and a kidney/pancreas transplant fellow. Five transplant related cases were presented by the residents and fellows and were discussed in detail with Dr. Tuttle-Newhall, with many of the transplant staff in attendance, as well. Next, Dr. Tuttle-Newhall was taken on a tour of the hospital, this included a viewing of the transplant operating rooms and the transplant regular nursing floor. Brief walk rounds were conducted and an additional patient case was presented to Dr. Tuttle-Newhall. With patient permission, she reviewed relevant labs and pertinent images with the resident group. She then briefly met and conversed with this pre-selected liver transplant patient. Finally, Dr. Tuttle-Newhall had lunch with residents, fellows and staff surgeons, hosted by the Department of General Surgery. A series of final questions were asked and answered and Dr. Tuttle-Newhall made closing remarks. Overall, Dr. Tuttle-Newhall’s visit was very well received by everyone at the Cleveland Clinic. The attendees at her various presentations were uniformly impressed by her. Many made comments about her accomplishments “for someone so young” and her friendly and approachable personality. Her presentation on “[Challenges to Women in Academic Medicine/Surgery](https://www.womensurgeons.org/challenges-for-women-in-academic-medicine-and-the-question-of-leadership/)” in particular struck a chord with many non-surgical women physicians, and several people approached me afterwards to express appreciation that the event was opened up and publicized for all women physicians, rather than just surgeons. I’ve already been asked whether we can have a visiting AWS professor every year! In contrast, the Grand Rounds presentation was made to our mostly-male institute, but even the senior staff were impressed by her and remained in attendance to hear her insights during the resident case presentations. We were privileged to host Dr. Tuttle-Newhall. She proved to be an excellent visiting professor and ambassador for the AWS, raising awareness of the challenges of being a women surgeon while also increasing visibility of how successful and accomplished a woman surgeon can become. Read Dr. Tuttle-Newhall’s experiences as an AWS Visiting Professor [here](https://www.womensurgeons.org/what-its-like-to-be-a-visiting-professor/). Read her talk “[Challenges for Women in Academic Medicine and the Question of Leadership.](https://www.womensurgeons.org/challenges-for-women-in-academic-medicine-and-the-question-of-leadership/)“ \*\*\*\*\*\*\*\* **Coming soon… applications for 2014-2015 Visiting Professors and host sites!** The Kim Ephgrave Visiting Professor program provides medical schools with the opportunity to request top women surgeons as speakers and receive funding from the AWS Foundation. Opportunities to lecture heighten the visibility of women surgeons while encouraging women medical students to pursue similar careers. In addition, the Kim Ephgrave Visiting Professor Program promotes dialogue between practicing surgeons and the academic community. The program was recently named in memory of [Dr. Kim Ephgrave](https://www.womensurgeons.org/News/In_Memoriam.asp#Ephgrave) (1956-2012), who served in the AWS Leadership from 1997 – 2002 and as AWS President in 2000/2001. Kim Ephgrave Visiting Professors have an opportunity to share professional and personal experiences with Department Chairs, Faculty, Residents and Students through grand rounds, walk rounds, lecture and research presentations and other arranged opportunities. Medical Centers provide the platform for the experience by hosting the Kim Ephgrave Visiting Professor at a breakfast, luncheon and/or dinner meetings and arranging for clinical experiences. Click [here](https://www.womensurgeons.org/AWS_Foundation/Programs.asp) for more information on the Visiting Professor Program. **Categories:** Uncategorized --- ### [Failure](https://blog.womensurgeons.org/failure/) **Published:** April 8, 2014 **Author:** Blog Team **Content:** 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](http://books.google.com/books?id=IDESAAAAYAAJ&pg=PA431&lpg=PA431&dq=osler+mistakes&source=bl&ots=RpiWxNXxi1&sig=xaVkg0Bl4YsrbVLSyGetuaghmbg&hl=en&ei=BVzXTOqWA4SKlweFyPz-CA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CCYQ6AEwAw#v=onepage&q&f=false)) 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](http://www.compassionfatigue.org/pages/Top12SelfCareTips.pdf) [Preventing Compassion Fatigue](http://www.selfgrowth.com/articles/Preventing_Compassion_Fatigue_-_A_Handout_For_Professionals.html) [Do’s and Don’ts of Compassion fatigue](http://web.memberclicks.com/mc/page.do?sitePageId=47835&orgId=4t) This post originally appeared November 13, 2010 on Dr. Brandt’s website *[Wellness Rounds](http://wellnessrounds.org/2010/11/13/failure-2/)* \~~~ [![](http://blog.womensurgeons.org/wp-content/uploads/2014/04/mlbrandt1.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/04/mlbrandt1.jpg) *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](http://wellnessrounds.org/about/) and [tweets](http://twitter.com/drmlb).* **Categories:** self-care, training --- ### [Practical Wellness Tips to Surviving Residency](https://blog.womensurgeons.org/practical-wellness-tips-to-surviving-residency/) **Published:** April 8, 2014 **Author:** Blog Team **Content:** by: Brittany Bankhead-Kendall, MS, MD In medical school, I remember the first week of orientation they had a lecture on wellness and all the pieces of the theoretical “wellness pie” that we should be balancing: emotional, physical, occupational, social, intellectual, spiritual, environmental. While this “pie” looks fantastic, and on paper it’s an evenly divided 1/7th for each piece, any resident knows this is never going to be the case for our five years of general surgery training. Here are some tips and ideas I’ve picked up along the way during my intern year: 1. Take the stairs during rounds, it may be the only physical activity you get. 2. Find ways to tighten different muscle groups while sitting in a chair and flex/release them during grand rounds, lectures, etc. It’s a tiny bit of exercise AND it helps you stay awake post-call. Win-win. 3. For post-call lectures or grand rounds, COLD caffeinated drinks (i.e. frappucinos, iced coffees, coke, etc.) are, in my opinion, your best bet on helping keep you awake. HOT coffees or other caffeinated beverages like tea would be a good runner up. 4. Park as far away as you can do safely. Extra walking and think time to and from the hospital. 5. Make non-hospital friends. It’s easy to get sucked into the hospital bubble and you always have something to talk about. But it’s good for your brain and your sanity to talk to people about something other than “How’s *the patient* doing?” 6. Bring your food from home if you’re ever able to. It feels like a tiny bit of normalcy to not eat cafeteria food. 7. Don’t blame gaining intern pounds on the cafeteria food. There’s always a way to eat healthy (even if it’s just portion sizes), no matter what options there are. 8. Wear your regular jeans on weekends or at night when you can, it will remind you what your normal size is supposed to be. It’s easy to gain weight in scrubs and never realize it. 9. Study for lectures and cases as if you were the attending and everything being done depends on your knowledge of it. 10. Any time you can be outside, take it! Even if it’s walking to clinic instead of driving, or taking the outside route to your car instead of the inside route. The sunshine is good for you. 11. Be tough as nails like you normally are; but if something gets to you- a patient’s story, your attending’s choice words, your family’s misunderstanding of what you’re doing with your time, it’s okay to cry. Just do it in private (private bathroom stalls or your car are generally acceptable), compose yourself ASAP, and get back on the horse as fast as you can. Don’t wallow in sadness or being upset, but get your good cry out; it’s okay to have human emotions. 12. Find something spiritual that you can connect with, whether it’s meditation, prayers, whatever your beliefs. It will get you through the long hours and the hard days to come. 13. If you’re early in your residency, and find that your current field isn’t for you, CHANGE! It’s much easier to justify 1-2 years of training you won’t use, than to have a lifetime of not enjoying going to work every day. 14. Sometimes when residency’s hard and just no fun, remember that this is your JOB. You’re paid to do it, just like every other employee on the earth is paid to do their job. Sometimes you just work hard because you’re supposed to work hard. 15. I don’t read, but I wish I did. Having a good book to read would be a great way to wind down at night. 16. Power bars and those small nut packets are great to keep in your white coat pocket for major hypoglycemic moments on rounds and in the OR (obviously in preop or postop). 17. There are small, organic power juices and drinks that would be a good source of energy/caffeine if you really, really needed it. 18. Keep surgery journals in your locker or somewhere at work for down time at work when you could be doing something productive. 19. Keep Excedrin, Tylenol, Motrin, whatever works for you in small supply at work; you WILL need it and will be so glad to have it for a headache, etc. 20. Wash your white coat every once in a while. And wear comfortable shoes! 21. Remember your family and friends, and do nice things for THEM every once in a while. Call them on the way to or from work, send them an email or a text while riding the elevator or waiting for a call back from a consult. Keep these relationships thriving, they are the ones you will turn to when things get really tough or really great. Obviously I’m an intern and have a long way to go, but these are things that have helped me along the way this year! ***Does anyone else have tips & tricks they use for wellness during a surgical residency?*** *Brittany Bankhead-Kendall, M.D, *M.S.* is a PGY1 general surgery resident at Methodist Dallas Medical Center and a member of the AWS Communications Committee. 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.* **Categories:** Uncategorized --- ### [A bit of kindness](https://blog.womensurgeons.org/a-bit-of-kindness/) **Published:** April 17, 2014 **Author:** Blog Team **Content:** *by Amalia Cochran, MD* The following is an excerpt from an email I recently received from a mentee: *“I love, love, love surgery, but even as someone who has thrived in this environment, I now acknowledge that there are some aspects of the culture of surgery/academics/surgical and medical education that I am deeply unsettled by and wish very much to change. I see fellow students, residents, fellows, young faculty transform from being full of zeal and goodwill into angry, bitter, jaded people, and it’s absolutely disheartening to see. What’s more infuriating (to me because of the wrongness of it all and because I’m such a fixer) is that those who have been negatively affected and are the very ones capable of enacting positive change because they’ve “been there” sadly become the very ones who perpetuate the indignities of the broken culture, and they don’t even recognize that they’re doing so.”* Her important question that she asked me, and one that I found incredibly wise, was, “Did you ever struggle with this during your training or see this among your colleagues? Or even now?” I asked her if I could answer this on the blog, and she graciously said yes. It was important for me to do so because I feel obliged to make some confessions related to her concerns. The biggest one? I had **many** days during my residency when I was so tired, so broken, so frustrated that I wasn’t a nice person. While I was able to focus on doing the right thing for my patients, I could be and often was impatient with students who needed nurturing and staff who were still learning too. I was so Hell-bent on my own survival, on not making mistakes, on not showing any shred of evidence that I might not be able to succeed as a surgeon that I had no qualms about running over people. I nearly quit surgical residency during my PGY2 year because I didn’t like what I was my self becoming (then was nurtured by some VERY kind mentors who managed to help me hang in there). I attribute a significant portion of my behaviors when they weren’t outstanding to sleep deprivation and not having a functional set of skills for coping with my chronic exhaustion. I also attribute some of my less-than-ideal behaviors to the surgical culture in which we were supposed to prove that we’re tough and don’t have flaws. Reality check: I may be resilient- I far prefer that word to “tough”- but I do have flaws. Sometime around my 40th birthday, I became okay with that. - I want to believe I was asked about this topic because I’m seen as someone who is generally patient and supportive. A few key lessons have helped me get back to this place, one in which I think I existed prior to my 7 years of complete exhaustion and chronic stress. - We’re all struggling. Every one of us is, in one way or another. That’s not a source of shame, it’s a source of humanity. - If those moments in which your lesser self shows up are rare, people believe you when you apologize for your behavior. - We are all learning, ever hour of every day. That’s what we’re here to do in a teaching environment. - As someone in a position of leadership, my team and those around my team rely on me to set a tone. I don’t want that tone to be one of nastiness, blaming, and negativity because I want/ need a high-achieving team. Therefore, it’s up to me to be supportive, to be patient, to take a deep breath before reacting, even when my gut wants to say, “WHAT were you thinking?!?” - When people are intimidated, their ability to think critically is impaired. Working in an ICU, I need everyone around me to be a critical thinker. Kindness does much more towards that end than bullying. - If all else fails, go for a walk with the dog. Dogs are masters of this moment being the very best moment ever and that influence is contagious- particularly on a snowy day if one has a Siberian Husky in their life (as I do). [![](%5Bsiteurl%5D/wp-content/uploads/2014/04/Happy-Livvie-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/04/Happy-Livvie-300x225.jpg) If nothing else I wrote tonight resonates with you, it’s my hope that a picture of an incredibly happy husky will help you pause and be a bit kinder. This post originally appeared March 24, 2014 on Dr. Cochran’s website [*Life in the Wild West* ](http://www.amaliacochranmd.com/a-bit-of-kindness/) \~~~ [![](%5Bsiteurl%5D/wp-content/uploads/2014/04/AmaliaCochran.jpeg)](%5Bsiteurl%5D/wp-content/uploads/2014/04/AmaliaCochran.jpeg) *Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah. She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah. Her research interests lie in surgical education and in clinical outcomes in burns. She is completing her term as Vice President for the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [The Changing Face of Medicine](https://blog.womensurgeons.org/the-changing-face-of-medicine/) **Published:** May 8, 2014 **Author:** Blog Team **Content:** by Minerva A. Romero Arenas > *We cannot all succeed if half of us are held back.* > *– Malala Yousafzai* Elizabeth Blackwell, a teacher and immigrant to the U.S., turned to medicine after a friend confided on her deathbed that she would have been spared much suffering had her physician been a woman. She went on to become the first woman to earn the Medical Doctorate in the U.S. She was admitted as a prank by the all-male students on the faculty – who allowed the students to vote on Elizabeth’s admission never thinking they would allow a woman to become their peer. The face of medicine has changed significantly in the 160+ years since [Dr. Blackwell](http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_35.html) graduated from Geneva Medical College (now Hobart and William Smith College/SUNY). Women are pursuing medical careers in record-breaking numbers. Female applicants to medical schools went from less than [10% in 1965, to approximately 50% in 2005](https://www.aamc.org/download/311370/data/2012_figure1.pdf). In 2013, [48 schools had a female majority of the class](https://www.aamc.org/download/321442/data/2013factstable1.pdf). [![](%5Bsiteurl%5D/wp-content/uploads/2014/05/MinervaHCLDRfig1.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/MinervaHCLDRfig1.jpg) The changes seen in medical schools, however, are not representative of the currently active physician workforce. Women make up less than one-third of all physicians, and only [15% of general surgeons](http://www.acshpri.org/documents/ACSHPRI_Surgical_Workforce_in_US_apr2010.pdf), and 4-6% of neurosurgeons, urologists, and orthopedic surgeons. Data of gender representation in residency reflect similar trends. In 2011, [nearly half of female residents](https://www.aamc.org/download/305520/data/2012_table2.pdf) were training in primary care (pediatrics, internal medicine, family medicine) and less than 10% in surgical specialties. [![](%5Bsiteurl%5D/wp-content/uploads/2014/05/MinervaHCLDRfig2_acs.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/MinervaHCLDRfig2_acs.jpg) Why are women doctors more often choosing primary care than surgical fields? About 5 years ago, I was talking on the phone with one of my lifelong mentors when she asked me, “Minerva, why not?” I was unable to come up with an answer. I was nervous about a realization I had just a few weeks before: I loved surgery. I had just spent 2 months working long hours with excellent residents and surgeons. They had a great work ethic, were cool in the face of chaos, showed compassion toward their patients, and had a passion for their work that I had not seen in any other field. What should have been an exciting moment actually terrified me. Did I have what it takes to be a surgeon? And would it be worth making the sacrifices it would take for possibly 5-10 years of training? Just days away from starting what we call “audition rotations” in the fourth year, switching to surgery was also a scheduling nightmare. I personally called the clerkship directors to apologize for a late cancellation. Thankfully, they were graceful and encouraged me to “figure it out,” even offering to allow me back later in the year if I ultimately decided against surgery. It was not surprising that they were perhaps a bit skeptical of this decision. Surgery had crossed my mind during college, but fell off my list at some point in my first two years of medical school. I had planned to pursue a residency in internal medicine and eventually subspecialize in a field like medical oncology or infectious disease. These fields were friendly to women, and most importantly, I thought would help me merge my love of medicine and public health. Many of the mentors and role models I met were primary care physicians. When I announced my interest in surgery, nobody hesitated at trying to save me/tell me why it was so hard – after all, surgery programs have one of the highest percentages of [residents quitting](http://www.amsa.org/AMSA/Homepage/Publications/TheNewPhysician/2007/tnp397.aspx) training. “You won’t have a personal life.” “[Do you want to have children?](http://well.blogs.nytimes.com/2012/02/23/the-plight-of-the-pregnant-surgeon/?_php=true&_type=blogs&_r=0)” “What does surgery have to do with public health?” The issue of lifestyle differences for surgeons is serious. [In a 2009 study](http://www.ncbi.nlm.nih.gov/pubmed/?term=troppmann%5Bau%5D+women+surgeons) (the year I graduated medical school), women surgeons were less likely to have children and more likely to have their first child later in life. Male surgeons were more likely have a spouse who was the child’s primary caretaker. Reassuringly, 82% of women in that study would choose their profession again. If I had a nickel, for every time I heard “but I never met a woman surgeon” maybe I would have paid off my student loans by now. As a member of two key underrepresented groups in medicine (woman and Latina/Hispanic), I have felt the need to share my story with students who may have similar doubts about pursuing careers in medicine and surgery. I am involved in mentoring & leadership through several organizations ([National Hispanic Medical Association](http://www.nhmamd.org/), [Latino Medical Student Association](http://www.lmsa.net/), [Alliance in Mentorship](http://www.mimentor.org/), [Tour for Diversity in Medicine](http://www.tour4diversity.org/), and [Association of Women Surgeons](http://www.womensurgeons.org/)). Many of the premedical and medical students I meet at mentoring events are surprised to meet a 1) surgeon, 2) woman surgeon, or 3) Latina surgeon. I was too when I met them in medical school. In fact, many of my patients are too. When making rounds at the hospital, I have frequently heard patients tell someone on the phone, “Let me call you back, the nurse just walked in the room.” I have the utmost respect for my colleagues in nursing and do not take offense to these innocent remarks – after all, since [9 out of 10 nurses are female](http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf) it is more likely that a patient will encounter a woman who is a nurse than a woman who is a doctor. As I continue my training to become a general surgeon, I have come up with a couple of answers that I was so worried about years ago. More than halfway through my training, I can confidently say, Yes, I do have what it takes to be a surgeon. And it **IS** worth all the sacrifices. Please join me on Tuesday May 13, 2014 at 8:30pm Eastern (for your local time click [here](http://www.timeanddate.com/worldclock/fixedtime.html?msg=%23hcldr%3A+The+Changing+Face+of+Healthcare+with+Minerva+Romero+Arenas&iso=20140513T2030&p1=250&ah=1)) as I guest moderate the weekly #hcldr tweetchat. - **T1:** How important/beneficial is diversity in health care (e.g., gender, age, ethnicity, background, etc.)? - **T2:** How can we encourage women and other underrepresented minorities to pursue careers in medicine/surgery, or any non-traditional field? - **T3:** What can we, as healthcare leaders, do to stop discriminatory comments or behaviors in healthcare, esp. to women doctors, minorities? - **CT:** What’s one thing you learned tonight that you can use to help a patient tomorrow? This article was originally posted on the [Healthcare Leadership Blog](http://hcldr.wordpress.com/2014/05/07/changing-face-of-medicine/) on May 7, 2014. ***\~~~*** [![](%5Bsiteurl%5D/wp-content/uploads/2014/10/minerva-romero-bio-pic1.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/10/minerva-romero-bio-pic1.jpg) *Minerva A. Romero Arenas, MD, MPH is completing a research fellowship in the Dept. of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, TX. She is a General Surgery Resident at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.* *Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.* She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.* **Resources** National Library of Medicine. Dr. Elizabeth Blackwell Biography on “Changing the face of Medicine.” Accessed April 2014. [www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography\_35.html](http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_35.html) American Association of Medical Colleges. Women in Academic Medicine Statistics and Medical School Benchmarking, 2011-2012. 2012. <https://www.aamc.org/members/gwims/statistics/> American Association of Medical Colleges. Table 1: U.S. Medical School Applications and Matriculants by School, State of Legal Residence, and Sex, 2013 [www.aamc.org/data/facts](http://www.aamc.org/data/facts) American College of Surgeons Health Policy Research Institute. The Surgical Workforce in the United States: Profile and Recent Trends. [http://www.acshpri.org/documents/ACSHPRI\_Surgical\_Workforce\_in\_US\_apr2010.pdf](http://www.acshpri.org/documents/ACSHPRI_Surgical_Workforce_in_US_apr2010.pdf) Troppmann KM, et al. Women surgeons in the new millennium. Arch Surg. 2009 Jul;144(7):635-42. doi: 10.1001/archsurg.2009.120. Health Resources and Services Administration. The U.S. Nursing Workforce: Trends in Supply and Education. 2013. <http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf> **Image Credit** <https://www.nlm.nih.gov/hmd/about/exhibition/changingthefaceofmedicine.html> **Categories:** Uncategorized --- ### [The Power of a Stitch](https://blog.womensurgeons.org/the-power-of-a-stitch/) **Published:** May 9, 2014 **Author:** Blog Team **Content:** ## Reflections from the Association of Women Surgeons’ Booth @ the 3rd USA Science & Engineering Festival By: Shannon F. Rosati, MD [![](%5Bsiteurl%5D/wp-content/uploads/2014/05/10258516_541106626006641_3872253334923614080_n.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/10258516_541106626006641_3872253334923614080_n.jpg)As a surgical resident, I have spent countless hours arduously laboring on my craft – in my intern year, it was knot tying and holding perfectly still in the OR to maintain exact retraction; in my second year, it was central line placement and the art of the sub-cuticular skin closure; now in my third year, it is operating, fascial closure and having a team of junior residents looking to me to help them learn. It was with these lessons in mind that I spent the weekend volunteering at the [3rd USA Science and Engineering Festival](http://www.usasciencefestival.org/). Amongst hundreds of booths, led by teams from NASA, the NIH, the EPA and the National Science Foundation, to name a few, I went to represent the Association of Women Surgeons. Our booth was not flashy- there were no robots, no gravity defying experiments, no inflatable cadaver lungs. We sat with few simple tools: needle drivers, Adson pickups, scissors, foam boards, and suture. As the first child approached, a young girl no older than seven, I looked around, nervous – what did I have to offer that could compare with the amazing experiments and innovations that surrounded me? There was a ROBOT one row over after all! The child asked, “ What does your booth do?” And so I answered her with a question of my own- “ do you want to learn how to place a stitch?” Immediately, her eyes lit up, eagerly nodding her head “yes”, after looking to her mother, who said, “This lady is a doctor. She can teach you.” ![](%5Bsiteurl%5D/wp-content/uploads/2014/05/10152588_541106649339972_90795664089372402_n.jpg)I demonstrated for her what I have come to take for granted over the past several years – load your needle, place it perpendicular to the skin, turn your wrist and drive it through to the other side of the incision. Next the tie (here we did instrument ties) – place the needle driver in between the two ends of the suture, loop one end around, and pull through. After loading the needle for her (not one child stuck themselves, respecting my instruction on the sharpness of the needles), and painstaking concentration, she was able to place one suture, with one knot. “See?” I told her. “You’re ready to be a surgeon!” The look on her face and her excitement at having completed the task was echoed throughout the weekend – more and more children, all immediately engrossed in the placement of one single, interrupted stitch, all smiles and excitement when their task was accomplished. Who knows if any of the several hundred children I encountered this past weekend will have a future in the medical field. What I do know is that this experience for me not only reaffirmed my desire to teach others, but also, and more importantly, reminded me of how much I can learn from the simplest of tasks. We owe it to our patients to remember that each and every stitch is important, that everything we do can make a difference and has an impact on those for whom we are charged with caring. As I journeyed home from Washington, DC, more exhausted from my weekend of suturing with these children than from my last 80 hour workweek, the words of one of my “junior surgeons” resonated in my mind. This young boy, having finished his stitch, surveyed his slightly less than perfect knot quizzically, while his mother asked him “what would you tell your patient?” He stated simply: “I would say that I did my best.” And therein lies what I will continue to strive for, as a resident, a future fellow, and attending – to do my best, at each and every stitch, for each and every patient. ![](http://blog.womensurgeons.org/wp-content/uploads/2014/05/S-Rosati.jpg) *Shannon F. Rosati, MD is a General Surgery Resident at the Medical College of Virginia (Virginia Commonwealth University).* **Categories:** Uncategorized --- ### [Featuring 2013 ACS Surgical Forum Excellence in Research Award Recipient: Nicole Tapia, MD](https://blog.womensurgeons.org/featuring-2013-acs-surgical-forum-excellence-in-research-award-recipient-nicole-tapia-md/) **Published:** May 12, 2014 **Author:** Blog Team **Content:** *General Surgery Resident Nicole Tapia, MD was honored a Surgical Forum Excellence in Research Award at the 2013 American College of Surgeons Clinical Congress held in Washington, D.C. Her work entitled “[PACT Project: Standardized Resident Hand-off Implementation Improves Hand-off Quality](http://www.journalacs.org/article/S1072-7515%2813%2900727-8/pdf)” was also chosen as one of the top three resident presentations at the American College of Surgeons South Texas Chapter Meeting held in Austin, Texas during February 2014. The Association of Women Surgeons is proud to present Dr. Tapia’s work—in her own words—on the blog.* **Standardizing Resident Hand-offs to Improve Hand-off Quality** by Nicole Tapia, MD Morbidity and mortality conferences allow us to review our complications and ask ourselves if it was preventable, how it happened, and what we could have done differently to achieve an alternate outcome. There is usually a lesson to be learned during discussion of the adverse patient event, and a new best practice can develop as a result of such dialogue. I have come to believe that the question of “what could I have done differently” is applicable to many realms of surgical life – struggling in the operating room with a new task, juggling management of a surgical team as a senior resident with both junior resident and attending expectations, and even balancing home and resident life. Recently, my institution offered an Advancing Clinical Excellence (ACE) in Health Care research grant which challenged residents to propose a study to improve health care delivery. They asked us to approach health care with a unique resident perspective and hypothesize and test our ideas. Brainstorming with another research colleague and my research mentor, we agreed that a current hot topic which is omnipresent in resident work-life is the unintended consequences of the ACGME work hour requirements. In particular, our residents and staff have noted challenges that come with increased patient handoffs as we transitioned to a night-float system. We all agreed that anecdotally, we thought quality of patient care was likely worsened by this change. Our research group determined that to test and study our hypothesis and improve handoffs, we needed to focus on verbal communication of patient information, as we work at several hospitals with varied electronic medical records and wanted our approach to be independent of a computer system. We set out to improve patient handoffs using a three-pronged approach: (1) determine current limitations and shortcomings of patient handoffs, (2) develop an ideal handoff, and (3) test the new handoff comparing subjective and objective quality measures. Utilizing a focus group of residents and surgical staff to determine current limitations as well as the ideal handoff, everyone agreed that patients should be discussed based on acuity — communication of events and plans of the sickest patients should occur first. This should be followed by in-depth discussion of the newest admissions, then changes to the current patients. Finally, a task review for the on-coming shift would be reviewed in top-down fashion. We developed a mnemonic, PACT (Priority, Admissions, Changes, Task review), to help our residents remember this discussion based on acuity. Measuring pre- and post-PACT implementation, we found that with PACT implementation, residents had lower incidence of incomplete tasks and lack of patient knowledge on morning rounds, decreased discrepancy between junior and senior handoffs, and senior residents reported junior residents were better able to handle emergencies. We were encouraged by our findings, but in true reflective fashion, thought we could further improve our handoffs. One limitation we found was that there were considerable interruptions during the handoff process. Additionally, we found that although residents were discussing the PACT content, they preferred to discuss patients based on list order – organized by patient location – rather than true acuity. Achieving complete buy-in to the new process has not been without resistance, even though our outcomes were excellent with improved handoff practices. As a result, we developed a second iteration of the handoff process (PACT 2.0) to address these limitations, and we are testing it head-to-head with our current PACT system, in a randomized controlled trial. We are currently analyzing the results and hope to report soon on our outcomes. As a previous research resident and now third-year clinical resident, I have witnessed the junior residents transfer care of their patients with improved communication and feel confident that the night float residents have better knowledge of the patients on their census as a result of the work we have done so far. We introduced the PACT handoff system to our interns at orientation this past year and intend to do so again when they show up in late June. I feel privileged that through a unique grant opportunity at my institution, we were able to review our handoff process and ask ourselves not only what we could do differently, but also, were able to institute change. **Our experience has made me curious: How does your program do handoffs? Do you do handoff training?** ***\~~~*** [![](%5Bsiteurl%5D/wp-content/uploads/2014/05/Headshot.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/Headshot.jpg) *Nicole Tapia, MD, is a general surgery resident in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, currently in her third clinical year. She recently completed two years of research, focusing on trauma and resident education. Nicole hopes to be a trauma surgeon at an affiliated academic center, where she can work with residents and medical students.* **Categories:** Uncategorized --- ### [How to Become a Wildly Successful Researcher](https://blog.womensurgeons.org/how-to-become-a-wildly-successful-researcher/) **Published:** May 15, 2014 **Author:** Blog Team **Content:** by: Marie Crandall, MD, MPH, FACS So, I can’t honestly claim to be a wildly successful researcher, but I understand, in principle, the effort required. I have slogged away at an academic career for the past decade, becoming modestly successful. With that disclaimer, I think some of this might be helpful to those starting out. The world of academic surgery is absolutely broadening. Historically, academic surgeons wrote about a particular clinical question or perhaps ran a basic science lab. Now, there are many paths to academic achievement; some of the more common being public health, outcomes research, innovation, business, and policy. When I was a resident, I was selected to go into the lab and I said, “Bleah! Can’t I get an MPH instead?” Well, it turned out I couldn’t do it then, but three years later, I was fortunate enough to be selected as the trauma fellow at the University of Washington. UW had an NIH-funded training grant that paid for my MPH, which laid the foundation for my ensuing research in topics like domestic violence, gun violence, and disparities. Which leads to the first principle: ## Figure out something you like. If you HATE staring at Petri dishes or massacring rats, and find endless negative studies unrewarding, then you should probably not pursue basic science. Conversely, if you are deeply passionate about toll-like receptors, but the idea of testifying before Congress members about gun violence researchers makes you want to heave, then the lab is the place for you. I will detail a few common research career paths. However, understand that there are ALWAYS exceptions to these rules, and your most heartfelt passions of today may seem, I don’t know, trite in a decade. Anyway, that was my second disclaimer. **Basic Science:** To become a successful basic science researcher, you must somehow obtain the skills and the mentorship to pursue this path. If you want to go down this path, generally, you must match in a residency program that will allow you to do research. That area of research may not define your career, but the 1-2 years will help you learn how to design experiments, understand rigorous research methodology, and the importance of persistence and repetition. If you enjoy it, as you finish your residency, think of areas of research interest that are relevant to your career, and look toward mentors at your institution or other institutions for potential research fellowship or junior faculty positions. The mentors are absolutely key because basic science research is EXPENSIVE. You will need grant money, and most of it comes from sources like the NIH, DOD, or major foundations. The 3-, 5-, and 10-year plans for basic science researchers are outside the scope of this blog, but a simple Google search can provide more information. **Clinical Research:** This is probably the most familiar type of research. Ask a clinical question, devise a retrospective or prospective study to answer the question. It seems fairly straightforward, yet can be challenging to do well. Most high-impact researchers today have advanced degrees in statistics, health services research, epidemiology, or other such disciplines. Or, they have research partners with PhDs in one or more of those areas. If there is a productive clinical research team at your institution, and you have the time and interest, it can be an invaluable experience to participate in one of these projects. It can afford you basic statistical and data manipulation skills, as well as let you know if sitting on your butt in front of a computer all day during your research time is the right career path for you. Many residency and fellowship programs are supporting residents to obtain Master’s degrees during their research years, while working on clinically relevant projects. Areas like public health, public policy, and outcomes research would also fit into this category. So, let’s say now you’re on this path. ## What next? Writing is deeply under-appreciated. Some people enjoy it, others hate it, some are wonderful wordsmiths, others are abysmal writers. You would think enjoyment or at least being prolific would correlate with skill, but you instinctively know that’s not the case if you’ve been forced to read Dickens ever in your life. Anyway, the key is to keep it simple and here is my formula: - Abstract = usually structured, usually <250-300 words - Introduction = 1-3 pages that state the importance of the problem, overview of the current literature, GAPS in the current literature which inspired your research question, hypothesis - Methods = 1-3 pages, your methods. Really, I can’t help you with that - Results = 1-4 pages that iterate your important findings. Don’t hesitate to use graphs and tables, but try to keep it to a total of 5 or 6. That’s the max that is usually acceptable for print - Discussion = 1-3 pages summarizing the MOST important of your findings, then the limitations of the study (after the biggest limitations, state arguments right there why that limitation is irrelevant), then come back around to the importance of the work and future directions ## Cardinal rules: - Do not plagiarize - Authorship is intricately political and complicated, figure it out ASAP!! I have been irate at people for years (and people have been justifiably irate at me) for author order disputes. Don’t let it happen to you. I just realized I’ve used up two single-spaced pages, which is really excessive for blogdom. Ah, well, the topics of “finding an academic job,” “finding grant money,” and “shameless self-promotion” will have to be covered at another time. In the meantime, keep researching and remember the fame-worthy words of my former Chair, Ron Maier, “Success is directly proportional to your ability to tolerate rejection.” | [![](http://blog.womensurgeons.org/wp-content/uploads/2014/05/Crandall-MD-Marie-2010-NMFF.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/Crandall-MD-Marie-2010-NMFF.jpg) | |---| | | *Marie Crandall, MD, MPH, FACS is an Associate Professor of Surgery and Preventive Medicine in the Division of Trauma and Critical Care at Northwestern University Feinberg School of Medicine. She is originally from Detroit, MI, a product of Head Start and local public schools. Dr. Crandall obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley in 1991, and completed her M.D. in 1996 at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001, and in 2003, completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA. During her fellowship, she obtained a Masters in Public Health from the University of Washington. Dr. Crandall performs emergency general and trauma surgery, staffs the SICU, and is an active health services researcher. Dr. Crandall loves travel, triathlons, hiking, and is a passionate animal rights activist; you can follow her on Twitter [@vegansurgeon](http://twitter.com/vegansurgeon).* **Categories:** Uncategorized --- ### [Creative Writing for Surgeons](https://blog.womensurgeons.org/creative-writing-for-surgeons/) **Published:** May 15, 2014 **Author:** Blog Team **Content:** By: Carol EH Scott-Conner, MD, PhD **WHY WRITE?** If you keep a journal, you are familiar with the process of putting words to an event. Writing down what happened allows you to place the event into a kind of context, externalize it, reflect upon its significance, and maybe remove some of the heat of emotion from it. This brief article deals with the logistics of transforming those journal entries into published creative fiction or nonfiction. **WHY SHARE YOUR STORIES?** Think back to those early years when you, as a young person, began to formulate life goals and when you first heard the vocation (in the truest sense of calling) that led you to surgery. Perhaps you were influenced by a life event, an encounter with a charismatic surgeon, a family member in the business, or maybe your goals were shaped by things you read. By books and stories. Stories capture the imagination by tapping into a cultural heritage that goes back to the days when our distant ancestors gathered around the fireside to tell tales. Physicians who write for a wider audience dare to share their own stories with the public. We work in a time of severe fiscal and administrative constraints. Much of our time and energy is spent dealing with these issues. It can become joyless. Somewhere along the line, patients became consumers, and physicians and other members of the healing professions became providers. Creative writing is a way for you to renew your own passion and to communicate the passion – the drive that keeps us in our careers – to the next generation of potential surgeons and to outsiders. [![](%5Bsiteurl%5D/wp-content/uploads/2014/05/journals-blog.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/journals-blog.jpg) **START BY KEEPING A JOURNAL** Any writer needs material. Fortunately, as surgeons we are surrounded by the deepest mysteries of life and death. We routinely encounter people in crises, and are able to observe a great range of humanity up close and person. It is no accident that some of our greatest writers, such as Checkhov, were physicians. The best place to start is simply to keep a journal. There is no pressure to ever share what you have written with a broader audience, but if – at some future date – you wish to do so, you will have material. If you have never kept a journal, I recommend the “[Morning Pages](http://juliacameronlive.com/basic-tools/morning-pages/)” approach described by Julia Cameron. She suggests that you begin every day by writing three pages of anything you wish. Three pages – no more, no less. I have been doing this for about 14 years. I spend about 30 minutes at the start of each day with a cup of coffee and my journal. I write one or two significant events that I recall from the day before, or I write down my dreams, or I write down some possible solutions for writing projects that I am stuck on. Sometimes I can only finish one or two pages before I have to go to the OR. In that case, I finish my three pages at the end of the day. Over the course of the day, I might make a note or two of something that caught my eye or captured my imagination. Let’s say, for example, that when I shook hands with a patient’s husband after surgery, I was struck by how strong and warm and blunt his hand was, and that (like many farmers) he had lost the terminal part of a finger or two. I might note down simply “farmer’s hands.” The next day, I might journal for a page or two or even all three about how that hand felt and about all the hands over the years, all the family members (husbands, primarily nowadays) I’ve spoken with, all those interactions. Or, on my bike ride home, I might catch a glimpse of migrating white pelicans in flight. That becomes something to note down, and write about the next day. Why not just write about it when it happens? First of all, usually there isn’t time. Second, the delay allows reflection, and you have a topic or topics in mind when you sit down to write. You aren’t simply facing a blank page with a fuzzy mind and a cup of coffee in hand. Over time, material accumulates and the habit of writing becomes engrained. Maybe you will start to get the urge to share your experiences with a broader audience. The material that follows deals with various aspects of creative writing for publication. **FINDING YOUR GENRE: FICTION VERSUS NONFICTION VERSUS POETRY** About twenty years ago I started to get inquiries from male colleagues (most of my colleagues, in those days, were men) who had daughters – “my daughter is thinking of going into surgery. What can I give her to read?” and when I tried to come up with a list, I realized that the very few books available at that time written by female surgeons, mostly memoirs, although very true were largely written from a place of bitterness and struggle. There was very little I could come up with at that time that conveyed the sense of joy and vocation that I would want to pass along. So I set out to write. I began thinking I would write a memoir. So, let’s start with memoir as an exemplar of creative nonfiction. Creative nonfiction is a term used to apply to the general body of writing the truth, in which the writer uses some or all of the techniques of fiction. The one thing that is not allowed is trampling on the facts. Memoir is particularly tricky. The inevitable editing that has to occur – simply winnowing down the events of a lifetime into a handful worthy of inclusion – is of necessity subjective. Memoir says, here is the truth, as best I remember it. It is a window into a period of time, a way of life. A memoir that is perceived as self-serving is self-defeating. Memoir needs to tackle the difficult issues – it is the tension between the narrator and the world that brings it to life. Think back to the hardest times in your professional life and ask yourself if you are willing to bring these to the page. Ask yourself also if you have kept good enough records (or have access to good enough records) to accurately reconstruct what happened. Ask how you will incorporate patient-specific details. How will you portray administrative struggles? How will you deal with family issues? Add to that the difficulty in reconstructing the past, in the absence of accurate records, and you may start to see the appeal of fiction. Creative nonfiction for surgeons goes much farther than memoir, however. It encompasses a spectrum ranging from essays such as “[A Piece of My Mind](http://jama.jamanetwork.com/collection.aspx?categoryid=5766)” in JAMA that explore the humane aspects of the practice of medicine through pieces that explain various aspects of medicine and healthcare for the public. There is an almost insatiable appetite for this kind of material, and it forms an easy segue from the writing you have already done in your professional life to the creative writing realm. Let’s talk specifically about “A Piece of My Mind.” It’s one of the first things I turn to when each new issue of JAMA arrives. The vast majority of these pieces are clinical vignettes and feature a physician and a patient – sometimes the physician is the patient. The guidelines specify that the piece must be nonfiction. Information can be withheld, but nothing can be changed. The permission of the patient is required, if the case is in any way identifiable. The piece must be short – the word limit is 1800. Increasingly, in this kind of writing, the consent of the patient or family (and the opportunity to review the piece of writing) is required. Most of the time, consent is readily granted and leads to a new dimension in the patient-surgeon relationship. Physicians are sometimes driven to write after they experience the health care system themselves, either as a patient or as the close relative of a patient. Often the experience is a negative one. The thing that distinguishes the best of these pieces of writing is a sense of distance, a dispassionate objectivity that can only come with time. Indeed, one medical literary journal noted that this was the single largest failure they noted in rejected pieces. Fiction affords greater latitude. The first thing to understand about fiction (and it took me a while to get this basic point) is that it has a structure. Much of what we encounter in the course of our work as a surgeon is simply anecdote. Something happens. Fiction needs a protagonist, and the protagonist must have a goal. Something intervenes to thwart attainment of this objective, and there is conflict with resolution. Often the protagonist emerges changed in some way. So for the typical clinical encounter, the protagonist might be a patient, a surgeon, a trainee, a family member. The possibilities are endless. Simply taking a clinical vignette and changing various aspects to make the patient unrecognizable is not enough to make something fiction. And this gets me to a key point. If you are really serious about creative writing, you would do well to take advantage of opportunities around you to learn the craft. Poetry is a thing apart. Poetry, more than other forms, demands attention to the shape (form) as well as the content. My experience as editor-in-chief of our literary journal, [The Examined Life](http://theexaminedlifejournal.com/), has convinced me that writing poetry for publication requires specialized skills and knowledge which I do not possess. Writing poetry for yourself, of course, is another issue. I included some references at the end that may be helpful, but the remainder of this short article with deal exclusively with prose, especially in expanding upon some of the key issues in writing for publication. **LEARNING YOUR CRAFT** I come from Iowa City, the home of the famous “[Writers Workshop](http://www.uiowa.edu/~iww/)” – now, I’m not part of the workshop and I haven’t studied there (it’s an extremely competitive MFA program). But I subscribe to the *philosophy*behind the name. Workshop implies a place where things are made; and part of the philosophy is that writing is a craft, and that aspects of the craft can be learned, taught, and practiced. Studying these aspects of craft allow you to express yourself far more effectively. As surgical educators, we know that some trainees come to surgical residency with a greater degree of eye-hand coordination and learn operative skills faster than others, but none of us would expect a raw trainee to go into the operating room and perform an appendectomy without study and practice. Similarly, we need to lay to rest the myth of the born-writer, who sits alone in a room and is visited by a creative muse. The words just flow, and you either have it or you don’t. Just as we all learned how to operate, how to perform scientific experiments, so too creative writing is a set of skills to be studied. How do you get started? It’s not that different from the search for a collaborator with specific expertise when you embark upon a research project. All universities have creative writing programs. An increasing number of medical schools incorporate creative writing into the curriculum for the medical students. Once you start asking around, you are likely to find a core group of physician-authors at your own institution. There may even be a literary journal, either on-line or print, at your college of medicine. For sure, there’s a good chance your university has one. At the University of Iowa there are at least three. The University hosts the prestigious Iowa Review, a well-established literary journal. The College of Medicine hosts the new The Examined Life Journal (of which I am the editor-in-chief), now putting together its fourth issue. And there is at least one student-run journal at the University. Writing conferences such as the Iowa Summer Writing Festival provide a variety of short courses and the opportunity to interact with fellow-writers, most of whom are not physicians. There are, in addition, specialized conferences designed for medical writers, such as The Examined Life Conference held at the University of Iowa Carver College of Medicine. How do you work with the material at hand? Obviously, respect for confidentiality and feelings of patients and colleagues must rule. This is why I went the fiction route! It’s not enough just to change the names. Remember, you aren’t writing a case report. The part that we as physicians may find most compelling – the medical details of the case – really matter the least. What matters is the interaction between individuals. How people change. Use a writing group (preferably non-physicians) or writing courses to “workshop” your writing. Get your piece as good as you can get it, and then let your group have at it. Take careful notes! Notice what they found incomprehensible (jargon!) or what fascinates them. Correct the jargon (I had a group get hung up on “laparotomy pad” for several minutes) and expand upon the fascination. For example, several years ago I wrote a short story called “The Sound of Thunder,” about an unsuccessful resuscitation. Initially I thought it was about the tension between a surgical resident (who wanted to go all out and take a dying elderly patient to the OR) and an attending who decides otherwise. I live in a rural area so I often mix bits of nature into my stories – I threw in a snapping turtle (“once they bite, only the sound of thunder makes them let go.”) The piece was triggered by an actual event, but I drew on a lifetime of these decisions to invent a composite resuscitation scenario that was pure fiction. Protecting the patient was the easiest thing in the world, because the medical details of the scenario (although they had to be true to life) mattered the very least. When I shared this story in a writing workshop, the non-physicians in the group liked the medical details, but they were fascinated by another aspect – how do you go home at night after a day like that? How do you interact with your spouse? What do you say? ([Read the completed piece here.](http://hospitaldrive.med.virginia.edu/hospital-drive/issue-9-fall-2012/the-sound-of-thunder-4/)) There are a variety of excellent books out there for the neophyte (or even the experienced) writer. I particularly recommend Robin Hemley’s [Turning Life into Fiction](http://www.amazon.com/Turning-Life-Fiction-Robin-Hemley/dp/1555974449). At heart, all writers are magpies and thieves, picking up bright jewels from the sidewalk, stitching them together into some kind of narrative. All writers deal with issues of disclosure and respect for that which should not be written. For the nonmedical writer, it may be issues related to family or friends. For us, it is patients. **WRITING THE SHORT STORY** For many medical writers, a short story starts with a clinical anecdote. This problem also occurs with beginning fiction writers who are not physicians. The problem is that an anecdote is not a story. A story has a structure, but an anecdote is just something interesting, bizarre, or amusing that happened. Many of the tales we tell our friends are really anecdotes. You can take an anecdote and shape it into a story, but you have to do the work and you have to understand the structure and conventions of a short story – these shape the expectations (consciously or unconsciously) of your readers. That odd thing that happened during your last call night? It’s an anecdote. Put it into the structure of a story – add a protagonist (hero), a task, a complication, and a resolution; change the clinical facts, and it might be a short story. When I think of the structure of a story, I remind myself of the fairy tales I read as a child. Most of them began something like this: “Once there was a \_\_\_\_. Every day, she \_\_\_\_\_. Then one day, \_\_\_\_\_. So she \_\_\_\_” etc. and so on until “And they lived happily ever after” Your story doesn’t have to state those parts explicitly, but your clinical anecdote might provide the interruption – the “then one day…” element. How did that occurrence complicate your life, change your life, or change your outlook? It doesn’t have to be a huge change, but there must be some kind of transformation. The nice thing is that it’s fiction! So the clinical details, all the identifying information, are easy to change, once you set your mind to it. Was it a case of a critically injured burn patient? Well, change the mechanism of the injury, the age and gender of the patient, the distribution of the burn over the body, the clinical issues; create a composite out of all the experiences you have had, and draw essential truth of the story from how you were affected. Or maybe change it to a critically injured non-burn trauma patient. The possibilities are limitless. **WRITING CREATIVE NONFICTION** The best creative nonfiction draws on techniques used by fiction writers to create interest, suspense, or to move the reader. The difference is that nothing has been changed. As I noted above, there is an increasing trend to involve the patient (or patient’s family) and to get consent, rather than to omit identifying details and simply press on. Creative nonfiction for surgeons actually encompasses a wide range of forms. There is memoir, clinical vignette, reflections on your own illness or professional experience, the transformation of going from medical student to resident, or the clear explication of medical facts in such a way as to fascinate the lay public ([Gawande, Oliver Sacks)](http://www.nydailynews.com/blogs/pageviews/writer-m-prose-tip-scalpel-atul-gawande-oliver-sacks-pauline-chen-blog-entry-1.1637450). I ventured into creative nonfiction when, a little over a year ago, I was diagnosed and successfully treated for Stage I breast cancer. At this point in my career, my practice consists exclusively of patients with breast disease, so there was a certain irony. When I began to reflect on the experience, nonfiction narrative offered the perfect vehicle. I started to think about scars, the scars of burn patients, the scars of surgical patients, physical and emotional scars of all kinds. I wrote a rambling lengthy [reflection](http://pulsevoices.org/archive/stories/cover-up) on scars which I submitted to Pulse – Voices from the Heart of Medicine. A generous-hearted editor went through several iterations with me and the final piece, balancing fact and reflection, was published in their online journal. What I learned from the process was the importance of emotional distance from the experience, and the balance between the triggering event or events and the internal reflection on those events. **SUBMITTING TO LITERARY JOURNALS** Let’s shift gears and talk about getting published. And I ask you to forget for a moment the world of The New Yorker, Paris Review and the Atlantic. If you are publishing in those, you really don’t need my advice. For the rest of you, follow me into the world of small literary journals where many creative writers are happy to find a niche. Getting published in the world of creative writing follows a completely different set of rules than the kind of scientific, or technical writing that we are used to. To start from the most basic rule – when you submit a paper to one of the surgical journals, you follow the rule of “no simultaneous submissions.” When I send a story to a literary journal, I (and all the other creative writers out there) routinely send it to five, ten, sometimes twenty at the same time. This is just simply reality. I have had stories accepted for publication on the first go-around, and I have had others accepted after 50 or 60 rejections (and some revision). It can take a journal a year to decide to reject a story – and life is short. Because the literary journals have failed to exercise draconian rules, each small but established journal may receive thousands of submissions for an issue, of which they may publish 30. You can do the math. In some ways, publishing in literary journals is very similar, however. Just as some surgical research papers are ideally suited for the Annals of Surgery and others belong in Transplantation (or some other subspecialty journal), so too literary journals have niches. To take a clear example, there is a literary journal called The Healing Muse (see below) that is housed at the Center for Bioethics at SUNY Syracuse. That journal occupies a clear niche that will be different from, say, The Chicago Review. Look through some copies of the journal before you submit. A complete listing of literary journals can be found at New Pages (see resources at the end of this article). Here is a short list of small literary journals that concentrate on medical humanities and that accept submissions from individuals outside their own institution: - [The Examined Life](http://theexaminedlifejournal.blogspot.com/p/submit-your-work.html) (fiction, nonfiction, poetry) – the Literary Journal of University of Iowa Carver College of Medicine - [Pulse – Voices from the Heart of Medicine](http://pulsemagazine.org/submissions)(poetry and nonfiction) - [The Healing Muse](http://www.upstate.edu/bioethics/thehealingmuse/) - [Ars Medica](http://ars-medica.ca/index.php/journal) - [Hospital Drive](http://news.med.virginia.edu/hospitaldrive/) **WRITING BOOKS** This all usually culminates in the desire to write a book and have it published. Books have a kind of permanence and heft, a gravitas that pieces published in periodicals do not. As with shorter pieces, if you are going to write a book, it needs to fit into one or another type or genre. Will it go on the Memoir shelf or the Novel shelf? Will it be history, or historical fiction? Maybe you are going to write science fiction. Choose a genre and study the forms, expectations, and best examples of that genre. Generally you will need a completed manuscript before you approach an agent or publisher. University presses are natural publishers of nonfiction books (such as memoir, or the history of a department of surgery or a specialty), but tend to shy away from fiction. A third option, besides commercial publishers and academic presses, is self-publishing. Options such as CreateSpace and Kindle Direct have made this easy, painless, and sometimes the best option. There are a large number of excellent books about the process of writing (and getting published). I recommending going to a large local bookstore (or public library) and browsing the “writing” section. **A FEW LAST WORDS** As I said in the beginning of this piece, writing is a learned art just like surgery. You can learn how to do it, if you wish. **Three elements for success as a writer are:** - Material – we have no shortage of that as surgeons! - Writing – in other words, sit down and write. Perseverance helps here - Knowledge of, and respect for, the craft – study the craft of writing, and READ, read, read As surgeons, we have unparalleled access to the human experience, and the demonstrated ability to persevere when we take on a task. Take time to add some knowledge of the craft and go forth and get published! It is so much fun to send something out into the world and then hear back from an old friend at another institution (or a colleague at your own institution) who just read it. **RESOURCES** - Julia Cameron [The Artist’s Way: A Spiritual Path to Higher Creativity](http://www.amazon.com/Artists-Way-Spiritual-Higher-Creativity-ebook/dp/B006H19H3M/ref=sr_1_1?s=books&ie=UTF8&qid=1400169172&sr=1-1&keywords=Julia+Cameron+The+Artist%E2%80%99s+Way%3A+A+Spiritual+Path+to+Higher+Creativity.). New York, Putnam Books, 1992. This will get you started on your “Morning Pages” journal. - Robin Hemley [Turning Life into Fiction](http://www.amazon.com/Turning-Life-Fiction-Robin-Hemley/dp/1555974449/ref=sr_1_1?s=books&ie=UTF8&qid=1400169150&sr=1-1&keywords=Robin+Hemley+Turning+Life+into+Fiction). St Paul MN, Gray Wolf Press, 2006. Although geared to fiction writers, this book deals with a lot of issues related to transforming actual events that happened to real people into printed words. - Carolyn Forche and Philip Gerard (eds) [Writing Creative Nonfiction](http://www.amazon.com/Writing-Creative-Nonfiction-Philip-Gerard/dp/1884910505). Cincinnati OH, Story Press, 2001. Lots of great chapters dealing with all aspects of nonfiction writing, although not specifically medical. - John Gardner [The Art of Fiction: Notes on Craft for Young Writers](http://www.amazon.com/Art-Fiction-Notes-Writers-Vintage-ebook/dp/B003N9AZG4/ref=sr_1_1?s=books&ie=UTF8&qid=1400169085&sr=1-1&keywords=John+Gardner+The+Art+of+Fiction%3A+Notes+on+Craft+for+Young+Writers.). New York, Vintage Books, 1984. A classic, inspiring as well as offering guidance. - Janet Burroway [Writing Fiction: A Guide to Narrative Craft](http://www.amazon.com/Writing-Fiction-Guide-Narrative-Craft/dp/0205750346/ref=sr_1_1?s=books&ie=UTF8&qid=1400169042&sr=1-1&keywords=Writing+Fiction%3A+A+Guide+to+Narrative+Craft). 5thedition. New York, Longman Press, 2000. Lots of examples of good fiction, as well as concrete guidance. - [NewPages.com](http://newpages.com/): This is an online listing of Literary Magazines – of all kinds, not just medical – with links to their websites - Mark Strand and Eavan Boland. [The Making of a Poem: A NortonAnthology of Poetic Forms](http://www.amazon.com/The-Making-Poem-Norton-Anthology/dp/0393321789). Good basic information if you want to write poetry. - [The Iowa Summer Writing Festival](http://iowasummerwritingfestival.org/) – An annual offering of weekend and week-long courses in all aspects of creative writing. Relatively inexpensive, and totally accessible (anyone can come) with classes limited to 12. Great value and great fun! - [The Examined Life Conference](http://www.medicine.uiowa.edu/theexaminedlife/Program.aspx) – An annual conference dedicated to writing as a part of the medical humanities. [![](http://blog.womensurgeons.org/wp-content/uploads/2014/05/carol-scott-conner.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/carol-scott-conner.jpg) *Carol Scott-Conner is Professor and former Head of the Department of Surgery at the University of Iowa Carver College of Medicine. As she grew older, she turned to creative writing as a way of conveying the rich and varied experiences she has had as a surgeon. A collection of her short stories was published as [A Few Small Moments](http://www.amazon.com/Few-Small-Moments-Short-Stories/dp/0615454127) and other short stories are available at [her website](http://www.scott-conner.com/).* **Categories:** Uncategorized --- ### [Making Time for Arts and Humanities in Medical and Surgical Education](https://blog.womensurgeons.org/making-time-for-arts-and-humanities-in-medical-and-surgical-education/) **Published:** May 21, 2014 **Author:** Blog Team **Content:** by: Susan Pories, MD, FACS I became interested in working with medical students on reflective writing when I was a tutor in the Patient Doctor III course, for third year students transitioning from the classroom to the clinic. In 2004, I began the Writers’ Circle, a group of faculty and students that continues to meet regularly during the academic year to encourage student writing. Out of this came our book, ***[The Soul of a Doctor:Harvard Medical Students Face Life and Death](http://www.amazon.com/The-Soul-Doctor-Harvard-Students/dp/156512507X)****,* a collection of medical student writing, published by Algonquin in 2006 and now in its fifth printing, with over 27,000 copies in print. This has been translated into Chinese and is now being published in Japanese as well. This book is used as part of the medical student curriculum in several medical schools. I am also the Reflections Editor for the ***[Journal of Surgical Education](http://www.journals.elsevier.com/journal-of-surgical-education/)***(previously Current Surgery) and over the years, I have helped many medical students publish their essays in this venue as well. Most recently, one of my students published her essay in the *New England Journal of Medicine (*[Mourningon Morning Rounds](http://www.nejm.org/doi/full/10.1056/NEJMp1300969) by Mounica Vallurupalli, B.S.: NEJM 2013; 369;5). Over the years, we have had many wonderful physician writers, such as Atul Gawande, Rafael Campo, and Jerome Groopman come and spend time with the students, which has been inspirational and educational. Our writers group was filmed and interviewed by PBS in November 2013 when the Poet Laureate of the United States, Natasha Trethewey, joined us for a discussion, which was a thrilling experience. Watch [student physicians embrace poetry to hone art of healing](http://www.youtube.com/watch?v=sKP2rmEO1RM). Most recently we had a two day visit with Dr. Danielle Ofri, prolific and thoughtful author and the Editor of the Bellevue Literary Review. As part of her visit, Dr. Ofri gave a taped interview for the Cambridge Forum which was broadcast widely [Danielle Ofri: Why Doctors Write](http://www.youtube.com/watch?v=Q4aocklsf9c). I have become convinced that this sort of interaction and opportunity for reflection is integral for maintaining balance in a medical career. As such, I have joined forces with like-minded educators at Harvard Medical School and we now have a Committee on Arts&Humanities@HMS, dedicated to the eventual formation of a Center for the Arts, Literature, Music, and Humanities at HMS. Working with student writers is a labor of love for me and I am currently working on two other book projects with the students. One is a [collection of narratives from the Mentored Clinical Casebook project at HMS](http://www.ncbi.nlm.nih.gov/pubmed/17457078) which is a project that pairs first year students with patients they follow for an entire year. The second is the Harvard Intern Project, where we are collecting reflections from interns. I am especially delighted when students who are interested in surgery participate in the arts and am very proud of our AWS medical students and residents such as Sophia McKinley, who recently published a beautiful essay in the Journal of Surgical Education (*Too Nice to be a Surgeon* by Sophia Kim McKinley, EdM; JSE Volume 71/Number3 \_ May/June 2014) and Christina Grassi, who plays viola with the [LongwoodSymphony Orchestra](http://www.longwoodsymphony.org/), an orchestra of physicians here in Boston. I will be moderating a panel for the October 2014 ACS meeting in San Francisco entitled **Surgeons as Artists** and look forward to broadening the discussion on this important and timely topic. [![](http://blog.womensurgeons.org/wp-content/uploads/2014/05/pories.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/05/pories.jpg) Susan Pories, MD, FACS is the co-editor of *The Soul of a Doctor* and co-author of *Cancer: Biography of a Disease*. She is an Associate Professor of Surgery at HarvardMedical School, Immediate Past President of the Association of Women Surgeons and the Vice-Chair of the American College of Surgeons, Women in Surgery Committee. She is the Medical Director of the Hoffman Breast Center at Mount Auburn Hospital. Dr. Pories co-chairs the HMS Academy Writing for Scholarship Interest Group, she is Faculty Advisor to the HMS writers’ group, and is the Co-Chair of the Arts & Humanities @HMS Planning Committee. **Categories:** Uncategorized --- ### [Blogger Q&A: What are you reading?](https://blog.womensurgeons.org/blogger-qa-what-are-you-reading/) **Published:** June 5, 2014 **Author:** Blog Team **Content:** **[Amalia Cochran](http://twitter.com/amaliacochranmd), MD, MA, FACS, FCCM:** [*The Goldfinch* by Donna Tartt](http://www.amaliacochranmd.com/june-reading-round-up/) [![](https://images-blogger-opensocial.googleusercontent.com/gadgets/proxy?url=http%3A%2F%2F1.bp.blogspot.com%2F-yR6K-WPWf5o%2FU49nZVrt0gI%2FAAAAAAAAALI%2FwY6Db0-HXxc%2Fs1600%2Fthe%2Bgoldfinch.jpg&container=blogger&gadget=a&rewriteMime=image%2F%2A)](https://www.goodreads.com/book/show/17333223-the-goldfinch?from_search=true) **[Christina Cellini](http://www.urmc.rochester.edu/people/21782244-christina-cellini), MD, FACS, FASCRS:** I am currently reading *The Secret* by Rhonda Byrne [![](https://images-blogger-opensocial.googleusercontent.com/gadgets/proxy?url=http%3A%2F%2F1.bp.blogspot.com%2F-MUly1w2QuKM%2FU49n5WRou4I%2FAAAAAAAAALQ%2F47tNmuMz4mk%2Fs1600%2Fthe%2Bsecret.jpg&container=blogger&gadget=a&rewriteMime=image%2F%2A)](https://www.goodreads.com/book/show/52529.The_Secret?from_search=true) **[Marie Crandall](http://twitter.com/vegansurgeon), MD, MPH, FACS:** I’m currently reading 3 things; I’m in the middle of A *Traitor to His Class: The Radical Presidency of Franklin Delano Roosevelt*, just finished a fun graphic novel, *Juicy Mother: Celebration* by Jennifer Camper, and *The Lowland* by Jhumpa Lahiri. [![https://www.goodreads.com/book/show/3301907-traitor-to-his-class?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/traitor.jpg)](https://www.goodreads.com/book/show/3301907-traitor-to-his-class?from_search=true) [![https://www.goodreads.com/book/show/370851.Juicy_Mother?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/juicymother.jpg)](https://www.goodreads.com/book/show/370851.Juicy_Mother?from_search=true) [![https://www.goodreads.com/book/show/17262100-the-lowland?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/thelowland.jpg)](https://www.goodreads.com/book/show/17262100-the-lowland?from_search=true) **[Celeste Hollands](https://twitter.com/celestehollands), MD, FACS, FAAP:** *The Athena Doctrine* ; *The Noticer* [![https://www.goodreads.com/book/show/16250170-the-athena-doctrine?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/athena.jpg)](https://www.goodreads.com/book/show/16250170-the-athena-doctrine?from_search=true) [![https://www.goodreads.com/book/show/6261270-the-noticer?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/thenoticer.jpg)](https://www.goodreads.com/book/show/6261270-the-noticer?from_search=true) **[Lauren Nosanov](http://twitter.com/laurenbnosanov), MD:** I’m reading Pauline Chen’s *Final Exam* [![https://www.goodreads.com/book/show/335690.Final_Exam?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/exam.jpg)](https://www.goodreads.com/book/show/335690.Final_Exam?from_search=true) **[Callie Thompson](http://twitter.com/callie_mt), MD:** Sadly, I haven’t found much free time for reading outside of textbooks and journal articles but I am currently in the middle of three books. Two of them are about raising a French Bulldog and one is about puppy training. You might’ve guessed that my children have successfully convinced us to get them a dog and I am trying to prepare myself. | | |---| | | **[Jane Zhao](http://twitter.com/jzhao3), MD:** I recently completed *There Is No Me Without You: One Woman’s Odyssey to Rescue Africa’s Children* by Melissa Fay Greene and *The Hero of Ages* by Brandon Sanderson. Now I’m in the thick of *Advanced Trauma Life Support: Student Course Manual*. [![https://www.goodreads.com/book/show/119729.There_Is_No_Me_Without_You?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/nomewithoutyou.jpg)](https://www.goodreads.com/book/show/119729.There_Is_No_Me_Without_You?from_search=true) [![https://www.goodreads.com/book/show/2767793-the-hero-of-ages?from_search=true](%5Bsiteurl%5D/wp-content/uploads/2014/06/hero.jpg)](https://www.goodreads.com/book/show/2767793-the-hero-of-ages?from_search=true) [![https://www.goodreads.com/book/show/17141989-atls-student-manual?from_search=true](http://blog.womensurgeons.org/wp-content/uploads/2014/06/atls.jpg)](https://www.goodreads.com/book/show/17141989-atls-student-manual?from_search=true) **\~~~** **What are YOU reading? Let us know in the comments below.** **Categories:** Uncategorized --- ### [The Importance of Mentoring](https://blog.womensurgeons.org/the-importance-of-mentoring/) **Published:** June 17, 2014 **Author:** Blog Team **Content:** Last month, the Healthcare Leadership Tweet Chat (#HCLDR) invited me to participate as guest moderator to discuss The Changing Face of Medicine. You can read the accompanying blog post [here](http://hcldr.wordpress.com/2014/05/07/changing-face-of-medicine/). The weekly Tuesday evening #HCLDR chat engages a diverse community made up of patients, medical students, doctors, surgeons, residents, nurses, healthcare executives, and many others with a shared interest in healthcare leadership. Some international colleagues also joined from Europe, the Philippines, and Australia. [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/hcldrparticipants.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/hcldrparticipants.jpg) For many Tweeters, it was also the first time joining the #HCLDR Tweet chat. We were very proud to have the support of the American Medical Women’s Association ([AMWA](http://www.amwa-doc.org/)) and the Association of Women Surgeons ([AWS](https://www.womensurgeons.org/home/index.asp)). [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/heapsfuture.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/heapsfuture.jpg) The #HCLDR platform resulted in an engaging conversation on the importance of diversity in medicine. One question we discussed was how can we encourage women and other minorities to pursue careers in medicine/surgery or any non-traditional field? Among the many excellent responses, a common theme emerged of the importance of mentoring. [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/mentormentormentor.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/mentormentormentor.jpg) [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/rolemodelsmentors.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/rolemodelsmentors.jpg) [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/strongmentorship.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/strongmentorship.jpg) Another important factor is to expose students to careers in medicine and surgery early. “Building the pipeline” can be achieved through personal interactions and through support of outreach programs and organizations. One of our AWS members recently wrote on her experience in showing young students what she does daily as a surgeon on [The Power of a Stitch](https://www.womensurgeons.org/the-power-of-a-stitch/). [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/hccareers.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/hccareers.jpg) [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/outreachprograms.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/outreachprograms.jpg) Demonstrating that diversity is important to the organization and showing students that doctors are also people they can relate to are other important aspects of mentoring. [![](%5Bsiteurl%5D/wp-content/uploads/2014/06/showwomenearly.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/showwomenearly.jpg) [![](http://blog.womensurgeons.org/wp-content/uploads/2014/06/whyisharemystory.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/whyisharemystory.jpg) How do you find mentors? We previously tackled the topic of finding a Mentor in our **Lean In** Book Review, which you can find [here](https://www.womensurgeons.org/lean-in-book-review-discussion-part-two/). A quick recap on working with mentors: 1. Be mindful of the mentor’s time 2. Strangers can be mentors. Don’t be afraid to seek out someone no matter how much you admire them. 3. “Excel and you will get a mentor” 4. Have more than one mentor. ***What has your own mentorship experience been like? Have you been a part of an organized mentorship program? How can mentoring be fruitful endeavor for faculty? If you have not downloaded the AWS Pocket Mentor you may do so [here](https://www.womensurgeons.org/aws-pocket-mentor-now-available-as-e-book/). You can also read our [AWS blog post](https://www.womensurgeons.org/blogger-q-a-advice-passed-down-from-our-mentors/) for good advice passed down from our mentors.*** **Categories:** education, gender differences, mentorship --- ### [This is My Story: The Power of Mentorship](https://blog.womensurgeons.org/this-is-my-story-the-power-of-mentorship/) **Published:** June 24, 2014 **Author:** Blog Team **Content:** by: Katherine Jeffress, MA, MPH Earlier this month Dr. Minerva posted on the “[Importance of Mentoring](https://www.womensurgeons.org/the-importance-of-mentoring/)” on the AWS Blog. At the end of her post she asks, “What has your own mentorship experience been like?” This is my story… It begins in a rural village in Ghana West Africa where I was serving as a Peace Corps Volunteer. Originally placed there to teach science at a junior secondary school I quickly found myself starting a large multi-site adult literacy program for women and doing community outreach visits while working at an HIV/AIDs treatment center at a district hospital. While there I met a surgeon who was doing a locum at the hospital from South Africa. It was his mentorship and example that initiated my desire to be a surgeon. He was one of the lost boys of Sudan who after walking many miles to a refugee camp was eventually resettled in Canada. There he studied to become a surgeon and then later he returned to work in Sub-Saharan Africa. Although based in South Africa he did locums in areas all over the content that had surgical shortages. His life story had really moved me so one day I finally mustered up the courage to asked him for some career advice. I asked him if I wanted to work in global health in Sub-Saharan Africa after the Peace Corps what skills and expertise were most needed. He replied, “In Sub-Saharan Africa we need surgeons. We have many great doctors here but many countries don’t yet have the capacity to fully train surgeons or equip operating theatres for complex procedures. Some are lucky enough to go overseas to train and bring the technical expertise back but many many people here still do not have access to basic surgical care. You should become a surgeon.” That night he provided me with many pieces of life advice (some of which I’ve forgotten) but I couldn’t remove the ideal of becoming a surgeon from the back of my mind. It was such a foreign and strange idea to me. Later I returned to the USA a very different person and went back to my graduate studies in psychology and anthropology feeling a bit lost and completely out of place. I knew at that point that I wanted a career in global health but had no clue about the variety of jobs that were out there or what skills and qualifications I actually needed to get those jobs. It was also at that point that I started working with a career advisor at my university who taught me how to network and set up informational interviews with people who had jobs I was interested in. These informational interviews consisted of 15-20 minute conversations where I would listen to the story of how they got to where they are now, what qualifications and attributes someone would need to succeed at what they do, and what their job was truly like. Every conversation I had was extremely helpful and some even led to long-term mentoring relationships. During this time I also formed another mentoring relationship with an Anthropology Professor of mine who was originally from Australia. The support and guidance she provided me set off a cascade of life events that ultimately lead me to Australia where I ended up obtaining a Masters degree in International Public Health and working as a researcher to help develop estimates of gynecological disorders for the most recent update of the World Health Organization’s Global Burden of Disease Study. It was happenstance that I ended up working on genital prolapse a condition that requires surgery to ultimately treat it. I was shocked by how prevalent the condition is in many poor countries with high birth rates. What was even more shocking was how few women outside of developed countries ever received treatment for it. I again became painfully aware of the lack of access the worlds poor have to basic surgical procedures. The influence of my Sudanese mentor combined with this experience finally resulted in me deciding to apply to medical school so that I could one day be trained as a surgeon. Since I’ve started medical school I have continued to seek out mentors for advice and guidance. In my search for surgical mentors I’ve participated in a formal mentoring program at my university and found mentors through my prior university’s alumni database and through the Association of Women Surgeons database. Some of my mentors have had me shadow them while they work. Others I’ve meet for coffee or over Skype. Notably, I’ve found the Association of Women Surgeon’s Annual Meeting to be a particularly great place to meet with women in surgery face to face for mentorship opportunities. Many unexpected opportunities have been opened up for me through mentorship. One mentor that I met through my prior university’s alumni network was incredibly generous and offered me the opportunity to do research with him over the summer break between my first and second year of medical school. While there I quickly feel in love with research in vascular surgery. I also met another wonderful mentor who gave me more great advice about how to become a competitive applicant for a surgery residency and what programs would be a particularly good fit for me given my interest in global surgery. She even invited me to a brunch with other female surgeons in the area. I’ve found it incredibly helpful to have mentors at varying points in their career that work in a variety of different practice settings. Some of my mentors have come and gone others may stay for years. I would not be the person I am today without these mentors. Their support, example, advice, and guidance have and are providing me with a safety net for my success. These relationships have cultivated innovation and creativity in my research endeavors and life pursuits. Their stories and example have played an integral role in helping me get a clear vision of what I want to do professionally. Their advice and guidance has been pivotal in enabling me to identify tangible and achievable career goals that are consistent with this vision. These mentors have also shown me how to obtain these goals by outlining a clear path to take. They’ve done this by: · Sharing their story with me · Outlining the specific skills and expertise I need to build · Indicating the vital research or leadership experiences I need to have at each training level. · Sharing great resources to study to efficiently obtain the scores I need. · Teaching me how to be a valuable member of the team even at the medical student level. · Providing opportunities I need to develop myself so I’m prepared to enter the profession or by introducing me to people that can. When the journey has become difficult and I’ve questioned the path I’ve chosen to take my mentors have helped me keep prospective, given advice to increase my resilience, and shown me that there is a place for me in the surgical world even if at times I may feel like I don’t belong. It is their support and inspiration that led me to medical school and pushes me to work hard to pursue a career in surgery. I really don’t know what words to use to express the deepest gratitude I have for the amazing people who have come into my life as mentors. They have had a profoundly impact on the course of my life. They have shown me that mentoring is an extremely powerful tool for career success. If you don’t have the right set of mentors I strongly encourage you to seek them out. If you’ve had amazing mentors or want to provide the experience you never had the privilege of having I encourage you to pay it forward. I for one can’t wait to pay it forward. ——————————————————————————— Katherine Jeffress, MA, MPH is a 3rdyear medical student at Sydney Medical School. Prior to this, she received a Masters of Liberal Arts degree in Psychology from Harvard University where her thesis focused on the effectiveness of culturally adapted treatments for post-traumatic stress disorder in refugee and internally displaced children. She also received a Masters of International Public Health from The University of Queensland and while there worked as a Research Officer at the Centre for Burden of Disease and Cost-Effectiveness. Katherine served as a United States Peace Corps Volunteer from 2007-2008 in Ghana, West Africa. She is passionate about global surgery and the provision of high-quality health care to poor and marginalized people around the world. She can be followed on [Twitter](https://twitter.com/KatieJeffress). **Categories:** Uncategorized --- ### [My Quest for a Masters in Medical Education](https://blog.womensurgeons.org/my-quest-for-a-masters-in-medical-education/) **Published:** June 24, 2014 **Author:** Blog Team **Content:** By: Jean Miner, MD, FACS; Co-Chair of the AWS Clinical Practice Committee “See one, do one, teach one.” Most, if not all surgical trainees heard this throughout their residency years. Was this the best way back in the day? Probably not. Is it the best way now? Certainly not. The dynamics of surgical education have changed drastically over the past decade. A combination of duty hour restrictions, new learning initiatives, technological advancements and stringent requirements have necessitated that educators adapt new methodologies of teaching. When we all think back to our favorite professors and instructors, it seems as if teaching came naturally to them, but as we now know, teaching is hard. And it is even more difficult to do it well. Over the past few years, I realized that my formalized knowledge of curriculum development, assessment methods and teaching practice was inadequate to teach the next generation of surgeons. Coming to this awareness, I determined my own need for training to become a better educator. At that point, I started to search for formal opportunities and found a multitude of options for pursuing further education. I wanted to share some me of my findings in the hope that it may make it easier for colleagues interested in a structured curriculum to find their perfect match. Below, is a summary of the options that interested me most. After careful deliberation and a year of procrastination, I chose to pursue a Master’s in Medical Education at the University of New England’s program for several reasons. The completely online aspect was essential as I didn’t want to worry about travelling for any portion and I can complete assignments at whatever time works for me. Secondly, the format is such that assignments are always due on Wednesdays and Saturdays for each course. This has allowed me to develop a routine to meet the deadlines. The cost is reasonable for advanced education. Finally, the most important feature is the flexibility. After four credits in one of the two disciplines, a student is awarded certification. I particularly liked this option because I was uncertain whether I would be able to keep up the pace for the traditional two year structure. The program allows for a student who has gained certification to complete the full Master’s program within 5 years. I have now completed my first course, “Improving Instructional Effectiveness” and have thoroughly enjoyed every aspect. Already, the knowledge gained from the course has allowed me to implement effective changes within my daily teachings. **Master’s Programs** **University of New England** The master’s degree in Medical Education Leadership is a two-year web-based program designed especially for working professionals that utilizes asynchronous, distance learning within a professional community. The 33-credit hour MEL curriculum is designed to enhance your skills in a variety of professional areas of academic medicine—curriculum, instruction, assessment, personnel development, organizational development, leadership skills, business and finance, and research and evaluation—through professional application and scholarship. The master’s degree also allows for two electives (three credits each) and culminates in an applied project. The final requirement of the program is a professional portfolio that is a longitudinal integration and application of learning. ## ## Online Graduate Certificates ## Program Development in Academic Medicine This twelve-credit hour program provides you with the core program development concepts in curriculum, instruction, learner assessment, program evaluation and research methods in academic medicine. This set of courses is one of the foundations for the UNE Master of Science in Medical Education Leadership. ## ## Leadership Development in Academic Medicine This twelve-credit hour program provides you with the core leadership development concepts in personnel development, organizational development, leadership skill training, and business/finance in academic medicine. This set of courses is one of the foundations for the Master of Science in Medical Education Leadership. Approximately $23,000 for full Master’s degree **[USC – Keck School of Medicine](http://keck.usc.edu/en/Education/Department_of_Medical_Education/Master_of_Academic_Medicine/Program_Information.aspx)** The Master of Academic Medicine is offered through the Keck School of Medicine of the University of Southern California in collaboration with the Schools of Dentistry and Pharmacy. Our program employs a blended model, combining on-line coursework with on-campus face-to-face sessions, one week each March. **A Master’s Program for Today’s Challenges** Our goal is to cultivate leaders who will develop and advance educational programs for healthcare professions globally. Health professions education is continuously evolving, which requires leaders that are process experts with a broad repertoire of approaches that can be applied to varied content arenas and situations. The program addresses a challenge in health professions’ education – the need for qualified educators who can model and lead change in their respective schools and programs. Graduates will be positioned to guide future generations of health professionals toward better meeting the health needs of our global society. Approximately $50,000 (not including travel for one week in CA) **[John Hopkins](http://education.jhu.edu/Academics/masters/MEHP/index.html)** The Johns Hopkins University, through an innovative collaboration of its Schools of [Business](http://carey.jhu.edu/ "Johns Hopkins - Carey School of Business"), [Education](http://education.jhu.edu/ "Johhs Hopkins School of Education"), [Medicine](http://www.hopkinsmedicine.org/som/ "Johns Hopkins School of Medicine"), [Nursing](http://nursing.jhu.edu/ "Johns Hopkins School of Nursing"), and [Public Health](http://www.jhsph.edu/ "Johns Hopkins School of Public Health"), is offering a world class degree – the ***Master of Education in the Health Professions*** (MEHP) – that prepares a new generation of health professionals to teach effectively for schools and training programs related to medicine, public health, nursing, and other health professions. The MEHP program consists of an 18-credit core in Evidence Based Teaching–which can also be taken as a stand-alone post-master’s certificate–and a 15-credit option to focus on educational research or educational leadership. The program format is entirely online. Approximately $40,000 **Additional Master’s Programs** <http://www.aacom.org/InfoFor/educators/mec/facultydev/Pages/CertificatePrograms.aspx> **Courses/ Fellowship** **[ACS Surgeons as Educators Course](http://www.facs.org/education/sre/surgeons-as-educators.pdf)** The six-day intensive course is designed to provide surgeons with the knowledge and skills to enhance their abilities as teachers and administrators of surgical education programs. The course emphasizes the needs of adult learners and the techniques necessary to develop an effective learning environment for medical students, surgical residents, colleagues, and others in the health profession. The maximum class size of 32 allows highly interactive sessions $3,950 for American College of Surgeons members $4,450 for nonmembers **[ASE SERF Fellowship](http://www.surgicaleducation.com/research-fellowship-serf-overview)** A one year, home-site fellowship designed to equip investigators with the skills and knowledge needed to plan, implement and report research studies in the field of surgical education. Following acceptance into the SERF program, each fellow is carefully matched by the program’s faculty with a SERF Adviser, a respected and knowledgeable researcher who will serve as the fellow’s mentor and consultant on their particular project. ($1700) [![](http://blog.womensurgeons.org/wp-content/uploads/2014/06/Jean-Fung-Miner-smaller.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/06/Jean-Fung-Miner-smaller.jpg) Jean Miner, MD, FACS is the Program Director for General Surgery Residency at Florida Hospital, Associate Professor, UCFCOM & FSUSOM and serves as the Co-Chair of the AWS Clinical Practice Committee. **Categories:** Uncategorized --- ### [My International Surgery Elective](https://blog.womensurgeons.org/my-international-surgery-elective/) **Published:** July 10, 2014 **Author:** Blog Team **Content:** 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](http://qdumh.qd.sd.cn/a/yiyuangaikuang/yiyuanjianjie/huangdaoyuanqu/index.html). 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. | [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/IMG_0528.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/IMG_0528.jpg) | |---| | View from Lao Mountain | | | | | | | [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/IMG_0413.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/IMG_0413.jpg) | |---| | 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 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. | [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/Huangdao-Hospital.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/Huangdao-Hospital.jpg) | |---| | The outpatient entrance of the Affiliated Hospital of Qingdao University, Huangdao Branch which formally opened its doors in 2011 ([picture source](%5Bsiteurl%5D/wp-content/uploads/2014/07/Huangdao-Hospital.jpg)) | 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. | [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/IMG_3235.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/IMG_3235.jpg) | |---| | Outside the Huangdao Community Health Service Center, where patients can receive preventative care or chronic care management | 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](http://online.wsj.com/news/interactive/HEBILLtblONLINE). In China, the cost is approximately 3200 RMB, which if converted to US dollars would be [less than $1K](http://blogs.sph.harvard.edu/ashish-jha/the-peoples-hospital-cost-transparency-and-hospital-care-in-the-middle-of-china/). Same disease process, same step-by-step operation, but a drastic reduction in cost. | [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/HE-AA071_BILLtb_G_20140221171213.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/HE-AA071_BILLtb_G_20140221171213.jpg) | |---| | An infographic that breaks down the typical appendectomy bill generated from a US hospital ([picture source](%5Bsiteurl%5D/wp-content/uploads/2014/07/HE-AA071_BILLtb_G_20140221171213.jpg)) | 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. | ![](%5Bsiteurl%5D/wp-content/uploads/2014/07/IMG_3174.jpg) | |---| | My classmate from [UTHealth](https://med.uth.edu/) 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. | 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](http://www.buffalo.edu/) for my next half decade of [general surgery training](https://www.facebook.com/UbGeneralSurgeryResidency). 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](http://wis.studentsurgicalassociation.com/) 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](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356843/). 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](https://www.womensurgeons.org/), [WordPress](http://wordpress.com/), [Facebook](https://www.facebook.com/womensurgeons), [Youtube](http://youtube.com/), and [Twitter](http://twitter.com/womensurgeons) 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. | [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/janewithpt.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/janewithpt.jpg) | |---| | Here I am checking up on my patient. No identifying features of the patient are shown out of respect for the patient’s privacy | 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](http://bionews-tx.com/news/2014/06/02/uthscs-anil-kulkarni-awarded-fullbright-scholarship-to-teach-immunonutrition-in-india-and-houston/), 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. | [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/gaikuang_bg.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/gaikuang_bg.jpg) | |---| | An aerial view of Qingdao ([picture source](http://qdumh.qd.sd.cn/a/yiyuangaikuang/yiyuanjianjie/huangdaoyuanqu/index.html)) | | | | **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.** **\~~~** *![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/jane_zhao-200x300.jpg)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](http://www.twitter.com/jzhao3).* **Categories:** training --- ### [Mentorship](https://blog.womensurgeons.org/mentorship/) **Published:** July 10, 2014 **Author:** Blog Team **Content:** **By: Shilpa S. Murthy, MD, MPH** Socrates mentorship of Plato lead to advancements in philosophy and science. William Halstead’s mentorship style, based on Socrates’ teaching methods, lead to Harvey Cushing’s success in creating the field of neurosurgery.1For centuries, mentorship of surgical trainees has been critical to progressing the field of surgery. Strong mentorship and devoted development of a surgical trainee can lead to advancement and innovation in the field. As a medical student, one may not anticipate the crucial role a mentor plays through transitions in their career. A trainee goes through three transitions where guidance is critical to the development of a skilled surgeon: the transition from medical student to surgical resident, surgical resident to surgical researcher, and resident to surgical attending. All three transitions come with their own challenges as well as rewards. During these phases, it is important to gain direction from knowledgeable individuals who already experienced these transitions. They will guide trainees through un-anticipated challenges. Similarities in personality and background are important in mentorship interactions but common goals and values create a successful relationship. I was fortunate to meet three mentors whose life’s work aligned with my own goals of training the next generation of physicians and reducing the inequalities in health care. In 1998 the percentage of female surgeons was 21.8% and in 2008 that number increased to 32.3%.2In a field where the female voice is sparse and still growing, strong female mentorship can be fruitful for young women surgeons. In medical school I was fortunate to have a female mentor who was a dean and pediatrician who shared a passion for medical education. Few women in science have been able to reach the prominent academic position she holds. As a professional woman, she experienced the unique challenges that women face as they continue to advance professionally in the medical field. With her female voice, guidance, and insight borne from years in the profession, I have been better able to navigate my career as a surgeon. The female perspective is important for women in medicine, but excellent mentorship comes from both genders. During my research years as a surgical resident, I am pursuing oncology projects in Rwanda in global surgery. Making waves to define a new academic field, global surgery, can be rewarding but extremely challenging. It is complex since there are numerous cultural and ethical issues. I am privileged to be mentored by a surgeon who is a pioneer in the nascent field of global surgery. Modeling his cross cultural interpersonal communication skills and sharing our passion for equity in surgery, I have been able to successfully develop a breast disease training course with my Rwandan colleagues. But even with this success, the field is severely underfunded and due to funding challenges our projects almost fell through. However, his guidance and experience on how to navigate philanthropic meetings and administrative hurdles ultimately led to successful outcomes. His kindness, altruism, and passion towards reducing inequities in surgical care globally is to be modeled and commended. During surgical residency, a trainee also needs a mentor who is invested in developing their technical and cognitive surgical skills. In my clinical residency program, I met a hepatobiliary surgeon who has pushed me to strive harder. His engagement and experience in my development has been un-wavering through professional and personal hurdles. I always trust his advice because I know it is coming from someone who truly cares about me. Although each mentor has a slightly different background than my own, pieces of their personality, experiences, and backgrounds resonate with me as an individual. Their trust and belief in me has led to fruitful relationships and they are like family. My mentors have been crucial in my transition from medical student to surgical resident and as a surgical researcher. Their un-wavering support during hurdles I didn’t anticipate have strengthened our bonds. Recognizing my passions for surgery, education, and equitable care for impoverished populations they are guiding me towards concrete goals that will hopefully make a lasting contribution to society. While the line of Socrates mentorship continued in Plato and eventually worked its way to William Halsted and Harvey Cushing, so too will the teachings of my mentors. I hope to pass on our shared values, goals, and their kindness to those I mentor in the future. **References** 1.) Assael, Leon. Every Surgeon Needs Mentors: A Halsteadian/Socratic Model in the Modern Age. *J Oral Maxillofac Surg*. 68:1217-1218, 2010. 2.) Association of American Medical Colleges Accessed June 6, 2014 https://www.aamc.org/download/53502/data/wimstatisticsreport2009.pdf [![](http://blog.womensurgeons.org/wp-content/uploads/2014/07/murthy.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/murthy.jpg) *Dr. Shilpa S. Murthy is currently a second year research fellow at the Center for Surgery and Public Health, Brigham and Women’s Hospital in Boston, Massachusetts. She recently completed her MPH at Harvard School of Public Health and has interests in global surgical oncology, surgical disparities, and medical education. She is a general surgery resident at Indiana University.* **Categories:** Uncategorized --- ### [Running a Multi-Disciplinary Breast Center](https://blog.womensurgeons.org/running-a-multi-disciplinary-breast-center/) **Published:** July 24, 2014 **Author:** Blog Team **Content:** by: Holly Mason, MD FACS One of the great challenges and great accomplishments of my career has been the oversight of the Baystate Breast & Wellness Center. Under one roof, patients can undergo breast imaging, breast surgery consultation, plastic surgery consultation and high risk assessment. Patients with cancer are transitioned to medical and radiation oncology at the Cancer Center at the appropriate time. The sum of all of this is that coordination of care is needed between multiple specialties, providers and staff all while respecting the patients emotional needs and desires. The presence of nurse navigators significantly improves this coordination of care and lowers the anxiety of the patient as they now have a guide to lead them through the care process. Finesse and patience is required when dealing with the specialties; I am a surgeon and may not understand why a specialist has to do things in a certain way or why the process takes a certain amount of time. I simply want things done (that is the surgeon in me). As a surgeon in a leadership position, I need to temper the surgeon part of my personality to give the collaborative part of me a chance to succeed. We live in a time of change and our practice needs to keep up with that change. The purpose of our clinical steering committee is to delve into the processes of the Breast Center to sort out those that work both for the patient and the institution and those that do not. Our leadership team regularly looks at metrics to ensure that our access rates are appropriate and that our imaging meets or surpasses national standards. It is necessary to look at the financial impact of the choices we make and the tests that we order. No other specialty highlights this challenge quite like breast cancer care. We have advanced technology to evaluate patients but it is necessary to choose wisely what is indicated medically and what is not to keep costs under control. We can’t order a test just because we can. We have the surgical skills to treat the breast in the form of the patients choosing, but, as recent data shows, there is significant cost both to the patient (increased complication rates for patients undergoing bilateral mastectomy and reconstruction, for example) and to the health care system. Most of my hour-long visit with a breast cancer patient is spent trying to find the correct balance for the individual patient that optimizes cancer care and minimizes risk. I am fortunate to work with providers as passionate about breast cancer as I am. Our multidisciplinary team meets regularly to review protocols and practices to ensure that we are keeping up with the rapidly changing world that is breast cancer care. Together, we strive to provide high quality efficient care that can work in a changing cost-control environment. As a surgeon in a leadership position, I balance the need to keep a “big picture” view of the impact of our patient care choices with the maintenance of an active clinical practice. I wouldn’t have it any other way. [![](%5Bsiteurl%5D/wp-content/uploads/2014/07/Mason-Holly-sm-.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/Mason-Holly-sm-.jpg) *Dr. Holly Mason is the Director of Breast Surgical Services at Baystate Medical Center in Springfield, MA. She is also the Co-Medical Director of the Baystate Breast & Wellness Center. Besides her specialized work in breast surgery, she enjoys time with her husband and two daughters and tries to remind herself to take a deep breath every now and then to enjoy the world around her.* **Categories:** Uncategorized --- ### [Women Surgeon Leaders for the 21st Century](https://blog.womensurgeons.org/women-surgeon-leaders-for-the-21st-century/) **Published:** July 25, 2014 **Author:** Blog Team **Content:** By: SreyRam Kuy, MD, MHS **Part I: The Status of Women in Leadership Roles, Changing Culture and Leadership Training** “If you’re offered a seat on a rocket ship, don’t ask what seat! Just get on.” -Sheryl Sandberg, Chief Operating Officer of Facebook, from *Lean in: Women, Work, and the Will to Lead* “When you ask women, they do want these things \[leadership roles\] and they want them as much as men do.” – Patricia Numann, MD, Former President of the American College of Surgeons and Association of Women Surgeons Founder “I used to walk down the street like I was a super star… I want people to walk around delusional about how great they can be – and then to fight so hard for it every day that the lie becomes the truth.” -Stefani Germanotta, entertainer known as “Lady Gaga” Introduction** A century ago Orison Marden published, “How They Succeeded: Life Stories of Successful Men Told by Themselves,” describing the leadership and career success stories of prominent late nineteenth century US leaders such as Alexander Graham Bell and John D. Rockefeller. Among these profiled nineteenth century leaders was Helen Gould, an heiress, philanthropist and a law school graduate. Ms. Gould remarked upon the confines of nineteenth century America upon opportunities for upward mobility available to women, “I do not see, for my part, how any child from the poorest tenements could ever grow up and develop into strong, successful men or women… And it is harder on the girls than the boys! The boys can go forth into the world and probably secure a position… but the poor girls have so few opportunities.” And yet, she had the prescient foresight to say, “But I don’t think it matters much what a girl does so long as she is active, and doesn’t allow herself to stagnate. There’s nothing, to my mind, as pathetic as a girl who thinks she can’t do anything.” A century later, the first woman to be inducted as president of the American College of Surgeons proved that “girls” can indeed do anything. ![](http://blog.womensurgeons.org/wp-content/uploads/2014/09/Patricia-2BNumann-300x200.jpg)Dr. Patricia Numann remarked on leadership roles that “When you ask women, they do want these things and they want them as much as men do.” Clearly, there is a wealth of talent among women surgeons. What is the status of women in leadership roles in medicine today? And, what are the resources to assist women medical students, surgical residents and surgeons in advancing in leadership roles in their hospitals, communities, universities, and professional organizations? **The Status of Women in Leadership Roles in Medicine** In 1960, only 5% of medical students were women.[\[1\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn1) Today, at least half of medical students are women. Has the advancement of women in leadership roles in medicine kept up with the growth of women entering medicine? In a cohort study of all US medical school graduates from 1979-1993, women were more likely than men to pursue an academic career (10% more women than would be expected with proportional representation of men and women, with women significantly over-represented among medical school graduates entering academic medicine).[\[2\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn2) However, the percentage of women who advanced to associate or full professor were significantly lower than their male counterparts. The percentage of women medical school faculty members holding full professorship has grown slowly over the years, from 7% in 1978 to 15% in 2005.(Nattinger) This is in contrast to the fact that 30% of male faculty have held the rank of full professor consistently over this time period and that in 2005 only 11% of department chairs were women. Some of the factors that have been suggested for this gender disparity in leadership roles in medicine include less preparation for an academic career, fewer resources at the beginning of the career such as salary disparity either due to sexual discrimination or ineffective negotiation, lack of mentoring, less supportive institutional environment, and societal norms dictating home life and child care responsibilities which impact career trajectory.[\[3\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn3),[\[4\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn4),[\[5\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn5) To close the gender leadership gap, a multifaceted approach is necessary. A number of strategies have been suggested. Changing the culture of medicine, disseminating knowledge about resources for leadership training, increasing awareness of promotion criteria, improving mentoring of junior women surgeons and developing negotiation skills are several other avenues that empower women surgeons in emerging as leaders in academic and organized medicine. **Changing the Culture of Medicine** Valantine and Sandborg describe one institutional model which aims to change the academic culture to allow integration of work-life balance and flexibility policies into the promotion process, such as parental leaves and tenure clock extensions, which would enable institutions to better recruit and retain the best and brightest of both women and men.[\[6\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn6) Fried et al. describe another multifaceted institutional intervention to address career advancement obstacles faced by women faculty.[\[7\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn7) By targeting problem identification, leadership involvement, education of faculty, mentoring, reduction of isolation and increased integration of women faculty into the scientific community, they reported a significant increase in the number of women promoted to associate professor rank over a 5 year intervention period. Other institutional change frameworks emphasize the need to increase the visibility of women and the work they do by tracking and publishing institution specific data on women in leadership positions and valuing women’s relational skills by training deans and other administrators to look for and recognize the value of women’s behind the scenes relational expertise in collaboration.[\[8\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn8) The National Institute of Medicine (NIH) developed a tool to assess if an institution has a Culture Conducive to Women’s Academic Success (CCWAS).[\[9\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn9) The CCWAS consists of four elements, equal access, work-life balance, freedom from gender biases and supportive leadership. This can be a valuable tool for institutions seeking to reinvigorate their culture to enable women to flourish in academic medicine. **Leadership Training** Sonnino describes valuable resources available for professional development and leadership training, available on the Association of Women Surgeons Website[\[10\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn10)and the American Journal of Surgery.[\[11\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn11) These opportunities of professional development described include courses provided by the AAMC (Association of American Medical Colleges), the ELAM (Executive Leadership in Academic Medicine) program for women, ACPE (American College of Physician Executives) Leadership Development Program, Harvard University MBA training programs, and the Robert Wood Johnson Foundation Fellowships. ELAM offers senior women faculty at medical and dental schools a year-long fellowship training experience to enable them to develop the skills need to competitively seek higher level administrative positions at academic medical centers.[\[12\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn12) Research has demonstrated that women physician who participated in ELAM were more successful than non-ELAM women physicians in attaining department chair or Dean level positions.[\[13\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn13) Leadership training needs to begin early, in medical school and residency training. Taking an active leadership role to enable effective teamwork and patient care during residency medical school is the training grounds the future surgical leaders.[\[14\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn14) The American College of Surgeons hosts an annual Residents as Teachers and Leaders Course at their national headquarters in Chicago, Illinois at no cost to surgical trainees.[\[15\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn15) Residents are taught effective teaching skills including learning how to give feedback to learners, establish time for teaching, and seeking teaching opportunities in the operating room and on the wards. Residents are also taught techniques for successful leading such as conflict resolution, integrating diverse working styles, and leading productive teams. The American College of Surgeons also has course of practicing surgeons, Surgeons as Leaders: From Operating Room to Boardroom.[\[16\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_edn16) This three day course teaches surgeons about consensus building, changing culture, conflict resolution, emotional intelligence in order to have personal insight, and practical translation of leadership principles into daily action. By incorporating a multifaceted approach of fundamental change in institutional culture, leadership training, negotiation skills, development of mentoring relationships and awareness of promotion criteria, hopefully we can one day see more women surgeons following in the footsteps of Dr. Numann in leading our hospitals, communities, and professional societies. Check out next month’s AWS newsletter to learn read the second segment of this two part article, “Women Surgeon Leaders for the 21st Century: Part II – Negotiation Skills, Developing Mentorship Relationships, and Promotion Criteria”. **Parting Thoughts from Women Leaders** “Always aim high, work hard and care deeply about what you believe in. And when you stumble, keep faith. And, when you’re knocked down, get right back up and never listen to anyone who says you can’t or shouldn’t go on.” – Hillary Rodham Clinton, Former US Senator, First Lady and Secretary of State “I always did something I was a little not ready to do. I think that’s how you grow. When there’s that moment of ‘Wow, I’m not really sure I can do this,’ and you push through those moments, that’s when you have a breakthrough.” –Marissa Mayer, Chief Executive Officer of Yahoo “As a leader, I am tough on myself and I raise the standard for everybody; however, I am very caring because I want I want people to excel at what they are doing so that they can aspire to be me in the future.” –Indra Nooyi, Chief Executive Officer of PepsiCo —————————————————————————————————— [![](http://blog.womensurgeons.org/wp-content/uploads/2014/07/SreyRam-Kuy-Photo-Red.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/07/SreyRam-Kuy-Photo-Red.jpg) SreyRam Kuy, MD, MHS was born in Cambodia, grew up in Oregon, graduated from Crescent Valley High School as Valedictorian, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology. Dr. Kuy’s passions are healthcare policy, physician leadership and health services research. After college she worked as a Kaiser Family Foundation Barbara Jordan Health Policy Scholar in the Senate, writing speeches and policy briefs for Senator Tom Harkin on women’s health, coverage for breast cancer screening and treatment, and health care instrument safety. She attended medical school at Oregon Health Science University, then finished general surgery residency in Wisconsin. She earned her master’s degree in health services research at Yale University School of Medicine as a fellow in the prestigious Robert Wood Johnson Clinical Scholars Program. She is also a writer. Her first book, Soul of a Tiger, describes her family’s survival during the Cambodian Genocide known as the Killing Fields. Her second book, 50 Studies Every Surgeon Should Know, will be released in 2015 by Oxford University Press and describes seminal research in the surgical field. Dr. Kuy is an assistant professor of surgery at Louisiana State University and the Overton Brooks Veterans Affairs Medical Center. --- [\[1\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref1)Hamel M, Ingelfinger J, Phimister E, Solomon C. Women in Academic Medicine – Progress and Challenges. NEJM. 2006;355:310-312. [\[2\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref2)Nonnemaker L. Women Physicians in Academic Medicine: New Insights from Cohort Studies. NEJM. 2000;342:399-405. [\[3\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref3)Nattinger A. Promoting the Career Development of Women in Academic Medicine. Arch Intern Med. 2007;167:323-324. [\[4\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref4)Bickel J, Wara D, Atkinson B, Cohen L, Dunn M, Hostler S, Johnson T, Morahan P, Rubenstein A, Sheldon G, Stokes E. AAMC Paper: Increasing Women’s Leadership in Academic Medicine: Report of the AAMC Project Implementation Committee. Acad Med. 2002;77(10):1043-1058. [\[5\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref5)Allen I. Women doctors and their careers: what now? BMJ. 2005;331:569-572. [\[6\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref6)Valentine H, Sandborg C. Changing the Culture of Academic Medicine to Eliminate the Gender Leadership Gap: 50/50 by 2020. Acad Med. 2013;88(10):1411-1413. [\[7\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref7)Fried L, Francomano C, MacDonald S, Wagner E, Stokes E, Carbone K, Bias W, Newman M, Stobo J. Career Development for Women in Academic Medicine. JAMA. 1996;276:898-905. [\[8\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref8)Morahan P, Rosen S, Richman R, Gleason K. The Leadership Continuum: A Framework for Organizational and Individual Assessment Relative to the Advancement of Women Physicians and Scientists. Journal of Women’s Halth. 2011;20(3):1-10. [\[9\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref9)Westring A, Speck R, Sammel M, Scott P, Tuton L, Grisso J, Abbuhl S. A Culture Conducive to Women’s Academic Success: Development of a Measure. Acad Med. 2012;87(11):1622-1631. [\[10\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref10)Association of Women Surgeons. <https://www.womensurgeons.org/CDR/AJSprofdevleadershiparticle.pdf>. Accessed 6/10/2014. [\[11\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref11)Sonnino R. Professional development and leadership training opportunities for healthcare professionals. The American Journal of Surgery. 2013;206:727-731. [\[12\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref12)Richman R, Morahan P, Cohen D, McDade S. Advancing Women and Closing the Leadership Gap: The Executive Leadership in Academic Medicine (ELAM) Program Experience. Journal of Women’s Health & Gender Based Medicine. 2001;10(3):271-277. [\[13\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref13)Dannels S, Yamagata H, McDade S, Chuang Y, Gleason K, McLaughlin J, Richman R, Morahan P. Evaluating a Leadership Program: A Comparative, Longitudinal Study to Assess the Impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women. Acad Med. 2008;83:488-495. [\[14\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref14)Kiesewetter J, Schmidt-Humber M, Netzel J, Krohn A, Angstwurm M, Fischer M. Training of Leadership Skills in Medical Education. GMS. 2013;30(4). [\[15\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref15) American College of Surgeons. Residents as Teachers and Leaders Course. http://www.facs.org/education/residentsasteachersandleaders.html. Accessed 6/10/2014. [\[16\]](file:///B:/Clients/AWS%20(120)/Communications%20&%20Publications/eConnections%202013-2014/2014%208%20August/Women%20Surgeons%20-%20Developing%20Leaders%20in%20Academics%20and%20Organized%20Medicine.docx#_ednref16)American College of Surgeons. Surgeons as Leaders: From Operating Room to Boardroom. <http://www.facs.org/education/surgeonsasleaders.html>. Accessed 6/10/2014. **Categories:** leadership --- ### [2014 AWS Conference Details - SAVE THE DATE](https://blog.womensurgeons.org/2014-aws-conference-details-save-the-date/) **Published:** July 25, 2014 **Author:** Blog Team **Content:** **Sunday, October 26 – Tuesday, October 28, 2014** *Complete Brochure COMING SOON!* **Sunday, October 26th \| 2014 AWS Conference:** ***Transitions – Thriving Amidst Change*** Westin St. Francis \| 335 Powell Street, San Francisco, CA 6:30 am – 3:00 pm ***AWS thanks our Platinum Sponsors:*** [![ Covidien](%5Bsiteurl%5D/wp-content/uploads/2014/07/cov_hrz_rgb_pos_HiRes.jpg)](http://www.covidien.com/)[![ Ethicon](http://blog.womensurgeons.org/wp-content/uploads/2014/07/Ethicon_RGB-color-electronic-use.jpg)](http://www.ethicon.com/) **Conference Highlights Include:** - Sunrise Scientific Session - Medical Student and Resident Starr Poster Presentations - Green Solutions for the Operating Room Presentations - Presentations: - *Challenges to Leadership in Surgery*, Nancy Ascher, MD, FACS, University of California, San Francisco - *The Changing Face of US Healthcare: How to Optimize Your Career*, John E. Hedstrom, JD, American College of Surgeons - *The Challenge: Transition to a Healthier You*, Carol E.H. Scott-Conner, MD, FACS, University of Iowa Carver College of Medicine - *Transitions and Resilience: Growing and Thriving Throughout Your Life and Career,* Janet Bickel, MA, Janet Bickel & Associates, LLC - Directed Networking Sessions: *Tools for Personal Success*, Topics include: Strategies for Family planning, Work/life Balance; Success under Stress, Financial and Retirement planning, Private Practice: Navigating a successful career, Social Media “How-tos,” Alternate/nontraditional career paths, Successful negotiation strategies, Mentorship and Career advancement Interested in participating in the 2014 AWS Green Solutions for the OR Contest? Deadline to submit is August 3, 2014. **Monday, October 27th \| AWSF Awards Dinner & Reception** Westin St. Francis \| 335 Powell Street, San Francisco, CA 6:00 pm – 10:00 pm The American College of Surgeons’ Women in Surgery Committee sponsors the reception for women surgeons attending the Clinical Congress and their guests. The AWSF Awards Dinner follows. The reception is complimentary. Individual dinner tickets must be purchased in advance. **Tuesday, October 28th \| AWS Networking Breakfast** Nordstrom Café\| 865 Market Street, San Francisco, CA 8:00 am – 10:00 am Networking Breakfast for AWS members and non-members. No pre-registration required. The breakfast is complimentary. **Hotel reservations can be made through the American College of Surgeons’ travel agency.** **Stay tuned… a complete brochure is COMING SOON!** **Categories:** Uncategorized --- ### [Book Review: Success Under Stress](https://blog.womensurgeons.org/book-review-success-under-stress/) **Published:** August 12, 2014 **Author:** Blog Team **Content:** The AWS Clinical Practice Committee reviews *Success Under Stress: Powerful tools for staying calm, confident, and productive when the pressure’s on* by Sharon Melnick, Ph.D. ![](http://blog.womensurgeons.org/wp-content/uploads/2014/08/success-2Bunder-2Bstress.jpg) “The best time to plant a tree was 20 years ago. The second best time is now.” – Chinese proverb We recently reviewed the book [Success Under Stress](http://www.amazon.com/Success-Under-Stress-Confident-Productive/dp/0814432123), by Sharon Melnick, Ph.D., a business psychologist affiliated with Harvard medical school that works with leading business professionals nationwide. The subtitle of the book sums up the reasons to read it: “Powerful tools for staying calm, confident and productive when the pressure’s on”. While her examples are very business oriented and may be difficult to apply directly to our daily lives, the principles and ideas behind her examples are very applicable and resounded with many of us on the committee. One of the key points she makes early on, is that we cannot control (or be responsible for) everything in our lives. We must focus on the things over which we can influence the outcome, and do those well. Take ownership of your contribution, and don’t stress over portions not within your control. A key to succeeding in stressful situations is in understanding the source of the stress. She defines stress as an internal response “when the demands of a situation exceed your perceived ability to control them”. When she describes the average business professional as having 30-100 ongoing projects, being interrupted 7 times an hour, and facing communication from multiple technologies 24h a day, suddenly their lives seem a little more similar to ours! She also emphasizes that you cannot give 100% of your effort for 24h all day every day. Your mind and body need recovery time. Planning “off-button” activities not only decreases your level of stress, but makes you more productive when you are “on”. The key to surviving, and succeeding, is in how you perceive your role, how you exert control over your day, and what you consider to be success. **Categories:** Uncategorized --- ### [In Memoriam: Thomas R. Russell, MD, FACS](https://blog.womensurgeons.org/in-memoriam-thomas-r-russell-md-facs/) **Published:** August 21, 2014 **Author:** Blog Team **Content:** AWS lost a long time friend and supporter this month. Dr. Russell is remembered fondly by those Council members who had the privilege to interact with him during his visits to the annual Spring Council meeting that was held at ACS headquarters in Chicago. ![](http://blog.womensurgeons.org/wp-content/uploads/2014/08/tom1.jpg) He is seen in this photograph accepting the AWS Nina Starr Braunwald award on behalf of the ACS in 2006. He worked hard to support women in surgery. Read more about Dr. Russell [here](https://www.facs.org/about-acs/thomas-russell). Some thoughts from AWS members are included here. Please comment below or visit our [Facebook page](https://www.facebook.com/womensurgeons) and share your stories about Dr. Russell or comment on this story. *“Dr. Russell was very accessible, even to the resident. He came to speak at our institution, and in his answers, he discussed how he attempted to answer as many inquiries or problems as possible in his position as executive director of the ACS. He understood that medicine was changing, and tried to make sure that no surgeon was left behind. He acted as both guardian and muse.”* *“\[Dr. Russell’s first interaction with the AWS as Executive Director of the ACS came at a Spring Council meeting in Chicago.\] When he had the politically sensitive task of mending the fence \[after a prior meeting of the AWS with a colleague had not gone as well as expected\]. The look on his face as he entered the room was not unlike the ones I’ve seen on residents walking into an operating room to discuss a difficult situation with an edgy attending. It was clear he was trying so hard to let the AWS know he really felt bad about what happened, that all is defenses fell away and he spoke from the heart. He talked about how his own daughter wanted to be a surgeon and how he really and sincerely wanted the AWS and ACS to work together to make things better for all women surgeons. He was so genuine and earnest in his talk that no one had the heart to re-hash the hurt feelings. We thanked him for his sincerity and have appreciated his efforts on the part of the AWS ever since.”* *“I have been fortunate to mentor and train Katie Russell, Tom Russell’s daughter, as a general surgery resident for the last 6 years. Katie is truly her father’s daughter, someone who approaches every situation with kindness and enthusiasm, and someone whom you can unequivocally depend upon. Although I peripherally knew Tom before Katie joined us at Utah, I got to know him better during her time here, which was a genuine privilege. Every time I would run into Tom at a meeting, I would get a warm hug and he would express his gratitude for my mentorship of Katie. What I couldn’t ever explain to Tom was that Katie is one of those superstars for whom I feel like I have had to do relatively little – I’ve simply encouraged, provided opportunities, and enjoyed being within her orbit. I see his grace and humility in all of my interactions with her, and I am better for knowing them both. Tom will be deeply missed. I’m grateful that another generation of the Russell family is part of our wonderful profession. He leaves us an amazing legacy in many ways.”* We look forward to reading more memories from our members. Please respond of below or on our Facebook page. **Categories:** Uncategorized --- ### [Self Care and Meditation](https://blog.womensurgeons.org/self-care-and-meditation/) **Published:** August 21, 2014 **Author:** Blog Team **Content:** *by: Betsy Tuttle-Newhall, MD, FACS* When one mentions the word “meditation”, images of saffron robed monks and lotus flowers come to mind for many; however, meditation is simply the act of quieting the mind and focusing the attention. Meditation is a practice, no one starts the practice being perfect and “doing it right, (which is an important concept for surgeons!). It is by doing and making space for attention that one learns. For those of us who work all hours of the day or night, and are constantly bombarded by phone calls, texts, pages, and other people’s needs, a moment of calm is invaluable to our own health and well-being. Meditation is about training your mind to be in the moment either for that purpose alone, or for the other benefits of well-being- calm, relief of anxiety, cooling your anger and frustration, opening our own heart and preventing compassion fatigue. It is about being in the moment- not worrying about the past, or planning the future- is it about being mindful of the present; it is about focused living. It is ironic that we all can “do this “ practice in the operating room. For many of us, we are “in the moment” with the gunshot wound to the abdomen, or the breast cancer in the breast or whatever our focus in the operating room. Where we are often not focused however, is on ourselves. Meditation has many benefits including promoting internal energy (or “prana” the life force), compassion, forgiveness, courage and patience with others, and most importantly, ourselves. Meditation comes in many forms and is often tied to the religious discipline with which it is associated although it doesn’t have to be religious in nature. There is active or walking meditation or sitting meditation, or even what I call the “office meditation” where you can sit in your chair and take 5 minutes to clear your head and re-orient. You can take advantage of any moment in which you can calm the mind and be “aware”. The practice is about being in the moment. Meditation has been practiced by Christians, Doaists Buddhists, Hindus, Islamists and many other religious disciplines. One of the earliest references to meditation as a practice comes from the Hindu Vedas, the ancient Indian texts. It is here that one of the oldest mantras was written, the Gayatri mantra. “ Mantra” simply refers to a sound or phrase used during prayer or meditation. The Buddha described meditation as a way to relieve oneself of suffering. A disclaimer- I am not Buddhist, and struggle with my relationship to the Divine either in the traditional Judeo-Christian faith in which I am raising my family or in any other form. I am grateful however, that God (in whatever form you believe in Her) is patient with me. I found myself more than 15 years ago traveling with my friend Dr. Shelly Stelzer, who now resides in Potsdam New York, to the Omega Institute for a week long yoga and meditation retreat. I had no idea where I was going with her, or what this all meant. I never got to spend much time with her, and it was an opportunity for another adventure. I found myself immersed in a weeklong instruction with Sharon Salzberg from the Insight Meditation Society regarding meditative practice and John Friend studying Anusara Yoga. To say it was a transformative week, is an understatement. It was a week that changed my life for the better although the bar was set pretty high for my next week away with my friend. It was a challenge for me to incorporate what I had learned into my daily life (and certainly, my surgical colleagues at that time were a little wary of my experiences. However, they were my experiences and I kept them to myself unless you asked me about them). Being more aware and having that invaluable instruction lead me to attend several other courses with Sharon Salzberg and inviting her to Duke for a weekend retreat regarding Meditative Practice as a prevention of Compassion Fatigue. We sold out tickets 2 days after we posted the conference. She is a Buddhist trained meditation teacher, and her training was in the classic Buddhist tradition. There are 4 noble truths in Buddhism which make a nice context in which to discuss meditative practice, its goals and the benefits for those of us who spend energy on many people, and often have little left for ourselves. The first noble truth of Buddhism is that life is about suffering; suffering loss, instability, dissatisfaction that things just haven’t turned out right for us, our friends or family, and our patients. The second noble truth suggests that suffering is related to attachment and ignorance-attachment to things that are not permanent and are not really that important in the big picture or things that are in constant flux, and ignorance about who we really are. Most of us have this ideal of who we “should be” – certainly I do, and more times than not, I fall short of who I think I should be. My suffering comes from my lack of awareness of who I really am and the acknowledgement that I am “good” and usually, doing the best I can at whatever moment in time. I hold myself up to an ideal that if I do not meet, I am afraid of being “less than” in this culture of high achievers and for me, that I may not really “belong” or “deserve” to be here (wherever here might be). When I am tired, or sleep deprived or had a busy day, I am often ignorant of my inner light. Of course most days, I know that I belong and deserve to be “here”. Like most, if not all the women surgeons I know, I have worked hard to be where I am and care for the patients I care for and teach the students and residents for whom I am responsible. Sometimes the struggle with work and family and other issues can be overwhelming. Sometimes, I just need a little reminder of who I really am underneath the superficial layers of wear and tear and underneath all the work and responsibilities. Really all suffering is, is the practiced art of denial- denial to our real situation, denial to who we are and denial about what we can or cannot do. The third noble truth is about the possibility of the cessation of suffering and the fourth noble truth is about the path to take to relieve suffering. In Buddhist teachings, the relief of suffering is through the noble eightfold path, but basically it is about the “right view, right intention, right speech, right mindfulness and concentration”. All of this sounds like Surgery to me- being where you are at the moment and “doing the right thing”. Staying focused on the task at hand, and solving the problem for your patient. Finding your “rightness” or center, and enhancing your courage can be enhanced by having a practice of quieting the mind and just being aware, learning to step back, and observe. It really doesn’t take a lot of time and the benefits to you and those around you are priceless. There are several community forums and meditation centers that can help one develop a practice; however for most of us, that is impractical to fit one more thing into our already crowded schedule. From a practical standpoint, for busy surgeons, you can practice the “stepping out’ of your busy schedule and just focus on your breath. What follows is certainly not a complete description of a meditative practice, just a simple way to start; references are added at the end for your perusal. The key to the practice is making time, and space for it in your daily life. The simplest form of meditation is to focus on your breath. Taking a comfortable seat, closing your eyes (and turning off the radio, TV to make where you are quiet) and feeling your breath moving in and out is a simple way to start. Take 5 minutes in the morning at the breakfast table, to sit and just breathe -bringing your attention to the in and then out breath. Let the distracting thoughts about what the day requires come and go. The practice of meditation is the letting go and returning to the breath. You can sit in a chair, cross legged on the floor or use a meditation bench- it doesn’t matter. Just be comfortable and quiet the mind. There are many type of practices that you can pursue and both formal and informal instruction, however the one that I am most familiar with and what I use in my own practice is that of “Metta” meditation. I have had the great fortune to attend several workshops with Sharon Salzberg of the Insight Meditation Institute over the years, and this is her type of practice. Metta refers to “loving kindness” meditation and centers around the heart literally and figuratively. It is about fostering compassion in ourselves for ourselves and those around us. Again, in taking a comfortable seat, take a few breaths and center the breath on the center of the chest. Sitting quietly, in your mind – steadily repeat “ May I be happy, may I be healthy, may I be safe, may I live my life with ease”. Use the intentions of kindness for yourself to restore or enhance your reservoir of energy that you expend on others. I find that by using this kindness mantra focusing on myself, then my family, my friends, and most importantly, and finally, for the people I don’t like and that challenge me- enhances my ability to keep an open heart, my compassion and equanimity. It also allows me to “see “the challenging people in a light that allows me to deal with them, in fashion that doesn’t drain me and makes me less judgmental of them. When stray thoughts butt into my mind, which they always do, acknowledge them and let them go. Restore your focus on your mantra. It really is that simple-set your phone for 5 minutes, and try it. I reach for this practice daily and whenever I just can’t “find it” (whatever “it “is). There are many mantras available for you to repeat, or you can just focus on your breath, the practice is of quieting the mind. I also find that when I have had a particular challenging day, or am about to face one, and I am busy, I can find 3-5 minutes to listen to a guided meditation or spiritual music in my office or on my iPod driving in. (I know you are not technically supposed to multi-task while meditating, however, you do what you have to do to find the space.) I believe that even if you do not pursue formal instruction or delve into this further, the practice of just making 5 minutes daily for you just to “be”, will be transformative for you. I encourage you to care for yourselves as well as you care for others. Namaste. Betsy Tuttle-Newhall, MD, FACS Resources - [Insight Meditation Kit:](http://www.sharonsalzberg.com/books-audio/83) A step by step course on how to develop a meditative practice by Sharon Salzberg. One of my favorite gifts for people who ask me about meditating. - [Unplug: Books and Audio](http://www.amazon.com/Unplug-For-Hour-Day-Weekend/dp/1591796385) by Sharon Salzberg. This is a set of cards, and audio you can use whenever you have time and listen to and from work. It is a set of restorative practices that simply teach you to let go. Included is a guidebook as well. - [Voices of Insight](http://www.amazon.com/Voices-Insight-Sharon-Salzberg/dp/157062769X), written by the teachers at the Insight Meditation Institute. This is a group of stories about how these regular people found their way from the West to a mostly eastern based meditation practice and guidelines for assistance in developing your own practice. - Any of the following books by [Sharon Salzberg](http://www.amazon.com/Sharon-Salzberg/e/B000APLA86/ref=sr_tc_2_0?qid=undefined&sr=1-2-ent): Loving Kindness: The revolutionary art of happiness. Real Happiness at work: meditations for accomplishment, achievement and peace. Faith (my favorite). Quiet Mind: A beginner’s guide to meditation. Love your enemies. Heart as wide as the world. - CDs or iTunes purchase, [Don’t bite the hook: findingfreedom from anger, resentment, and other destructive emotions.](http://www.amazon.com/Dont-Bite-Hook-Resentment-Destructive/dp/1590304349) This is more Buddhist in nature as it is taught by Pema Chodron as a weekend retreat that was in part recorded. Again, easy to listen to in the car or as a Podcast. She teaches about the concept of patience, and focuses on what we can practice to change our habitual response. I find her incredibly funny and very wise. - CD or ITunes purchase: [Mantras for Life. Deva Premal](http://www.devapremalmiten.com/music/cdsdvds/mantras-for-life). It is a very beautiful rendition of some ancient Hindu Mantras with specific intentions. - For retreats or more focused time: - [Omega Institute in located in Rhinebeck, New York ](http://www.eomega.org/)and offers multiple type of retreats regarding spiritual practices, yoga, meditation, or leadership development. - [Insight Meditation Society, located in Barre, Massachusetts](http://www.dharma.org/). Their schedule is located on line and the website is a fabulous resource. - [Shambala Sun](http://www.shambhalasun.com/). A predominantly Buddhist magazine , online and by subscription. Great resources for finding good meditation communities where you live. **Categories:** self-care --- ### [Women Surgeon Leaders for the 21st Century Part II: Profiles in Leadership](https://blog.womensurgeons.org/women-surgeon-leaders-for-the-21st-century-part-ii-profiles-in-leadership/) **Published:** September 12, 2014 **Author:** Blog Team **Content:** By: SreyRam Kuy, MD, MHS ![](%5Bsiteurl%5D/wp-content/uploads/2014/09/Robert-Frost-two-roads.jpg) **Introduction** We had the privilege of interviewing several influential women surgeon leaders. Patricia Numann, MD, FACS, Barbara Lee Bass, MD, FACS and Susan Moffatt-Bruce, MD, FACS shared their wisdom, their experiences, and their inspiration with us. Spanning a spectrum of specialties, roles and backgrounds, these women leaders have changed the face of surgery in America. We thank Drs. Numann, Bass and Moffat-Bruce for their generous time and their invaluably candid answers. Hopefully, these stories will inspire the next generation of women surgeons to continue this incredible legacy of strength, courage and resilience. We salute the Women Surgeon Leaders who have defied obstacles, made their own path on their own terms, and paved the way for generations of women and men to come. We are indebted to these surgeons who have been leaders, educators and mentors to so many young surgeons. And, we are indebted for their courage in sharing their journey in taking the roads less traveled. **Interviews** **Dr. Patricia Numann** ![](%5Bsiteurl%5D/wp-content/uploads/2014/09/Patricia-2BNumann-2B-2BRed.jpg) Dr. Patricia Numann is an endocrine surgeon and the Lloyd S. Rogers Professor of Surgery Emeritus at SUNY Upstate Medical University in Syracuse, New York. She earned her medical degree from SUNY Upstate Medical University in 1965. She then did a combined medicine and surgery internship, and then stayed to complete her surgery residency there in 1970. Dr. Numann started as an Assistant Professor of Surgery at SUNY, and then quickly rose through the academic ranks at SUNY Upstate, serving as Associate Dean of the College of Medicine and Medical Director of the University Hospital. Dr. Numann founded the Association of Women Surgeons in 1981 when she invited as many female surgeons as she could identify to a breakfast at the October meeting of the American College of Surgeons in the San Francisco Hilton Hotel. Up until this point there was no formal organization serving specifically the needs of women surgeons. Since that first breakfast in 1981 the Association of Women Surgeons has grown into a powerful national organization serving the needs of women medical students, residents and surgeons. Dr. Numann was the first woman to serve as Chair of the American Board of Surgeons, Founder and President of the Association for Surgical Education, and a President of the Association of Women Surgeons. In 2011 Dr. Numann became the 92nd president of the American College of Surgeons and its second woman president. **Interviewer:** What do you see as the greatest skills need to be successful as a leader in academic surgery and in surgical organizations? **Dr. Numann:** Optimism, Integrity, Thick Skin, Moral Courage. The ability to give more. Good listening skills. Curiosity and diverse interests. Pride in other’s success. High Standards **Interviewer:** What are the biggest challenges and obstacles you yourself faced in your career? What are challenges you saw your female colleagues in surgery facing in their careers? What do you see as the challenges women surgeons face today in advancing as surgical leaders in academic institutions and in national surgical organizations? **Dr. Numann:** I guess if I had viewed things as obstacles or problems, I do not think I would have done well. \[Instead\], I would think “Now isn’t that a silly thing to think or say.” I would then decide whether I wanted to deal with any of it or ignore it. Most could just be ignored. I then found a statement by Dawn Steel who was the first woman executive of Paramount studios. “Never try to teach a pig to sing, you waste your time and annoy the pig.” I kept it taped to the side of my desk. When people were outrageous or intractable I would think “Pig” and change the topic and strategy to solve the problem. You cannot want to win every battle or convert every person to your way of thinking. \[Rather\], I found being useful to whoever or whatever got me through many a tough spot. No one would accept my application for a surgical residency in 1964. So I made a deal with my chair to do \[an internship\] with 6 months of Medicine and 6 months of Surgery. If I did not want Medicine and had done well enough in Surgery, I could have a spot in our pyramidal program. In those days prejudice was very open. I think in some ways that is easier than now where much is unconscious bias that diminishes women’s contributions. I think women still face unconscious bias \[in that people assume\] that they are not fiscally as wise, that they are too conflicted when they are mothers, that they are not physically or mentally as strong as men. I also think that they are not put on the list for promotion as commonly as men. In several cases I have seen women have a great deal of trouble when a child had problems or when they faced divorce. The part time position is still viewed very negatively. It is hard to get back after a period of part time work. \[Research\] granting agencies are fairer, but still I think when \[reviewers are\] unblinded to gender \[they\] favor male applicants. I think more objective data is needed to prove women’s equality is some of these issues. The old boy’s network is still in good standing in many, if not most surgical organizations. Even when women get to be represented in good numbers the leadership positions more frequently go to men. ![](%5Bsiteurl%5D/wp-content/uploads/2014/09/Patricia-2BNumann.jpg) **Interviewer:** What are ways that you overcame those obstacles? Can you give concrete examples? What did you learn from these obstacles? **Dr. Numann**: I think hard work and being useful helped overcome many obstacles. I had one chairman who fired me regularly. Fortunately I had tenure and many colleagues who supported me and respected me professionally. I decided to mostly ignore him and continue to work, participate in organizations, and be sure that my quality was excellent. I was always a bean counter. I would count cases, publications, abstracts, requests for presentations and keep track of my quality so I knew I was as good as anyone around me. It made it hard for him to get rid of me. He never did. I felt very vindicated when he left and \[also by the knowledge that\] other really terrific people also had trouble with him. I wanted to start a Breast Center when he was chair. He refused to fund it so I went to the Hospital Auxiliary and they had a fund raiser to begin the program, then we became self-sufficient. \[This would later become the Patricia J. Numann Center for Breast, Endocrine & Plastic Surgery at SUNY Upstate\]. There is always a way around an obstacle. Only if you are stubborn and want it just one way will you fail. **Interviewer:** What are the greatest rewards you believe you’ve gotten from being a leader in a surgical organization? **Dr. Numann:** I could not put one as greatest. I always loved taking care of patients, whether for trivial problems or great ones. I loved the technical aspects of surgery. Doing a complex operation perfectly is such a joy. I loved teaching essentially everyone, patients, nurses, med students, residents and peers. If I got a complicated referral, I would offer the referring surgeon the opportunity to come to the surgery. I loved administration, planning new things, resolving problems. I think the only thing I never really liked was writing. I never considered it something I did well. The greatest rewards have been the things that I have helped develop or facilitate that made life better for individuals. Whether it was that they had more fulfilling careers, went through difficult problems more easily or actually impacted the well-being of masses of people. I have gotten great recognition from organizations in the form of awards and election to office but what gives me the greatest pleasure is when I run into someone and they tell me what a difference I made for them. **Interviewer:** What do you see as your greatest achievement as a surgeon? And what is your greatest achievement as a leader? **Dr. Numann:** As a surgeon, I believe I changed the standard of breast and endocrine surgical care in my area, by not only being a good surgeon but also by teaching many surgeons to be good as well. I would always follow the literature and scientific developments and bring them to the care of patients in our area. As a leader, I think through AWS and my advocacy for women I have made it easier for women to become surgeons and to be treated as equals. I believe in my role on the Council of Scientific Affairs of the AMA, I saw that standards for mammography were implemented. As President of the American College of Surgeons I helped raise awareness and facilitate support for the WHO to include surgical care in its public health mission. As associate dean of our medical school, I helped improve the logistics of navigating our curriculum for our students. I began the Women in Medicine Committee. As Medical Director \[of our hospital\], I took a hard stance on bad behavior but I always listened to both sides. I always tried to allow people to save face. **Interviewer:** Do you have any regrets from your experiences as a surgeon leader, or would you do anything differently? **Dr. Numann:** I have no real regrets. If I would do anything differently, I may have chosen to look at being a chair and should have written more. **Interviewer:** What mistakes would you advise mid-career women in surgery to avoid in order to be successful in pursuing leadership roles in academic surgery and national organizations? What mistakes would you advise young women in surgery to avoid? **Dr. Numann:** Keep Calm and Never Give Up. I think many young men and women want too much too quickly. I think many do not respect those before them who have made so much possible for them. I think some do not deal well with adversity and give up. When this Chair was firing me regularly, I was talking with a patient who was a successful business man about my difficulty and my interest in leaving. He said, “I would help you do whatever you wish to do, but let me tell you, I wouldn’t respect you much for letting one rotten SOB run you out of your home.” I must say that changed my thinking – probably forever. No one ever ran me off. **Interviewer**: What additional words of wisdom do you have for mid-career women in surgery? For young women surgeons just entering practice? For residents in training? **Dr. Numann:** I believe it is important to try and make things work but if they will not, \[then\] look to change the situation. There is no best time to have children so do it when you want to. Do not be afraid to be a single parent if you want a child and do not want a spouse. Choose your spouse carefully. Do not be afraid to stick your neck out. For residents in training, I think it is very important to have a local support system. Sometimes you really need to be fed a good meal, taken away from the work or have a shoulder to cry on. \[You need someone\] who loves you unconditionally and will not judge you. I found most of them outside medicine. I also think throughout life it is important not to be an elitist. You learn so much by having friends of all kinds. For all, I think it is important to have interests beyond medicine. I have found that people whose only identity is their professional self are often not as successful or happy in the long run. **Interviewer:** Are there specific leadership courses or organizational training resources you’d recommend to women surgeons interested in pursuing a leadership role in academic surgery or national organizations? **Dr. Numann:** I think the ELAM course is very good. I think public speaking courses such as Dale Carnegie’s are good. The Harvard course for Chairs. The ACS Surgeons as Leaders and Surgeons as Educators are great. I have also found it very helpful to serve on Board of Directors where you meet many talented people who look at the world a bit differently than most doctors. **Dr. Barbara Lee Bass** ![](%5Bsiteurl%5D/wp-content/uploads/2014/09/Barbara-2BBass-2Bhead-2Bshot.jpg)Dr. Barbara Lee Bass, MD, FACS is a gastrointestinal, breast and endocrine surgeon, and the John F. and Carolyn Bookout Distinguished Endowed Chair at Methodist Hospital in Houston Texas and Professor of Surgery at Weill Medical College of Cornell University. Dr. Bass did her undergraduate studies at Tufts University, attended medical school at the University of Virgina School of Medicine, completed general surgery training at George Washington University Hospital and a fellowship in gastrointestinal physiology at the Walter Reed Army Institute of Research, while serving as a Captain in the US Army Medical Corps. Dr. Bass has been a fellow in the American College of Surgeons since 1989, and has served in many influential capacities, including the Chair of the ACS Board of Governors, as member of the ACS Board of Regents, and surgeon champion of the ACS NSQIP. Dr. Bass was honored with the American College of Surgeons’ highest honor, the Board of Regents 2013 Distinguished Service Award, which recognizes Dr. Bass’s commitment to the initiatives and principles embodied by the American College of Surgeons. Dr. Bass was also a guest speaker at TedMed, one of the premier conferences focusing on thought provoking and novel approaches to health and medicine. **Interviewer:** What do you see as the greatest skills need to be successful as a leader in academic surgery and in surgical organizations? **Dr. Bass:** There are two sides to that coin. The first piece is the academic piece. You have to have academic credibility. You have to do the hard work of building that academic credibility yourself. You have to write, you have to network, and you have to have some credibility as a thought leader in that area. My area of academic credibility was in gastrointestinal cell biology. I was funded early in my career with VA Merit and Career Development awards. I had the gastrointestinal surgeons’ career development award and the College’s career development award. You have to have some credibility as an academic surgeon and you have to think about what your contribution to that field will be. It can be in translational research, it can be in educational research, etc. But you have to demonstrate that you have the chomps to do that piece. Then people will say, “she’s done the hard work to get there.” The other side of that coin, of being a leader in surgery is similar to leadership in any other venue. You have to have a profound sense of optimism in people; that you are making it better for everyone, not just for you. Successful leaders can really inspire others with that sense of future and optimism. A good leader really has a sense of service; you’re there to serve the cause. And, you’ve got to be able to communicate. You’ve got to build bonds. You build bonds by listening to people and gathering people together. **Interviewer:** What are the biggest challenges and obstacles you yourself faced in your career? What are challenges you saw your female colleagues in surgery facing in their careers? What do you see as the challenges women surgeons face today in advancing as surgical leaders in academic institutions and in national surgical organizations? **Dr. Bass:** I’m old enough that I didn’t have obvious people to look up to, to think “I want to be like that person.” When I was a medical student at the University of Virginia in the 70‘s there were no women residents or faculty. The obstacle is not knowing how to do “this”, when there isn’t anyone who looks like you, and you want to do “this”. It was very hard to figure how to get where I wanted to go. ![](%5Bsiteurl%5D/wp-content/uploads/2014/09/Barbara-2BBass-2Bspeaking.jpg) But here was a transplant surgeon there, Dr. Leslie Rudolph, who helped me. I didn’t take surgery until the end of my third year. Then, Boom! I realized I was a surgeon! So very late in the game, I went to talk to this guy \[Dr. Rudolph\], and he was wonderful. He said, “This is wonderful. We haven’t had any girls go into surgery. You must meet Olga Jonasson and Kathy Anderson.” He managed to get me hooked with one of them. I actually ended up training where Kathy Anderson was a faculty, and she was kind of a distant guardian angel and was a great source of advice. It took 8 or 10 years before I met Dr. Jonasson and was “adopted” by her. **Interviewer:** What are ways that you overcame those obstacles? Can you give concrete examples? What did you learn from these obstacles? **Dr. Bass:** Blossom where you’re planted. I decided to stay where my family was. You have to realize that you can’t necessarily have the freedom to go where you want to go, because you need the infrastructure. There were times where that made me angry, but in the end it preserved me. I saw my other women colleagues who didn’t have that infrastructure. I was very lucky to have parents and in-laws and a husband who supported me. And my payback to them was that I never left them. Sometimes we get caught up thinking we have to do it the traditional way, and we don’t focus on what keeps us grounded and successful as people in our lives. Then we get turned upside down. There are promising women who started out in surgery, and are no longer in the field. Maybe they jumped too high, or they got lost. When I look at my colleagues who have been successful in their careers, they’ve each done it in different ways. We’ve meandered. Find the pathway that’s consistent with who you are. Other obstacles are the structures that we all have in our institutions. We all have these structures in our institutions – they have inertia, they don’t have leadership teams that evolve in the way we’d like them to or they don’t share our values. People automatically look to that more familiar and regular progression. We see that men get promoted more rapidly than women. We have to recognize that these structural barriers in our institutions are still in evolution. But you have to remember, it’s a marathon, not a sprint! Try to keep your eyes on the big picture. You have 40 years in this business; don’t prematurely think that you have to jump to the next step or next opportunity. **Interviewer:** What are the greatest rewards you believe you’ve gained from being a leader in a surgical organization? **Dr. Bass:** My favorite reward is when you go someplace and you run into some med student who you have no recollection of them in your life, and they tell you they are so appreciative of what you’ve done for them. Then you realize you made an impact on this person’s life. You make a lasting impact when you didn’t even realize you touched them. I think being a leader gives you a voice and an impact that goes beyond your title. It’s nice to see some of the things that you’re demonstrated become the scenery. See the success you’ve had spill over to those behind you. I don’t want to hear about how unusual I am; I want this to be very normal. We want that critical mass. It’s no longer odd \[to be a woman surgeon\]. Now it’s becoming normal, even in a demanding surgical field. I think the most important contribution I’ve made is just being “there” and doing it. **Interviewer:** What do you see as your greatest achievement? **Dr. Bass:** I’m proud of my boys, of my family, and the incredible relationship I have with my parents. Having many siblings, I’m the only one that stayed close. **Interviewer:** What mistakes would you advise mid-career women in surgery to avoid in order to be successful in pursuing leadership roles in academic surgery and national organizations? What mistakes would you advise young women in surgery to avoid? **Dr. Bass:** Don’t be prematurely sensitive or aggressive, or feel that you’re not getting there. However, occasionally you do feel that you’re up against the wall and you’re not getting where you want to be, whether due to the leadership or the infrastructure. Then you start the slow burn, you start looking. Sometimes you have to say, this is not working, then move on **Interviewer:** Are there specific leadership courses or organizational training resources you’d recommend to women surgeons interested in pursuing a leadership role in academic surgery or national organizations? **Dr. Bass:** I never took them; I just did it by osmosis and learning from the good people around me. **Dr. Susan Moffatt-Bruce** ![](%5Bsiteurl%5D/wp-content/uploads/2014/09/Susan-2BMoffatt-Bruce-2BPink-2BCheckered.jpg) Dr. Susan Moffatt-Bruce, BSc, MD, PhD, MBOE, FACS, FRCP is a cardiothoracic surgeon at the Ohio State University Medical Center. Dr. Moffatt-Bruce completed her undergraduate studies at McGill, her medical school and general surgery residency training at Dalhousie University, a PhD in Transplant Immunology at the University of Cambridge and a Cardiothoracic Surgery fellowship at Stanford University. Currently, Dr. Moffatt-Bruce is the Associate Dean of Clinical Affairs, Quality and Patient Safety at Ohio State University, where she oversees process improvement at a 6 hospital, 1100 bed academic medical center. Dr. Moffatt-Bruce is also the Associate Director for the Center for Lean Healthcare Research at the Ohio State University Fisher College of business. **Interviewer:** What do you see as the greatest skills need to be successful as a leader in academic surgery and in surgical organizations? **Dr. Moffatt-Bruce:** The best trait or most important attribute is the flexibility to be accommodating. Leaders have to react quickly to many situations and so really being accommodating and flexible is key to the organization. Also, leaders have to be available. The people you lead want to have access to you. The greatest skills needed to be successful as a leader in surgery are being available, accountable, and accommodating. **Interviewer:** What are the biggest challenges and obstacles you yourself faced in your career? What are challenges you saw your female colleagues in surgery facing in their careers? What do you see as the challenges women surgeons face today in advancing as surgical leaders in academic institutions and in national surgical organizations? **Dr. Moffatt-Bruce:** One of the biggest challenges is that if you start going down a pathway that seems reasonable, everyone is happy to help. However, if you start going down a pathway less traveled, people are less likely to help. I started as a physician scientist and was doing well. Then I became a physician administrator and it was difficult to find a mentor who really understood the challenges and what changes I would need to make. I believe this particular challenge may be specific to women. Because you’re a woman, they think you’ve changed your mind, that you’re finicky. Changing paths may be a challenge but it is so worthwhile when you know it is the right choice. Being able to share that with a mentor that understands and embraces change is the challenge. **Interviewer:** What are ways that you overcame those obstacles? Can you give concrete examples? What did you learn from these obstacles? **Dr. Moffatt-Bruce:** First off, I didn’t know there would be obstacles. The first part was realizing there were very real obstacles that would have to be overcome. When I became an academic administrator, I had to go out of my comfort zone and engage with women and men outside the medical profession. Biophysical engineers, people in health care reform, etc. That is always perceived as “Why is she here? You’re a surgeon, why are you here?” I had to embrace them and assure them that I was there to learn and to collaborate. By leveraging research opportunities and proposing joint ventures, particularly around Surgical Outcomes Research, I was able to create “Win-Win” situations for them and for me. How cool is using Google Glasses to train residents!!! **Interviewer:** What are the greatest rewards you believe you’ve gained from being a leader in a surgical organization? **Dr. Moffatt-Bruce:** Oh gosh, there are many rewards. Just realizing my potential to not just influence a small cohort of residents and patients, but to touch so many other domains of health care is the reward. So many people ask me why \[be a physician administrator\]? Hands down, its’ because I can influence so many patients and that’s a tremendous privilege. **Interviewer:** What do you see as your greatest achievement as a surgeon? And what is your greatest achievement as a leader? **Dr. Moffatt-Bruce:** My greatest achievement has been in instilling in this large academic medical center a culture of accountability and safety. As a result, we’re now influencing residents and medical students in a culture of accountability and safety. And now I’m starting to influence that on a national scale. Its’ unusual to have a thoracic surgeon willing to be a spokesperson for these things. We have nationally accepted quality metrics, which are frankly very challenging indicators. I’m able to sit on these committees and say, “These are not good metrics”. We as surgeons have that ability to shape what is measured as “quality” but we have to go and engage. The National Quality Forum is the national committee that actually endorses the CMS metrics, and I’m a member of that committee. **Interviewer:** What accomplishments are you personally most proud of in your career or in your personal life? **Dr. Moffatt-Bruce:** My children. My children now never accept the status quo, they ask about everything. They make sure that what I’m telling them, what their school teachers tell them, what their music teachers tell them is accurate. They’re not afraid to question (although it can be quite exhausting!) **Interviewer:** Do you have any regrets from your experiences as a surgeon leader, or would you do anything differently? **Dr. Moffatt-Bruce:** Would I do anything different? I would have taken the same path. But, I would have been more appreciative during my residency and during the junior faculty years about what the hospital/academic mission is. I was in a silo during the training just trying to make it through. I never appreciated what it was to have a mortality index; to not meet a SCIP measure. I never was inquisitive enough. Absolutely, there would have been opportunities to be involved as a junior faculty or resident. You have to make those opportunities. ![](%5Bsiteurl%5D/wp-content/uploads/2014/09/Susan-2BMoffatt-Bruce-2BGoogle-2BGlass.jpg) **Interviewer:** What mistakes would you advise mid-career women in surgery to avoid in order to be successful in pursuing leadership roles in academic surgery and national organizations? What mistakes would you advise young women in surgery to avoid? **Dr. Moffatt-Bruce:** I think that women have to really think what their priorities are. You have to weigh the pros and cons about what you’re asked to do. Be thoughtful about what you engage in and what you commit to. **Interviewer:** Are there specific leadership courses or organizational training resources you’d recommend to women surgeons interested in pursuing a leadership role in academic surgery or national organizations? **Dr. Moffatt-Bruce:** Lots of great resources that women can use to improve. The AAMC early career development courses; they’re really super. Young women faculty should think about taking that in their first 1-2 years. In the professional societies, anytime they offer courses on coding, etc., take them, and take them a couple times to really benefit. ELAM is also a great experience when you become an Associate Professor **Interviewer:** What else would you like to share about surgical leadership with members of the AWS? **Dr. Moffatt-Bruce:** I’d want to share with other women that sometimes circumstances and opportunities pose themselves at inopportune times; and our resources have to be used to assess them or embrace them, but not to be anxious. You have to make choices and there will always be opportunities to seize that. It all depends on what you make of it. **Conclusion** We are indebted to Patricia Numann, MD, FACS, Barbara Lee Bass, MD, FACS and Susan Moffatt-Bruce, MD, FACS for having the courage and generosity to share their hard earned wisdom, experiences, and inspiration with us. As the face of surgical leadership evolves, we know that taking the road less traveled is a challenging feat, but well worth the effort. And the rewards of the journey enrich not just the intrepid explorer, but also pave the path for every future dreamer to come. ![](http://blog.womensurgeons.org/wp-content/uploads/2014/09/Eleanor-Roosevelt.jpg) --- **Categories:** leadership --- ### [Networking = Connectivity](https://blog.womensurgeons.org/networking-connectivity/) **Published:** October 16, 2014 **Author:** Blog Team **Content:** by: Sharon Stein, MD, FACS To me, networking is all about connectivity. It is about finding people with whom I have something in common and forming bonds. Sometimes it gives me opportunities, sometimes it allows me to connect colleagues, and sometimes it allows me to help someone out. But it is focused on having a network of people who I feel comfortable talking to, learning from, and asking help from. There are tons of places to network. I see networking opportunities in meeting patients, in speaking to referring physicians, and at work cocktail parties. I also see opportunities at my daughter’s school, at the grocery store, pretty much anywhere. Don’t think about networking just in terms of fellow physicians, power players. The wife of colleague might be the one to put a bug in someone’s ear and provide a great opportunity. I never go into a networking opportunity with an agenda. I look for interesting new people that I enjoy speaking with and have something in common with. In fact, networking “how to lists” say look for opportunities to help others. If I can help someone finish a project, find a mentor, point out a job opportunity, it creates great bonds, which are often reciprocated. Most networking lists say take business cards, add them to your phone and follow up with an email. One of my colleagues goes one step further. She always writes down the names and information about the family members of people she meets. The next time she sees a colleague she can ask how Junior’s tennis match went, or how her daughter’s wedding was. When she meets that new person again, they feel a personal connection because she remembered. I thought this was a great idea and it has worked well. For me, Association of Women Surgeons has been a great place to network. For starters, we all have something in common – we are female surgeons trying to make our way in the world of surgery. In general, we tend to be doers, interesting people, and motivated by our jobs. Although I can bond with surgeons at ACS, and other surgical society meetings, the large group setting can be intimating. The smaller setting of AWS has provided me with the courage to approach senior surgeons, I wouldn’t otherwise have access to. This has been a great way to meet some of my role models. Prior to introducing myself, I practiced my opening, who I am, what I wanted to discuss with them. To take things a step further, I volunteered and have participated in committee work. This brought me into even smaller group situations working for a common goal. Just last year, I met someone at AWS who took the time to introduce herself to me. Now we have worked on a number of projects, very successfully and it has turned into a great opportunity for both of us to advance our professional goals. Networking is about making friends, just like in high school. It’s easy to be intimated by the group of cool kids sitting at the lunch table. But now that we are grown ups, I have found that my role models and colleagues are really open to talking to me. Even if I am tired at the end of a day of conference, I always try to go to the social event and speak with one new person. You never know when those new contacts will turn into a great opportunity, or a great new friendship. When I look back at people who have assisted me with creating opportunities, some of them had formal relationships, people I worked with. Just as frequently, they are folks who I met in casual settings, maintained a relationship with, and now have become friends and supporters of my career. Come network with me at AWS Conference…I’ll look forward to meeting you. Here are some resources for networking. - <http://passivepanda.com/networking-tips> - <http://www.forbes.com/sites/theyec/2014/07/28/how-to-network-the-right-way-eight-tips/> - <http://www.businessinsider.com/how-women-can-network-more-effectively-2013-11> --- ![](%5Bsiteurl%5D/wp-content/uploads/2014/10/stein.jpg)Sharon L. Stein is an Associate Professor in the Department of Surgery at University Hospitals/Case Medical Center in Cleveland Ohio. She is a member of the division of Colon and Rectal Surgery. She serves as associate program director and surgical director of the inflammatory bowel disease center. She did her training in general surgery at Massachusetts General Hospital and fellowship at NewYork Presbyterian Hospitals Cornell and Columbia. **Categories:** Uncategorized --- ### [The Art and Science of Touch](https://blog.womensurgeons.org/the-art-and-science-of-touch/) **Published:** October 28, 2014 **Author:** Blog Team **Content:** Recently one of our own Women Surgeons, Dr. Carla Pugh, was an invited speaker at the popular [TEDMED 2014](http://www.tedmed.com/event/stage2014) event. In the session “Play is not a waste of time,” Dr. Pugh discussed Haptic Learning – the Art and Science of Touch – and her own experience with integrating this concept in surgical education. Dr. Pugh started her talk with a powerful recollection of a difficult procedure in the emergency room – a thoracotomy. Dr. Pugh noted something made her seriously worried: the resident working with her seemed to have missed a critical finding while leading the thoracotomy, cardiac massage, and evaluation of the patient. “As a surgical educator I am worried why my resident missed the blood clot around the heart, and things were moving so quickly that there was no time to discuss this great learning opportunity.” I had the opportunity to interview Dr. Pugh to discuss her TEDMED talk and more. In regards to the education opportunity that was missed with the resident, Dr. Pugh notes that providing feedback to residents is not built into the system. “The goal is to take care of patients & make money… Nobody gets paid to teach. Feedback is not built into the system… People who enjoy teaching do it, but it is not well-integrated. How do you teach residents how to be assertive? How to learn points of the operation? This is something that happens every day in medicine.” Unfortunately, Dr. Pugh has noted that this is something that has not changed since even her days in surgical residency. Despite high expectations, she notes that it is rare for people to provide direct detailed information/feedback. This is how she got into Haptics. Dr. Pugh holds a patent to a sensorized clinical exam model. She landed her first patent in 1998 during her postgraduate studies at Stanford University. The models can sense aspects of the physical exam such as tactile technique. One exciting finding to be published soon, was a model adapted for the clinical breast exam (CBE). Dr. Pugh’s team was collecting data on CBE from experienced clinicians to help identify which technique was most sensitive to detect a mass in the breast. The data was supposed to help teach medical students the appropriate technique for CBE. A surprise finding was that 10-15% of clinicians were missing the mass in the model! Upon review of the data from her sensorized model, it was found that a specific examination technique was associated with being more likely to miss the mass. Dr. Pugh notes, “We must go beyond the paper and pencil test.” The technology is now available to help assess clinical exam and surgical skills. Incorporating this type of feedback into medical education and continuing medical education will likely make a big difference for patients. Dr. Pugh grew up in Berkeley, California, and has long been interested in science and medicine. At 5 years old she received her first stethoscope and “was listening to people’s ankles at the grocery store.” As a child she had her first run-in with the power of touch “I was always taking things apart,” she notes. It was during one of these play sessions in the living room, she was electrocuted at 5 years old. “My hand was stiff!” How do I get involved? Dr. Pugh has an active research lab, which usually consists of engineering students. She has had two residents working in her lab. In addition to traditional surgical meetings, Dr. Pugh attends conferences usually dominated by engineers, like [NEXTMED](http://www.nextmed.com/) where Medicine Meets Virtual Reality. Thank you, Dr. Pugh, for reminding us to dream big and never forget the art and science of touch. ![](http://blog.womensurgeons.org/wp-content/uploads/2014/10/minerva-romero-bio-pic1.jpg) *Minerva A. Romero Arenas, MD, MPH is a General Surgery Resident at Sinai Hospital of Baltimore. She recently completed a research fellowship in the Dept. of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, TX. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.* *Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.* *She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.* **Categories:** medical students --- ### [2014 AWS Conference Breakout Session - Mentoring & Career Advancement](https://blog.womensurgeons.org/2014-aws-conference-breakout-session-mentoring-career-advancement/) **Published:** November 21, 2014 **Author:** Blog Team **Content:** by Nancy L. Gantt, MD, FACS Our packed table energetically discussed mentoring, sponsorship and career advancement. The discussion highlighted challenges some of the members were having at their own institutions. We spent a lot of time talking about the difference between mentorship and sponsorship, and why both are necessary for academic success. Dr. Emina Huang provided her insights about the difference between those two roles and how to find a sponsor. She noted that sponsorship is different than mentoring – the former helps with providing opportunities and exposure; the latter helps you with the steps to get there. The discussion about Mentorship highlighted the following points: - Mentorship is valuable in all aspects of your professional AND personal life. - You will likely need more than one mentor, as a single person may not be able to meet all your needs. - Selecting a Mentor will be facilitated if you approach someone that you have worked well with, as your values have to be similar. - A mentor, or sponsor, can be someone outside your home institution. - If you are being stymied in your career progression by your Mentor because of their insistence to “follow specific channels” you may need to creatively develop a plan to include your current Mentor and a potential sponsor figure to further your career. - Members were directed to the Career Development Resource on the AWS website: “Strategies for Building an Effective Mentoring Relationship”. In closing – you can have it all – just not all at the same time. Mentors and sponsors can help you achieve personal and professional success. **Categories:** career development, mentorship --- ### [The Year of Mentorship](https://blog.womensurgeons.org/the-year-of-mentorship/) **Published:** November 21, 2014 **Author:** Blog Team **Content:** by Betsy Tuttle-Newhall, MD, FACS As we start a new year of *e**Connections*, and continuation of the mission of the Association of Women Surgeons (AWS) Foundation, the members of the Foundation Board want to dedicate this year of fundraising in honor of Mentors and the Concept of Mentorship. The overall mission of the AWS Foundation is to provide opportunities for the educational and professional growth of women in Surgery. Many of the signature programs of the AWS are supported by the Foundation including the Kim Ephgrave Visiting Professor program as well as several national awards including the Nina Starr Brunwald Award, Olga Jonassan Distinguished Member Award, Honorary Member Award, Hilary Sanfey Outstanding Resident Award and the Patricia Numann Medical Student Award. The Foundation also supports the Resident and Poster Competition at the Annual AWS meeting to encourage and facilitate interaction between students and residents training in Surgery. The Foundation was started in 1996, and has provided many of the AWS members ways to heighten their visibility and created advancement opportunities. The Foundation and its board have been and continue to be the “mentor” organization for the AWS. What is mentor? What is mentorship? And why is this important? A mentor is defined as a “wise and trusted teacher, an influential sponsor or supporter”. Many of us during our careers have benefited from people who have taught us, encouraged us and supported us during specific or all phases of our careers. Mentors are often responsible for bringing Surgery to our attention when we are students. They are also responsible for teaching trainees, especially in Surgery, those lessons that are not described in a text or journal article- lessons in such things as rules of surgical culture, compassion, professionalism, communication skills, and ethics. They also knowingly or unknowingly teach us about personal matters, and self-preservation or lack thereof. Mentors are responsible for teaching us, often lessons that are transferred across generations. ***“Mentoring is to support and encourage people to manage their own learning in order that they may maximize their potential, develop their skills, improve their performance and become the person they want to be.”*** Eric Parsloe, the Oxford School of Coaching & Mentoring There are many ways to mentor- formally via programs in your institution or via society programs such as the American College of Surgeons, or informally, by establishing a relationship to support a trainee or trainees in professional or educational matters. Mentorship relationships can involve formally assigning a faculty member to a trainee, and setting up a schedule for meetings, for adequate time to discuss issues. As for the trainee, there are many themes in a mentor-mentee relationship. These can include issues of the mentor being the professional role model, being compassionate and supportive, acting as a critic or a career counselor. Mentees often need specific goals for their relationships with mentors and they need to appreciate that their goals and expectations must be kept in the context of their training program and their expected level of professional performance. There are many difficulties in establishing a successful mentor and mentee relationship. The most prevalent barrier to this relationship is lack of time. Mentors are often overcommitted with busy clinical or academic schedules, and trainees have their own time limitations with training hour restrictions and mandatory lectures and labs. Scheduling time in advance and scheduling those meetings at regular intervals can help make these meetings a priority for everyone involved. Secondly, there are often a limited number of faculty members who are interested or qualified to be a mentor. In the current era of declining re-imbursements and lack of funding for educational activities, faculty members are pressured to produce clinically and academically, limiting their time for non-reimbursed or credited activities. Similarly, issues of different generational priorities, gender and cultural differences in the available mentors can adversely affect the establishment of the relationships between the trainee and the mentor. While more and more women, gay and lesbians as well as international trainees are currently training in surgery, the diversity of the academic faculty has not kept up with the diversity of the training population. It is imperative that available mentors are sensitive to issues in the diverse population of trainees that are different than their own, and that issues are evolving over time to ensure that any mentor can have a mentorship relationship with any trainee. Often, it is not one person that is a mentor to a developing surgeon but a group of people over years, that train, influence and support the trainee. It does take a village to raise a child, and I would argue a well-trained surgeon as well. As an example, for many years, early in my career, I was one of the only women I knew, interested and eventually training in Surgery. Women in Surgery were few and far between in the Southern part of the United States at that time. During my third year medical student rotation, I happened to be on service with teams of all male residents, and all male attendings. I spent a lot of time with several individuals that were professional role models for me including Chuck Harr, MD, Curt Mosteller, MD and Gary Craddock, MD. There was one woman trainee when I was student- Ginger Chiantella, MD and I thought she was marvelous. There were more over time including Catherine Share, MD who had a great influence on me as well. I also started a life-long friendship with one of the Surgical Attendings, Dr. Jesse Meredith, the “old dad”. When I was student, I would often round with “Old dad” at night, where he would tell me stories, and teach me about what was important to Surgeons- patients ( “who always come first”), compassion (“you can never have enough”), integrity and work ethic. When I was a fourth year student, I did not match in Surgery for post graduate training out of medical school mostly due to my own lack of insight into how the system worked at that time, but also due in part to the attitudes of the program directors and some of the surgeons I interviewed with. I often heard in interviews that as a woman, I did not have the “stamina to train “as a surgeon. I was also accused by some of trying to “take a man’s position”. Despite, the disappointing turn of events, I eventually found my way to Boston to train with the help of many faculty along the way including the Dean of Students at Wake Forest, Patricia Adams, MD who at the time was a transplant nephrologist who would go on to become the first woman President of the United Network of Organ Sharing, a Pediatric cardiac surgeon at West Virginia University, Robert Gustafson, MD and of course, Dr. Meredith. I have never forgotten their support and frankly, their ability to judge my performance not my gender. Training in Boston opened many doors for me with the help of all of the Surgical Faculty at The Children’s Hospital of Boston (especially Drs. Hardy Hendren, Jay Schnitzler, Jay Wilson, and Bob Shamburger). Drs. Al Bothe and Glenn Steele gave me a chance to train at the Deaconess and Dr. Roger Jenkins told me I could do anything I wanted to but to try transplant. It was Dixie Mills, MD that reminded me that there are still issues for women in Surgery, and Susan Pories, MD who taught me a lot about grace under pressure. As I have progressed over my career, I have had many challenges, and while there has been a significant increase in the number of women training in Surgery, the number of senior women in Surgery in leadership positions academically has not kept pace for many reasons. At the completion of my training in Boston, I eventually completed a Transplant Surgery fellowship at Duke University Medical Center. I was the first woman fellow in Surgery at Duke, and the first woman attending in General Surgery to be pregnant and have children. Without the support of my chairman Dr. Robert Anderson and my Division Chief and friend, R Randall Bollinger, MD it would have been impossible for me to continue my career and have my children. My mentor and fellowship director, Dr. Pierre A. Clavien, now Professor and Chief of the Department of Surgery in Zurich Switzerland, taught me many things clinically, as well as teaching me how to be academically productive and know “how” to support and mentor junior faculty. I never had a formal relationship with any agendas working with these people who were and are my mentors, but I learned by listening and watching, occasionally asking for guidance and support. I still call the “old dad” often who is now 90 to discuss issues of management and development as he has more common sense than anyone I know. As for mentors in how to progress in academic rank, time management and my career, I have the members of the AWS to thank for that guidance and support. Without the support of past and present members of the council, the Foundation Board and the management personnel, I would never have known how to write a real CV, a letter of recommendation, a division chief and chairman prospectus, a budget and many other things. Thank you Drs. Ephgrave, Hooks, Numann, Walsh, Scott, Bergen, Cochrane, Sanfey, Dunn, Nuemeyer, Gantt and so many others. I have had the opportunity to be supported and work with so many wonderful mentors. How do I honor them? By being a mentor myself. I have tried as I have risen through the academic ranks, to support, encourage, and train women with a focus on teaching clinical care, and precise operative skill. I have a list of trainees with whom I feel particularly close on my CV and who I have advised and promoted during my career. I now find myself the only woman Division Chief at my institution and have been a woman chair. In order to honor our mentors, we must work tirelessly to make sure no matter where we are, that there are the basics for equitable treatment (ex: a maternity leave policy and paternity policy), and performance based assessment for every trainee. We as more senior members, need to take advantage of our seniority and position to often place ourselves “in the line of fire” to demand justice and fairness for all of trainees and junior faculty- if the need arises. We need to be the mentors that some of us didn’t have and give out career advice and support, and make phone calls to ensure that the all of our trainees, but especially the women, have access and opportunities to train at the best places they can train. Times are changing and it is a great time to be a surgeon. We are all beneficiaries of the people who have supported us and trained us over our lifetimes, and we can honor them by being mentors to our cadre of students. I would encourage all of our members to honor their mentors with a donation to the foundation, so that the AWS can continue what we do to support all of us. This is their year ! My favorite “old dad” story: Dr. Jesse H. Meredith is currently Professor of Surgery, Emeritus at Wake Forest University. He was a pioneer in many aspects of surgery including portal hypertension surgery, renal transplantation, reattaching severed limbs and the formation of Critical Care Units. He won the AMA’s distinguished service award in 2011 for his meritorious service in the science and art of Medicine and the Order of the Long leaf Pine in 2010, from then Governor of North Carolina Beverly Purdue. However, he is originally from Fancy Gap Virginia, plays a great fiddle and speaks with the native tongue of the South. He is a man of few words but when he speaks, everyone listens. When I was a third year medical student, I was rotating on trauma surgery of which Dr. Meredith attended. Being my first rotation, and being extremely uncomfortable and not knowing how to actually “do” anything, I would stand as close to the wall in the trauma bay when our team had a trauma patient, hoping no one would notice me and I could watch but not be in the way. One night, a young man came to the ED with a stab wound to the chest and was rolled in the trauma room in full arrest. There was a flurry of activity and everyone seemed to be moving at once, drawing blood, giving blood, examining the patient, achieving IV access. It was a hive of activity. Finally, the chief resident called out that there was a stab wound over the left nipple and he was going to open the chest. The chest tray was opened, calm came across the room and the incision was made, the retractor placed and the pericardium opened. A large hemopericardium was released with some improvement in the patient’s hemodynamics; however a small laceration was noted in the right ventricle that started spurting blood over the patient and the tray. It seemed like time stood still, with everyone watching the blood spurt when a gloved hand came through the back of the crowd, and a long gloved finger plugged the hole in the heart. Suddenly you heard the “old dad” say “well.., y’all know what to do now don’t cha…..” and off they went to the OR in a rush. He had appeared as if he were out of nowhere to solve the issue and save the patient. I do not remember to this day if anyone called him, he just knew when he was needed and he showed up. ——————- **Do you have a story to share about your mentor? Email us at info@womensurgeons.org or tweet us @womensurgeons and #HonorYourMentor.** **Or [make a donation](https://www.commercecorner.com/aws/fundraiser.aspx?id=12) to the AWS Foundation to #HonorYourMentor today.** **Categories:** Uncategorized --- ### [2014 AWS Conference](https://blog.womensurgeons.org/2014-aws-conference/) **Published:** November 21, 2014 **Author:** Blog Team **Content:** The annual Association of Women Surgeons Fall Conference was held at the stately Westin St. Francis in San Francisco, California on Sunday, October 26. The 2014 theme was “Transitions: Thriving Amidst Change.” The conference was attended by 124 people, 33 of which were medical students and residents. Presentations were interspersed by opportunities for networking with other attendees and corporate partners. **Celeste Hollands, MD** and **Lois Killewich, MD** moderated the Sunrise Scientific Session. Five abstracts of excellence were presented from among those manuscripts accepted for publication in the American Journal of Surgery: - **Hillary Braun, MD** “Perceptions of Surgeons: Women Surgeons Prefer Female and Communal Surgeons” - **Courtney Collins, MD** “Effect of Pre-Injury Warfarin Use on Outcomes after Head Trauma in Medicare Beneficiaries” - **Amy Liepert, MD** “ Protecting trauma patients from duplicated CT scans: the relevance of integrated care systems” - **Lisa McElroy, MD** “A Meta-Analysis of Complications following Deceased Donor Liver Transplant” - **Betsy Tuttle-Newhall, MD** “Prognostic impact of mechanical ventilation after liver transplantation: A national database study” Ethicon has supported our Grant program since 1996 – enabling us to award over half a million dollars in research grants to AWS members. **Heather Yeo, MD**, the 2014 AWS Foundation/Ethicon Endo-Surgery Fellowship winner presented her study: “Clinical trial on the efficacy of sacral neuromodulation (SNM) with Interstim for fecal incontinence following surgery for low rectal cancer with sphincter preservation”. Simultaneously, the 20 residents and medical students whose posters had been accepted for the 2014 STARR poster competition were being judged. The volunteer judges had a difficult assignment however eventually chose exemplary winners. The overall winner in the resident category was **Dr. Fariha Sheikh** for her poster entitled “Anesthesia Induced Neurotoxicity” and the overall winner in the medical student category was **Martha Henderson** from Emory for “Gender Differences in the Correlation of Objective and Subjective Assessments of Surgical Frailty.” The keynote presentation of the conference was graciously provided by **Nancy Ascher MD,** FACS, the *Professor and Chair, Department of Surgery Division of Transplant Surgery Isis Distinguished Professor in Transplantation, Leon Goldman, MD, Distinguished Professor in Surgery, University of California, San Francisco.* Dr. Ascher has devoted her career to organ transplants and transplant research and has had a distinguished career of public service that includes appointments to the Presidential Task Force on Organ Transplantation and the Surgeon General’s Task Force on Increasing Donor Organs. She also served as Chair of the Advisory Committee on Organ Transplantation for the Secretary of Health and Human Services from 2001 – 2005. She was also the **2007 AWS Nina Starr Braunwald Award** recipient. Dr. Ascher’s presentation focused on women in leadership roles in surgery. She described the influential role artistic works in Detroit had on her while growing up, statistics of women in all leadership roles and the work yet to be done to achieve position and pay parity for women in surgery. She discussed the roadblocks to success-patients, employers and ourselves. Evaluation of our performance can be stilted due to the “abrasiveness trap”: high-achieving men and women are described differently in reviews. How we are perceived matters, and issues of family concerns, pregnancy and work-life balance need attention at every level of training. [View Dr. Ascher’s presentation here](https://www.womensurgeons.org/challenges-to-leadership-in-surgery/). Attendees next heard “The Changing Face of US Healthcare: How to Optimize Your Career” presented by **Patrick Bailey, MD,** *Medical Director for Advocacy, American College of Surgeons.* An Arkansas native, Dr. Bailey is Chief of Pediatric Surgery at Maricopa Medical Center in Phoenix, AZ. He is completing work towards a Master of Legal Studies degree at Arizona State University’s Sandra Day O’Connor College of Law and is a Captain in the U.S. Navy Reserve. Dr. Bailey’s presentation focused on several topics of interest to the practicing surgeon. He discussed the implementation of regulations under the ACA, funding proposals for GME and the important role of advocacy in ensuring patient access to quality care. Dr. Bailey inspired many attendees to pay attention when opportunities for their expertise arise. As a surgeon, balancing personal and professional demands while maintaining some semblance of personal wellness can seem impossible. The next speaker, **Dr. Carol Scott–Conner MD, PhD, MBA,** *Professor of Surgery, University of Iowa Carver College of Medicine* is armed with a wealth of both personal experience and unique insight into success as a female surgeon. Dr. Scott-Connor, whose clinical focus is Surgical Oncology and Endocrine surgery, is the consummate surgical educator, the author of innumerable papers and texts and the recipient of many awards. She was named a “local Legend” by the National Library of Medicine and will be awarded the Honored Member Award from the American Association of Clinical Anatomists (AACA) in June 2015. In her spare time she serves as a Governor of the ACS. Dr. Scott-Connor’s inspiring and grounding presentation “The Challenge: Transition to a Healthier You” focused on the oft-neglected areas that require attention in order for women to be personally successful and enjoy it! She discussed organizational skills, ergonomics, mindfulness, exercise, companionship, reflective writing, burn-out and many other topics. Her addition of personal anecdotes gently drove home her bottom line- that many areas of our lives need tending if we are to be healthy. [View Dr. Scott-Conner’s presentation here](https://www.womensurgeons.org/transition-to-a-healthier-you). The final formal presentation of the morning was by **Janet Bickel, MA** a nationally recognized expert in faculty, career and leadership development with 40 years of experience in academic medicine and science. In addition to a wide-range of individual coaching clients, organizational clients have included United American Nurses, US Department of Commerce, and US Department of Health and Human Services. She is an Adjunct Assistant Professor of Medical Education at George Washington University School of Medicine and has also taught Leadership and Innovation at the CIA and the National Reconnaissance Office. During the Executive Leadership in Academic Medicine \[ELAM\] Fellowship Program’s first 15 years, she served on its Advisory and Selection Committees; among her many other roles she continues to serve as faculty and is a Principal Member of its Executive Development Council. AWS recognized her contributions and support of the goals of AWS by awarding her the **AWS Honorary Member Award** in 1992. Janet’s presentation “Transitions and Resilience: Growing and Thriving throughout your life and career” focused on how women professionals are inequitably evaluated, the challenge of balancing short-term benefit with long-term satisfaction, success traps and important decision criteria for taking on something new. Multiple small group breakout sessions inspired discussion about the challenges facing women professionals as they advance through their careers. Issues discussed included: How aligned are your professional goals with your current roles and your vision of “success”? How do you effectively communicate your goals and accomplishments in a 30-second “elevator speech”? How can you increase your influence in ways important to you? What is standing in your way? What interferes with adaptability? How can you become more agile? Janet emphasized preparing for success, transitioning, sustaining success, and then transitioning again all the while interweaving self-efficacy, political savvy, personal/professional growth and “communities of practice”. She emphasized that attendees needed to identify what resilience-promoting practice they were willing to commit to-and what *supports* were needed for this to work. [View Ms. Bickel’s presentation here.](https://www.womensurgeons.org/transitions-and-reslience/) After the AWS Business Luncheon, including election of 2014-2015 AWS officers, attendees reconvened in the Ballroom for directed networking sessions. Table topics included: - Financial management: **Meredith Duke, MD** - Work-Life Balance: **Joyce Majure, MD** and **Lauren Paton, MD** - Private Practice: **Yvette LaClaustra, MD** and **Shirin Towfigh, MD** - Alternate Career Pathways: **Liz Robertson, MD** - Family Planning: **Sharon Stein, MD** and **Stephanie Bonne, MD** - Social Media: **Erin Gilbert, MD** - Contract Negotiation: **Jennifer Rosen, MD** - Mentorship: **Emina Huang, MD** and **Nancy Gantt, MD** Discussion and networking at each table was lively-the session moderators found that once settled none of the attendees wanted to move! Overall the 2014 AWS conference was fun, informative and provided attendees with valuable skills to achieve personal and professional success. Please join us in Chicago for our 2015 Fall Conference on Saturday October 3, 2015. Respectfully submitted by Nancy L. Gantt, MD FACS **Categories:** Uncategorized --- ### [Ergonomics-A Call to Action-When Helping Others Harms the Surgeon](https://blog.womensurgeons.org/ergonomics-a-call-to-action-when-helping-others-harms-the-surgeon/) **Published:** December 24, 2014 **Author:** Blog Team **Content:** By: Celeste Hollands, MD, FACS Why was everyone shocked when shortly after my partner retired I told them he was only 62? He had had a heart attack and back surgery during his career. He walked with a limp and had to sit to operate due to years of standing in the operating room without regard to his own well being so he could provide outstanding surgical care to the children he served. We give our time selflessly, our reimbursement is diminished, there are certain health hazards to a job where you stand on your feet, but must we sacrifice our health? Isn’t there a better way to partner with industry to develop instruments and devices that are ergonomic or can be made ergonomic for all that use them? We all remember our childhood and think back to what has changed as we have grown up and grown older. I remember riding in the “way back” of our Volkswagen beetle-3 little kids delighted to be in that special secret place where only us kids would fit. Did my parents love us? Of course they did. Were they smart and educated? Yes. Safety devices such as seatbelts were neither widely available nor used at that time. When safety devices were developed, they were designed for the 50thpercentile male. So seat belts, especially the 3-point restraint systems naturally did not “fit” many smaller men, most women and almost all children. Car seats and booster seats were designed, kids were moved to the back seat to avoid injury from air bags which were the newest “safety” device and on and on it goes. Surgical devices and surgical instruments are largely similar in design approach. Those of us with smaller hands cannot operate many of the instruments in the manner that was intended. We have adapted in many cases-that is what we do-to provide the best care for our patients. Many of the adaptations result in work related injuries-either from misuse or repetitive use injuries in instruments that were not designed for small hands. Some injuries are not related to hand size at all, just repetitive use of instruments or surgical systems that were not designed with the user-the surgeon-in mind. Injuries related to the ergonomics of minimally invasive surgery (MIS) have been investigated and reported. Youssef and colleagues (1) analyzed the risk to surgeons from side standing and between the leg standing positions during laparoscopic cholecystectomy. They concluded that the American side standing position posed risks of injury to the surgeon due to increased physical demand and effort resulting in ergonomically unsound conditions for the surgeon. Esposito and colleagues (2) reported on work-related musculoskeletal disorders (WMS) of the upper extremity in pediatric laparoscopic surgery. Their work parallels the work of Park and colleagues (3) in that the longer you have been performing MIS and the larger your caseload the more symptoms you report and experience. Women performing laparoscopic surgery report more hand and shoulder symptoms than men and seek treatment for these symptoms more often even though they have been in practice a shorter time. This finding is from work by Sutton and colleagues (4). These findings seemed to be independent of glove size and probably more related to instrument handle size and design and/or table height. A recent discussion thread on the ACS Women Surgeons community focused on flexible endoscopes and the lack of ergonomics for those with smaller hands. A number of good suggestions came forth for adapting safely to this challenge. These tips included how to best use an assistant; how to position yourself, the patient and the table; and how to manage the dials and grip and manipulate the scope. This is all very valuable information however the tips do not solve the issue for those with small hands. One discussant brought forth the knowledge that there was an adapter available that could be obtained from the company rep that helped with manipulating the dials. If surgeons are discussing ergonomics and these work related injuries at all, it is likely behind closed doors, in a more private, more intimate setting-like the locker room or lounge since that is often where you immediately feel the mental and physical strain of the operation or procedure you just completed. It is when you have the time to readjust your focus for a moment to yourself that you are more likely to share your symptoms with those around you. Ergonomics and surgeons’ work related injuries are an important topic. Some of the ergonomics are relative to all surgeons and some will be unique to those with smaller hands and of smaller stature. Identifying the magnitude of the issue and then designing studies to document it while partnering with industry to fix it is the next step. We can wear support stockings, “sit when you can”, adjust table height, assume good posture and be mindful of our physical and emotional health. I remember when I was a resident one of the cardiothoracic surgeons was taking off his support hose in the lounge after the case and he told me that if I stayed a surgeon long enough that eventually gravity and low pressure systems in the body would be my enemy. He could wear support hose to help his legs but there were other things he could do little to manage. After 16 years in practice following 9 years of training, Mark, I get it! We can do our part to manage and control these ergonomic issues. We cannot remanufacture instruments and devices. I encourage you to share your experiences here on our blog. Let’s have a very powerful conversation that leads to meaningful results. If someone has already stated an issue you have experienced-acknowledge it and be counted. There is power in numbers and we need power to begin to get industry to respond and partner with us. Youseff Y, et al. Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position. Surg Endosc (2011) 25:2168-2174 Espositio, C et al. Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg (2013) 48:1750-1756 Park et al. Patients benefit while surgeons suffer: An impending epidemic. J Am Coll Surg (2010) 210:306-313 Sutton et al. The ergonomics of women in surgery. Surg Endosc (2014) 28:1051-1055 **Categories:** Uncategorized --- ### [AWS' Clinical Practice Committee pilots a TweetChat](https://blog.womensurgeons.org/aws-clinical-practice-committee-pilots-a-tweetchat/) **Published:** December 24, 2014 **Author:** Blog Team **Content:** Over the past few years, the Clinical Practice Committee has periodically read and discussed books which have provided beneficial tactics for added success in the management of our professional and personal lives. This activity has truly been enjoyed by the committee members. In search of ways to share this activity with the larger membership, we decided to pilot a tweet chat. The committee’s experience with twitter ranged from zero to those who frequently tweeted. Armed with some basic guidelines from the Healthcare Leadership blog and the buffersocial blog, the CPC had its first Tweet chat on November 10. The book for discussion was [Success Under Stress](http://www.amazon.com/Success-Under-Stress-Confident-Productive/dp/0814432123) by Dr. Susan Melnick. This book was [reviewed by Dr. Sasha Adams](https://www.womensurgeons.org/book-review-success-under-stress/) in the August issue of eConnections. Dr. Adams led the discussion for the tweet chat. There were seven participants. A few of us had some problems initially seeing the stream of conversation, especially if we were using Tweetchat.com. Those who used HooteSuite.com as the platform for the chat had absolutely no difficulty following the stream. In the end, everyone was able to contribute final thoughts about key messages gleaned from the book: Prioritize Pick your battles Control what you can- your 50% Be intentional rather than reactive Don’t just be reactive; anticipate Have control of your time; be purposeful Don’t let stress control the situation Though a little challenging, we successfully made it through our first tweet chat! We look forward to hosting another Tweet chat early next year featuring the Surgical Career Guide, due to be released in January, 2015. **Categories:** Uncategorized --- ### [Happy Holidays from the AWS!](https://blog.womensurgeons.org/happy-holidays-from-the-aws/) **Published:** December 28, 2014 **Author:** Blog Team **Content:** 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](https://www.womensurgeons.org/p/blogger-biographies.html) 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), ](http://es.wikipedia.org/wiki/Reyes_Magos)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](http://en.wikipedia.org/wiki/Rosca_de_reyes). *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. **Categories:** family life, medical students, residency, training --- ### [Cold hands, bright eyes, and tuberculosis… Happy New Year!](https://blog.womensurgeons.org/cold-hands-bright-eyes-and-tuberculosis-happy-new-year/) **Published:** December 30, 2014 **Author:** Blog Team **Content:** 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](https://www.womensurgeons.org/p/blogger-biographies) and the AWS! \~\~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lauren Poindexter MD Candidate, Class of 2015 Virginia Tech Carilion School of Medicine Nearly every child lining the [Pasadena Tournament of Roses Parade](http://www.tournamentofroses.com/) route on New Year’s Day in Southern California is bundled up to their noses in oversized parkas, gripping onto their parents hands tightly so as not to get lost in the excitable mass of humanity. Long before the start of the parade at 8:00am, bright-eyed children pull adults this way and that in attempts to touch the vibrant flowers, seeds, and grasses of the floats, stare at the huge costumed parade horses, and say hello to the perfectly-positioned musicians of the marching bands. Fascination and wonder predominates. Families are honored, a community gathers, rival football fans cheer, the nation celebrates a new year. Since the first Rose Parade in 1890 and the first Rose Bowl Game in 1902, the scene has only grown larger and more fantastic. New Year’s Day is my favorite holiday! However lighthearted the modern festivities appear, few know of the original purpose of the Rose Parade and its roots in medical history: it was a nineteenth century small-town public relations stunt to entice the families of tuberculosis patients to relocate to Pasadena. Their target audience was East Coast citizens trapped in frigid, blustery winters. The founder of Pasadena’s exclusive society, the Valley Hunt Club, was, himself, an East Coast transplant, former “consumptive,” and mastermind of the first Rose Parade. He established his club in 1888, the same decade when Prussian scientist Robert Koch identified the Mycobacterium tuberculosis organism, and at a time when physician specialists in America espoused the healing benefits of “climatic therapeutics” for tuberculosis sufferers. Physicians in those days recommended their patients receive modern tuberculosis treatment and rest in temperate locales – ideally ones offering drier climes, mild winters, and warm temperature ranges. Through the late 1800’s and early 1900’s, international medical journals, textbooks, and newspaper articles included the Greater Los Angeles Area in their purported list of ideal regions. The Valley Hunt Club’s goal was to capitalize on this movement. The 1890 Rose Parade featured a festival atmosphere of many athletic competitions and a parade of floral-bedecked horse-drawn carriages held under a sunny blue sky in the “dead of winter.” Vivid roses draped over horses necks and bundles of bright juicy citrus fruits wowed the 8,000 attendees. Foot races were run, children rode ponies, and visitors gushed in letters to their families. Amidst the sprawling citrus groves and well-established ranches, newly constructed mansions sprouted in Pasadena. A residential spectacle dubbed “Millionaire’s Row” consisted of an impressive line of winter retreats commissioned by Eastern magnates desperate for a seasonal escape. Famous residents included the Wrigleys of chewing gum fame and the Gamble family of Proctor & Gamble. Average citizens also sought treatment for tuberculosis in this region. Pasadena’s “Ballard Pulmonary Sanitorium” was well-known for its excellent outcomes and its success was complimented by donations of dollars and volunteer time from members of local women’s clubs. By 1910, Pasadena was one of the fastest growing cities in the US. When the Valley Hunt Club could no longer financially sustain the wild success of the Rose Parade, the non-profit Pasadena Tournament of Roses was created, eventually choosing William Wrigley’s winter mansion as its home base. Today, the parade progresses down the original “Millionaire’s Row” (now Orange Grove Boulevard) and past the Wrigley Estate. As a young child, I, too, was overwhelmed by the fantastic experience of the Rose Parade and fondly remember the years when we would spend New Year’s Eve at my grandfather’s townhouse across from the Wrigley Estate. He had ventured to Southern California as a young man to start his family in this beautiful region and was a strong supporter of the Tournament’s community involvement. Though I’ve since migrated back east for medical school, and my grandfather has passed away, I look forward to every opportunity to head home to Pasadena for this annual celebration. Spending time with my family on a crisp January morning watching scores of floats, marching bands, and equestrian units, plus a raucous college football competition, is my favorite way to start a new year. Now I know to credit this event to the Valley Hunt Club… and tuberculosis! \* Tradition dictates that no parade will be held on a Sunday, therefore January 2nd is an alternate date. **Categories:** family life, medical students, residency --- ### [Additional or Alternate Career Paths for Physicians](https://blog.womensurgeons.org/additional-or-alternate-career-paths-for-physicians/) **Published:** January 29, 2015 **Author:** Blog Team **Content:** by: Celeste Hollands, MD, FACS, FAAP Twenty years ago as I started medical school I focused on graduating and matching into a residency. The biggest decision was which residency was right for me. As I progressed through my residency, I addressed the question of general surgery or sub-specialty and then private practice or academics. That was it. There always seemed to be two forks in the road. I am not sure if it is because I am older and wiser or because times have changed but the career choices now seem to be organized more into a flow chart than two forks in the road. There are so many more choices and so many more options for additional training and these choices and options are available at many career levels. The information age has put all of this information at our fingertips much earlier in our career and we can plan for it instead of stumble into or settle for it when we need a change. The ability to have a blended career consisting of clinical and non-clinical responsibilities is one option. Another is a non-clinical or alternate career path where you likely will not engage in traditional clinical practice. Considering these options early and planning for the advanced degrees and additional training they may require is important. It is also equally important to talk to someone currently working in your area of interest and to seek out mentors in these areas. This article is intended to introduce these paths to you and provide resources for you to begin to consider these options. It is by no means an all-inclusive piece on alternate career paths for physicians. **Physician Executive Path** Interest in physician leaders continues to increase. If you are interested in joining the C-suite (Chief Medical Officer, Chief Operating Officer, etc. – the highest level healthcare executives with titles often starting with “Chief”) you will likely need some training in business. This training can be on the job training as you rise within your organization or you may choose to seek more formal training that will give you that business credibility you will need to be successful. Three advanced degrees to consider are MBA (Masters in Business Administration), MPH (Masters in Public Health), and MMM (Masters in Medical Management). These are the most popular degrees for this path but not the only ones. The resources listed at the end of this article discuss additional options or link to them. The [American Association of Physician Leaders](http://www.physicianleaders.org/) (formerly known as ACPE, American College of Physician Executives) is an important organization for physician executives and offers a number of educational programs. Additional certification as a [Certified Physician Executive](http://ccmm.org/) (CPE) is also available through the Certifying Commission in Medical Management (CCMM). **Other “Non-Clinical” or Alternative Career Paths** There are a host of other non-clinical or alternative career paths to consider. When searching for information on this topic the term non-clinical is used though any of these paths could be combined with clinical practice to form a blended career path. In general non-clinical jobs can be grouped into: Medical communications/writing/education; Consulting; Health Information Technology (Health IT); Pharma/Biotech; and Medical Law. The specific jobs for medical communications/writing/education can include: medical marketing, medical recruiting, certified medical education, medical publications, and medical blogging. Consulting jobs are generally for clinical cases or business challenges, medical start-up companies, medical device companies, and medical chart reviews. Health IT jobs may include electronic health records and medical informatics. Pharma and Biotech jobs exist in medical research (performing the research or a regulatory position), medical science liaison, medical sales, and medical entrepreneurship. Finally, medical law is another non-clinical area to consider. SEAK, Inc. is an ACCME accredited continuing education & publishing firm that hosts an annual conference entitled: [SEAK’s Non-Clinical CareersConference ](http://www.nonclinicalcareers.com/conference/)that may be of interest for those seriously considering these career paths. Blended, alternative or non-clinical career paths are certainly not for everyone. However, being informed about them and exploring them may just help you organize your best career path no matter what your current career level. ## Resources **General** <http://www.medscape.com/viewarticle/827680> [http://www.the-rheumatologist.org/details/article/1458007/Challenges\_and\_Rewards\_of\_a\_Physician\_Executive\_Career.html](http://www.the-rheumatologist.org/details/article/1458007/Challenges_and_Rewards_of_a_Physician_Executive_Career.html) <http://www.cejkaexecutivesearch.com/leadership-insights/executive-recruitment-library/inside-the-executive-office-physician-leaders-share-experiences-advice/> <http://creativeleadersforum.com/2013/02/09/do-physician-executives-need-advanced-degrees-barbara-letourneau-md-mba/> <http://www.nonclinicaljobs.com/2010/04/popular-alternative-medical-careers-for.html> <http://www.nonclinicaljobs.com/p/career-coaching-for-physicians.html> **Degrees** <http://business.louisville.edu/wpprod/images/Ranked20.pdf> [http://www.physicianleadership.com/articles/physician\_MBA.htm](http://www.physicianleadership.com/articles/physician_MBA.htm) <http://profitable-practice.softwareadvice.com/should-you-get-a-healthcare-mba-0114/> <http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2013/09/17/consider-a-master-of-public-health-in-addition-to-an-md> <http://www.healthcare-administration-degree.net/the-mba-for-physicans-master-of-medical-management-mmm/> <http://www.usnews.com/education/blogs/law-admissions-lowdown/2013/02/25/consider-career-goals-before-getting-a-joint-degree> <http://www.premedhq.com/2013/01/list-of-mdjd-programs.html> **Organizations, Conferences and Certifications** [http://www.physicianleaders.org](http://www.physicianleaders.org/) [http://ccmm.org](http://ccmm.org/) <http://www.nonclinicalcareers.com/conference/> **Categories:** career development --- ### [#HonorYourMentor](https://blog.womensurgeons.org/honoryourmentor/) **Published:** January 29, 2015 **Author:** Blog Team **Content:** ![](http://blog.womensurgeons.org/wp-content/uploads/2015/01/m-2Bcatherine-2Blee.jpg) **Mentor: M. Catherine Lee** **Recognized by: Chantal Renya** As the previous breast fellow at H. Lee Moffitt Cancer Center and Research Institute, I have had the privilege of working with Dr. M. Catherine Lee from the very beginning of the year. Dr. Lee has provided guidance on clinical and research aspects throughout the year me. I had never written a manuscript before and under her guidance I had three manuscripts accepted for publication. She had the time, patience and dedication to teach me and guide me throughout the process. She met with me on a weekly basis and more as needed. She even met with me outside of the hospital, including at coffee shops at 8pm and in her home on the weekends. She never once made me feel like an inconvenience. Under her guidance, I had two abstracts and poster presentations accepted, and three manuscripts accepted for publication. A vast improvement from where I started. She also provided me guidance in career decisions. She sparked my interest in an academic career with research, and as a result I have become a breast surgeon at University of Texas, MD Anderson Cancer Center. In addition, she has taught me new surgical techniques and critical thinking. If this were all, she would still be an outstanding mentor; however she has done more. When I first moved to Tampa, I had recently undergone a divorce. It was a hard time for me: moving to a new place, without any family, without any friends and newly divorced after a 12 year relationship. She gave me emotional support and made me feel welcome. She provided me a new home: a place to feel secure and to grow freely. My year would not have been the same without her. She is a strong, intelligent, brilliant surgeon who I would be proud to be half as good as she is. May I someday provide the same intellectual and emotional mentorship to someone else as she has provided for me. Do you have a story to share? Tell us about your mentor! Would you like to make a contribution to #HonorYourMentor? Click [here](/donate-today) and donate today. **Categories:** mentorship --- ### [#HonorYourMentor: Let's talk about mentoring](https://blog.womensurgeons.org/honoryourmentor-lets-talk-about-mentoring/) **Published:** February 13, 2015 **Author:** Blog Team **Content:** By: Sidrah Khan Women have made astonishing strides in medicine coming from an enrollment of 6% in 1960 to now forming 50% of the medical school classes nationally. Women have worked hard to make themselves equally represented in almost all specialties of medicine, including internal medicine, family medicine, and pediatrics. However, one field of medicine still remains unable to rid itself of the gender gap and that is surgery. Even with the female enrollment in medical schools being equal to that of men, women are greatly underrepresented in surgery, making up only 35% of general surgeons, and less than 20% in specialties such as orthopedic, neurologic and thoracic surgery. Women are not only less likely to pursue a career in surgery but they are also less like to attain leadership positions in academia. Women make up only 14% of department chairs, 20% of chief residents, and 12% of medical school deans. As a perspective surgeon, it is concerning to me that I am entering a field dominated by men and one with such a prominent glass ceiling. It worries me that I am pursing a career in which my gender alone will put me at a disadvantage when applying for leadership positions. It is disturbing that I have the possibility of faceing sexism and bias in my work environment because as a woman my family life will be considered a distraction. It is also concerning to me that I won’t have the right mentorship to learn from with such few women in leadership positions. Not only will I have to face the challenges that come with a rigorous surgical residency, but additionally the challenges that come along with being a female in a male dominant field. As a second year medical student, a few months away from starting my third year clerkships, I am looking forward to coming together with the members of the Association of Women Surgeons to discuss these issues and the reasons why surgery is still lagging in ridding itself of the gender gap and its glass ceiling. Being able to learn from experienced female surgeons about the challenges they have faced in their careers while trying to achieve leadership positions, will be of great benefit for my future. I would also like to hear what advice the members have for perspective surgeons on how to handle situations in which sexism arises and discuss the resources available for them. Lastly and most importantly, I am looking forward to discussing how we can increase mentorship for females in medical schools. I believe early and effective mentorship can provide more exposure to surgery, clarify common misconceptions and ultimately decrease the stigma that the field holds. I am hoping that with the combined effort of perspective and experienced female surgeons we can empower more women to not only pursue surgery but also attain top leadership positions in academia. - Jagsi, Reshma. [The “Gender Gap” in Authorship of Academic Medical Literature — A 35-Year Perspective](http://www.nejm.org/doi/full/10.1056/NEJMsa053910) - Zhuge, Y. Is there still a glass ceiling for women in academic medicine. April,2005 - [Women in U.S. Academic Medicine and Science: Statistics and Benchmarking Report 2011-2012](https://members.aamc.org/eweb/upload/Women%20in%20U%20S%20%20Academic%20Medicine%20Statistics%20and%20Benchmarking%20Report%202011-20123.pdf) ![](http://blog.womensurgeons.org/wp-content/uploads/2015/02/Sidrah.jpg) **Categories:** mentorship --- ### [Visiting Professor at Washington University](https://blog.womensurgeons.org/visiting-professor-at-washington-university/) **Published:** March 30, 2015 **Author:** Blog Team **Content:** ### by: Amalia Cochran, MD, MA, FACS, FCCM ![Visiting Professor](http://blog.womensurgeons.org/wp-content/uploads/2015/06/Visiting-Professor.jpg) **Categories:** Uncategorized --- ### [Engagement through Advocacy](https://blog.womensurgeons.org/engagement-through-advocacy/) **Published:** March 30, 2015 **Author:** Blog Team **Content:** by: Amy Liepert, MD “Oh my! You look too young to be a surgeon!” This was not exclaimed to me (this time) by a patient, although I have often heard that. As I am nearly 2 years out of my fellowship training and not having taken significant time off, my age is not much of a secret. However, instead of my response this time being an assurance that indeed I am old enough, and I am older than I look, as it might have been to a patient or family member, this time I responded differently. “With all due respect Lieutenant Governor, YOU do not appear old enough to be Lieutenant Governor!” With engagement in advocacy you never know what chance meeting, connection or opportunity might arise to put you in the position to influence and impact the care of your patients at a legislative level. While participating as part of my state’s physician advocacy day, known as Doctor Day, I had the opportunity to meet one-on-one with the young and female Lieutenant Governor of my state. Just as medicine and surgery has been undergoing a transformation with the incorporation of more female surgeons, women are making up a greater proportion in politics. As women have impacted and influenced the practice of surgery for the better, we also carry the responsibility to ensure equitable and quality care to our patients. This often requires engagement in the political arena. Engagement in these activities is not about partisan politics; it is about developing relationships with those who navigate within the political sphere. Those relationships allow us to share the important work that we do for our patients and to ensure that the amazing care that we have been trained to provide is protected. As I have participated in advocacy days and in-district meetings on both a national and state level, I have found myself talking less and less about specific policy agenda items and more about patients, the care I provide, and the challenges I have faced in delivering care. As legislators learn more about these real-life example circumstances they seek out solutions. More often than not, those inquiries lead back to the issue briefing that were meant to be the topic of discussion. Advocacy and engagement is less of an additional burden or task to the surgeon, but instead it is an extension of the important work that each of us contributes to our patients each and every day. Each phone call, each email, each letter, and each visit to legislators are important and vital components for the care of your patients. Relationships developed with legislators who can rely on you, as an expert surgeon reference, is a priceless gift that a surgeon can give to her patients. I encourage each of you to challenge yourself to engage in the on-going care of your patients by engaging with your (and you patients’) representatives. Share stories, successes and challenges. You will find legislative members of government who look similar to you and many who do not. But sharing your viewpoints, experience and expertise is a necessary extension of your role as a surgeon. It is now easier than ever to participate. Check out [Surgeonsvoice.org](http://surgeonsvoice.org), the advocacy dedicated webpage created by the American College of Surgeons. Here you will find all kinds of information including current issues. Log in with your ACS member ID number and last name. Engaging in advocacy is easy once you start. In order to make that transition look to join a Doctor Focused Advocacy Day in your state or attend the ACS Leadership and Advocacy Summit in April. These types of events are supportive, educational and fun. Finding common ground with legislators is the method to ensure a strong on-going foundation to the future quality of care for all of our patients. **Categories:** advocacy --- ### [Advocacy for Our Patients and Ourselves](https://blog.womensurgeons.org/advocacy-for-our-patients-and-ourselves/) **Published:** March 31, 2015 **Author:** Blog Team **Content:** by: Amalia Cochran, MD, MA, FACS, FCCM How many of you have written a letter or sent an email to your member of Congress about an issue? How many of you have called your member of Congress’ office? How many of you have visited your member of Congress office, either in the home district or in DC? How many of you aren’t sure this stuff matters? Does it *really* make a difference when you call or write or visit to discuss the SGR or the zero-day global or ongoing support for trauma systems? I’m here to tell you that it does matter. Our Senators and our Representatives are listening- maybe not they themselves directly, but they are using their staff members as their eyes and ears to review those emails and letters and calls. They are interested in what you, as a constituent, have to say. When you are able to develop a longer-term relationship with a staffer, you can even become a content expert for them so that when issues they know are within your scope of practice come up, they’ll contact you for support and further information. So, yes, your engagement on these things matters, and can even bring your Representative along to become a co-sponsor of meaningful legislation or to vote “Yay” or “Nay” in a way that helps our patients and helps the profession of surgery. I recently crowdsourced on Twitter, and immediately realized that the biggest gap for most people with advocacy is that they simply have no idea where to start. Here’s a helpful visual for you, recognizing that you want to start at the broad base of the pyramid: ![](http://blog.womensurgeons.org/wp-content/uploads/2015/03/advocacy-2Bpyramid.jpg) The great news is that the American College of Surgeons has developed a resource in the form of [Surgeonsvoice.org](http://surgeonsvoice.org/); once you log in to the site using your ACS member number, it provides you with a roadmap for advocacy, especially if you go to the Action Alerts. They set you up to seamlessly send an email to your member of Congress in two minutes or less. If you are interested in becoming a bit more engaged, the next step would be to set up an in-district meeting with your member of Congress and/or their staff. I strongly recommend that the first time that you do this, take someone with experience with you. It will make it less intimidating and more fun- and it’s an opportunity to participate in some peer mentoring. In-district meetings are easy to set up, and you can do it simply by making a phone call to their local office. Finally, a shameless plug. Please come to Washington, DC, in April for the [ACS Leadership and Advocacy Conference](https://www.facs.org/advocacy/participate/summit). It’s a wonderful opportunity to rub elbows with College leadership, you get trained in the process for doing Hill visits, and your appointments all get made for you. Most importantly, someone from your state will usually have done this before, so you have that experienced peer mentor who I alluded to above. So, get involved. Send a letter, make a call, set up a meeting…go to DC for the leadership and advocacy. Your voice matters. **Categories:** advocacy --- ### [A Different Kind of Mentor](https://blog.womensurgeons.org/a-different-kind-of-mentor/) **Published:** July 12, 2015 **Author:** Blog Team **Content:** by: Kathryn Hughes, MD, FACS Mentorship in medicine and surgery was not always formally acknowledged and promoted. Today not only is it acknowledged and promoted, but also the importance of mentorship for professional development through the arc of a career is stressed. However, for many women, the one-to-one relationship of the classic mentor-protégé remains elusive, complicated by gender and generational differences. This has been especially true for the groundbreaking women before me, and for some remains true even today. In a very real and tangible way, the [Association of Women Surgeons](https://www.womensurgeons.org/home/index.asp) has been a mentor to me, and perhaps to other women surgeons as well. The mission of the Association of Women Surgeons is “to inspire, encourage and enable women surgeons to realize their professional and personal goals.” This sounds a lot like the description of a mentor. (The AWS even publishes a book entitled [*ThePocket Mentor*](https://www.womensurgeons.org/Residents/Residents.asp)). So that begs the question, can an organization itself be a mentor? I would assert that it can be. Mentorship and the mentoring relationship overlap and encompass many other roles. One can have more than one mentor, each for different activities or components of work and career, or just one mentor to help with the big picture. Role model, professor or teacher, advocate, coach all come to mind, and mentors may be any or all of these to some degree. A mentor provides encouragement and support, advocacy and sponsorship; they guide and educate. The relationship between a mentor and protégée is notable for longevity over time. These sorts of professional relationships formed in the past as they do now, but they were spontaneous and organic, as junior- and senior-level individuals naturally gravitated together, bonding over shared interests or goals. However, mentorship was not well defined or delineated, not identified beyond one of its component functions of advisor, teacher, proctor or coach. The mentoring relationship retains that spontaneous and organic nature; it can’t be forced or assigned. Unlike then, however, there is encouragement to go and look for mentors. You will never find these relationships if you don’t look. I certainly had role models and champions along the way as I moved through the stages of my education. Teachers and professors and coaches, residents and attendings who took an interest in, supported and encouraged me. To them I am thankful and grateful. But there is an important part of the definition of mentorship, the concept of developing and nurturing the relationship and the guidance over time that differs from these relationships. Mentorship as I understand it is different, and it is more. [Women in surgery remain a minority](https://www.womensurgeons.org/aws_library/Why_AWS_is_Important.pdf), more striking as one advances through the ranks, just as striking in community practice as in academia. Whether academic rank or leadership in societies and organizations, the farther up the ladder you go, the fewer women you see. This is mirrored in community and in private practice, where there may be no women at all, or maybe just one. I am hard-pressed to think of many practices outside of breast surgery with more than one woman. A surgical practice may strive to have a woman, but rarely more than one. In fact, often if a community has more than one woman surgeon on staff, these women will usually be found in different specialties. This is very isolating. Although we have much in common with our female colleagues in other specialties and other professions, there is much about surgery that remains unique and uniquely challenging. We seek mentors to help us navigate the day-to-day challenges as well as to help guide the trajectory our career. Many of us have had meaningful guidance and mentorship from men, but since it’s a given that our male colleagues can’t truly understand the challenges unique to being both women and surgeons, their help can only go so far. This is the void that the Association of Women Surgeons fills. Into this place the organization steps in, as a surrogate for an individual mentor. As a group, the AWS makes good on the promise of its mission statement, taking the form of conferences, lectures, networking, committee work, and publications. Since the AWS first came together, the organization has been there for all women in surgery, at all levels. Along with other similar groups, the AWS has deconstructed the dynamics of the “good old boys network,” identifying and promoting both theory and practice of networking. Indeed, I believe by shining the light on mentorship, we now pay attention to it. Mentorship is deconstructed, defined, and promoted. Our students and trainees seek mentors. I don’t think this is a coincidence that the attention to mentors and mentorship has paralleled the activity and growth of women (and their organizations) in medicine and surgery. This benefits not just the young women in medical school and residency, but all physicians in all levels and stages of career, male and female. Today there are opportunities for women in surgery to find each other and connect, especially with the expansion of social media. Organizations like the AWS catalyze this. The challenges going forward are to harness the power of technology and social media to continue to connect, to network, to support, and to form mentoring relationships. To increase involvement and engagement in the core constituency of general surgery (as the meeting piggybacks on the American College of Surgeons annual Clinical Congress), and meaningfully include women in all of the surgical specialties, including GYN surgery, where a parallel organization such as ours does not exist. Our numbers will continue to grow, so will our influence. The fellowship and support of the Association of Women surgeons is the surrogate mentor for all of us as we continue to chip away at the glass ceiling, and provides the structure for those who do break through to send a ladder back down to offer other colleagues a rung to stand on and a way up. *Dr. Kathryn A. (Kathy) Hughes, FACS is a General Surgeon, practicing breast and general surgery. She has spent the majority of her career in private practice in community hospitals, where she has had leadership roles as Chief of Surgery and most recently Vice-President of the Medical Staff. In addition to the ACS and AWS, she is a member of the American Society of Breast Surgeons, the AMA, and the Massachusetts Medical Society, where she represents the North Essex District in the House of Delegates, and serves on the Committee on Women in Medicine.* *She currently resides and practices in Massachusetts. She has ventured out into social media and is on Twitter as @DrKathyHughes, you can find her on Facebook as DrKathy Hughes and on her page Behind the Mask. She blogs from[ Behind the Mask](http://behindthemaskmd.com/) on WordPress.* **Categories:** mentorship --- ### [AWS Foundation](https://blog.womensurgeons.org/aws-foundation/) **Published:** July 12, 2015 **Author:** Blog Team **Content:** By Hilary Sanfey MB. BCh. MHPE. FACS. FRCSI Chair, AWS Foundation Board I have been approached on a number of occasions by young surgeons who begin a conversation with “You won’t remember me BUT…… I was your medical student / resident, and because of you I decided to become a surgeon”. These are the most fulfilling moments of my career. Nothing gives me more pleasure than knowing I did or said something to help another person achieve success. After all, this is the AWS mission; to inspire, encourage, and enable women surgeons to realize their professional and personal goals. A considerable number of the women surgeons who have achieved significant leadership positions are AWS members, and owe their success in part to the mentorship, support, and collegiality offered by other AWS members. For example: ***Did you know that 9 of the 10 women surgeons who were successful in becoming chairs of academic departments of surgery are AWS members?*** The AWS Foundation relies on the generous financial support of AWS members and friends like you to deliver meaningful educational opportunities for medical students, residents, and women surgeon members and thus continue our work. You have the opportunity to recognize the person that helped you develop the skills and confidence you needed on your path to becoming a great surgeon. Your mentor will receive a special tribute letter recognizing your gift in his / her honor and your gift will be acknowledged on the AWS website. Donations will go to support AWS Foundation programs. These include: - **[The Kim Ephgrave Visiting Professor Program](https://www.womensurgeons.org/about-us/aws-foundation-awards/#VP)** – provides medical schools with opportunities to heighten the visibility of women surgeons while encouraging women medical students to pursue similar careers. In addition, the Visiting Professorship Program promotes dialogue between practicing surgeons, surgeons in training and the academic community. - **[AWS Foundation Awards Program](https://www.womensurgeons.org/about-us/aws-foundation-awards/#VP)** – honors outstanding female medical students, residents and AWS Members and provides opportunities for career advancement through exposure to successful women surgeons and potential mentors. Includes the Nina Starr Braunwald Award, Olga Jonasson Distinguished Member Award, the Past Presidents’ Honorary Member Award, Hilary Sanfey Outstanding Woman Resident Award and the Patricia Numann Medical Student Award. [Click here](https://www.womensurgeons.org/support-aws/donate-today/) to make your donation. Select “Legacy Fund” in the drop down menu under “Donation Type.” Following the amount of donation, click the “In Honor Of” box that will provide you with a drop down to enter your mentor’s name and contact information. Thank you for honoring your mentor with a tribute gift today! *![Sanfey 2015](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Sanfey-2015-300x298.jpg)Dr. Hilary Sanfey is Professor of Surgery and Vice-chair for Educational Affairs at Southern Illinois University, and the current Chair of the AWS Foundation Board. She was previously a Professor of Surgery in the Transplant Division of the Department of Surgery at the University of Virginia (UVA), where she was a member of the university Senate, and of the UVA Academy of Distinguished Educators.* **Categories:** mentorship --- ### [Book Announcement: Being a Woman Surgeon](https://blog.womensurgeons.org/book-announcement-being-a-woman-surgeon/) **Published:** July 12, 2015 **Author:** Blog Team **Content:** by Jane Zhao, MD ![preeti john](%5Bsiteurl%5D/wp-content/uploads/2015/07/preeti-john.jpg)Preeti John, MBBS, MPH, FACS, is the editor of *Being a Woman Surgeon: Sixty Women Share Their Stories,* an anthology of stories and poetry from 60 women surgeons around the country. The anthology will be the first of its kind. It was created after Dr. John found herself being asked by one female medical student after another about her personal pursuit into surgery. It was then that she realized what a dearth there was of first hand accounts from women about life as a women surgeon. In retrospect, this is not entirely surprising. Despite the numerous strides made toward gender equality in the 21st century, women still comprise little more than 20% of the surgical workforce. As a result, many women take heart when they can connect with other women surgeons. Now, thanks to this anthology, the tradition of passing on stories from one woman to another—as well as our male counterparts—is easier than ever. The authors of this anthology include but are most definitely not limited to the following surgeons: Nia D. Banks, Patricia J. Numann, Susan E. Pories, Kathleen Yaremchuk, Martha A. Zeiger, Joan Huffman, and Sylvia Marina Ramos. Compiling this anthology has been a labor of love for Dr. John over the last couple of years. I remember as a medical student receiving e-mails about this up-and-coming anthology. It is an honor for me to now as a resident be the one to introduce this anthology by Dr. John on the Association of Women Surgeons blog. ![being women surgeon cover only](%5Bsiteurl%5D/wp-content/uploads/2015/07/being-women-surgeon-cover-only-198x300.jpg)Here are what some of my favorite role model physician authors have to say about the anthology: “Dr. John has carefully collected an illuminating anthology of experiential writings from women surgeons. Her contributors vary in surgical specialty, years of experience, and personal situation. This rich and literate collection will prove fascinating reading for anyone interested in the world of medicine.” – Carol Scott-Conner, MD, PhD, MBA, FACS, author of *A Few Small Moments.* “An extraordinary collection of essays written by an even more extraordinary group of women, this book offers an unparalleled view of what it is like to be a woman surgeon. It is the book that I wish I had as a medical student and that even now I find inspiring.” – Pauline Chen, MD, FACS, New York Times columnist; author of *Final Exam: A Surgeon’s Reflections on Mortality.* “This is a poignant and moving narrative collection from women who each in their own way were pioneers in their field of surgery. The story of the courage, physical strength, stamina and, most of all, the mental fortitude required to complete surgical training is beautifully conveyed here. This collection will hopefully both inspire and make the path easier for the next generation of surgeons, both women and men.” – Abraham Verghese, MD, author of *Cutting for Stone*, *The Tennis Partner*, and *My Own Country.* “This book is an enthralling read. It is all too rare to hear the stories of surgeons, and even rarer to hear those of women surgeons. Yet here they are, told straight out, fearlessly, by residents and retirees alike. The stories are by turns funny, heartbreaking, flabbergasting, infuriating, inspiring-and at times all of these at once. Each voice here is singular and fascinating. But the collective effect is overwhelmingly moving. You want to hear more.” – Atul Gawande, MD, MPH, FACS, staff writer for The New Yorker, author of *Complications*, *The Checklist Manifesto*, and *Better.* “An inspiring compendium of stories that challenged a generation and defined an era. Being a Woman Surgeon will be the archival account of the women who dared to radically advance the world’s greatest profession.” – Marty Makary, MD, MPH, FACS, author of *Unaccountable.* To listen to an audio from Dr. John and some of the contributing authors, click [here](http://www.prattlibrary.org/booksmedia/podcasts/index.aspx?id=84170). *Being a Woman Surgeon: Sixty Women Share Their Stories* will be published June 1, 2015 by Gordian Knot Books. It will be 337 pages and sold for $29. Dr. Preeti R. John is a critical care surgeon who works at the VA Hospital in Baltimore, Maryland. She is also faculty at the University of Maryland. She is triple board certified in General Surgery, Surgical Critical Care, and Hospice and Palliative Medicine. \~~~ *[![JZhao](http://blog.womensurgeons.org/wp-content/uploads/2014/07/JZhao.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/07/JZhao.jpg)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 Housto* **Categories:** Uncategorized --- ### [The Influence of a Mentor](https://blog.womensurgeons.org/the-influence-of-a-mentor/) **Published:** July 12, 2015 **Author:** Blog Team **Content:** by: Betzy Childers When brainstorming about the role mentoring has played in my life, I realized it provided the answer to a question I have asked myself at various overwhelming and wonderful points in my 27 years of life, “*How in the world did I end up here?”* Now, I am wise enough to realize much of it is due to watchful and caring mentors who have shaped my journey, beginning with my parents. My experience is an intricate mix of running and academia with goals and dreams to bring the two together. I grew up as one of four children in a two-bedroom trailer home half a mile outside of a small cattle town in Hereford, Texas. My parents worked constantly, often two jobs, to make ends meet. They exemplified the meaning of determination and hard work, never wavering because they believed in a brighter future for their children. My mother often found work washing dishes, cleaning houses, and even worked nights at a meat-processing factory. Her fifth grade education didn’t impede her from instilling in us the value of working hard, being honest, and always doing our best. My father was off to work road construction before the sun rose and returned home after we had already eaten dinner. They taught me that pursuing a goal is possible when you believe it is a worthwhile cause. This is a valuable lesson that has applied to different challenges I have faced and will apply to challenges I will face on the road to becoming a surgeon. I first proclaimed I wanted to be a doctor during the final rounds of my third grade science fair. I found it appropriate at the time since I managed to move from a Spanish speaking classroom to an English one. I was making strides. Thank goodness they didn’t ask me how I planned to pay my way through college or medical school because I had no idea. All I knew was I needed to do well in school and I knew I needed to go to college. I continued to do well and soon after entering junior high, I discovered I was also a pretty good runner. My high school coach noticed my talent and began to encourage me to work a bit harder. He continues to be a vital part of my life and a lifelong mentor. Through his vision I learned to commit to a goal, pursue it with purpose, and most importantly, believe in myself, even when others think you are completely out of your mind. I have found this invaluable because there will be occasions when people believe that you don’t belong. I am thankful that I am able to believe beyond their doubt, which is an ability that proves to be important for doctors, especially surgeons. My coach’s guidance helped me earn a fully sponsored education and athletic scholarship to The University of Texas in Austin. This may have been the first time I thought, “*How in the world did I end up here?”* I was surrounded by world-class athletes, researchers, instructors and top-notch facilities. I had many once in a lifetime experiences. As a first generation college student and a student athlete, I learned to be increasingly tough, disciplined, and resilient. I returned to train under my high school mentor and earned a spot to represent Team USA in Edinburgh, Scotland in 2012, qualified for the Olympic Trials in the 5,000m later that year, and ran in the USA 5,000m Road Championships during my second year of medical school (2013). Pursuing my passions under the guidance of my mentors has encouraged me to dream a little bigger and be a little bolder. Each step has provided me with another tool or another learning experience. Above all else, I continue to have a love for running that remains with me wherever I go. It is something familiar and constant that helps me cope with the stresses of daily life in a healthy way. What a remarkable gift. I started medical school in 2012 and found myself in disbelief that life was happening to me. Shortly into our first semester we were to meet with faculty in various specialties to begin developing our professional network. Oddly enough, my mentor is a brilliant transplant surgeon. I met with him for the first time outside of the OR at 7:00am. I was wogging (walking + jogging) down the hospital hallway, almost late because I was a little lost. I pretended I was not out of breath and proceeded to introduce myself. Since that day he has continued to be open and available for any question that I might have. He has never discouraged me from any idea or organization I decided to start. He extended an open invitation to team meetings, rounds, and a few surgeries when I didn’t have to be in class. I have had the opportunity to learn by observing him interact with others and with me. In some ways it has been a journey of self-discovery, realizing where I am inevitably meant to be. The transplant floor at our University opens into a long hallway lined with black and white portraits of transplant recipients. Some photos have both the donor and the recipient, both smiling into the camera because they share a unique bond. Medicine and the hands of a particular surgeon helped offer them another chance at life. They were granted a little more time to pursue whatever they believe is worthwhile. I love walking down this long hallway. It inspires me to dream, to pursue, and ultimately become the surgeon I want to be. February 5, 2015 marked another unforgettable moment in my life. While on my surgery rotation, I wandered down to my mentor’s OR since I heard mention of a transplant. He immediately said, “Betzy you should scrub.” I had a flood of emotions. I went from wondering, “*what am I doing here”* to feeling sure of myself, an affirmative, “*I belong here*.” I marveled at his skill, his presence in the OR, and the absolute respect his team had for him. *“Take the bovie and go through the skin. Get a sense for how it works.”* As I continue toward the completion of my third year, I reflect on my experiences and the mentors who have shaped who I am and who I want to be. Simply speaking, a mentor is someone who advises you. I believe I have received life lessons, tools, experiences, and inspiration from my mentors. They have each guided me to become who I am, developed my strengths, and exposed my weaknesses. They are individuals who I can come to openly with insecurities, questions, and any doubt about what comes next. I believe in the powerful influence one individual can have on another at any given point in life. I actively serve as a mentor for students from disadvantaged backgrounds and speak at high school events whenever I am granted the opportunity. My hope is that something I say or do will inspire them to dream wildly and grants them the courage to pursue what they believe is worthwhile. All of which, many others have done for me. **Categories:** Uncategorized --- ### [Having it all means having good physical, mental and spiritual health, too!](https://blog.womensurgeons.org/having-it-all-means-having-good-physical-mental-and-spiritual-health-too/) **Published:** July 12, 2015 **Author:** Blog Team **Content:** by: Marie-Christine Wright, JD “I’m discovering that women can have it all, just not all at the same time.” If we can’t have it all at the same time, is there always room for wellness, and what does being well really mean? There is the obvious answer: physical health. But in addition, we must nurture our mental and spiritual health. A surgical career requires nurturing, but so does a human being: how do we do both, without compromising either? First we must view our life’s path in two timelines: the daily minutiae and the long-term. We want to exercise and eat well on a daily basis, which seems impossible when one has all but 10 minutes to shove hospital cafeteria food in one’s mouth, spends 12 or more hours on her feet rounding or in the OR, and has to keep up with her field by reading after work. When are you supposed to exercise if you are in the hospital by 5:30 am and home after 8 pm? While you may not have time for a gym session, you can execute a simple routine at home, whether it’s a brisk jog, yoga, or stretching. Take the stairs at work. Invest in healthy snacks that you can bring to work to prevent cafeteria binging, and spend the extra money to buy healthy prepared meals that are easy to warm up at home, rather than getting take out. Or, just prepare large batches of healthy fare once a week (if you’re like me and easily get bored eating the same thing, freeze single portions of several large dishes so that you can defrost something different each night). Admittedly, as a student, fitting in exercise and preparing one’s meals is much more doable. An hour of exercise can actually help break up a marathon study session and refresh the mind. And better eating translates to better thinking. Beyond exercise and eating well, spiritual nurturing comes in the form of community service. I always feel lighter and more fulfilled after spending time helping the community, whether I am assessing inpatients at the local drug abuse recovery shelter, or working on art projects with children. Your community service can, but does not have to, be medical in nature, especially if you have outside interests (side note, having outside interests makes you more interesting as well!). Long-term, mission trips are important humanitarian work that not only benefit the community you are servicing, but help fill the well of your soul, too. One of the members of the [AWS Medical Student Committee](https://www.womensurgeons.org/Students/Get_Involved.asp), National Chair Carla Valenzuela, recently traveled to Kenya to assist with a Head and Neck surgical mission. She described her experience as life-changing: “I would recommend a mission trip to anyone in medicine—it opens your eyes to health disparities and how much you can accomplish with patience, thinking resourcefully, and working as hard as possible to improve patient outcomes in a place where there are limited surgical subspecialists.” Medical schools are generally supportive of such trips, and students should not be afraid to ask for excused absences and flexibility to accommodate such essential experiences. Residents, too, will find their institutions supportive in planning around mission trips; you just have to know how to formulate your request. If you need to get away and recharge your batteries, take advantage of vacation days. Ultimately, being healthy requires that one set boundaries to protect life outside of work. From a resident’s perspective, “A lot of us lose some of our outside selves to medicine, and we are doing okay, but we could be doing so much better. We shouldn’t just accept ‘okay.’” *[![MC Wright](http://blog.womensurgeons.org/wp-content/uploads/2015/07/MC-Wright.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/07/MC-Wright.jpg)Marie-Christine Wright, JD is a medical student at Tulane and the National Vice-Chair of the AWS Medical Student Committee. A nontraditional second year student, Marie-Christine founded a financial firm in Switzerland and obtained her law degree before attending medical school. She has long been interested in pediatric neurosurgery and looks forward to empowering women to pursue careers in surgery.* **Categories:** self-care --- ### [Interview on Mentoring with Dr. Angela Neville](https://blog.womensurgeons.org/interview-on-mentoring/) **Published:** July 12, 2015 **Author:** Blog Team **Content:** by: Dr. Angela Neville, MD and Medical Student Katherine Jeffress, MA, MPH **How have mentors positively impacted your career?** Mentors have probably most impacted my career by being examples – good examples. 🙂 I feel that my mentors have helped and continue to help shape my career (and sometimes personal) path. Originally, my mentors helped me choose a career in medicine and subsequently in a surgical specialty. By finding people that I could identify with and learn from, I was able to begin molding myself to “be like them.” My career mentors were initially all men, because there were no women on my immediate teaching faculty. My junior chief year, my residency finally hired a woman who was wholeheartedly part of our residency. It was life changing to have a woman to aspire to be like. It was life changing to see male residents respect and feel that a woman could teach them something!! That being said, I feel that women can certainly have both men and/or women mentors. Ultimately, my mentors continue to impact my career by being there and caring about me as a person. If I have a question about a career decision, I know that my mentors will “have my back” and advise me in a positive way. **What have you learned through your mentoring experience?** I have learned that we all have insecurities and vulnerabilities, but that we are all just trying to be the best we can be. This is true for both men and women. Even the most outwardly accomplished person has their struggles about something and needs to be given the space to ask that question or explore their self doubt. The majority of the students / residents that have sought out my advice or opinion tend to be women, but I think that is because women tend to look outside of themselves and try and figure things out. I have perhaps been most touched when one of our male residents comes to me asking about how to handle a difficult emotional situation or what operation he should do. It reminds me that being open, approachable, and demonstrating sound judgment makes people feel comfortable asking for help when they need it. This is a huge part of being a good mentor. **What has surprised you about being a mentor?** Maybe, how important this role is to me. Sometimes, when I have thought about leaving academic medicine, the one thing that holds me back is the concept that I can be a role model of strength, competency, and compassion to both men and women and students and residents alike. As I mentioned before, there was a single woman surgeon at my teaching institution. Since that time, obviously, more and more women have joined teaching faculties across the country, but things are far from equal and there are still many stereotypes about women in surgery. I can remember when one of my female fellows (when I was a resident) told me she would rather be operated on by a man… Really!?! Men can be good and women can be good, just as men can be crappy and women can be crappy. I am compelled to see that we are evaluated (both in our hospitals and in the community) on merit more than gender. **How do I get the most out of mentoring?** Keep your eyes open, find the right mentor(s), and learn something from everyone. Every surgeon that I encountered during my training taught me something. Sometimes, it was by watching them interact with nursing staff or how they carried themselves in the OR during a crisis. Other times it was by seeing how they discussed a complication with a patient’s family member. When I saw something from that person that resonated with me and the surgeon I wished to become I tried to align myself with that person. This concept can work both professionally and personally. Conversely, I think there are also some “anti-mentors” out there — people who you really want NOT to be like!! Like I said, learn something from everyone. **What should a mentee look for in a mentor?** I would advise finding a mentor who you truly feel has your best interest at heart. Sometimes, this relationship takes a bit of time to develop, and you may need to put out a few feelers, but it is worth it in the end. Find a person who you trust so that you can be vulnerable without feeling uncomfortable or that your trust will be violated. Several mentors may be needed to fulfill different needs. For example, maybe you have really identified with a faculty member about how to achieve in the realm of research / academic medicine, but you seek a different direction in your personal life. Another mentor could be particularly useful here. The bottom line is that a good mentor will care about you. **Why do you believe mentoring is so important?** A career in medicine is not ‘normal’ in many ways. Doctors choose a different way of life. While many people out there have several careers in their lifetime, many of us chose medicine in our 20s and have not looked back. We went to school for years and accumulated significant debt. Maybe we delayed marriage or children for our career. Maybe we have neglected family and friends. More over, a surgical career can be exceptionally demanding and requires a constant giving of self. I feel like mentoring is incredibly important because it helps normalize this unique career path and offer advice that we cannot seek from people outside of this realm. My parents to this day do not understand what happens when I am on-call. “You mean you are spending the night in the hospital?” Mentors can provide insight about all aspects of life as a surgeon. Just the other day, I had one of our most accomplished (and intimidating) orthopedic surgeons give me sage advice about how to balance a busy life in surgery with a young child at home (my first and only son is 16 months old). I was amazed that he wanted to take a moment to pass on his experience to me, and it was particularly valuable. He is certainly someone that I felt it worthwhile to listen to, and his words have made me reevaluate my current actions. Mentoring can often help one work through all sorts of on the job struggles (am I doing the correct operation, should I look for a new job, how many days will I need for maternity leave, etc). **What advice do you have for future mentors?** My biggest piece of advice is to NOT advise, but to allow the mentee the freedom to make the decision they want to make. People know what they want. They know what is important to them. For some, it is to be the next president of the ACS. For others, it is to be closer to their family and work shorter hours. Both of these options are OK!! I feel like good mentors ask the mentees the right questions so that the mentee can come to their own truth. Often it involves giving the mentee the confidence to make their own decisions!! I can recall several students in my office in tears because faculty had told them they should really pick a certain specialty but they didn’t want to do that and were afraid of disappointing people. Or a resident in serious angst because somebody told them to rank a certain fellowship first, but they really didn’t want to go there. For the love of Pete!! It is their life. And we are more influential than we think. Those students or residents (and their family and friends) are the only ones that are going to have to live with their decision when they are long gone from our training institutions. How dare we put our personal biases on their life decisions? I guess I am just saying, be careful when you are mentoring. Mentors can be very influential, and I think it is extremely important that we are guiding our mentees in a direction that they truly want to go and not in a way that simply will be pleasing to us. **What do you think are the characteristics that make a good mentee?** This is a really hard question for me because there are so many types of mentoring relationships. I feel I have had many transient interactions with students or residents that came and went, but hopefully in that moment, I was a good mentor. So for those interactions, being a good mentee meant having the courage to come forward and ask the important question for one’s self at that time. In some of my more lasting mentoring relationships, often the mentees had some similar qualities to me and we were able to truly get to know one another. In this way, I knew what drove them both professionally and personally, so I was able to help guide decisions in the correct way. Thus, I am not sure there is a characteristic that makes one a “good mentee,” but feel that the relationship you have with your mentor should come naturally with the right person. I guess my one plea is patience with the mentor. (For example, it has taken me longer than I expected to do this blog. :/) We are all insanely busy, so respect that when you approach a mentor for advice you need to make sure you try and give them the time and space to help you. I will always put my work down for a few minutes to help my mentees, but I may need to reschedule to really get down to the nitty gritty of the problem. I have always been incredibly grateful when my mentors have made time for me, but I try and make sure I make this exchange convenient for them. **Final thoughts…** At the end of the day mentoring helps develop relationships in surgery that can last a lifetime. These relationships are rewarding to the mentee through their successes and the mentor who can watch with a smile as their mentee achieves. Mentoring humbles us as we help people through crisis and comforts us when our time of need arises. For me, mentoring is often a friendship that develops with another in a different life phase, but once established can certainly outlive the confines of that original setting. A special thank you to those who have and continue to mentor me and to my mentees who continue to enrich my life. Thank you to my student, Katherine Jeffress, who asked me to do this post. And thank you for reading. Best wishes for a healthy, happy life. *Dr. Angela L. Neville, MD is a practicing surgeon in the Division of Trauma, Acute Care Surgery, and Surgical Critical Care at Harbor-UCLA Medical Center. She is also the Interim Program Director, General Surgery Residency at Harbor-UCLA Medical Center, and an Associate Clinical Professor of Surgery at David Geffen School of Medicine at UCLA.* **Categories:** mentorship --- ### [Translating “Intellectual Capital” into “Career Capital”--What a Coach Can Do for You](https://blog.womensurgeons.org/translating-intellectual-capital-into-career-capital-what-a-coach-can-do-for-you/) **Published:** July 27, 2015 **Author:** Blog Team **Content:** By: Janet Bickel “We are not what we know but what we are willing to learn.”—Mary Catherine Bateson “Success comes to people who know themselves, learn how to manage and develop themselves, and know how and when to change the work they do.”–Peter Drucker The careers of all physicians represent an enormous personal (and often public) investment. Yet many find themselves ill-equipped to navigate the complex systems characteristic of medicine today and are thus unable to fully capitalize on this investment in terms of job satisfaction or achieving their potential as leaders. Translating “intellectual capital” into “career capital” requires many skills not touched upon during medical school or post-graduate training. Taking effective responsibility for your own career now includes multiple systems and communications skills—that is team-building, bridging numerous kinds of differences, addressing conflicts with sensitivity as they arise, hiring and delegating, negotiating, financial management, and handling chronic tensions between personal needs and organizational realities. Because surgeons work under such demanding conditions and time pressures, many do not develop these skills on the job. Moreover as they take on more responsibilities, some trusted tendencies (e.g. self-reliance, hard-driving perfectionism) can become impediments in such key areas as collaborating, delegating, and team-building. Mentors often provide critical career guidance but may be unavailable when most needed or may themselves be ineffective in key areas or may, like your boss, have a stake in you selecting a particular course of action. **Enhancing current and future performance** For these reasons, hiring a coach can be a wise investment. A staple of leadership development in the corporate world, coaching has been shown to increase the capabilities of motivated professionals particularly in accomplishing objectives, managing conflicting demands and improving collaborations. The professional coaching relationship is a confidential alliance tailored to the client’s needs and goals. Outsourced suppliers of candor and individualized attention, a coach encourages insights into blindspots and defense mechanisms; such supportive feedback spurs personal and professional growth. The coaching partnership creates a framework for incubating growth in the capacity for objectivity and mental complexity. Coaches usually assist their clients in seeking and incorporating feedback on interpersonal and communication skills in order to close the gap between their excellent intentions and the actual impact they’re having. Coaching can also focus on exploring alternative career options, navigating a transition, maximizing success in a new role, building a high functioning team, and adding power to communications. This relationship creates a safe exploratory, energy-producing space such that you see your motivations and assumptions with greater clarity and extract more meaningful lessons from your experiences. Coaching generally occurs through a combination of face-to-face and telephone meetings. The nature of the coaching goals and the client’s progress determine the frequency of coaching sessions, and the duration of the coaching relationship. Coaches generally stay available to their clients by email or telephone between scheduled meetings. **Deciding whether to invest** Common “tipping points” for seeking a coach include acquiring major new responsibilities, deciding to pursue a leadership position, or hitting an organizational or interpersonal “wall.” To identify possible coaches, you might obtain recommendations from colleagues or a Human Resources Office or Faculty Affairs Dean who may have lists of vetted local and non-local coaches. You may prefer to work with a local coach to facilitate face-to-face sessions, or you may be comfortable connecting primarily via phone or Skype. A web search may uncover a coach who is a good fit but vetting can be difficult and time-consuming. Indicators of a coach that is a good fit include: 1) understanding the client’s field and environment with some grasp of their day-to-day challenges; 2) meeting the client “where she is” in terms of personality and needs; and 3) maintaining strict confidentiality regarding the relationship. Deciding whether to invest in coaching needs to be weighed against other demands on your time and resources. If you’re on overload and don’t see how you can set aside time for the work, then perhaps this is not the time (even though a coach can help you get your schedule under control). With regard to affordability, check to see if you have access to a professional development account that can pay for coaching. Or if you’ve recently acquired new responsibilities (especially if no new resources have come along with the work), you may be able to persuade your boss that your department should cover the cost of your developing the required new skills. Each coach charges and handles payment differently, so this is important to discuss up front. When interviewing possible coaches, feel free to raise any question you have related to how they work; there are no dumb questions here! **In Conclusion** The speed and complexities of change and competition mean both more opportunities to grow and more ways for careers to derail. To fully develop your potential and capitalize on your substantial investment in your education, you owe it to yourself to consider what supports would serve you. As in athletics, professionals with superior competencies and dedication are more likely to work with a coach than amateurs—that is, it’s more a signal of ability than disability. *[![photojanet](http://blog.womensurgeons.org/wp-content/uploads/2015/07/photojanet.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/07/photojanet.jpg)Janet is a nationally recognized expert in faculty, career and leadership development with 40 years of experience in academic medicine and science. During the 25 years prior to creating her own business, Janet held positions of increasing national leadership at the Association of American Medical Colleges, including Associate Vice President for Medical School Affairs. She established an Office of Women in Medicine of national repute, including leadership development programs that have stimulated the careers of thousands of women physicians and scientists. She also led AAMC’s first programs in faculty affairs and in student professionalism. Janet continues to publish broadly, with over 60 peer-reviewed articles and two books.*[ www.janetbickel.com](http://www.janetbickel.com/) **Categories:** career development, self-care --- ### [Australian Surgeon Nikki Stamp's Blog](https://blog.womensurgeons.org/australian-surgeon-nikki-stamps-blog/) **Published:** August 18, 2015 **Author:** Blog Team **Content:** This is a blog you’ll want to follow. Dr. Nikki Stamp’s August 8th blog post was: ## [Why women in surgery need other women in surgery – #thisiswhatwelooklike and #ilooklikeasurgeon](https://drnikkistamp.wordpress.com/2015/08/08/why-women-in-surgery-need-other-women-in-surgery-thisiswhatwelooklike-and-ilooklikeasurgeon/) Read it, share it, and get inspired! **Categories:** Uncategorized --- ### [#ILookLikeASurgeon Update](https://blog.womensurgeons.org/i-look-like-a-surgeon-update/) **Published:** August 19, 2015 **Author:** Blog Team **Content:** **By Dr. Marissa Boek** The #ILookLikeASurgeon movement aims to celebrate diversity in surgery to show that a surgeon, in fact, can look like anyone. The response has been overwhelming, awe-inspiring, and unifying. This is about challenging stereotypes (not solely gender-related), celebrating differences, and achieving equality in the workplace. If you haven’t joined in, there’s never been a better time! **Brief background:** Building off the [\#ILookLikeAnEngineer](https://www.takepart.com/article/2015/08/12/look-engineer) campaign, it all started on 8/5 when surgery resident Heather Logghe asked the Twitter-verse if #ILookLikeASurgeon would be next. It was literally the tweet heard ’round the world, as to date there have been over **13,000 tweets** with nearly **34 million impressions** (Check out more stats [here](http://www.symplur.com/healthcare-hashtags/ilooklikeasurgeon/)) in **20 languages** from **over 75 countries**. And that’s not including other social media platforms, such as [Facebook](https://www.facebook.com/ILookLikeASurgeon?fref=ts) and Instagram. The movement has been endorsed by many of the big medicine and surgery organizations, including Association of Women Surgeons (AWS), American College of Surgeons (ACS), The Royal College of Physicians and Surgeons (RCS), the Association for Academic Surgery (AAS), and so many others. Here’s a brief round-up of the response over the last 9 days (and please add if I missed anything!): [Storify](https://storify.com/JasmineMiller/ilooklikeasurgeon) by pre-med student [Jasmine Miller](https://twitter.com/MillerJasmineL) – a compilation of posts [Tagboard](https://tagboard.com/ilooklikeasurgeon/237872) for cumulative, real-time data visualization across all social media platforms **Media coverage**: 8/11 BMJ Careers: [Female Surgeons use Twitter to challenge stereotypes](http://careers.bmj.com/careers/advice/Female_surgeons_use_Twitter_to_challenge_stereotypes) 8/12 Today Show Health & Wellness: [Female surgeons raise awareness about women in medicine with #ILookLikeASurgeon](http://www.today.com/health/ilooklikeasurgeon-raises-awareness-about-women-medicine-t38191) (Reposted by People.com) 8/12 Boston Magazine: [Boston’s Docs Show Support for the #ILookLikeASurgeon Hashtag](http://www.bostonmagazine.com/health/blog/2015/08/12/boston-doctors-surgeons-hashtags/) 8/13 NY Daily News: [‘I Look Like a Surgeon’ hashtag takes off after ‘I Look Like an Engineer’ movement that celebrated women in STEM](http://www.nydailynews.com/life-style/surgeon-hashtag-takes-highlighting-women-article-1.2325102) 8/13: iDIVA: [Female Surgeons Sun Stereotypes About Women in Medicine with #ILookLikeASurgeon](http://idiva.com/news-work-life/female-surgeons-shun-stereotypes-about-women-in-medicine-with-ilooklikeasurgeon/15081332) 8/14 Boston.com: [What does your surgeon look like? Female doctors take to Twitter for change](http://www.boston.com/health/2015/08/14/what-does-your-surgeon-look-like-female-doctors-take-twitter-for-change/zMOonb5LehqtKAqG0UW16L/story.html) 8/14 BBC News: [Female Doctors Saying “I Look Like A Surgeon”](http://www.bbc.com/news/blogs-trending-33935375) **Blog posts**: 8/7: Allies for Health: [\#ILookLikeASurgeon Tweet It. Own It.](http://alliesforhealth.blogspot.com/2015/08/ilooklikeasurgeon-tweet-it-own-it.html) By [Dr. Heather Logghe](https://twitter.com/LoggheMD) 8/8: Dr. Nikki Stamp: [Why women in surgery need other women in surgery – #thisiswhatwelooklike and #ilooklikeasurgeon. ](https://drnikkistamp.wordpress.com/tag/i-look-like-a-surgeon/)By [Dr. Nikki Stamp](https://twitter.com/drnikkistamp) 8/10: KevinMD: [\#ILookLikeASurgeon I am a surgeon and this is what I look like](http://www.kevinmd.com/blog/2015/08/ilooklikeasurgeon-surgeon-look-like.html) 8/11: Allies for Health: [What does #ILookLikeASurgeon really say about surgeons around the world? A Call to Action.](http://alliesforhealth.blogspot.com/2015/08/what-does-ilooklikeasurgeon-really-say.html) By [Dr. Ed Fitzgerald](https://twitter.com/DrEdFitzgerald) 8/12: Allies for Health: [Humanizing the Profession: Patient perceptions of #ILookLikeASurgeon.](http://alliesforhealth.blogspot.com/2015/08/humanizing-profession-patient.html) By [Terri Coutee](https://twitter.com/6state) 8/13: Allies for Health: [\#ILookLikeASurgeon: The Hardest Part.](http://alliesforhealth.blogspot.com/2015/08/ilooklikeasurgeon-hardest-part.html) By [Dr. Chris Porter](https://twitter.com/PorterOnSurg) 8/13: Evolution of a Female Surgeon: [Lessons I’ve learned Along the Way.](https://gmboland.wordpress.com/) By [Dr. Genevieve Boland](https://twitter.com/gmboland) 8/14: Allies for Health: #ILookLikeASurgeon: We can do it!!! By [Dr. Paula Ferrada](https://twitter.com/paulaferrada1) 8/14: Behind the Mask: [I Look Like a Surgeon, and #ILookLikeASurgeon.](http://behindthemaskmd.com/2015/08/ilooklikeasurgeon/) By [Dr. Kathy Hughes](https://twitter.com/DrKathyHughes) 8/14: Deanna J. Attai: [\#ILookLikeASurgeon](http://drattai.com/ilooklikeasurgeon/). by [Dr. Deanna Attai](https://twitter.com/DrAttai) BehindTheKnife – The Surgery Podcast [@BehindTheKnife](https://twitter.com/behindtheknife) **Categories:** Uncategorized --- ### [The Resident's Guide to Landing that First Job](https://blog.womensurgeons.org/the-residents-guide-to-landing-that-first-job/) **Published:** August 28, 2015 **Author:** Blog Team **Content:** By Sareh Parangi A few months ago we had the pleasure of having Julie Freischlag (Vice Chancellor of Human Health Sciences and Dean at UC Davis School of Medicine and an AWS member) come and speak at MGH about her thoughts on the future of vascular surgery. I thought it would be nice for her to chat with the residents and fellows rather informally about how to successfully find their first job and negotiate a package that will work for them. I realize that residents work very hard and as faculty most of our efforts go into teaching them all kinds of clinical pearls so they can be competent and caring surgeons. However, one thing we neglect to teach them well is the transition to the next phase of their life-a real job! Keeping in mind that many residents are doing fellowships, it is not clear to me that fellowship directors are including job search information in their fellowship either (to be clear, I am the fellowship director of the Endocrine Surgery fellowship at MGH and I feel that we also do not provide clear directions/help on job search or negotiation). For adults whose path has been fairly straightforward and clear: college >medical school> residency> fellowship, how to choose a job can be a daunting task, especially considering additional forces that come into play: marriages, partners, loans…etc…. I sat in the back and listened to Dr. Freischlag expertly provide her advice, having been a division chief, a chairman and a dean, she managed to keep the information current and simple. The residents and fellows were very engaged and asked tons of questions so it was clearly a topic that connected with them. She focused her thoughts on searching for academic jobs but I think some of the points could be applied more generally too. What did I get out of her talk and the answers she provided our residents/fellows? 1. Residents and fellows should look around for jobs, and write chairs and division chiefs. They should not necessarily wait only for posted jobs. Letters should be simple and grammatically perfect. 2. You should not just include a standard letter but also include details about why you like this particular department or division, what makes them special in your eyes and how you would fit into the department. Include what you “can do for them” in clear and simple language. Have a vision of what your contributions to their specific department would be. Do your research about that specific department, strengths and weaknesses… standard boiler plate letters just go in the garbage. 3. If you do get an interview, show that you can be flexible and open to wearing different hats early in your career: Is your dream to have a practice taking care of only melanoma patients but the chairman needs you to be flexible and take care of the medical student curriculum too? Remember that the chair/dean who is doing the hiring knows their own departments and therefore can see the forest not just the trees. In fact they may see how your career will/should develop at their institution better than you might yourself. By being dedicated and flexible and trusting the hiring chair you can work together to create a realistic package that works for everyone. 4. There may not be as much room for actual monetary negotiations as you think. Many academic practices have fairly standard boiler plate contracts and a certain salary in mind when looking for candidates. While there might be some wiggle room in negotiating a dollar amount, there might be more room in negotiating things like: administrative help, research start up dollars, office location, call schedule, OR block time, amount and definition of protected time. Try to set your own priorities, personally I have found being able to choose my own administrative assistant was so important to building my practice…staff that answers your phone, interacts with your patients, referring physicians and colleagues is very important; a good one can help build your practice, a bad one can add at least an hour or two of extra stress to the work day. 5. Be open about your alternatives with the Chair….if another institution is offering you a much better package financially or in other aspects, being open and honest about it is easier than beating around the bush. It will help everyone decide whether they can make the same “magic” happen at other institutions. 6. While you do want to cross all the “t”s and dot all the “i”s, you do not want to let the negotiations carry on too long…there will be a loss of interest in your good faith in the negotiating process eventually. Many of the chairs do not have the legal authority to change the hospital or physician organization boiler plate type contracts so do not get to bogged down with details that are not changeable, instead focus on the parts that might be changeable. 7. Many faculty move after a few years…your first job is not likely to be your only job anymore- so keep that in mind when negotiating for your first job! It’s not the end all be all of jobs! However, the tone you set (especially as a woman) during your first meetings/negotiations will often set you up for future promotions in the department so be careful to not come across as someone who does not care about the details and will take any job. 8. This next piece of advice by Dr Freischlag had me surprised for sure….as someone in academics my entire career, I had always been taught that without “protected time” in the first couple of years of your job- there would be no academic career. Dr Freischlag pointed out that protected time early in your new job may be a double edged sword, while you might be able to negotiate a lot of protected time to do your research and get preliminary data that will be critical in developing your research program… sometimes this will backfire. How you ask? Dr Freischlag gave many good examples of young surgeons that became increasingly less confident about their own clinical skills during the first 3-5 years of their clinical practice, did not get to interact with more senior faculty and further develop their skills, did not interact with primary care or referring physicians, and ultimately after 5 years found themselves, viewed as “poor clinical surgeons” that no one knew at the institution by year 5 making selling them as the “go to surgeon” quite challenging for the chair. While research is very important, remember that most chairs are hiring “surgeons” first and foremost and you do need to become a good surgeon who increases confidence and continues to learn the first few years of practice. In the first few years of your practice, it is expected that you will continue to be on the learning curve, most referring physicians will give you a “break” and your fellow colleagues are more than willing to jump in and help you anytime….do not lose this “window of opportunity”. So I guess the takeaway message is while you should negotiate for protected time, try to keep a balance so you do not lose your clinical skills and in case your research career does not exactly materialize as you thought it might…you can be confidently “sold” to colleagues as a phenomenal surgeon. Well, hopefully I have not misrepresented Dr. Freischlag’s important bits of wisdom. It was great having her here and interacting with the residents; they still corner me to tell me how grateful they are that I had arranged this special session with Dr. Freischlag. [![Parangi](http://blog.womensurgeons.org/wp-content/uploads/2015/08/Parangi.png)](%5Bsiteurl%5D/wp-content/uploads/2015/08/Parangi.png) *Dr. Parangi is a busy endocrine surgeon at Massachusetts General Hospital, Harvard Medical School in Boston, with a particular interest and expertise in thyroid and parathyroid tumors. She focuses her clinical efforts on endocrine surgery and applies her basic science knowledge and expertise to tumor progression in thyroid cancer. She has been one of the Boston surgeons named in Best Doctor and her excellent in both research and her clinical expertise have earned her a national reputation. She has been a council member for The Association of Women Surgeons and the most prestigious organization of endocrine surgeons in the US, The American Association of Endocrine Surgeons, and a member of the American Thyroid Association. She has won numerous awards nationally and at Harvard Medical School for her NIH funded research in the role of BRAF oncoprotein in thyroid cancer invasion.* **Categories:** career development, professionalism, residency, training, women --- ### [An Exclusive Perspective of “Being a Woman Surgeon”](https://blog.womensurgeons.org/an-exclusive-perspective-of-being-a-woman-surgeon/) **Published:** August 31, 2015 **Author:** Blog Team **Content:** By Miriam D. Weisberg As far as female pioneers in the surgical field are concerned, Preeti R. John has traveled the distance in more than one respect. After earning her medical degree at St. John’s Medical College in her native India, she ventured almost ten-thousand miles from home to start surgical residency training at Baltimore’s Johns Hopkins Hospital. Presently, John is a Critical Care surgeon and acting director of the Surgical ICU at the Baltimore VA Medical Center, as well as author of a history-making book. *‘Being a Woman Surgeon- Sixty Women Share Their Stories’* is an anthology of essays, poems, and interviews featuring a selection of surgery’s brave and inspiring female trailblazers. The book is the first of its kind and serves to fill a novel void in role models for women aspiring, or even considering, a career in surgery. John has elegantly illustrated both the obstacles and accomplishments of the progression of women in a male-dominant field, a topic which is sparsely documented. AWS would like to take this opportunity to celebrate the summer release of “Being a Woman Surgeon” by highlighting the magnitude of Dr. John’s contribution as editor and author. John will be present at a landmark event and book signing hosted by the ACS (at the 2015 ACS Clinical Congress in Chicago, Illinois on October 6th from 1-2pm), featuring a number of current and former leaders in surgery who have contributed their experiences to the book (see below for list of guests). It was a pleasure to interview John regarding her reflections since the book’s release. In exploring her intentions as editor, John’s powerful message and attention to detail shone clearly. *‘Being a Woman Surgeon’* is a treasure chest of honest, infuriating, and brilliantly inspirational stories that is bound to be a staple on the shelves of medical students, residents, and surgeons alike. **MW: Your anthology of 60 essays, interviews and poems written by pioneers for women in the surgical field is the first of its kind. It has been noted as inspiring for women and men alike. What was the initial spark that inspired you to create this compilation?** PJ: It was a series of sparks initiated by questions from medical students contemplating the field, as well as from residents who sometimes openly wondered whether all the hard work is worth it in the end. There were times during my training when I needed inspiration and I had often thought about how nice it would be to read about what other people experienced during training. There were several books written by men in the field, but very few by women. The books that I found were written by women during an earlier era when gender discrimination was rampant…and were not very inspiring. **MW: Atul Gawande called the book “funny, heartbreaking, flabbergasting, infuriating, and inspiring”. On your journey to a successful career in surgery, what was most infuriating for you and how did you overcome it?** PJ: Surgical training is challenging in many ways. There is very little flexibility with the call schedule and free time, and one has to miss several family functions and special occasions. During the first year, I think I remember having just 2 weeks of vacation with some free days during the December holiday season. Your priority becomes the hospital, your work schedule and patients – and everything else has to be less important. You have to remain focused and tell yourself that this is a temporary phase in life. Important occasions in your personal life might be missed, but once your goal is achieved, there will be more flexibility, and priorities can be re-shuffled. Depending on what specialty you choose and where you decide to practice, you can have some control over your schedule once you start practicing, so I had to keep reminding myself of this every time I missed a wedding or a funeral of a close family member. **MW: The book features female trailblazers in the surgical field such as Kathryn D Anderson, the first woman president of ACS, and Patricia J Numann, the founder of our very own AWS. Editing their stories and reflections must have been quite an experience. What did you enjoy most in the process of molding their stories together into the book?** PJ: I went through about 14 versions of the manuscript, with each manuscript changing as more contributions were added over time. Each time I received a contribution, I was thrilled, because I realized that the author had set aside valuable time, recognized the importance of this project and made this a priority. I felt a tremendous sense of responsibility; each contributor trusted me with their essay/poem/answers to interview questions, and expected that I would bring this project to fruition. I enjoyed this challenge, but what was even more gratifying was reading different contributions and realizing that no matter what our background, age or race, there were things that we have in common as human beings. For example Patricia Numann (founder of AWS) writes: *‘I am often asked if I regret not having children or a spouse. I have had a few wonderful men in my life. I am sure I have saved each, and myself, an unpleasant divorce. They remain good friends.’* I can certainly identify with this! **MW: In your program for Women’s History Month, you mentioned how different the experiences were for women in surgery during the 1970s/80s as compared to now. ‘Being a woman surgeon’ features female surgeons over a range of stages in their careers, from residency to retirement. What are some of the major differences you found among the experiences of your colleagues in writing this book?** PJ: Women who trained in an earlier era had to overcome a lot more difficulties than they do today. Overt gender discrimination was rampant and tolerated, which is no longer the case. Kathryn Anderson, the first woman President of the ACS, wrote in her essay about her experience with the Dean of Harvard Medical School: *‘I did run into overt sexism when I told the Dean of Students that I wanted to do a surgical internship and residency. I was told that women could not be surgeons, and if I even applied, the Dean would make sure I did not get any internship in Boston or elsewhere. So I did a year in Pediatrics at the Boston Children’s Hospital.’* Family support systems were not in place: giving birth to and raising children was a lot more challenging in that environment. Anderson’s essay highlights this: *‘In the 1960s it was very much okay to make sexist remarks and be overtly averse to training a woman. “You’ll only get pregnant and quit, wasting a place which could be better occupied by a man.”‘* Many of today’s surgical residents and young attending surgeons give no thought to the fact that they are women in what was once a male dominated field, simply because there are many more women surgeons around. We live in a society that is much more aware (and less tolerant) of gender discrimination. Most surgical residency training programs will not tolerate overt sexism. **MW: Today only about 21% of surgeons in the United States are woman. In addition, the number of women applying to and graduating from medical school is dropping every year. If you could identify a major turning point in the recent evolution of female physicians, to what would you attribute the decline in interest among young women to enter into surgery?** PJ: Despite the 2003 ACGME restrictions on resident work hours, residency programs in general remain far from family friendly. Residents who become parents and wish to spend a meaningful amount of time with their children, continue to find this challenging. Not only are residency programs physically demanding, they can also conflict with the peak period of family demands. Many female residents will become mothers… at ‘advanced maternal age’, which contributes to issues with infertility and pregnancy-related complications. Inadequate maternity leave post-childbirth makes things difficult for couples… Compared to Europe, the US has little time allocated to ‘maternity leave’ and no formal policy regarding maternity leave for surgical residents. ENT Surgeon and mother of four, Sujana Chandrasekhar, writes in her essay: *‘There is no national US policy on maternity leave per se. There is Family Medical Leave for men and women who need time off for family medical issues, including maternity… Anecdotes reveal that in training women have taken their four to six weeks of vacation time; in the military time taken for maternity leave must be made up by extending the training period. In practice, the woman often has to come up with her own version of maternity leave and any time needed subsequently for child care, and this is often the basis for pay inequity.’* Consideration of a fore mentioned factors has resulted in a low number of females electing a career in surgery, due in part to personal choices that women make during medical school. **MW: In your book, many of the contributors express perseverance, sacrifice, and passion. From your experience, what characteristics are most valuable to the success of a woman in the surgical field?** PJ: *Willpower-* the desire to train in this specialty. You have to like this more than any other field in medicine in order to be truly happy doing this (practicing surgery) for the rest of your life. *Perseverance and emotional strength*– there will always be times when you feel discouraged, when people say things that bring you down. You have to keep at it, and keep pulling yourself up after each failure. There is no-one at work who will keep encouraging you or praising you for working hard. *Physical stamina* – the long hours can be challenging, and there are periods when you are standing / on your feet for hours on end. You may not always have the chance to have a full meal during the day, and your body needs to be able to cope with the physical demands of doing long procedures, having very little sleep on certain nights. Breast Surgeon and former AWS President, Susan Pories, writes in her essay: *‘..Being strong is one of the most important qualities for a career in Surgery. You do need to be physically strong and have a strong ego and work ethic, just to keep going and show up every day without fail – even if the patient is not doing well, even if you don’t feel well, even if you made a mistake, even if you don’t get the promotion you want…’* **MW: Many of the contributors emphasized a mentor, role model, or individual who provided them with an opportunity that aided in driving their career forward or supporting them in their pursuit. Who was that person for you and in what way did they impact your career? What traits are most important in a mentor?** PJ: Mentors are important in any profession. It is the person that matters, not the age or gender. You need to have good personal rapport with your mentor… and feel comfortable approaching him/her and asking for… advice. (Likewise, a mentor) …has to be genuinely interested in helping you and be willing to set aside time to talk with you. I have had several mentors at various stages in my surgical training …Dr. Keith Lillemoe, Elliott Haut, and Anne Mosenthal. I remember Dr. Mosenthal advising me to speak up about problematic issues in the workplace. If you recognize a problem, you have to speak up about it, but with the right person. A good mentor will have your interest in mind, and will advise you about how best to approach the issue/s at hand. Book contributor, Kristy Weber (Orthopedic Oncologist, Professor of Orthopedic Surgery at University of Pennsylvania), wrote: *‘…I continue to seek out mentors at every stage of my career, even now… I have learned a great deal from my male mentors in the field. It is important to seek out mentors, not wait for them to find us. Now it is my obligation and responsibility to mentor younger women and men in the field.’* **MW: What advice do you have to the upcoming generation of physicians whom are considering this career path? What are some important factors you would encourage them to take into account?** PJ: You have to want to do this (a career in surgery) and nothing else. The training period is long and takes up a significant chunk of time during your adult life. There are always exams to study for …you don’t have much control over your schedule and your priorities have to change. Be prepared for sacrifices & adjustments… or else it will make you miserable and bitter. **MW: What steps or changes do you think the healthcare profession can take to make surgery a more welcoming and even playing field for women?** PJ: Flexibility with regard to training period/duration… Child care options and breast pumping rooms on site. More family friendly times for conferences. For example, starting morning conference at 6:30am makes things difficult because most child care and pet care centers open at 7am! Establishment of a unifying national policy for maternity leave amongst surgical residents… There has to be a complete cultural paradigm shift, and value needs to be placed on a reasonable maternity policy in the US for different professions. This has to be pushed by society, employers and mothers… and put into effect by Legislation. Wage equality for women in surgery. Ample evidence exists to document inequality in academic Surgery departments. Once more women assume leadership positions, perhaps this will be rectified. Women are beginning to take the helm at different institutions, and differences in pay and expectations between men and women are being brought to light. **MW: Final words about the book. Anything else to share. What is your number one take away?** PJ: *Mentors* (male or female) are important… Cultivate relationships. *Persevere*. You don’t have to be the best at something in order to do it. I knew nothing about the world of book publishing before embarking on this project. I had an idea and kept at it, despite the odds. For more on ‘Being a Woman Surgeon’: Review by David Hoyt featured in ACS Bulletin <http://bulletin.facs.org/2015/07/looking-forward-july-2015/> Available for sale at the American College of Surgeons 2015 Conference: at the ACS Logo and Merchandise Shop near the ACS Resource Center. Book signing event with editors and contributing authors will be held at the ACS Resource Center, McCormick Place, on Tuesday, October 6th between 1-2pm. [![being women surgeon cover only](http://blog.womensurgeons.org/wp-content/uploads/2025/06/being-women-surgeon-cover-only-198x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/08/being-women-surgeon-cover-only.jpg) Also available on [Amazon](http://www.amazon.com/Being-Woman-Surgeon-Sixty-Stories/dp/1884092632) and [Barnes & Noble](http://www.barnesandnoble.com/w/being-a-woman-surgeon-preeti-r-john/1121672995?ean=9781884092633) websites. ACS Book Signing Guest Contributors: Kathy Anderson, First woman President of ACS Patricia Numann, Second woman President of ACS, Founder of AWS Julie Freischlag, Chair, Board of Regents, Vascular Surgery, Former Chair of Surgery at Johns Hopkins Hospital Barbara Bass, Chair of Surgery at Houston Methodist Hospital; Recipient of ACS ‘Distinguished Service Award’ Susan Pories, Breast surgeon, Former President of AWS Marion Couch, Chair of ENT at Indiana University Martha Zeiger, Chair of Endocrinology at Johns Hopkins Hospital Sujana Chandrasekhar, President of American Academy of Head and Neck Surgeons Carol Scott-Conner, Former Chair of Surgery at Iowa University Joan Huffman, Critical Care Surgeon Minerva Romero, Surgical Resident Sarah Blair, Surgical Oncologist Deborah Kuhls, Critical Care Surgeon Helen Cappuccino, Surgical Oncologist Claire Cronin, Breast Surgeon Preeti R. John, Critical Care Surgeon, Editor of ‘Being of Woman Surgeon’ **Categories:** Uncategorized --- ### [2015 World Congress of Surgery: Bangkok](https://blog.womensurgeons.org/2015-world-congress-of-surgery-bangkok/) **Published:** September 15, 2015 **Author:** Blog Team **Content:** In spite of the tragic bomb explosion that occurred in Bangkok days before the start of the 2015 World Congress of Surgery (WCS), the conference took place as planned. The Congress was officially opened on Sunday, August 23rd by Professor Dr. Her Royal Highness Princess Cholabhorn Mahidol, founding President of the [Chulabhorn Research Institute](https://www.cri.or.th/en/pr_president.php), and the youngest daughter of the King and Queen of Thailand. [![1](%5Bsiteurl%5D/wp-content/uploads/2015/09/11-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/11.jpg)As a qualified scientist, HRH has attached the greatest importance to the role of science in social and economic development, and originally conceived the idea of creating a national institute to assist in the development of Thailand. Princess Chulabhorn graduated in 1979 from the Kasetsart University with a Bachelor of Science and first class honors and received her doctorate from Mahidol University in 1985. She was awarded the UNESCO Einstein Medal for her efforts in promoting scientific collaboration in 1986 and was the first Asian to be invited to join the Royal Society of Chemistry in the United Kingdom as an Honorary Fellow. Her Royal Highness suffers from SLE, but despite her poor health delivered a fascinating one hour lecture on *“The Princess Mother’s Medical Volunteer Foundation: The Blueprint of Surgical Care for All.”* During the opening ceremony, surgical leaders were presented with a coin to commemorate the occasion; AWS was represented on this occasion by past president Dr. Danielle Walsh. Later in the evening our AWS Founder Dr. Patricia Numann was admitted to Honorary Fellowship in the Royal College of Surgeons of Thailand. Amongst her numerous past distinctions, Dr. Numann is a past president of both the American College of Surgeons and the International Surgical Society US Chapter. For more than a decade she has hosted meetings for women surgeons in South Africa, Canada, Australia and Japan. In 2011, she was presented with the International Surgical Society Prize in recognition of the guidance, mentorship and inspiration she has provided to overseas surgeons both in practice and in training for four decades. [![2](%5Bsiteurl%5D/wp-content/uploads/2015/09/2-300x229.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/2.jpg)The U.S. Chapter of the ISS sponsors the Nyhus Traveling Fellowship, which allows a young US surgeon to attend the World Congress of Surgery. The surgeon must be a U.S. citizen, in training or within their first five years of practicing within the U.S. The Chapter provides up to $2500 towards the young surgeon’s travel and accommodation expenses and ISS waives the registration fees. The 2015 Lloyd Nyhus Traveling Fellowship was awarded to Dr. Stephanie Chao. Dr. Chao received her undergraduate degree in Biological Sciences from Stanford University, where she graduated with honors, distinction and Phi Beta Kappa. Dr. Chao attended medical school at the University of California San Francisco and completed her General Surgery Residency training, as well as her Pediatric Surgery Fellowship at Stanford University. Her research interests include improving hepatitis B and liver cancer prevention and control. Dr. Chao conceptualized the Jade Ribbon Campaign, which has become the global emblem for hepatitis B awareness and also founded “Hep B Moms”, a non-profit organization dedicated to reducing mother-to-child transmission of hepatitis B. Her work has been supported by numerous agencies including the Centers for Disease Control and Prevention. Dr. Chao has served on the Board of Directors of the National Resident Matching Program, as well as on Advisory Committees for the California Viral Hepatitis Clinical Task Force, the Immunization Action Coalition Birth Dose Project, and the US Congress Viral Hepatitis and Liver Cancer Prevention Control Act. Dr. Chao has received the Samuel L. Kountz Humanitarian Award and was the 2012 recipient of the Association of Women Surgeon’s Hilary Sanfey Outstanding Resident Award. Dr. Chao is now Assistant Professor of Pediatric Surgery at Stanford. Dr. Chao spoke during the AWS session and gave two oral papers at the WOPAFS session. [![3](%5Bsiteurl%5D/wp-content/uploads/2015/09/3-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/3.jpg)*Dr. Chao was presented with her award by Dr. Hilary Sanfey, President of the US-ISS Chapter* On Monday evening with the local assistance of Dr. Prinya Sakiyalak, Dr. Patricia Numann arranged a visit, with museum tour and dinner, to The Jim Thompson House ([https://en.wikipedia.org/wiki/Jim\_Thompson\_House](https://en.wikipedia.org/wiki/Jim_Thompson_House)). Most importantly, we had the opportunity to shop at a discount! Transportation was kindly arranged by Dr. Peenutchanee “Bea” Chartiburus, MD, who is Chief of Cardiac Surgery Unit in the Department of Surgery, Rajavithi Hospital, Bangkok. [![4](%5Bsiteurl%5D/wp-content/uploads/2015/09/4-154x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/4.jpg) *Bea with two of her dogs* [![5](%5Bsiteurl%5D/wp-content/uploads/2015/09/5-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/5.jpg) *Almost 50 people from nine countries attended the event. While most were surgeons we were also joined by several of our anesthesiology colleagues.* [![6](%5Bsiteurl%5D/wp-content/uploads/2015/09/6-300x122.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/6.jpg) *On Tuesday morning we had a very enjoyable networking breakfast hosted by AWS and the ISS – US Chapter. Once again we had a large, international attendance. Women represented Thailand, Canada, Taiwan, Japan, South Africa, Slovenia, UK, Australia, Malaysia, Sweden and Myanmar in addition to the USA. On a more somber note Dr. Nancy Perrier offred a moving tribute to both Dr. Eva Singletary and Dr. Teresa Flippo-Morton who died earlier this year.* [![7](%5Bsiteurl%5D/wp-content/uploads/2015/09/7-300x208.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/7.jpg) *Dr. Ines Buccimazza (South Africa) and Dr. Patricia Numann* [![8](http://blog.womensurgeons.org/wp-content/uploads/2025/06/8-300x248.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/8.jpg) *Dr. Peenutchanee Chartiburus (Thailand) and Dr. Nancy Gantt* *Dr. Chartiburus is holding a special gift from Mount Auburn Hospital in Cambridge, Massachusetts where the King of Thailand Bhumibol Adulyadej, also known as Rama IX, was born in 1927. The book gives the history of the hospital and has pictures of the Thai Royal Family. The King is the only monarch born on US soil, is revered by the Thai people and is the longest reigning monarch in the world.* On an academic note AWS sponsored three panel sessions , including one session co-sponsored with ASAP (Alliance for Surgery & Anaesthesia Presence). The first session on the “Woman Doctor and the Patient” was particularly emotional as speakers highlighted challenges in their environment, and provoked a lot of discussion and opportunity for future collaboration. The second session entitled Professional Development for Women Surgeons was equally well attended. - The female trauma patient in developing countries , Sushma Sagar India - Surgical risk factors unique to the woman patient, Stephanie Chao, USA - The pregnant woman surgeon. Kazumi Kawase, Japan - Tools of the trade: ergonomics for women in surgery. Anna Riemen, Scotland The second session entitled Professional Development for Women Surgeons was equally well attended. - Team training and teamwork in the surgical setting. Susan Pories USA - Leadership and critical decision making in times of crisis. Debra Wirtzfeld, Canada - Project management tools for surgical improvement. Nancy Gantt USA - Career development through organized surgery. Patricia Numann USA The third session co-sponsored by ASAP was entitled “Women in the Global Surgical Arena.” - Teaching surgery in low income countries. Chang Har Yip Malaysia - Humanitarian surgery in crisis areas . Sharon Stein USA - Extending the reach of the surgeon in a digital age: telemedicine, virtual classrooms and e learning. Marguerite Bonaventura, USA - Building programs and systems of surgical care. Sherry Wren USA The next meeting of the World Congress of Surgery will take place in late August 2017 in Argentina so please make plans to join us then For further information on becoming an ISS member, click [here](http://www.iss-sic.com/?id=61). **Categories:** Uncategorized --- ### [The Story of Rosie](https://blog.womensurgeons.org/the-story-of-rosie/) **Published:** September 16, 2015 **Author:** Blog Team **Content:** by: Susan Pories, MD, FACS “Rosie” is a secretary who worked for a surgeon on my floor in the Doctor’s Office Building for many years. Seeing Rosie in the hallway or elevator was always a little sunshine in the day. She always had a smile for everyone and made a little conversation while we rode up or down or walked down the hall together. She was a pro at the requisite Boston topics of conversation including the Red Sox, Patriots, the weather, and the traffic to and from the Cape. I can’t remember her complaining about anything except perhaps the snow. She made it her business to know every secretary and doctor in every office in our hallway and called them all by name. She delivered lunch to “her Doctor” whenever he was in the operating room and used the opportunity to make friendships with anyone in the OR lounge and cafeteria while she was at it. She wasn’t wasting time and she didn’t linger but she always made an encounter count. Her phone manner was as sunny as her in person demeanor and she was a big part of my decision to send both my husband and son to this surgeon when they needed his help. After they were seen in the office, she always asked after both of them and commented on how handsome they were. And they were both smitten with her after their visits there. One day Rosie disappeared from my hallway and the hospital. It turned out that her employer needed her to take on the electronic record and she just couldn’t face it. She was in her 70’s after all, but she was single and still needed to work. I was worried about her and how she was doing. But I soon learned that as soon as she left her job, she almost immediately had another offer and was working for another surgical group, with a big enough staff that she could avoid the computer requirements. This of course, was no accident. She clearly knew the value of connecting and making friends wherever she went. And when there was an opening and they heard she was available, she was at the top of their list. At one time Rosie worked for one of the Kennedys and she seemed to know everyone in Massachusetts. She is a great example of a consummate networker. Follow her example and you will also be successful: Smile, make eye contact, be present and focused in the moment with energy and enthusiasm, show a true interest in the other person, and have some ice-breaker topics or questions ready. Put your phone away and don’t look around for someone more interesting. If you are going to a meeting or a networking event, bring your business cards. Learn the person’s name and use in conversation. Be sure to follow up if appropriate with the article or contact you promised. The medical landscape these days is challenging to say the least and with mergers and other high level business decisions made by administrators, even surgeons can find themselves without a job and out in the cold. I have had many surgeons contact me looking for help finding a new position in these circumstances. Some openly shared with me that they wished they had built networks with other women surgeons before they were in trouble and had more friends to support them when they needed help. So it’s very important to build networks of all kinds in life, in the hospital, in your neighborhood and local community, and with colleagues and leaders around the country. The Association of Women Surgeons offers many opportunities for networking and building relationships. I have benefitted in countless ways from my participation in AWS and I hope you too will. You can read more about networking in ***Navigating Your Surgical Career: The AWS Guide to Success***, available on [Amazon](http://www.amazon.com/dp/B00VXVFKKU). And I hope to see you in Chicago at our meeting and our annual networking breakfast. **Categories:** networking --- ### [We Don’t Need Another Hero](https://blog.womensurgeons.org/we-dont-need-another-hero/) **Published:** September 21, 2015 **Author:** Blog Team **Content:** ***Deborah L. Benzil, MD, FACs, FAANS*** *Vice President, American Association of Neurological Surgeons MKMG and Columbia University Department of Neurosurgery* [![tina](%5Bsiteurl%5D/wp-content/uploads/2015/09/tina.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/tina.jpg) [Tina Turner’s](http://www.tinaturnerofficial.com/) iconic song says: *So what do we do with our lives? We leave only a mark Will our story shine like a life Or end in the dark? Is it all or nothing?* As a pioneer woman neurosurgeon, I strongly believe that the progress of women within medicine, particularly specialties where we remain under represented, requires us to move *beyond heroes*. Though we have already had to battle hard for ourselves, those who have made some progress may now be in a position to help others so their struggles are eased. To do this we must make a commitment with our lives, to make our stories shine. This is best accomplished by understanding the key concepts of: - Mentorship - Sponsorship, and - Role modeling (with some critical 21st century implications). **Mentorship** Mentor, recalled by Homer as the “wise and trusted counselor”, took care of the household while Odysseus was off fighting the Trojan Wars. From this ancient concept, modern organized mentoring has grown into an essential practice within many professional groups such as teachers, business executives, and more recently medicine (but not given nearly enough focus and attention). Mentoring is something we have talked about for a long time but don’t think we take seriously enough or do a good enough job when given the opportunity. The goal of a mentorship is to help the mentee become as good as they can be in the goals they develop for themselves. In this setting, the job of the mentor is to facilitate and steer that process using experience, contacts and critical assessment tools. A great mentor is easy to approach and makes themselves available. They will use and share experience and expertise as good listeners, observers and problem-solvers. We ***MUST*** remember that mentoring is more than just supporting and encouraging. It is applying all the skills to enable the mentee to reach their full potential. This can mean helping them recognize and fix their flaws and problems. **Sponsorship** Sponsorship is equally important and must become part of one’s culture. In this realm, I look for every opportunity to ***publically recognize*** the talents and accomplishments of younger colleagues. Some examples of easily accomplished sponsorship include: - ***Introductions***: One can embellish a formal introduction with an honest, flattering comment. *Example*: “Dr. Department Chair, this is Dr. Rebecca Smith. She is an extremely talented senior resident at Univerisity of X very interested in functional neurosurgery and has already published two important clinical papers.” - ***Reports*:** While delivering reports at Executive Board meetings or similar, always give public credit to the individual(s) who made significant contributions. *Example*: “The great work I am reporting on related to curriculum development was spearheaded by Dr. Judy Star who got significant support from the efforts of Dr. Jane Ray and Dr. Sam Steel” - ***Comments***: Look for every opportunity to sing the praises of worthy others in a public arena. *Example*: In the OR or surgeon’s lounge look for opportunities to say, “Suzie, you did a really great job on that extremely difficult case.” **Role Models** No doubt the next generation(s) of physicians needs to see role models with whom they can relate but we play an equally important role in leading by example. One must always be professional, courteous, prepared, gracious but not afraid to call out behavior that is unacceptable. It is not only ok but necessary to ask individuals to refrain from offensive speech and behaviors in the office and operating room. You shouldn’t hesitate to quietly and discretely remind individuals about being late, sloppy or unprofessional. Be particularly mindful of modesty in the OR. Let everyone knows that you are also a wife/mother/daughter/sister or that you love to hike/run marathons/watch [Homeland](http://www.sho.com/sho/homeland/home). There has recently been a worldwide Twitter movement in support of diversity within surgery [\#IlookLikeASurgeon](https://mobile.twitter.com/hashtag/ilooklikeasurgeon). It speaks volumes to the continuing need to support a new view of who and what a good surgeon is and how to appropriately balance our own lives with the lives entrusted to us by our patients. Through greater attention to the key concepts of **mentorship, sponsorship, and role models** we can move beyond heroes and create a [“new life beyond the thunderdome.”](https://en.wikipedia.org/wiki/Mad_Max_Beyond_Thunderdome) ![DLBENZIL 2013](http://blog.womensurgeons.org/wp-content/uploads/2015/09/DLBENZIL-2013.jpg) Deborah L Benzil, MD, FACS, FAANS is a neurosurgeon currently serving as the Vice President of the American Association of Neurological Surgeons. She practices neurosurgery in New York as a partner with Mount Kisco Medical Group with a faculty appointment with Columbia University School of Medicine. She is also founding partner of Benzil Zusman LLC consulting company by and for physicians. **Categories:** Uncategorized --- ### [#ILookLikeASurgeon Makes Its Way to the New England Journal of Medicine](https://blog.womensurgeons.org/ilooklikeasurgeon-makes-its-way-to-nejm/) **Published:** September 29, 2015 **Author:** Blog Team **Content:** By: Shree Agrawal, BS, Case Western Reserve University School of Medicine The hardest part of being a female medical student was not deciding to pursue a career in surgery. Instead, it was and still is difficult to reconcile my gender and passion. Fortunately, the merging of both materialized right in front of me, or more appropriately, on my smartphone in the form of #ILookLikeASurgeon. [![430126_4754334260201_426384693_n](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Shree-Agrawal-169x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/09/Shree-Agrawal.jpg)Shree Agrawal with Cleveland Indian’s mascot, Slider The tag #ILookLikeASurgeon has evolved from a social media movement of surgeon selfies, several blog posts, and countless tweets to a New England Journal of Medicine (NEJM) forum titled, “#ILookLikeASurgeon-What It Means and Why It Is Important for Women Surgeons.” I had the opportunity to serve as a moderator to a collection of voices behind the surgical mask. Women from across the country, representing different races, ages, and stages of training, confidently offered their honest reflections on issues surrounding “leaning in” to surgery. When I try to understand what it means to be a female and pursue a future in surgery, a few lessons from these inspiring women will stay with me. On trying to have it all and missing the mark sometimes, Dr. Dzifa Kpodzo, MD, MPH wisely encourages, “Rather than berating yourself for not being superwoman, congratulate yourself on your organization, efficiency and ability to problem solve.” To address the complex and elusive theory of “work-life balance,” Dr. Kathryn Hughes, MD, offers a modern concept of work-life integration. “…The term work-life balance misses the mark. I have used work-life integration, because balance is not realistic; work is a part of our lives, and the rest of our lives do not disappear when at work.” Dr. Stephanie Bonne, MD, insightfully penned a new personal mantra, “I think we can celebrate these \[our\] differences and support one another as a unique group who are, together, having a unique human experience-that of being a woman surgeon.” This forum lasts beyond one week of online conversations. It prompts an ever-evolving individual definition to #ILookLikeASurgeon empowered by this rich network of women willing to cultivate leaders, support students, and embrace the diversity we each bring to medicine and surgery. **Categories:** Uncategorized --- ### [I. AM. TIRED.](https://blog.womensurgeons.org/i-am-tired/) **Published:** October 21, 2015 **Author:** Blog Team **Content:** **I am tired today.** It was a call night, after a full day of operating. The pages came in steadily. I don’t mind the ones that have to do with patient care. Most are just from people trying to do the right thing for the patients. But the calls about whether the patient should be observation or inpatient at 3 am push my button. My internal ire rises after the call and I can’t fall back asleep right away, stealing at least 20 minutes of precious sleep. I wish these things didn’t bother me, but they do. I’m tired of having to negotiate with the OR desk to get my patient in the operating room. I’m just trying to fix a problem. This isn’t about getting to a golf course. It’s about the patient and their family being in pain and fear. If you are too nice, you get put in line behind the surgeon who yells and stomps their feet, even if your patient is more urgent. Negotiating takes energy, and I have none left. I am tired of insurance companies telling me what I can or can’t do for my patients. Even if they “pre-authorize” the operation, they retroactively refuse to pay for the operation. Why should I be the bad guy sending a bill to the patient for their cancer surgery in the midst of chemo for the insurer’s doubleback? I’m just trying to take good care of the patient. I’m tired of the EMR making things harder instead of easier. The only thing worse than dealing with the EMR is trying to take care of patients when it goes down. I am tired of patients not showing up for appointments and even operations. Please don’t send me suggestions about appointment reminders, billing for no-shows, etc. We do all those things. They still don’t show. Until they arrive in the emergency room. With a non-emergent problem that needs elective surgery. Demanding it be done now. On my night of call. I’m tired of eating processed food from a package in my coat pocket because there’s no time for sitting to eat. Getting to the gym means subtracting from the small bank of time with my family or sleeping even fewer hours than I do already, and I’m just to tired to climb on some piece of equipment and make it move. Sigh….Pager went off again. Someone needs a surgeon. Wake up and do the job. It’s a privilege to serve. Even if you are tired. [![Walsh-Danielle-c57](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Walsh-Danielle-c57-214x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/12/Walsh-Danielle-c57.jpg) *Danielle Walsh, MD, FACS is a pediatric surgeon and Associate Professor of Surgery at Brody School of Medicine at East Carolina University. She is a past president of the Association of Women Surgeons.* **Categories:** family life, self-care, women --- ### [Learning to Lead & Lean In: A Medical Student Perspective on AWS.](https://blog.womensurgeons.org/leadlean-in/) **Published:** October 29, 2015 **Author:** Blog Team **Content:** [![1st year Medical Student Sarah Armenia at the AWS Conference 2015.](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Conference-Picture-1-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/10/Conference-Picture-1.jpg)1st year Medical Student Sarah Armenia at the AWS Conference 2015. Author: Sarah Armenia I first became familiar with the [Association of Women Surgeons](http://womensurgeons.org) after a simple Google search of “women in surgery.” After becoming a physician assistant a year prior, I had decided to apply to medical school instead of entering practice in order to become a surgeon. I was already aware of the [American College of Surgeons](http://www.facs.org) from reading the Journal of the American College of Surgeons, but I had yet to discover an organization like the Association of Women Surgeons. As a member of the national medical student committee, I was given the opportunity to collect recordings and photos of AWS members discussing why they loved being a part of the AWS. I initially thought interviewing women who have spent their careers shaping surgery and medical education might be intimidating. However, this fear quickly dissipated as every woman shared her story with humble honesty. I developed an impression of these inspiring women as role models from afar, and never expected such a level of approachability, warmth and [mentorship](https://www.womensurgeons.org/we-dont-need-another-hero/). Each woman I approached for photos or videos happily participated and provided deep insights about their experiences within AWS. Their excitement to be a part of an organization like AWS was palpable. The women around me were the very embodiment of the changing face of surgery embraced by the [\#ILookLikeASurgeon](https://www.womensurgeons.org/ilooklikeasurgeon-makes-its-way-to-nejm/) campaign. The essence of the conference was embodied by a panel presentation focusing on “Productivity and Wellness Across the Surgical Spectrum.” Seven speakers shared personal tips and tricks for “[leaning in](https://www.womensurgeons.org/lean-in-book-review-discussion-part-one/) without stressing out.” Each woman illustrated that there is no single definition of balance that works for all. The importance of continuing to strive for success with a mindfulness of our own personal definition of balance resonated throughout the day. The balance of research, education, and personal development was equally represented with each session. Following a morning of recognition of the scientific accomplishments of AWS members along with a scientific poster session for both medical students and residents, an executive presence workshop fostered a period of self-reflection and step-wise identification of the individual values. Whether it was a medical student, resident, or faculty member, there was an unique energy when we all shared common values and goals. I felt honored to have such an experience occur at an early stage of my education, as a first year medical student. The feelings of [solidarity](https://www.womensurgeons.org/solidarity/) and support I experienced after interacting with other AWS members strengthened my motivation to continue moving forward along this long journey. **Categories:** career development, leadership, medical students, mentorship, networking, resources, women **Tags:** AWS, ILookLikeASurgeon, LeanIn, medstudents, WomenSurgeons --- ### [Inspiring & Encouraging Women Surgeons Blog](https://blog.womensurgeons.org/womensurgeonsblog-nov2015/) **Published:** November 5, 2015 **Author:** Blog Team **Content:** *by Minerva Romero Arenas, MD, MPH* It was only a month ago that thousands of surgeons met in Chicago for the annual [American College of Surgeons](http://www.facs.org) Clinical Congress. Just days before, however, over 150 women gathered for yet another Association of Women Surgeons conference. Medical students, residents, and attending surgeons met to present their scientific work, celebrate accomplishments, discuss professional development, and network. An inherent part of the meeting is the ongoing development of relationships and mentoring that goes on at all levels. We learned from [first-year medical student](https://www.womensurgeons.org/leadlean-in/), Sarah Armenia, about the power of this experience even at such an early stage in training. The importance of mentoring is highlighted by the variety of activities specifically organized at AWS & ACS for medical students, residents, and fellows – and even a high school students. The [\#ILookLikeASurgeon](https://twitter.com/hashtag/ilooklikeasurgeon) movement was coined by surgery resident, [Dr. Heather Logghe](https://twitter.com/LoggheMD), inspired from the [\#ILookLikeAnEngineer](https://twitter.com/hashtag/ilooklikeanengineer?lang=en) movement. Male and female surgeons around the world have embraced the hashtag on social media, calling for increasing visibility of women in surgery. Research shows many people make career decisions based on exposure to different professions and is often limited to the experience of those around us. Hopefully, these ongoing efforts to recruit and mentor students through careers in medicine and surgery will eventually lead to an increase in diversity. Nonetheless, the number of women in surgery is still [lagging behind](https://www.womensurgeons.org/the-changing-face-of-medicine/) other disciplines and diminishes up the academic and leadership ladders. The energy in Chicago fueled our commitment to increasing the visibility of women surgeons. We hope you tune in weekly for our new posts to gain insight into our professional accomplishments, challenges, debates, and in the process remember that the AWS leaders and members at the end of the day, are also just surgeons. *The conference was a great way to meet in person, but we can keep the conversation going all year long using the Comments for each blog post. Follow us on social media ([Twitter](https://twitter.com/womensurgeons), [Facebook](https://www.facebook.com/womensurgeons)) for updates on the blog & AWS.* **Categories:** career development, education, leadership, medical students, mentorship, networking, professionalism, resources --- ### [An Attitude of Gratitude](https://blog.womensurgeons.org/attitude-of-gratitue/) **Published:** November 8, 2015 **Author:** Blog Team **Content:** *By: Beth Shaughnessy* It can be a difficult task to think about gratitude because we may become a little hardened and insensitive in light of the demands on our time. I can’t help but smirk when I read articles that identify a percentage of physicians who are experiencing burnout, as if this is a fixed, unmoving percentage. I think we all experience burnout at some point or another, and we do our best to learn from it, rein it in, keep it under wraps, keep it controlled. Step back with me, then, and take a quiet look at what you have around you. [![Dr. Beth Shaughnessy with sisters Kathleen Shaughnessy Maddalone, Suzanne Shaughnessy, Rosemary Shaughnessy Bartosik.](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_20151022_074116387-copy-169x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/11/IMG_20151022_074116387-copy.jpg)Dr. Beth Shaughnessy with sisters Kathleen Shaughnessy Maddalone, Suzanne Shaughnessy, Rosemary Shaughnessy Bartosik. I just returned from a much delayed vacation, having arranged my first ever group vacation with only my sisters. I am fortunate to have them as a dependable source of support. As Thanksgiving approaches, I am grateful that I live in a country that holds this celebration. While in Ireland, my sisters and I received many questions regarding our rituals, our recipes, and I am reminded of how these rituals allow us to pull together, step back, see the big picture, and be grateful for what we have. In returning home, I received the warm welcome of my son and my husband; I missed them, but was grateful that they realized how much I needed this renewal. October also offered the opportunity to renew ties with old friends through the AWS and ACS, to deepen some new bonds, and to meet new people as well. It amazes me how we continue to learn from each other and nurture women at every level of training and practice. I am that young woman who began medical school, but different. I am that fresh young resident, but different. I am that new surgeon in practice, but different. The greater depth of understanding people and of surgery, of understanding academics and service, takes time, elicits a price, but has left me a better person. As Dr. Suzanne Klimberg, the past president of the [Society of Surgical Oncology](http://www.surgonc.org) and the [American Society of Breast Surgeons](http://www.breastsurgeons.org), has mentioned, we need to adopt an attitude of gratitude, thank those who have helped us, and then turn to help those with whom we travel, or who follow. **We’re in this together, not alone.** Maybe now, before Thanksgiving, turn your thoughts inward and then redirect them outward as you display your attitude of gratitude. It might just be reflected back at you. **Categories:** family life, mentorship, networking, resources, self-care **Tags:** burnout --- ### [Gratitude at Home and Work](https://blog.womensurgeons.org/gratitude-at-home-and-work/) **Published:** November 13, 2015 **Author:** Blog Team **Content:** *By Lauren B. Nosanov* Steeling myself for an incoming 5 year-old MVC victim with reportedly fixed and dilated pupils per the EMS report, I am overwhelmed with gratitude that my own children are safely asleep in their own beds. In this circumstance, and plenty of others, being grateful comes easily. Each day, surgical residency pits us against the horrible, messy reality of being human. The suffering of our patients offers endless opportunities to take stock of our own fortune and breathe a sigh of relief. Yet gratitude does not always come as readily as perhaps it should. [![Lauren celebrating Halloween with her family](%5Bsiteurl%5D/wp-content/uploads/2015/11/Lauren-Nosanov-with-Family-280x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/11/Lauren-Nosanov-with-Family.jpg)Lauren celebrating Halloween with her family. At hour twenty-three of a grueling call, amidst a raging migraine and the incessant chirping of the pager, it is far easier to wallow in self-pity. Finding the capacity to be grateful in these moments requires a great deal of fortitude (and a strong cup of coffee or two), and is something I continue to struggle with on a daily basis. It is a matter of perspective, and requires conscious intent. Although there are times when it seems completely impossible to achieve balance between the hectic demands of work and home life, I remind myself that there is no one else and no place else that I would rather be. *[![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Lauren-Nosanov-300x264.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/11/Lauren-Nosanov.jpg)* *Dr. Lauren Nosanov is currently a member of AWS and a general surgery resident at MedStar Washington Hospital Center. She is passionate about issues surrounding surgical education, mentorship, and finding a balance between motherhood and medicine. Outside of medicine she enjoys practicing Taekwondo and spending time with her husband and children.* **Categories:** family life, professionalism, residency, self-care, training --- ### [GRATITUDE - 10 Things to be Grateful for](https://blog.womensurgeons.org/gratitude-10-things-to-be-grateful-for/) **Published:** November 18, 2015 **Author:** Blog Team **Content:** *By Sarah B. Bryczkowski* Gratitude – To be grateful, give thanks, show appreciation. For those of you who don’t know, I am forever optimistic. I always hope for the best. Even when the fecal matter hits the ventilation system, I try to find a positive spin and learn something. There are so many things to be grateful for, which makes it hard to summarize in a post that is short and sweet. In an effort to avoid becoming #tldr (too long, didn’t read), I’ve made a short list. I encourage everyone to take a moment and reflect on the things in your life that you are grateful for. **G**etting to operate. It’s such an awesome privilege. For that I am grateful. **R**elaxing on post-call days. Second only to the one day off in seven. **A**ncillary staff. Because without them my job would be impossible. **T**eachable moments. I love being able to teach patients, students and my children. **I**n-laws and parents. Because they somehow always know when I need a hug or a hand. **T**he Internet. Without it there would be no #SurgTweeting or #SurgSandwiches. **U**ninterrupted sleep. Whether on call or at home. **D**ate nights and play dates. **E**very single day.*Last but not least, I am grateful for relationships. Some days can be extraordinarily difficult. We have all had moments where we just want to throw in the towel and call it a day. It’s God, family, friends, colleagues, mentors, patients and even Twitter friends that make it all worth while. Hope you’ve enjoyed reading my little bit about gratitude. Please take a moment and share what you are grateful for on Twitter using the hashtag #SurgGratitude and #SurgPostIts. You can find me on Twitter @SarahB\_MD To see the original post on my blog, follow this link: [Sarah Bryczkowski MD](https://sarahbryczkowskimd.wordpress.com/2015/11/17/surggratitude-10-things-to-be-grateful-for/) [![image1](http://blog.womensurgeons.org/wp-content/uploads/2025/06/image11-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/11/image11.jpg) *Sarah Bryczkowski is currently a general surgery resident at Rutgers-New Jersey Medical School. She is an active clinical resident after completing two years of clinical outcomes and education research.* **Categories:** self-care --- ### [A Family Affair](https://blog.womensurgeons.org/a-family-affair/) **Published:** November 25, 2015 **Author:** Blog Team **Content:** *By Linda Farkas* This Thanksgiving has given me much to reflect on; myself changing jobs, my husband and I moving across country, one daughter completing her first year out of college and living in New York City, another daughter graduating from college and considering her next step, and a third daughter deciding on where to attend college so she can change the world. I find these transitions within my family to be gratifying and exciting! This is also the first Thanksgiving after many years in which I have “no patients” as I transition to my new job. In previous years, in the 2-4 weeks prior to Thanksgiving, I would spend time determining recipes, finding time to shop, and figuring out where we would be for dinner. In all these years, I would practice “traditional” Thanksgiving endeavors. But this was *also* the time of year I encouraged all of my patients and their families to discuss family health. As a colorectal surgeon, I see many patients in their 60’s-80’s succumb to colorectal cancer. Yes, the great majority of these patients never had a colonoscopy at 50. However, since my fellowship, I have heightened concerns for my 30-40 year old patients with cancer. While we were aware of the clinical diagnosis of Lynch Syndrome and Polyposis Syndromes, we did not have genetic testing until recently. Even with this screening technology, disease recognition still primarily requires a known family history to be truly preventative. The ultimate goal is to direct unaffected but at-risk patients to cost-effective individualized surveillance programs proven to saves lives. This effort requires cooperation amongst the family. Thanksgiving is symbolic of traditions across America, but it was also declared as National Family History Day by the Surgeon General in 2004. Over the next few months, as families gather, this is a ripe time to discuss the family tree. Family discussions should not be exclusive to cancer, but also premature coronary artery disease, aneurysms, etc. The US Department of Health and Humans Services has a printable form available in English and Spanish at[ https://familyhistory.hhs.gov/](https://familyhistory.hhs.gov/). This form should then be shared with respective physicians to assess any appropriate changes in screening to allow longer healthier lives for all at-risk patients. Too often I hear from my patients with Lynch Syndrome: “I knew my father had colorectal cancer. If I had known my aunts/uncles/cousins/grandparents had endometrial/colorectal cancer at < 50 years of age, then I would have… 1. started my scopes earlier. 2. done the “right tests” 3. prevented my cancer.” I also agree with these comments. Therefore, this is the season to begin a new tradition by discussing our family trees with our families, if we have not already done so. We should extend this practice to our patients by encouraging them to do the same in these next months. Health is not achieved by our individual attempts to maintain our weight, exercise and avoid smoking–it is a *Family Affair*.[![Linda Farkas Headshot](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Linda-Farkas-Headshot-151x142.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/11/Linda-Farkas-Headshot.jpg)*Dr. Linda Farkas is a faculty member at Duke Raleigh Hospital and Duke University Hospital practicing as a colorectal surgeon. She received her medical degree from Loyola University Chicago Stritch School of medicine and has been in practice for 26 years.* **Categories:** advocacy, education, family life --- ### [Saying NO](https://blog.womensurgeons.org/saying-no/) **Published:** December 3, 2015 **Author:** Blog Team **Content:** *By AJ Copeland* My Chair asks me to host the Department holiday party at my house. An office nurse hits me up to purchase giftwrapping for her son’s fundraiser. My mother wants to come along when we buy our tree. As we hurdle into the holiday season, it is easy with our busy schedules to feel especially overscheduled and overstressed during what is “supposed to” be a joyous time of year. It is tempting to take on new commitments when asked to, whether out of guilt, a need to be liked, fear of rejection, conflict avoidance, or a misguided notion that we can “do it all”. And so it is particularly useful at this time to review strategies to say “NO”. Saying “no” can be one of the biggest gifts you give yourself and those you love, because it will reduce your stress levels and give you more time for what’s really important. Why is it so hard to say “no”? Research studies have shown that many times people will say “yes” to a request simply because saying “no” makes them even more uncomfortable. The fact is that most people, especially women, have been socialized to be nice to others. Saying “yes” also appears to be hardwired. Research shows that when women are cooperative, neural activity in the brain’s reward region dramatically increases; our brains actually reward us for people-pleasing. It’s helpful to remember that “No” is an honorable response, and it is your prerogative to use it. It is *your* time/money/talents/labor/assets/whatever that are being solicited, and you have the choice to accept or decline what is being asked. You deserve to assert your boundaries and be respected! Remind yourself that it’s not personal: saying “no” does not mean you’re rejecting the asking person; it means that you’re turning down a specific request that the person is making of your precious resources. When faced with an “ask”, respond initially with a brief pause. This gives the impression you are seriously considering the request, even if you have no intention of accepting. Next, thank the person for the compliment of asking you. After that, use a simple, direct, and confident declarative statement starting with the word “No” — it’s easier to keep the commitment to say “No,” if it’s the first word out of your mouth. “No, I won’t be able to help with that.” Make eye contact and use a sympathetic, but firm tone. Shake your head “No” as you say, “No.” Don’t apologize, don’t explain. It is a trait of adult children that we feel we have to give a very good reason for not doing something we have been invited or asked to do. You may briefly state a reason why you are declining the ask, but you do not owe anyone an explanation. You have your reasons and they may not be ones you wish to discuss. If this is the case and if pressed, say something simple like, “I’m just not able to.” An alternative approach is to respond, “Let me think about it and get back to you.” Then, on your own time, assess whether the request aligns with your own priorities. If necessary, ask for more details. Remember that there are only so many hours in the day. This means that if you say “yes” to a new commitment, invariably something else (including time for relaxation and self-care) will need to be jettisoned from your schedule. Do a rigorous cost-benefit analysis, and then get back to the asker (within a defined period) with a yes or no. The pause tactic enables you to avoid responding “yes” as a knee-jerk. If you would really like to do what’s being asked, but simply don’t have the time/resources, one option is to say, “I can’t do this, but I *can*…” and offer an alternative commitment that you can keep. Or, “I’m afraid this doesn’t work with my schedule this year, but please ask me again next time.” This way you can have control over your involvement. Remember: Be true to yourself, your convictions, and your priorities. Saying no is a skill that gets easier with practice. Start today by identifying opportunities to honor yourself more fully by saying no. [![ACS_photo](http://blog.womensurgeons.org/wp-content/uploads/2025/06/ACS_photo-157x237.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/ACS_photo.jpg) *Dr. Copeland is a longtime member of the Association of Women Surgeons, joining the Council in 2002 and serving as the organization’s President in 2008-2009. She is a Fellow of the ACS, and a member of the Women in Surgery Committee of the ACS. She began her term as the third AWS Governor to the American College of Surgeons in 2012. She treasures the many friendships she has made through the AWS and the opportunity to associate with so many beautiful, talented, and smart women surgeons (and surgeons-in-training) of all generations.* **Categories:** family life, professionalism, self-care --- ### [Food For Thought Posts Coming Soon](https://blog.womensurgeons.org/food-for-thought-posts-to-come/) **Published:** December 5, 2015 **Author:** Blog Team **Content:** Be on the lookout for a new weekly “Food for Thought” post each Sunday on womensurgeons.org! We hope to hear from you in our comments section throughout the week as we explore life as surgeons! – Your AWS Blogging Team **Categories:** Uncategorized --- ### [A persistent beat: motherhood and urban gun violence](https://blog.womensurgeons.org/a-persistent-beat-motherhood-and-urban-gun-violence/) **Published:** December 10, 2015 **Author:** Blog Team **Content:** *By Stephanie Bonne* My newsfeed is punctuated by the screaming of anger, fear and rhetoric. An argument articulated in bursts of 140 characters. An argument that cannot be won. The ebb and flow of the “conversation” about gun violence bubbles up every so often, every time there is a mass shooting event. We discuss how to prevent events like this, and trauma surgeons like me or others who work in emergency care bring up the same point: That this is not just a problem of mass shooting. This happens every day, across America, in an epidemic of gun violence. A public health problem that needs to be addressed as such, with money, research and resources. I have worked in trauma centers in Detroit, St. Louis, Chicago and now Newark. Gritty, urban places where the tempo of gun violence is unrelenting and audible. Eight, 10, 12 gunshot victims a night is not uncommon, but not considered “mass” simply because more than one person pulled a trigger in different parts of town. The pager going off, every few minutes to hours. Each page is someone hurt, dying, or dead. My colleagues are right – that although mass shooting tragedies punctate our stream of consciousness, the more shocking numbers are in our daily experience with gun violence. So I could write another post, adding my voice to the choir of those who would point this out. Instead, I want to write about the mothers of my patients. Nothing in my training could prepare me for the experience of talking to mothers in the waiting room, or for how that would change when I became a mother myself. And no matter how numb I get to the violence I see in the emergency room, I never get numb to family conversation that follows in the waiting room after a long operation. I always make sure to change my scrubs so that they don’t see their baby’s blood on me while I speak. Their eyes are first worried, with furrowed brows, that relax when I say, “we are done with surgery, and he is alive.” But deeper worry returns when I give more detail. “He needed 20 units of blood.” “We left her belly open, and she will need more surgery.” “He is paralyzed.” “She will have a long hospitalization and is at risk for many bad complications.” “He is not out of the woods yet.” I imagine, that while I speak, they are not thinking of the man or woman lying on the operating room table, but instead are remembering an infant in their arms. The unthinkable joy of the first time they held their baby, so great they thought their heart might explode. Followed by first steps, first words, first days of school. Lives of hope, joy and potential, forever changed in their trajectory by a split second and the pull of a trigger. No matter how old the patient, that was someone’s baby once, and when that baby was born, that mother wanted what every mother wants: the best for their child. Now that child is unconscious, filled with tubes and holes. Sometimes the conversation is shorter. “We tried everything we could, but his injuries were not survivable. We tried and tried, but his heart stopped and he has died.” The end of a story that started with unthinkable joy, just 2 floors up in L and D a few short years ago that ended today in the stark fluorescent light of the trauma bay. Nothing left now but the deafening silence of a period placed on the last sentence of the last page of that story. I don’t know what the answer is to the epidemic of gun violence in this country. But I do know that talking to mothers over and over again is exhausting in a way that stays with you long after the day has passed. These problems will not be solved by hyperbole and rhetoric spouted out in 140 character lines. Nobody wins these arguments. There are two extremes here: one side that wants complete gun control, the likes of which we see in Europe and Japan, which isn’t going to happen in this country, as a matter of culture, precedent, and law. The other extreme advocates for unfettered access and ability to carry any weapon of their choosing, which we know leads to the arming of dangerous people as collateral. As long as the two extreme sides of this argument, refuse to bend their stance, or even talk about a way to meet in the middle, we will continue to emotionally elevate this argument and will never come to a resolution. What we can do is bend, listen, discuss, and most importantly, study this problem. Work together to find meaningful solutions supported by the intersection of data and common sense. We can slow this problem down, stop the unrelenting pace of gunshot victims so trauma surgeons like myself don’t have to look into the eyes of these mothers hour after hour, day by day, year after year. *[![Bonne-picb-0715-200x300](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Bonne-picb-0715-200x300-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/Bonne-picb-0715-200x300.jpg)Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force. Dr. Bonne is the current Communications Chair for the AWS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, family life, training --- ### [Spin Doctors](https://blog.womensurgeons.org/spin-doctors/) **Published:** December 16, 2015 **Author:** Blog Team **Content:** *By Kelley Bullard* The two most powerful words in any language are YES and NO. When my daughter was two and a half, she earnestly asked one day from her car seat: “Can I drive when I’m older? Can I drive… when I am four?” Our eyes met in the rear view mirror. She was completely earnest and I struggled to contain my smile. “Why of course you can drive when you are older sweetheart,” I replied. “When I am four?” she asked again. “We will negotiate when you are four, and you will definitely drive when you are older than two and a half!” Luckily her teachers at preschool had used the word ‘negotiate’ and she knew it meant that she would get some part of what she wanted. When I looked in the mirror again, I saw her contented smile focused on the tattered ‘black kitty’ who accompanied her through her toddler years. As a surgical educator and intensivist I see times when the ***way*** we communicate is more important than the information being conveyed. I watch residents in the early stages of their careers struggle with this lesson as they talk to families and interact with nurses. I have watched residents with great potential react while exhausted and get labeled as *temperamental* (or a worse descriptive term, especially if the resident is a woman). I have seen residents not gain the confidence of patients or their families because they are unable to find their *strong, confident voice*. The tremendous role “tone and timing” play in this process cannot be overstated. In other words, in communicating, ***spin counts.*** I reflected on the conversation with my daughter and catalogued the techniques I could use in future conversations. What approach in the conversation had worked? Can I apply it to future encounters with my toddler, my partner, the residents I train, my co-workers, patients and families? First, I mirrored the feeling of my listener. This non-verbal skill requires two things: *empathy and the ability to place yourself momentarily in a similar frame of mind*. When Daniel Goleman examined persons in ‘socially intelligent’ conversation, he noticed a cadence occurred. A non-verbal linking was seen where a person’s body language and tone invites the listener.1 This interpersonal rhythm creates a receptive framework within which a conversation can take place. *Even if the content of the conversation is not one of complete agreement or good news,* a ‘yes-framed’ conversation allows acknowledgement and creates an environment of understanding *and learning.* Second, I remained ***positive***. Even though I was conveying “NO, darling, you cannot drive when you are four,” I said it with a positive spin and an upbeat attitude. I focused on ‘YES’, instead of ‘NO’. I focused on the possibilities. By focusing on what is possible we reframe the conversation. It is this positive revision that allows the listener to think outside the box of scarcity. My hierarchical surgical training in a pre-eighty-hour work week residency did not prepare me for this philosophical approach. And, I have to admit, I was very skeptical when I began reading about the improvements in outcomes, and productivity seen with positive-based communication techniques (a.k.a. management skills). Over the past decade, psychologists have replicated that a positive approach yields increased performance, productivity and outcomes. Shawn Achor suggests that it is the *happiness* this *positive approach* produces that creates all the other endpoints2. I am not proposing a simple-minded ‘Pollyanna’ attitude where one walks around ignoring the tragedies of life. As surgeons, we see many fates that are difficult to process emotionally. What I am proposing is that we focus on the real possibilities that exist, even in desperate situations. And yes, this requires an optimistic stance; difficult as this may be at times, it has a logical foundation, as Rosamund and Benjamin Zander explain in *The Art of Possibility*3: “… the people who see the glass as “half-empty” are the ones wedded to a fiction, for ‘emptiness’ and ‘lack’ are abstractions of the mind, whereas ‘half-full’ is a measure of physical reality under discussion. The so-called optimist, then, is the only one attending to real things, the only one describing a substance that is actually in the glass.” This approach not only makes sense, it is one that is successful in achieving the desired outcome. Having tried the alternate experiment of simply saying “no” to a two-year-old, I have found that the positive approach achieves better results. In other words, the *spin* we use determines how well we communicate. Regardless of how far we go in our careers, there is wisdom to be gained in every interaction. My two-year-old taught me skills that have served me in my committee work, in program improvement efforts, and in managing the Surgical ICU in a busy urban trauma center. It is an acquired skill that requires practice and attention, and is worth the effort. - Goleman, Daniel, *Social Intelligence: The New Science of Human Relationships,* Random House Publishing Group, New York, 2006 - Achor, Shawn, *The Happiness Advantage: The Seven Principles of Positive Psychology that Fuel Success and Performance at Work,* Crown Publishing, New York, 2010 - Zander, Rosamund and Zander, Benjamin, *The Art of Possibility*, Penguin Books, New York, 2002 *![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/kelleyb-195x300.jpg)Dr. Bullard is an Associate Clinical Professor of Surgery at the University of California, San Francisco – East Bay Surgery program. She has a robust General Surgery and Acute Care Surgery practice that offers continuous opportunities for surgical education. She is specialty trained in Trauma / Critical Care and is the Director of the Surgical ICU at Highland General Hospital. She acts as a faculty mentor for the East Bay Women in Surgery group which supports women residents as they mature through their years of surgical training. Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, professionalism, resources, training --- ### [Food For Thought: Fearing “Leaning In”](https://blog.womensurgeons.org/food-for-thought-fearing-leaning-in/) **Published:** December 20, 2015 **Author:** Blog Team **Content:** *By Shree Agrawal* *We will now start featuring a new blog post each Sunday as well as Wednesday! Our Sunday post will be a reflection or question from AWS members. Follow our blog (enter your email below the “Subscribe to AWS Blog” on the right-hand side of the screen) and join the conversation in the comments section or on Twitter!* Sheryl Sandberg’s “leaning in” has been featured, referenced, or adapted for most women in medicine/surgery events I have attended in the past year, and for good reason. Five years later, her TED talk and Lean In book continuously remind me of the complex issues we face, as women, in all environments—professional and personal. In leading my own medical school chapter of the Association of Women Surgeons\*, my personal and professional interactions with my female peers have highlighted the fears many female medical students have about “leaning in” to a potential career in surgery. When talking about finding mentors, exploring research opportunities, seeking shadowing experiences, or other issues surrounding a future surgical career, I usually hear a variety of responses: - “I am afraid of wasting a mentor’s time, especially if I eventually choose a different area of medicine.” - “I just do not have much experience with research and I may not meet the expectations of a PI.” - “I have come to terms with the fact that I want to become a surgeon, unfortunately. I am afraid now I will have to sacrifice my personal life in the future.” - “I am nervous about being in an OR. I do not know what I should be doing or where I need to go. Maybe I will just wait until our clinical rotations to explore surgery.” It is clear in these statements—not only do we “negative speak” about our capabilities and goals but also we negatively consider the perceived time and resources of potential mentors or professors. We are more likely to hesitate about leaning in to surgery for fear of failing, exhausting resources, and being perceived as incompetent. These fears only manifest in the 2014 AAMC statistics which report only 25-30% of total surgical trainees to be female physicians, excluding neurosurgery, orthopedic surgery, and thoracic surgery. ***So for every level of training in medicine, how have you found ways to lean in, and what advice would you give to those who may be hesitant about exploring surgical subspecialties?*** \*[Follow this link, if you are interested in starting an AWS Chapter at your medical school](https://www.womensurgeons.org/student-section/medical-school-chapters/) *[![Shree Agrawal](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Shree-Agrawal-218x230.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/Shree-Agrawal.jpg)* *Shree Agrawal is a member of the AWS Medical Student Committee and is a second year medical student at Case Western Reserve University. She is passionate about clinical research surrounding patient decision-making and medical education.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, gender differences, medical students, professionalism, resources, training, women --- ### [Inhale, Exhale, Say Yes](https://blog.womensurgeons.org/inhale-exhale-say-yes/) **Published:** December 23, 2015 **Author:** Blog Team **Content:** *By Shree Agrawal* Saying yes is complicated, powerful, and full of potential. Celebrities like Shonda Rhimes, known for her Thursday night television series and recent book, Year of Yes, and Ryan Seacrest, whose persona hosts many media outlets, have participated in the social experiment of saying yes to every opportunity they each are offered. They have earned success by saying yes and having the courage and ability to figure out how to fulfill each of their commitments. Medicine is no different from Hollywood. In each, only a small percentage of people achieve success. In 2013, the AAMC reported 48,000 people applied to medical school, and approximately 20,000 matriculated into their first year. In addition to international medical schools, the NRMP reported 41,334 registered applicants in 2015 for 30,212 available positions. This does not include the 80,000 people who take the MCAT each year and 13.2 million students who attend four-year American colleges and universities. At each level of pursuing a career in medicine, any student would likely attribute progressive success to saying yes, often. “Yes!” at this point in my career, is automatic, feasible, and essential. This habit led me to the unbelievable chance [to work with my mentor, Dr. Wood](https://www.womensurgeons.org/econnections-2015-december/mentor-spotlight-dr-hadley-wood-by-shree-agrawal/#sthash.2QDDelqw.dpbs). I am not apt to change my ways in the near future because I am constantly discovering and developing my professional values by engaging in new experiences. However, there a few guidelines I have found helpful to saying yes: 1. Assess whether current opportunities contribute to overall growth - If yes, what are my next steps both within and beyond this opportunity - If no, assess my current investment of time and energy 2. Is this opportunity exciting? Could it develop into passion? - Talking to peers/superiors, asking for a trial period, or researching more thoroughly helps me determine this for myself. 3. Align the purpose of this experience to a personal area of development or exploration - Otherwise, I risk losing the motivation to perform at the level expected of me. 4. Always factor about 10-15% of weekly scheduled time for an emergency or unexpected time delay - I learned this rule from a time management workshop; it has saved me from being overwhelmed and allowed me to be there for the people I cherish. 5. Organization and technology are essential. - A few great applications for your phone/computer: Google Calendar, Calendly, Boomerang, Google Keep, and Breathe 6. Schedule fun activities to look forward to, immediately. - It is difficult to say no to maintaining my personal well being, after already saying yes in my schedule. [![](%5Bsiteurl%5D/wp-content/uploads/2015/12/IMG_4118-300x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/IMG_4118.jpg)This is me, saying yes to yoga at the end of a long week. Photo credit belongs to my yoga instructor, who is also a phenomenal SICU nurse! I do not have the ability to predict my future circumstances or potential opportunities. Practicing yoga has taught me to be present when I assess how an endeavor will influence my life. Being a medical student has given me the luxury to say yes, without providing a tangible reason. These guidelines should not hinder any of us from taking risks and uncovering a new source of inspiration or fulfillment. When I have agreed to seemingly unreasonable or daunting responsibilities, I have found profoundly meaningful experiences that have impacted my professional path. *So take a deep breath, be present, and say yes.* References: <http://www.success.com/article/ryans-world> <http://nces.ed.gov/fastfacts/display.asp?id=372> <http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2012/02/27/demystifying-the-mcat> *[![Shree Agrawal](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Shree-Agrawal-218x230.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/Shree-Agrawal.jpg) *Shree Agrawal is a member of the AWS Medical Student Committee and is a second year medical student at Case Western Reserve University. She is passionate about clinical research surrounding patient decision-making and medical education.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, medical students, self-care --- ### [Food for Thought: All I want for Christmas is my Doctor](https://blog.womensurgeons.org/food-for-thought-all-i-want-for-christmas-is-my-doctor/) **Published:** December 27, 2015 **Author:** Blog Team **Content:** *By Minerva Romero Arenas* Throughout residency my family and friends have offered their thoughts on my working during holidays. The following essay is some food for thought based on the many opinions I’ve received. It is not unusual for us medical professionals to alternate working one or another holiday.[For a great blog on the happenings at the hospital during the holidays, click here.](https://www.womensurgeons.org/happy-holidays-from-the-aws-2/#sthash.4NZaNJyb.dpbs) When we manage to get a holiday off, it frequently means spending a significant portion of our salary to fly home if you are from out-of-state. When it doesn’t work out we are thankful for technology like FaceTime, which allows us to maintain a [virtual presence during the festivities](https://www.womensurgeons.org/happy-holidays-from-the-aws-3/#sthash.7h2pgLkg.dpbs). If the scheduling gods are in your favor the administration may actually maneuver a trade-off where you work really hard one week in order to get the other holiday off- this win-win gives everyone at least one true holiday off. Our families slowly grow used to it. Initially there is denial: “what do you mean you don’t get Christmas off?” “But you were actually there in the hospital all night?” Sometimes there is anger. It is so unfair that their beloved Doctor happens to be the one who had to work this year (again). They are always working so hard– studying countless hours during medical school; struggling to survive the brutal (but better than it used to be) 80-hour workweeks in residency. I’m told when people finally reach junior attending- they are yet at the bottom of another totem pole where they also take most of the holidays for the team. Eventually there is acceptance, and dare I say pride to share their doc with the patients. Perhaps after hearing many stories of lives saved and even of lives lost, there is an understanding that sometimes there is a greater purpose for our being here. Presents will be there to be opened late, the smiles and hugs will still be meaningful, and sometimes our sick patients and their families simply need us more at that time. *[![minerva-romero-bio-pic1](http://blog.womensurgeons.org/wp-content/uploads/2025/06/minerva-romero-bio-pic1-292x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/minerva-romero-bio-pic1.jpg)Minerva A. Romero Arenas, MD, MPH is a General Surgery Resident at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.* *Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.* *She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life, professionalism, residency, training --- ### [Food for Thought: 2016-Time for a Change?](https://blog.womensurgeons.org/2016-time-for-change/) **Published:** January 3, 2016 **Author:** Blog Team **Content:** Lately I’ve started noticing a common theme- in public and private conversations, in various parts of the internet, the gathering of momentum. In November of this year I attended the Millin Meeting, the one day annual conference of the Royal College of Surgeons of Ireland (RCSI). As it happened, one of the presentations that day was to be on the topic of women in surgery. In her speech, the surgeon covered the history of women surgeons in Ireland, discussed the current challenges of being a woman in surgery, and even gave a shout out to the #Ilooklikeasurgeon movement. Afterwards, a member of the audience asked the speaker about the problem of recruiting and retaining women into the surgical field. She paused for a moment before responding, “Both women AND men reject surgery careers due to problems with work/life balance.” Surgery is no longer for those who decide it’s ok not to have an apartment because they can live out of the call room \[true story\]. While traditionally seen as a woman’s issue, more and more men are expecting and demanding time for both family life and leisure. Indeed, my twitter feed is evidence of the importance of #SurgParenting, proud surgery folk displaying some of their greatest achievements. And have you taken a look lately at #ilooklikeasurgeon? So many fabulous women (and men) doing amazing, fun, diverse things from marathons to rock climbing to race car driving. Truly, we love surgery, but we love life too. And the world we work in should reflect the changes in our society. A few days ago I came across an interesting blog post by Victoria Bateman, an economist working in academia: <https://www.timeshighereducation.com/blog/academia-desperate-need-workplace-revolution>. If more women are to benefit from the gender equality that society prizes, she writes, it is time for the world of work to change. While she doesn’t refer to surgery, the problems she discusses regarding academia ring uncannily close to home. We hear about leaning in- and as noted in [Shree’s post](https://www.womensurgeons.org/food-for-thought-fearing-leaning-in/) there’s still a lot of work to do in this regard. However, whether it is economics, engineering or surgery, women have proven themselves more than capable time and time again. It’s no longer a male/female issue. It’s about changing a work culture that has become outdated and outmoded. Work/life integration is important to all of us. And people have started speaking up. It seems a change is in the works for the culture of surgery. Have you noticed it too? *[![IMG_20140404_143206](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_20140404_143206-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/IMG_20140404_143206.jpg)* *Dr. Ainhoa Costas Chavarri is a General Surgeon and Hand Surgeon who does full-time #globalsurgery. She has been living and working in Rwanda for the past two and a half years. She has started again so many times she has lost count. But every single time it has been worth it.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, family life, gender differences, professionalism, self-care, training, women **Tags:** Food4Thought --- ### [Starting Again](https://blog.womensurgeons.org/starting-again/) **Published:** January 7, 2016 **Author:** Blog Team **Content:** *By Ainhoa Costas Chavarri* **In the beginning, there is the excitement:** The promise of interesting new people! exotic new places! shiny new things! Everything is wonderful in this daydream world of possibilities. But then reality comes along and hands you some practical weights to bring you back down into perspective. There will be moving involved. The distances may be literal and large- another city, another country. Or smaller but significant- a different office, remodeling a room for a new addition to the family. The most important part of the moving, however, the biggest change in starting again is often internal. Because in the shuffling and shifting and reorganizing of things, memories and thoughts get kicked up like dust. And that’s when the doubt creeps in: But I’ve grown so fond of this old place! Can I part with these old things I’ve become so accustomed to? What about all my favorite people and friends? Can I leave all that behind? Should I? And what if? What if I don’t like those new places? What if I don’t like any of those new things? What if I don’t like any of those new people? What if those new people don’t like me? What if no one likes me?! The doubt has somehow morphed into fear. It is such an irrational thing this fear, we can look at it plainly and say, “Here are my accomplishments,” and rattle off an impressive list. But the fear doesn’t listen. It finds the weak spots in our armor and chips away in attempts to send us back to those all-consuming emotions of our awkward teenage years. Back when we were afraid we weren’t popular enough, or smart enough, or athletic enough. “What is this really about?” you ask, as you look in the mirror, reminding yourself that you are now much stronger and wiser than that past self. And that’s when you realize that starting again is all about re-evaluating yourself. That moving from known places of comfort (or discomfort as it may be) to new places, literal or otherwise, can leave one feeling not just exhilarated, but also exposed and vulnerable. That behind the superficial worries and doubts, deep down there is a real human need to know: *Am I good enough? Can I do this?* Sometimes starting again is our choice, and sometimes life gets in the way of our choices. These necessary transition periods allow us to revisit and acknowledge the old or past (and perhaps give gratitude for it) while at the same time forcing us to reassess our current selves. Whether it’s going into residency, starting a new practice, becoming a parent, finalizing a divorce, moving to a new location, or any other life-altering events- Am I good enough? Can I do this? The answer is yes. Your future awaits you, excited. [![IMG_20140404_143206](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_20140404_143206-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/IMG_20140404_143206.jpg) *Dr. Ainhoa Costas Chavarri is a General Surgeon and Hand Surgeon who does full-time #globalsurgery. She has been living and working in Rwanda for the past two and a half years. She has started again so many times she has lost count. But every single time it has been worth it.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development --- ### [Food for Thought: When the Doctor Becomes the Patient](https://blog.womensurgeons.org/food-for-thought-when-the-doctor-becomes-the-patient/) **Published:** January 10, 2016 **Author:** Blog Team **Content:** *By Nickey Jafari* During my first year of medical school, my class had the honor of having Dr. Jeffrey Piehler, a retired thoracic surgeon, come speak to us. You may know him as the author of the New York Times essay, [“Ashes to Ashes but First a Nice Pine Box”](http://www.nytimes.com/2014/02/02/opinion/sunday/ashes-to-ashes-but-first-a-nice-pine-box.html?_r=0). You may also know him as the incredibly talented and dedicated surgeon that he was, being elected into all the major societies for cardiothoracic surgeons. [![abcde](%5Bsiteurl%5D/wp-content/uploads/2016/01/JeffPiehler-300x200.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/JeffPiehler.jpg)Jeff Piehler, seen sitting in the pine coffin that he build has passed away. *Credit Shari Hartbauer/Lincoln Journal Star.* In 2002, Dr. Piehler was diagnosed with prostate cancer. This ultimately forced him to retire as he lost sensation in his fingertips from the aggressive treatments he underwent. In “Ashes to Ashes, but First a Nice Pine Box”, Dr. Piehler writes about how, after over a decade-long battle that he knew he would ultimately lose, he decided to build his own coffin. Both in his NYT article and in his lecture to my medical school class, Dr. Piehler reflected on how his diagnosis forced him to confront his own mortality and taught him about what he valued most in his life. Dr. Piehler passed away on November 14th, 2014 and I am forever grateful to have had the opportunity to shake his hand. I am sharing this with you today in hopes that you find the time to [read more about Dr. Piehler](http://jeffreypiehler.com/site/a-surgeon-with-incurable-cancer/) and to view his documentary, [“Patient: A Surgeon’s Journey” (trailer)](https://vimeo.com/123257731) No words I could ever write would even begin to convey the profound effect he has had on others (both medical professionals and patients). He will be remembered as an impressive surgeon, but more importantly, an inspiring human being. ![Screen Shot 2016-01-07 at 12.54.05 PM](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Screen-Shot-2016-01-07-at-12.54.05-PM-241x300.png)Nickey Jafari with Dr. Paul Farmer at the American College of Surgeons 2015 Conference. *Nickey Jafari is a 2nd year medical student at the University of Kansas School of Medicine. She was born in Tehran, raised in Kansas, and attended Drake University in Iowa for her Bachelor’s degree in International Relations and Biochemistry. She is passionate about global health and is interested in how better access to and quality of surgery can help tackle disparities in outcomes.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, self-care **Tags:** Food4Thought --- ### [Cervical Cancer](https://blog.womensurgeons.org/cervical-cancer/) **Published:** January 13, 2016 **Author:** Blog Team **Content:** *By Minerva Romero Arenas* I remember the first time I diagnosed cancer. I was a 3rd year medical student and was at one of our schools medical student-run Clinics [Commitment to Underserved People](http://phoenixmed.arizona.edu/community-health-initiative-phoenix). The patient, a post-menopausal patient whose primarily language was Spanish, had come to clinic with a chief complaint of vaginal bleeding. She confided in our team that she knew there was something wrong about that, but she had no health insurance and could not afford to pay her rent and go to see a doctor. A friend had referred her to the CUP clinic. After finishing discussing the rest of her medical history, I prepared for the physical exam. I was actually teaching another student how to perform examinations that day. “After gently inserting the colposcope, we look for any obvious abnormalities, any discharge, or evidence of bleeding.” I remember saying, “Then we will swab for the Pap smear.” There is a saying in medicine that vaginal bleeding in any woman who has already gone through menopause is considered cancer until proven otherwise. When the colposcope was opened, the light turned on, there it was – a streak of red from the os of the cervix slowly making its way halfway down the vaginal sidewall. I remember feeling my heartbeat and trying to remain calm as we completed the examination. “We will come back with the attending doctor in a few minutes,” I told the patient. The discussion that followed was heartbreaking not only due to the ominous findings on our exam making cancer our most likely diagnosis; the patient without insurance, could not afford all of the out-of-pocket expenses to complete the imaging and additional laboratory testing that was necessary to finalize diagnosis and develop a plan of care. Unfortunately, this story is all too common and it does NOT need to be so. Every year over 12,000 women will be diagnosed with cervical cancer in the US and over 4,000 will die from cervical cancer, [according to the CDC](http://www.cdc.gov/cancer/cervical/basic_info/index.htm). Many cases are caused by a virus, the human papillomavirus (HPV), which is transmitted by close contact such as sexual intercourse. There is now a vaccine available against HPV which is currently recommended for young girls and women, preferably prior to first sexual contact. Cervical cancer is most often diagnosed in young women 20-50, although 15% of cases occur in women over 65. It is most likely to be diagnosed early in the pre-cancerous stage by a widely available test called the Pap smear. The test is named so after [Dr. George Papanicolau](http://weill.cornell.edu/archives/blog/2011/06/george-papanicolaou-development-of-the-pap-smear.html), who was affectionately known as Dr. Pap, who established this cytopathologic method of evaluating cells taken from swabs of the cervix to diagnose cancer while at Cornell University Medical College. When the Pap Smear was first introduced, cervical cancer was the number one killer of women. Since its publication in 1946, the Pap smear test has become widely accepted and has greatly reduced the death rate for women worldwide. The field of exfoliative cytopathology was born and the Dr. Pap’s smear is now used not only for cervical cancer but also for dozens of other tumors. *[![minerva-romero-bio-pic1](http://blog.womensurgeons.org/wp-content/uploads/2025/06/minerva-romero-bio-pic1-292x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/minerva-romero-bio-pic1.jpg)Minerva A. Romero Arenas, MD, MPH is a General Surgery Resident at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.* *Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.* *She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** resources, self-care, women --- ### [Food for Thought: President Obama’s SOTU Cancer Promise - Is It Possible?](https://blog.womensurgeons.org/food-for-thought-president-obamas-sotu-cancer-promise-is-it-possible/) **Published:** January 19, 2016 **Author:** Blog Team **Content:** Below are just two examples of promises President Obama has made to “cure cancer”: 2009 address to Congress: “*Our recovery plan … will launch a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time.”* 2015 State of the Union: *“For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all”.* It is an admirable effort to dedicate oneself to. President Obama’s most recent mention of a promise to “cure cancer” was greatly inspired by Vice President Biden’s tragic loss of his 46-year-old son, Beau, to brain cancer. Unfortunately, this is a loss that millions of Americans know all too well. Cancer is the 2nd leading cause of death in the United States and the American Cancer Society projects there will be 595,690 cancer deaths this year. It is a disease we have faced throughout history. The word “cancer” itself comes from the “Father of Medicine”, Hippocrates. Our oldest known description of cancer is found in the Edwin Smith Papyrus and dates back to 3000 BC.Understanding that the word “cancer” is attributed to more than one-hundred unique diseases, makes it hard to even imagine a single [“magic bullet”](http://www.vox.com/2015/3/30/8312713/why-we-dont-have-cancer-cure).Not all cancers are a death sentence (e.g. 5-year survival rates for prostate cancer identified at both a local or regional stage are nearly 100%), but many of the advances made in survival rates can be attributed to better screening measures, such as pap smears for cervical cancer, facilitating early stage detection. Where improvements in overall survival have substantially progressed for breast cancer and melanomas, there is still room for improvements in survival rates for lung and pancreatic cancer. Deadly pancreatic cancer claims more than 90% of those diagnosed within five-years. Liver cancer has similarly dismal survival rates. Meanwhile, lung cancer is an especially large contributor to the global burden of disease, taking well over 1.5 million lives annually. The question remains, can we “cure” it? If so, is a “cure for cancer” something we will see in our lifetimes? Advances with both radiation and surgical technique have been critical. Monoclonal antibodies have made enormous strides in helping target *specific* subtypes of cancer, as well as *reduce toxicities* patients face compared with older chemotherapy options. There is no doubt that the more we learn about the genetics of each individual cancer, the more progress we can make. The evolution of approaches to cancer can be exemplified by the [American Cancer Society](http://www.cancer.org/acs/groups/cid/documents/webcontent/002048-pdf.pdf) in our approaches to breast cancer. I question if cancer is an inevitable consequence of a certain percentage of cell divisions or if so can we find a cure? In light of this new focus on research to find a cure, I also hope we do not abandon current research to find lifestyle causes for cancer to improve overall survival from preventable cancers. Share your thoughts with us using the hashtag #Food4Thought [![AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg](http://blog.womensurgeons.org/wp-content/uploads/2025/06/AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg-296x296.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg.jpg)*Nickey Jafari is a 2nd year medical student at the University of Kansas School of Medicine. She was born in Tehran, raised in Kansas, and attended Drake University in Iowa for her Bachelor’s degree in International Relations and Biochemistry. She is passionate about global health and is interested in how better access to and quality of surgery can help tackle disparities in outcomes* . *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, leadership **Tags:** Food4Thought --- ### [Starting Over: Making a Resolution That Works](https://blog.womensurgeons.org/starting-over-making-a-resolution-that-works/) **Published:** January 20, 2016 **Author:** Blog Team **Content:** *Lauren Poindexter, MD* Making New Year’s resolutions is, for many, a task fraught with expected failure. The time-worn “Go to the gym more often,” “Lose weight,” “Eat better” sound like positive endeavors nearly all of us can adopt, but how many gym memberships (mine included) go unappreciated after one, two, or three months? I offer you an alternative: a resolution that will result in decreased stress, happier days, and rewards for you, your families, and your patients. “Practicing gratitude.” Start small. Let’s start with our bodies and brains. Identify specific reasons for being grateful about the hands, arms, legs with which we do our work. List unique aspects of your personality for which your coworkers and friends are grateful. Our bodies enable us to bring healing and hope to our patients. Our brains calculate risks, seek out novel solutions to medical problems, and translate complicated medical jargon for patients and their loved ones. How often do we undervalue our physical and emotional strength? How often are we kinder and gentler with our patients than we are with ourselves? Once the thought of gratitude crosses your mind, focus one or more realistic actions you can initiate this week. Provide nurturing fuel for your ever-active body. Maybe seek out the fancy English cheddar cheese and apple selection at the market to stock up on simple snacks for the long days in the operating room. Offer your hips and thighs a much needed “thank you” for their hard work. Resolve to let your budding gratitude grow into a daily habit this New Year. One of my favorite hours to practice gratitude is at dawn when I’m finishing morning rounds. I’ve compiled a short list of the prettiest vantage points in the hospital to see the sun rise above the Phoenix skyline. I take a short moment to abort my habitual internal whine about my tired body and supplanted it with gratitude – I can be *fully present* in the hospital *right now*, to bring my patients *peace* and *comfort* during a sometimes painful recovery process in an often overwhelming environment. Do you have a moment during the day when you can stop to look around and see nature peeking through the busy-ness? How grateful we can be for moments of beauty! [![AWS Blog 1-20 picture](%5Bsiteurl%5D/wp-content/uploads/2016/01/AWS-Blog-1-20-picture-298x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/AWS-Blog-1-20-picture.jpg)The Phoenix skyline facing east from the 6th floor of Barrows Neurological Institute at St. Joseph’s Hospital and Medical Center. Gratitude serves as a positive affront to the stresses that threaten our inner peace. A number of [AWS bloggers and members](https://www.womensurgeons.org/gratitude-10-things-to-be-grateful-for/#sthash.z0jFH732.dpbs) have [championed this cause previously](https://www.womensurgeons.org/gratitude-at-home-and-work/). Join us in practicing gratitude this New Year! What actions would you like to take to incorporate gratitude into your daily routine? Do you have a favorite spot to view the sunrise at your work? Please share below. *[![LKP crop](http://blog.womensurgeons.org/wp-content/uploads/2025/06/LKP-crop-280x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/LKP-crop.jpg)Lauren Poindexter, MD is a preliminary PGY-1 general surgery resident at St. Joseph’s Hospital and Medical Center (Phoenix, AZ). Originally from Los Angeles, she worked as a certified athletic trainer in Colorado before choosing a career in surgery. She completed her undergraduate degree at University of Southern California, graduate degree at University of Arkansas, post-baccalaureate pre-medical courses at Harvard Extension School, and medical degree at Virginia Tech Carilion School of Medicine (Roanoke, VA). Her research interests include coagulation disorders in trauma and synthetic materials for regenerative medicine.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care, training --- ### [Food for Thought: Surgery and Public Health](https://blog.womensurgeons.org/food-for-thought-surgery-and-public-health/) **Published:** January 24, 2016 **Author:** Blog Team **Content:** *By Nickey Jafari* This week, I want to discuss where surgery and public health intersect. First, a little personal background: I took a global public health class with Dr. Debra DeLaet at Drake University for my International Relations major and absolutely fell in love with public health. I highly recommend [her textbook](http://www.amazon.com/Global-Health-21st-Century-Globalization/dp/1594517339), if you are interested in the subject. Since medical school, I have been a passionate supporter of [Partners in Health](http://www.pih.org), a community coordinator for their fundraising branch [Partners in Health Engage](http://act.pih.org/page/content/community-organizing/), and a complete and total [Dr. Paul Farmer](http://www.achievement.org/autodoc/page/far1bio-1) fangirl. I also hope to pursue an MPH between my 3rd and 4th year of medical school. The [World Health Organization](http://www.who.int/trade/glossary/story076/en/) defines “public health” as “all organized measures to prevent disease, promote health, and prolong life among the population as a whole.” Sounds pretty important, right? A broad range of issues fall under this umbrella, from access to family planning to clean drinking water to vaccines and infectious disease control. However, throughout my admittedly limited experience with the study of public health, I have felt most of the conversation focuses overwhelmingly on better access to primary care. While I want to make it clear that I *do not* in any way disagree with how critical primary care is, I wanted to begin a discussion on the emerging opinion of how increased quality of and access to surgery worldwide will *also* make a considerable dent in the [global burden of disease](http://www.uniteforsight.org/global-health-surgery/module2). My motivation for this? I would hate for someone who is interested in surgery, like myself, to feel discouraged from pursuing it because they feel as if it is not *also* an integral component to the overall well-being of populations. More importantly, *this opinion will help save lives*. After all, the keynote speaker at the American College of Surgeons Clinical Congress this past year was Dr. Paul Farmer himself, and his topic was “Addressing Unmet Surgical Need: The Role of Academic Surgery”. *I believe that access to quality surgery is part of our basic right to health*. It is estimated that about 13% of the global burden of disease (Lancet Commission on Global Surgery, 2010) is amenable to surgery, and that this number could be seriously underreported, especially in low and middle-income countries (LMIC). For those who are passionate about health disparities, the one we are addressing here is stark – the WHO estimated that 90% of deaths from injuries occur in LMIC, while the poorest third of the world’s population receives 3.5% of the 234 million surgical operations performed globally (read more [here](http://worldsurgicalassociation.org/burden-of-surgical-disease/)). Additionally, numerous [studies](http://www.globalsurgery.info/wp-content/uploads/2014/01/Grimes_costeffectiveness_surgery_review_2013.pdf) show many surgical interventions can be cost-effective, especially in LMIC. In addition, the Lancet Commission on Global Surgery has highlighted 5 key points to focus on for public health disparities: 1. Five billion people do not have access to safe, affordable surgical and anesthesia care when needed. 2. 143 million additional surgical care procedures are needed in LMICs each year to save lives and prevent disability. 3. 33 million individuals face catastrophic health expenditure due to payment for surgery and anesthesia care each year. 4. Investing in surgical services in LMICs is affordable, saves lives, and promotes economic growth. 5. Surgery is an “indivisible, indispensable part of health care.” My question is how can we take this information and begin to include the advances in the role of global surgery as part of our regular discussions regarding public health and medical training? It has never been more important. “The need for surgery to be recognised on the public health agenda has never before been so requisite. With the epidemiological transition in disease patterns away from the infectious and towards the chronic and non-communicable it is time for surgery to be considered as a public health priority” [World Surgical Association](http://worldsurgicalassociation.org/burden-of-surgical-disease/) [![Nickey Jafari with Dr. Paul Farmer](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Screen-Shot-2016-01-07-at-12.54.05-PM-241x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/01/Screen-Shot-2016-01-07-at-12.54.05-PM.png)Nickey Jafari with Dr. Paul Farmer *Nickey Jafari is a 2nd year medical student at the University of Kansas School of Medicine. She was born in Tehran, raised in Kansas, and attended Drake University in Iowa for her Bachelor’s degree in International Relations and Biochemistry. She is passionate about global health and is interested in how better access to and quality of surgery can help tackle disparities in outcomes.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, leadership, training **Tags:** Food4thou --- ### [Starting Over, with Ourselves](https://blog.womensurgeons.org/starting-over-with-ourselves/) **Published:** January 27, 2016 **Author:** Blog Team **Content:** *By Kim Resnick* I tug on my white tennis skirt nervously. The man (no doubt) who insisted that white tennis clothes were de rigueur at my new tennis club should be tarred and feathered. These hips simply don’t work in white Lycra; I am conscious of every lump, bump, and ridge. “Don’t be so hard on yourself, Kim. Relax and follow through on your forehand,” my new coach grins as he critiques. The sweat sluices down my back, pooling at the top of my waistband as I hop across the court chasing serves, wondering why I decided to learn a new sport at my age- and with my career choice. I turn around to make certain that no one is behind me as I lunge after another ball. I am a successful surgeon. I am a Division Director at a large, tertiary care center. I am a mother of 2 adorable, (and I think) well-adjusted children. I am newly divorced- yet still standing after the pain of the split up. I tick these facts off in my head. And I am having angina on this tennis court as a way to combat the inevitable burnout that begins when our coping skills turn maladaptive or simply cease to work. Burnout describes the literal depletion of our physical, emotional, and social lives that may occur when we don’t allow time for repletion. Dike Drummond, in his piece “Physician Burnout: Why it is not a Fair Fight,” notes the tendency that medicine has to push all other life priorities to the side1. This inherent tension between the work/life balance tends to span our entire career, and worsens as we get older. It is when the balance of the scales tip that we tend to view food, alcohol, sedentariness, and isolation as ways to cope with imbalance. This scale tipped precipitously out of my favor while in the throes of my divorce. Ten hour OR days became the norm as I struggled to isolate myself from the rest of my life. My 5 am boot camp fell quickly to the wayside as I was simply too fatigued. My new “skinny” jeans were kicked to the corner of the closet as I turned to staple comfort foods. I justified it by claiming that I simply did not “have time for me.” I was depleted. And then I took control of my life. I left my first position for a new academic career about which I felt passionate. Gone were the 30 hours per week spent in the OR. Exercise, which has a well-known anti-stress effect, has become part of my routine once again. Weight lifting twice weekly and once weekly tennis lessons have miraculously restored my own stores of dopamine, norepinephrine, and serotonin. I discovered a passion for cooking for my family. I am more comfortable in my own skin. My core feels stronger, I have more confidence. I am a better mother and a better physician. We can turn this fight into a fair one. We can pro-actively replete our emotional, physical and social stores. We can become the caretakers we were meant to be only when we start with ourselves. Reference: - <http://www.thehappymd.com/blog/bid/295048/Physician-Burnout-Why-its-not-a-Fair-Fight> *[![Cervical cancer Resnick photo](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Cervical-cancer-Resnick-photo-1-291x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/Cervical-cancer-Resnick-photo-1.jpg)Dr. Kimberly Resnick, MD is the division director of Gynecology Oncology at Metrohealth Medical Center, Case Western Reserve University in Cleveland Ohio. Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care --- ### [Food for Thought – Surgery: I Love This Job](https://blog.womensurgeons.org/surgery-i-love-this-job/) **Published:** January 31, 2016 **Author:** Blog Team **Content:** *By Lauren Poindexter, MD* When was the last time you stood in the operating room and paused to think, “I LOVE this job”? What was it about that particular case, patient, or situation that caused you to feel a deeper gratitude for your vocation? As a general surgery intern, the prevailing feeling I experience on a daily basis is overwhelmed (as many of you may not so fondly remember ), but I am also energized by specific situations that emphasize the honor of diagnosing, incising, and healing. [My most recent blog entry](https://www.womensurgeons.org/starting-over-making-a-resolution-that-works/#sthash.4hCY1rfN.dpbs) for the Association of Women Surgeons offered a broad suggestion that gratitude makes for a valuable New Year’s Resolution. I want to highlight a professional moment of gratitude in which I participated in an organ procurement (on a Sunday evening, of course!), I was deeply touched not only by the rare chance to follow the lead of a gifted transplant surgeon and improve my understanding of abdominal anatomy but also by the opportunity to assist in the transfer of life-sustaining tissue from one patient to another. I am indebted to those patients who declare themselves organ donors, to their families for upholding the wishes of the deceased, and to the organ donation teams that enable safe and legal procurements to take place. How grateful I remain to walk in the footsteps of talented surgeons who learned in just the same manner. How grateful we are to have a voice in promoting organ donation. Have you experienced a poignant moment recently or in your training that evoked a similar sense of gratitude? Alternatively, when did you last feel particularly honored to care for a special patient? ![LKP crop](http://blog.womensurgeons.org/wp-content/uploads/2025/06/LKP-crop-280x300.jpg)*Lauren Poindexter, MD is a preliminary PGY-1 general surgery resident at St. Joseph’s Hospital and Medical Center (Phoenix, AZ). Originally from Los Angeles, she worked as a certified athletic trainer in Colorado before choosing a career in surgery. She completed her undergraduate degree at University of Southern California, graduate degree at University of Arkansas, post-baccalaureate pre-medical courses at Harvard Extension School, and medical degree at Virginia Tech Carilion School of Medicine (Roanoke, VA). Her research interests include coagulation disorders in trauma and synthetic materials for regenerative medicine*. *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, residency, self-care, training **Tags:** Food4Thought --- ### [Balance](https://blog.womensurgeons.org/balance/) **Published:** February 3, 2016 **Author:** Blog Team **Content:** *By Andrea Merrill* If you had asked me about balance at age 10, I would have taken this question literally, immediately conjuring up an image of the balance beam that tortured me daily at gymnastics practice. The meager 4 inches of smooth, brown leather mocked me as I struggled with simple jumps, handstands, and half-turns. At 10, I was small but strong, shy but determined and I lacked the grace and finesse required for the delicate art of the balance beam. I remember standing tall, trembling, arms held high as I willed myself to arch backwards into a backbend, to overcome my fear of falling, my fear of failing, likely a metaphor for life to come. In medical school, balance became about understanding physiology, homeostasis, and how the body regulates itself. What happens when the immune system runs rampant, unchecked, and begins attacking itself? How does the body compensate when there is too much sodium? Too much potassium? Too much stress? I have now reached my 5th year of surgical training (3 years clinical, 2 years in “the lab”) and I continue to struggle with this concept of balance, or more specifically now, “work-life balance”. What does the term “work-balance” mean to me? As a woman? As a surgeon? As a person? *[![image1](%5Bsiteurl%5D/wp-content/uploads/2016/02/image1-224x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/02/image1.jpg)*Unfortunately, when the term “work-life balance” comes up with regards to professional women, it often takes the form of “work-family” or “work-mother” balance. A few months ago there was an article in the [Huffington Post](http://www.huffingtonpost.com/entry/male-politicians-family_56550fbce4b08e945fea67b4) that asked male politicians questions normally reserved for female candidates. Questions included: - When you were campaigning, did you get many questions about how you balance being a congressman and a father? - Do you consider yourself a feminist? - How do you and your family split up housework? - What advice would you give to fathers who are thinking of getting into politics? - During your campaign, did you get many questions about your family life and how you could juggle being a father while being a politician? - What does the phrase “work-life balance” mean to you? While my first reaction was to laugh at seeing these typically “female” questions being asked of men, it was clear from their answers that “work-life balance” was just as important to them as their female counterparts. *So why then does “work-life balance” seem to always be a gender issue, or more precisely a female issue?* I’ve been contemplating this conundrum often these days as I try to choose my specialty in general surgery. When I entered residency, bright-eyed, gung-ho, and overachieving, I had aspirations of becoming a high volume academic hepatobiliary surgeon with a thriving clinical research “lab” on the side. And then residency happened…and burnout…and then I thankfully started my research years. Not everyone needs the time “off” to step back, reflect, and think about what they want in life, but for me this hiatus came at the perfect time. *[![IMG_8204(1)](%5Bsiteurl%5D/wp-content/uploads/2016/02/IMG_82041-300x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/02/IMG_82041.jpg)*Additionally, I was very fortunate to have a wonderful mentor guide me through meaningful research on breast cancer. I must admit, I had been very hesitant to consider breast surgery as a specialty previously, and am still unsure of my fellowship choice. Some of my male colleagues and attendings have made snide remarks, implying that breast surgery is lesser surgery than transplant, vascular or cardiac surgery. A male device representative at an academic conference applauded my research in breast cancer by saying, “Breast surgery is a great specialty for a woman because it allows her to raise a family and children.” As a single female resident (with aspirations of one day having a family), this concept of “work-life balance” only being about me being a surgeon, mother, and wife is a hard one to grasp. It doesn’t take into account the rest of who I am or my other interests. It doesn’t account for my desire to write or to maybe one day be an associate editor of a medical journal. It doesn’t account for my love of cooking, baking, photography or travel. So it seems that I am still struggling to figure out what “work-life balance” means to me, how to interpret it in the context of my life and who I am, and how to achieve it going forward in my surgical career. I think it has different meanings for different people and it shouldn’t be gender based. For some, work truly is their life and that is where they derive the most pleasure and meaning. For others, they seek alternate joys to balance out some of the hardships of what we do for a living, either in a spouse, children, friend, hobbies, or other academic pursuits. “Work-life balance” is not one size fits all. I think back to that 10-year-old girl, trembling on the balance beam. I watch her slowly bend backwards, finally going for it, intent with concentration. And then as her hands approach the beam, she falls, hard onto the ground. She sits stunned for a moment, before she gets back up onto that menacing narrow beam of wood and tries to find her balance again. *[![IMG_8679](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_8679-300x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/02/IMG_8679.jpg) Andrea Merrill is a general surgery resident at Massachusetts General Hospital. Currently she is taking time to pursue an editorial fellowship at the New England Journal of Medicine. She eventually plans to complete a fellowship in Surgical Oncology. Her research interests include improvements in breast cancer surgery and gender disparities.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, family life, gender differences, residency, training --- ### [Food for Thought: The Patient Side of Medicine](https://blog.womensurgeons.org/the-patient-side-of-medicine/) **Published:** February 7, 2016 **Author:** Blog Team **Content:** *By Abigail Forbes* I was diagnosed with Juvenile Idiopathic Scoliosis when I was 8 years old. After many years of driving hours away to doctor appointments, the frustration of wearing a back brace as a teenager, and increasing back pain, the decision was finally made for me to undergo spinal correction surgery. The surgeon placed rods on my upper curve during the operation, and unfortunately my lower spinal curve continued to progress over the next year as I grew. I was still hurting, my clothes still ill fitting, and we were starting to question the benefit, if any, I got from the surgery. Frustrated, my parents and I sought out second opinions regarding further treatment; it was a unanimous opinion that my surgeon should have placed rods on both of my thoracic and lumbar curves. We were disappointed with the decision by the first surgeon regarding my surgery, because I was going to need a revision surgery to essentially start over. At 15 years old, I underwent my second major surgery to remove the first surgeon’s hardware for replacements rods spanning a longer area of my spine. [![](%5Bsiteurl%5D/wp-content/uploads/2016/02/AF-post-sculpture-225x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/02/AF-post-sculpture.png)Abigail constructed a sculpture using the hardware from her first surgery. Now being on the other side of medicine as a physician in training, I have gained a sense of empathy for my surgeon’s judgment call. As students, we feel inadequate as future physicians if we do poorly on an exam or miss a few questions while being pimped, and it’s easy to feel discouraged. I cannot imagine the toll it must take on a surgeon when the surgeries they perform lead to complications or even failure. Surely he did not intend for me to have to go back under the knife, give up my position on my soccer team, get behind on months of classwork, and inflict any more pain than I had already endured. I have now personally seen that medicine is not a flawless science and doctors cannot not be held to a perfect standard either. As a future surgeon, it is inevitable that I will make mistakes. I must remember to learn from my mistakes and not be discouraged, to seek advice of fellow physicians when I am unsure, and to listen to my patients and encourage their questions. However, my experience as a disappointed patient, allows me to better connect with my patients and understand their concerns. An experience that I once viewed as a misfortune, can now be appreciated from both a patient’s and physician’s point of view. This insight, I believe will only make me a better surgeon. ***To practicing surgeons, how are you are able to stay positive after a failed surgery or loss of patient?*** *[![AF post](http://blog.womensurgeons.org/wp-content/uploads/2025/06/AF-post-177x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/02/AF-post.png)Abigail Forbes is a third year medical student at University of Texas Medical Branch in Galveston, Texas. She completed her undergraduate degree at Baylor University where she discovered her passion for anatomy and went directly into medical school wanting to pursue surgery. She is active in her Plastic & Reconstructive Surgery Interest Group and helped found the UTMB Association of Women Surgeons student chapter. Her research interests involve improving patient distress and hypertrophic scarring after burn injuries.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* ***P.S. New on the Blog: Join our FEBRUARY BOOK CLUB featuring Dr. Paul Kalanithi’s WHEN BREATH BECOMES AIR on 2/21 and 2/28. Live Tweet-chat details to come!*** **Categories:** advocacy, career development, medical students, training **Tags:** Food4Thought --- ### [Maintenance of Self](https://blog.womensurgeons.org/maintenance-of-self/) **Published:** February 11, 2016 **Author:** Blog Team **Content:** *By Jean Miner* As many before me have asked, is there such a thing as balance when it comes to our careers and life outside the hospital? Maybe not, but we can realistically reach an *equilibrium* when we prioritize and allot time for all our responsibilities. Every time we step into the operating room we multitask, lead, and organize. Utilizing these same skills we have honed over time will aid us in our endeavor to reach stability between our career, family, friends, health, and most importantly our “self”. **ENLIST** others to join you in your journey for equilibrium. As health care providers, we often neglect our own healthy sleep, diet, fitness, and preventive measures. Regarding your path to getting healthy – find a family member, friend, or colleague who has similar or even higher goals than you to help you design a plan or challenge. Set a realistic goal that fits into your timeline. Sign up for a race; any distance is better than none. Consider planning one around a weekend getaway or as a relay with family or friends. Get a Fitbit or similar device/app and challenge long lost friends and distant relatives across the country to join you for a weekly challenge. For our personal lives, **SCHEDULE** time with significant others, family, and friends. At work we stay on track with planned surgeries, call schedules, and regular mandatory meetings. In order to be successful away from the hospital employ these same tactics. Have regular “date nights” with those important to you. Block off time to attend school functions, quick lunches with old friends, or just run errands. Some of the best advice I have been given and heard from many others on this same topic is; **DELEGATE** the tasks you can’t make time for or those at which you are not efficient. For example, if you love to cook but can never make it to the grocery, consider grocery delivery or using a service that creates the recipes and delivers the ingredients. For those of us who hate to clean, hire a maid to come biweekly to take care of the essentials. Love your pet but feel guilty about leaving them in the house all day? Find a dog walker or a doggy day care to use a few times a week. In today’s connected world, one can find service providers to accommodate most any need. A major complaint I often hear from colleagues is not having time for ourselves and always feeling pulled in multiple directions. The first step is to not overextend yourself- this was well covered in the December newsletter discussing [“Saying Yes and No”](https://www.womensurgeons.org/econnections-2015-december/debrah-wirtzfeld-saying-yes-and-saying-no/#sthash.gbjMIO9X.dpbs). When we have too much on our plates, the smallest piece of the pie ends up being served to us. Often we need to **TAKE TIME** to do a little self-reflection to make key decisions. In order to attain that sense of self we need to take time to do the things that keep us centered. For some, it may be a few minutes to meditate or pray each morning, others may do yoga or curl up with a good book before bed. Gardening, cooking, knitting, or listening to music helps others. Whatever your escape is, make time for it in your daily or weekly routine. Once you have reached a semblance of balance, the next step is investing the time and effort to **MAINTAIN** your relationships and health. Persist with your exercise regimen even after reaching your goal by setting a new one. Continue your personal life schedule until it has become routine and expected. Plan your annual exam and mammograms for the same time each year and make sure no one encroaches on that time. Just like the Board of Surgery has mandated the MOC (Maintenance of certification), we must establish a MOS (Maintenance of Self) to reach our desired equilibrium. *![JeanMiner_4c (002)](http://blog.womensurgeons.org/wp-content/uploads/2025/06/JeanMiner_4c-002-200x300.jpg)Jean Miner is an Associate Professor at the University of Central Florida College of Medicine and a Surgical Attending with Florida Hospital’s General Surgery Residency. She is finishing up a Masters in Medical Education Leadership at the University of New England. Her work life is in equilibrium with her personal life as a mother of three girls who loves spending time with her husband and family traveling the country and world. In her “spare time” she loves to cook, be outdoors and read as many books as she can.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons* **Categories:** career development, resources, self-care --- ### [February Book Club: When Breath Becomes Air](https://blog.womensurgeons.org/february-book-club-when-breath-becomes-air/) **Published:** February 14, 2016 **Author:** Blog Team **Content:** This month, the blog will feature Dr. Paul Kalanithi’s recently published book, *When Breath Becomes Air*. If you have not already, we suggest purchasing your own copy and joining us while we cover his work, here on the blog and on Twitter (follow @WomenSurgeons, @ShreeAgrawal21, @minervies, and @jzhao3). [![635876975230606294-When-Breath-Becomes-Air---cover](http://blog.womensurgeons.org/wp-content/uploads/2025/06/635876975230606294-When-Breath-Becomes-Air-cover-180x266.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/02/635876975230606294-When-Breath-Becomes-Air-cover.jpg) We will post reflections about the first half of his book on *February 28th* and the second half on *March 13th* to discuss your reactions and thoughts. Please follow *\#AWSFood4Thought* to join us on Twitter on *March 13th* and use the comments sections below to tell us what you think as you read along with us! A brief synopsis from the publisher, Penguin Random House: At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. *When Breath Becomes Air* chronicles Kalanithi’s transformation from a naïve medical student “possessed,” as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. For additional articles written by [Dr. Paul Kalanithi](http://paulkalanithi.com/):<http://stanmed.stanford.edu/2015spring/before-i-go.html>[http://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html?\_r=0](http://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html?_r=0)<http://www.newyorker.com/books/page-turner/my-last-day-as-a-surgeon>*Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons* **Categories:** resources **Tags:** Food4Thought --- ### [Integrating Surgery and Family Life](https://blog.womensurgeons.org/integrating-surgery-and-family-life/) **Published:** February 17, 2016 **Author:** Blog Team **Content:** *By Lillian Erdahl* As part of the discussion on work and life, I want to introduce a term I heard recently. A speaker at a conference I attended mentioned the concept of *work-life integration* rather than balance. Life, meaning the roles I have outside of my work. Many roles i I play sometimes conflict with each other, including: breast and general surgeon, teacher of residents and medical students, mother to two children, wife, daughter, granddaughter, aunt, sister, and friend. For now, I will focus on how I manage being a mother and being a surgeon. The struggle of working mothers and working parents is not unique to surgeons. However, the nature of my profession poses certain unique challenges. I cannot interrupt what I am doing in the operating room to talk to my child’s teacher or pick her up immediately from daycare if she has a fever. Some days the operating room gets delayed or a case is more complicated than predicted. What do I do when I get stuck at work late? What if my son has a special day at school on my operating day? There are a number of ways I have managed to handle these potential conflicts. The keys are preparation, planning, setting realistic expectations, defining priorities, flexibility, and staying in the present moment. How does that work for me? Preparation means we have two forms of childcare. Over the years these have changed, but we have always had a nanny or au pair for the off hours plus daycare or preschool during the regular work day. Planning means that my husband and I review the family schedule several weeks in advance. When it comes to setting realistic expectations, I start with myself. No, I will not be able to take my children to and from school most days, but I can attend parent-teacher conferences and the occasional Halloween Parade. It is also important to find out from my son which events matter most to him. Would he rather have me at his soccer game or his book fair? what is the order of priority for him? This is something I also have to ask myself. Is it a priority to participate in Journal Club or be home for dinner? All of this planning and preparation sounds great, but sometimes flexibility is needed to deal with the unplanned situations. Who am I going to call when I am unexpectedly in the operating room late and my husband is out of town? Knowing that I have a backup plan helps me to stay in the present moment. I take a minute to ensure that my children are cared for and then I can shift the focus back to my patient. Similarly, I work with partners I can rely on to cover for me if I have a family emergency. This allows me to focus on my family, knowing my patients are receiving excellent care. To me, that is work-life integration. *[![iPhone31 (2)](http://blog.womensurgeons.org/wp-content/uploads/2025/06/iPhone31-2-286x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/02/iPhone31-2.jpg)Lillian Erdahl practices Breast and General Surgery at the University of Iowa Hospitals and Clinics where she is Assistant Professor of Surgery. She is also married to a surgeon and mother to two children. She enjoys cross-country skiing, yoga, cooking, and spending time with her extended family. After enjoying her training at Penn State Hershey and Mayo Clinic, she is happy to be back in her hometown cheering on the Hawkeyes.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, family life, self-care --- ### [Food for Thought: Progressive Advice for Mentees](https://blog.womensurgeons.org/progressive-advice-mentees/) **Published:** February 22, 2016 **Author:** Blog Team **Content:** *By Gabrielle Rieth* I recently encountered an instance in which a mentor suggested that I and other female medical students rely on antiquated gender stereotypes to succeed in our upcoming clinical clerkship rotations. This advice was dispensed without any accompanying professional recommendations, such as pre-rounding on patients, recalling the patient’s medications and allergies, understanding the patient’s medical history, or practicing patient presentations prior to reporting to her residents or attending physicians. There is nothing amiss with possessing or utilizing “feminine” characteristics to enhance or improve one’s work environment. I personally felt the recommendation was inappropriate for the setting in which it was dispensed. It seemed, to me, to neglect other vital assets we as future physicians and surgeons will contribute to our clinical teams. I am soft-spoken and often characterized as “nice,” “sweet,” or “adorable.” I express my gender identity in a way that is traditionally ascribed to females. This combination of characteristics allows me to be perceived as non-threatening, accessible, and approachable – all of which have benefitted me when working with new colleagues and with patients. What advice do you provide your mentees regarding gender norms in the hospital? How do you, as an attending, stay progressive? *[![Profile photo](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Profile-photo-165x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/02/Profile-photo.jpg)* *Gabrielle Rieth, MS, is an M2 at Case Western Reserve University School of Medicine. She is originally from the Albany, New York area and completed her undergraduate work at Cornell University before migrating to the midwest.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, gender differences, medical students, resources, training **Tags:** Food4Thought --- ### [My Wake-Up Call](https://blog.womensurgeons.org/my-wake-up-call/) **Published:** February 24, 2016 **Author:** Blog Team **Content:** *By Sharon Stein* *Cardiovascular disease…Not me- I am too young for that.* I was shocked when I got the text from my husband. A friend and colleague had just had a stroke. She was in the Neuro ICU with dysarthria and left sided paralysis. Her systolic blood pressure was greater than 200. This wasn’t some white haired mentor of his – this was our friend, someone we go out to dinner with, our contemporary. She is a go-getter, an excellent physician, on the top of her game. Sure she worked too hard, didn’t have enough time for exercise, didn’t eat as well as she could have, but she is not different from me. She couldn’t have had a stroke, she is too healthy, she is too young, she could *be* me…. February is American Heart Association Health Month and the truth is that despite our medical training, we tend to be really bad patients. Women are ***more likely to die from heart disease than cancer***. In fact, it is the number one killer of women. And busy women like you and me overlook our risk factors and delay our self care. I’m not overweight, I don’t eat red meat, I don’t smoke, I work out. I am too busy taking care of my patients, my family, the bills. I don’t have time for my “Well Woman” Check (<https://www.goredforwomen.org/well-woman-visit/well-woman-visit/>) and my risks are pretty low….. The truth is, without having a cholesterol, blood pressure, and glucose checked, it is hard to determine our true risks of coronary artery disease. Women also ignore the early signs of cardiac or cerebral vascular disease. The fatigue, flu like symptoms, and shortness of breath may not be the result of working too hard, they may be the early signs of coronary artery disease. My friend thought she was just tired and under the weather…right up until her office staff noticed she was mumbling her words. I am amazingly grateful that my friend made a full recovery. She is back to work and doing great. She had a huge wake up call that she needed to take better care of herself: emotionally and physically. She’s made major changes to prioritize herself, and minimize her stress but it shouldn’t take a heart attack or stroke for us to do that. This month, let’s make a promise to ourselves, that we will make the effort: to get our annual check up, to work out a little bit more, to eat a bit healthier and take better care of ourselves. *[![Sharon Stein](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Capture8-209x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/Capture8.jpg)* *Sharon Stein is an associate professor of surgery in the division of colon and rectal surgery at University Hospitals/Case Medical Center in Cleveland Ohio. She is the secretary of the Association of Women Surgeons.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, self-care, women --- ### [When Breath Becomes Air: Understanding Mortality](https://blog.womensurgeons.org/when-breath-becomes-air-pt-1/) **Published:** February 28, 2016 **Author:** Blog Team **Content:** *Tweet chat (follow @WomenSurgeons) and additional blog post to come on March 13th 8 PM EST!* *By Shree Agrawal* Dr. Paul Kalanithi’s memoir, *When Breath Becomes Air*, as Dr. Abraham Varghese promised in his foreword, confronted me with the truth of mortality. The kind that lies beyond textbooks, evidence-based medicine, and clinical research. Prior to reading his work, I perceived statistics about patient populations experiencing difficult diagnoses to exist in a world detached from my reality. I likened data surrounding diseases to Dr. Kalanithi’s perspective of “country facts”, his term for theoretical old wives’ tales about dangers in his hometown. The probabilities of human vulnerabilities, especially those that could apply to my loved ones and me, are ones I avoided and discreetly hoped to be untrue. When I read about his evolution from pre-medical years to those as a neurosurgery resident, there is a surprisingly relatable quality. I am with Dr. Kalanithi in his gross anatomy lab and clinical experiences as a medical student and then resident. My experiences are tangibly similar in the context of his own. I can only wonder what separates us, any of us—the cadavers we see in medical school, Dr. Kalanithi, patients (past and future), and me? Was their organized chaos of simultaneous life-sustaining and death-promoting cells, electrical synapses, buzzing hormones and chemicals, any different from that of my own? There are many things I am left with, only midway through his posthumous work; but most indelibly, “When there’s no place for the scalpel, words are the surgeon’s only tool.” He echoes the values in this blog, and more importantly, in the humanities and ethics of medicine: the doctor-patient relationship, taking time to listen and discuss diagnoses, developing responsibility and ownership of mistakes, and guiding the patient-centered decision making processes. As I pause away from the gravitas of Dr. Kalanithi’s memoir and see my email ping with a new message, it becomes grossly irrelevant, now miniscule, in recognition of his existence. Please share your thoughts in the comments below or on Twitter with #AWSFood4Thought for this month’s February Book Club featuring *When Breath Becomes Air*. *[![Shree Agrawal](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Shree-Agrawal-218x230.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/Shree-Agrawal.jpg)* *Shree Agrawal is a second year medical student at Case Western Reserve University and an active member of AWS on the national medical student committee and within her Northeast Ohio region. She is passionate about patient-centered decision-making, clinical research, and academic medicine. In her free time, she enjoys practicing yoga, boxing, and cooking.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, medical students, residency, resources, self-care, training **Tags:** Food4Thought --- ### [Polka-Dots, Checks, and Stripes: Does Gender Expression Matter?](https://blog.womensurgeons.org/polka-dots-checks-and-stripes-does-gender-expression-matter/) **Published:** March 3, 2016 **Author:** Blog Team **Content:** *By Gabrielle Rieth* I am soft-spoken and often characterized as “nice,” “sweet,” or “adorable.” I express my gender identity in a way that is traditionally ascribed to females. This combination of characteristics has allowed me to be perceived as non-threatening, accessible, and approachable – all of which have benefitted me when working with new colleagues and when interacting with patients. However I also recognize that these traits may cause those same colleagues to overlook or underestimate my work ethic. *Knowing this,* I still do not bother to invest additional energy to correct their behaviors or assumptions about my capabilities. Why? While my peers are busy assessing my competence from the way I speak or portray my gender, I am focusing on getting ahead in my career. This was my default internal monologue. I drew inspiration from the #ILookLikeASurgeon campaign and believed my gender has made progress, as it is 2016 and the culture of medicine is changing. *Until recently.* I just completed my second year of medical school and will be beginning the clinical years of my medical training this July. In advance of this transition, our school hosted a student panel featuring graduating M4 students. Some of the wisdom offered by the panel related to strategies for standing out during rounds, but a fair portion of the information offered by the female students pertained to appropriate attire and what would, or would not, be perceived as professional by their senior colleagues. Obviously there is a standard of attire both genders should adhere to, which many medical schools ingrain in their students; but the gendered commentary provided by the panel causes me to wonder how I will be perceived in the hospital. Will the fact that my professional closet contains subtly floral prints, embellished tops, or lace skirts in addition to the standard uniform of monochromatic pants and blouses detract from my contributions as a member of the medical team? Will I be discounted before I even have a chance to prove myself? How often have we all, as students and mentors, judged someone based on their appearance, only later to be “surprised” or “astonished” when that same person acts or speaks in a way that contradicts the preformed opinion of them in your consciousness? Professional appearance matters for all genders within medicine, and though the female professional appearance was emphasized on the panel; does this perspective also harm our counterparts as well? How can we stop this cycle of judgment, validation, and awe of our peers – and ourselves – moving forward? *[![Profile photo](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Profile-photo-165x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/02/Profile-photo.jpg)Gabrielle Rieth, MS, is an M2 at Case Western Reserve University School of Medicine. She is originally from the Albany, New York area and completed her undergraduate work at Cornell University before migrating to the midwest.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, medical students, professionalism, women --- ### [Walk in his Shoes: When Breath Becomes Air](https://blog.womensurgeons.org/walkinhisshoes/) **Published:** March 6, 2016 **Author:** Blog Team **Content:** This month, we are reading Dr. Paul Kalanithi’s [When Breath Becomes Air.](https://www.womensurgeons.org/february-book-club-when-breath-becomes-air/) Join us for a tweetchat Sunday, March 13th at 8pm EST by following @WomenSurgeons and the #AWSFood4Thought. I honestly did not know what to expect from the book. When I told friends about my pre-order, they wondered whether they too could read the book as it sounded “terribly sad.” As I picked it up one evening – a break from studying general surgery – I found myself bracing for an emotional challenge. I was genuinely surprised that I could not put the book down. Being in my Chief Resident year, I thoroughly enjoyed getting to know Paul from English major to medical student to neurosurgery resident. I had the acute feeling that I was walking in his shoes. I appreciated the patient anecdotes, reminding me of my own patients who raised similar questions in my training. His eloquent writing style raising in my mind memories of my own path to becoming a surgeon, questions about life goals, mortality, love. Take a look back at medical student Shree Agrawal’s thoughts on [Part I](https://www.womensurgeons.org/when-breath-becomes-air-pt-1/) of the book (@ShreeAgrawal21). Next week, Dr. Jane Zhao (@jzhao3) will write another #AWSFood4Thought post on Part II. Join us for a tweetchat Sunday, March 13th at 8pm EST by following @WomenSurgeons and the #AWSFood4Thought. *[![minerva-romero-bio-pic1](http://blog.womensurgeons.org/wp-content/uploads/2025/06/minerva-romero-bio-pic1-292x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/minerva-romero-bio-pic1.jpg)Minerva A. Romero Arenas, MD, MPH is a General Surgery Resident at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate. Follow @minervies on Twitter.* *Her interests include surgical endocrinology & oncology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.****Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.*** **Categories:** Uncategorized --- ### [Colorectal Cancer Awareness](https://blog.womensurgeons.org/colorectal-cancer-awareness/) **Published:** March 10, 2016 **Author:** Blog Team **Content:** *By Linda Farkas* October is the “pink” month. Pink is everywhere for breast cancer. Major cities light up pink fountains, pink skyscrapers, and even “real men” (football players) wear pink for breast cancer (BC). Kudos to breast cancer awareness for hitting a home run through their campaigns, which can be measured in action. This success can be seen with increased mammography screening up to 70.2%, depending on a woman’s insurance. (ACS, Surveillance Research 2016). Other than the “Get your Butt in Gear”, or the Traveling Colossal Colon, colorectal cancer (CRC) awareness is silent. Why? Is it sexier to talk about breasts, than colons, rectums, colostomies and stool? CRC screening compliance does not fare as well. By any modality- guaiac cards, sigmoidoscopy, colonoscopy, and barium enemas it still hovers around 50%. (2009 NCQA data-reflecting 2003-2008 data) So every March (let’s face it –every day) I use CRC Awareness to my advantage as I counsel my patients. Women are the easiest to mobilize for CRC screening, as they are often the medical decision makers of family units. While CRC is the 3rd most common cancer, it is the 2nd most common cause of cancer death. Our diligence about breast health should be equal to that for colon health. Forty-seven percent of all inflicted with CRC are women. Therefore, it is equally important to promote screening for themselves as well as the men in their lives: husbands, fathers, brothers, sons, and friends. Testing may be as infrequent as every 10 years versus yearly mammograms. However, I stress that while mammography finds cancers early, colonoscopy **PREVENTS** cancer. Testing is **therapeutic** at that same visit, as polyps are removed to prevent progression to cancer and subsequent surgery. The STOP CRC Foundation, founded by the first woman boarded in colorectal surgery, Dr. Ernestine Hambrick, had the best message for the public: **Do the Test. Find the Polyp. Skip the Cancer!** One obstacle to screening is the “prep”. I remind my patients of a multitude of preps on the market that are not always a four liter jug. Having gone through the prep myself, I can now give advice on mixing Miralax in a variety of clear fluids to prevent taste fatigue. Baby wipes and butt cream are also helpful! Still there are those that are firmly resistant to screening due to factors like time, courage, or dignity. Another acceptable screening option would be to take home three hemoccult cards. Any screening is better than none. While we advocate for our patients, we as physicians need to have these discussions with our own families. I think over the years I have “shamed” all my family members and in-laws to be tested lest they succumb to CRC with a known colorectal surgeon in the family! What-ever- it –takes! Last but not least, we have to think of ourselves. The airplane industry has always been ahead of the health industry. They are the founders of the check list take-off that many hospitals have just begun to incorporate. Also, remember the takeoff message? “In the event of … an oxygen mask will automatically appear. If travelling with someonewho needs assistance, secure your mask first, and then assist the other person” Why? Because if you become hypoxic before you can help others, then the two of you succumb to hypoxia. Likewise, as physicians, if we do not take care of ourselves, then we fail to care for others. We are not invincible or immune to disease. It saddens me each time as I hear about fellow colorectal surgeons who have succumbed to CRC, and never had their scope. They were so busy caring for others they forgot their own self-care. I silently applaud surgeons who realize the importance of their own screenings and find creative ways to get their own scopes done, even in their busy schedules. While CRC awareness month is becoming more known, I doubt it will ever reach the awareness of BC: blue city fountains, sky rises, and football shoes. Still, we must do our part to prevent the 2nd most common cancer death in ourselves, loved ones, and patients. I had my colonoscopy in 2014. **When did you get yours, or when will you schedule yours?** *[![Linda Farkas Headshot](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Linda-Farkas-Headshot-151x142.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/11/Linda-Farkas-Headshot.jpg)* *Dr. Linda Farkas is the first Chief of the Division of Colon & Rectal Surgery at UC Davis. She received her medical degree from Loyola University Chicago Stritch School of medicine, and received her following training from University of Illinois/Cook County Hospital. and has been in practice for 26 years and proud to have had the opportunity to operate with Ernestine Hambrick, the first woman to be boarded in Colon & Rectal Surgery.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** resources, self-care, women --- ### [When Breath Becomes Air: Lessons Learned](https://blog.womensurgeons.org/lessons-learned/) **Published:** March 13, 2016 **Author:** Blog Team **Content:** *By Jane Zhao* **Join us for a tweetchat tonight, Sunday evening, March 13, at 8 PM Eastern Time and follow @WomenSurgeons, @jzhao3, @ShreeAgrawal21, @minervies and the #AWSFood4Thought!** It is only when confronted with our own mortality that some start to embrace life. In part two of his memoir, Dr. Paul Kalanithi takes us on a journey from the time of his diagnosis of terminal lung cancer to his last few days and shows us just how alive he is throughout the time he is actively dying. Rather than summing up his narrative, I have highlighted certain passages from Part Two in chronological order to give an accurate depiction of his transformation from doctor to patient back to doctor, all the while juggling various roles as husband, son, and finally as a new father. Warning: There are spoilers ahead! **\~~~Excerpts from “Part Two: Cease Not till Death”\~~~** ***“’I’m never coming back to this hospital as a doctor.’”*** Kalanithi tells his coresident this immediately after he is diagnosed with stage four lung cancer. He later reneges and returns to work, but initially, it was inconceivable to think any other way. Surgery, particularly neurosurgery, as he states “is really hard work, and no one would have faulted me for not going back.” It is not only physically taxing but it can be emotionally and mentally draining. Kalanithi always describes neurosurgery as a calling because there is absolutely no incentive to pursue neurosurgery as a job. As a job, “it is one of the absolute worst.” ***“Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.”*** It does not matter how many patients we treat or how many times we walk through the process of death and dying. At most, we can be there for our patients, as they come to terms with their own mortality, but the experience is otherwise a solitary one. As a neurosurgery chief resident, Kalanithi is a seasoned veteran when it comes to the topic of broaching poor prognoses, but he only truly began to understand the scope of loneliness that comes with terminal diagnoses after his own experiences with lung cancer. ***“…without that duty to care for the ill pushing me forward, I became an invalid.”*** How do any of us identify ourselves? Our profession shapes the way we are viewed by those around us. When we find ourselves stripped of the ability to perform our sense of duty, our world turns upside down. We face an existential crisis. *Who am I now?* What defines you beyond surgery? Did Kalanithi’s memoir create a sense of gratefulness because you can still do the job you are passionate about? ***“Grand illnesses are supposed to be life-clarifying. Instead… my ability to make lunch plans had been shot to hell.”*** There is no science to knowing when death will happen, even when it is certain. What are you supposed to do when you do not know how much time you have left? This is the struggle Kalanithi faces, when his chemotherapy regimen stalls his cancer just enough for him to perform full speed at back at work. He was in his final year of training, when everyone else was actively job hunting. He knew his time was limited. He knew his values. Given one year, he could write a book. Given ten years, he could return full force to his clinical practice. The trouble, though, is he has no idea where he falls in that spectrum. ***“Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.”*** Kalanithi discovered the power of having faith, whether it was in God, people, or some higher force controlling destiny and fate. When the answers to *why* and *how* were not found in science, he found his comfort in God, returning to the faith of his childhood. Where do you find the answers to *why* and *how*? Where do you seek comfort in the journeys your patients and loved ones travel? ***“There we were, doctor and patient, in a relationship that sometimes carries a magisterial air and other times, like now, was no more, and no less, than two people huddled together, as one faces the abyss.”*** The patient-physician relationship is a two way street. When patients die, physicians are not immune to mourning. We grieve. We need hope. In the care of our other patients, we bury this vulnerability. However, even as a patient, Kalanithi recognized when the end is near, by the sadness his oncologist cannot hide. ***“’I can’t go on. I’ll go on.’”*** This is a message to all of us. We keep moving even when we cannot. In life we have no other option. Time does not stand still for anyone. In our darkest moments, Kalanithi is encouraging us all to go on. \~~~ Part Two of Kalanithi’s work ends relatively abruptly, with him describing the joy his new daughter brings to his life. His health deteriorates before he has a chance to finish the great work he began. His wife, Lucy, helps us follow him to the end of his journey in the epilogue. My eyes stayed surprisingly dry throughout Part One and Part Two, but tears started flowing once I reached the epilogue. The love between both of them was—is—obvious. His dream of becoming published was fulfilled by her, and together they show us the best way to live is to “cease not till death.” **Previous posts about When Breath Becomes Air can be found by [Minerva Romero Arenas](https://www.womensurgeons.org/walkinhisshoes/) and [Shree Agrawal](https://www.womensurgeons.org/when-breath-becomes-air-pt-1/).** *![JZhao](http://blog.womensurgeons.org/wp-content/uploads/2025/06/JZhao-135x180.jpg)* *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 McGovern Medical School, University of Texas Health Science Center 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.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency, resources, self-care **Tags:** Food4Thought --- ### [The Impact of Shared Experience](https://blog.womensurgeons.org/the-impact-of-shared-experience/) **Published:** March 16, 2016 **Author:** Blog Team **Content:** ***Reflections from the Panamerican Trauma Society/Association of Women Surgeons’ Women in Surgery Panel at the 28th Panamerican Trauma Congress in Santa Cruz de la Sierra, Bolivia*** *By Marissa Boeck* In a giant convention hall, blindingly bright lights shine down on a long table in the middle of a makeshift stage. A moderate-sized crowd filters in. While the majority are women, there is a mix of genders that spans generations, all coming to hear a handful of female surgeons speak. Included is a mother from the local community who brings her adolescent daughter, in the hopes of reinforcing that despite local or cultural female stereotypes, her daughter can achieve whatever she sets her mind to. The panelists come from different training and geographic backgrounds, from medical school graduates to senior attendings, general surgeons to those specializing in trauma, bariatrics, or gynecology, hailing from Bolivia to Panama to Canada. The venue is the [2015 Panamerican Trauma Congress](http://www.boliviatrauma2015.com/?lang=en) in Santa Cruz, Bolivia. [![MB_1](%5Bsiteurl%5D/wp-content/uploads/2016/03/MB_1-300x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/03/MB_1.png) The seed for this event was planted a few years ago by [Dr. Paula Ferrada](https://twitter.com/pferrada1), Colombian by birth and American by training, marriage, and work, who is also a trauma and critical care surgeon at Virginia Commonwealth University and chair of the [Panamerican Trauma Society](http://www.panamtrauma.org/) (PTS) Education and Research Committee. She proposed having sessions focused on women in surgery at the society’s annual congress. The tipping point for adoption came from the global [\#ILookLikeASurgeon](http://www.ilooklikeasurgeon.org/) social media movement started by surgery resident [Heather Logghe](https://twitter.com/LoggheMD). Through increased recognition of diversity gaps in surgery, the creation of a strong virtual social media community, local ties with the 2015 PTS congress organizing committee, and collaboration with the [Association of Women Surgeons](https://www.womensurgeons.org/) as a co-sponsor, the Women in Surgery/Mujeres Cirujanas Líderes panel was born. Our goal was to share experiences and provide examples of success at varied levels of training from across the globe, while also trying to elucidate why [proven gender gaps in medical leadership](https://hms.harvard.edu/harvard-medicine/voices/mind-gap?utm_source=twitter&utm_medium=social&utm_campaign=hms-twitter-general) exist. We also aimed to show that appearance, be it gender, race/ethnicity, or otherwise, does not dictate what one can accomplish. The importance of the panel was confirmed even before it happened when three panelists, myself included, were invited to discuss the event on a [local talk show](https://www.youtube.com/watch?v=OLSjQJLbms8&feature=youtu.be&t=1773). The segment also incorporated positive messages and insightful questions sent via Whatsapp during the live taping, and placed a correspondent on the street asking people if women can and should hold leadership positions, with most (thankfully) answering a resounding yes. [![MB_2](%5Bsiteurl%5D/wp-content/uploads/2016/03/MB_2-300x180.png)](%5Bsiteurl%5D/wp-content/uploads/2016/03/MB_2.png) The conference panel began with us attesting to why such an event is still needed in this day and age. Most of us highlighted personal struggles and barriers that rang similarly true across generational and geographical boundaries. These challenges included patients or staff consistently perceiving us as the medical student or nurse despite being the leader of the medical team, the fight to become a surgeon while ignoring the naysayers arguing we don’t fit the stereotype, or the ability to balance a full personal life with a demanding career. When asked what we would choose if we had the option to do it all over again, not one of us said we would be anything other than what we are, a surgeon. But to be clear, there was no sugar-coating. All of us freely admitted that pursuing a career in surgery is not an easy task. However, and partly because of this, it is also one of the most rewarding professions. Although a finite, one-hour event within a discrete, annual congress, the idea is to continue the conversation from the panel through new connections and a growing community of surgeons, women and men alike. This will dispel the notion that anyone is alone in their professional pursuits or struggles, promoting instead the idea that support to succeed exists and is accessible. The panel has already spawned a Spanish-speaking Whatsapp group between panelists and attendees from across the Americas. This has led to inspiring messages of solidarity and community, and a forum for discussion on subjects such as mentorship and patient management. All of this argues for the importance and need to foster such events at future global conferences. We also made a point to highlight the incredible power of social media, including Twitter and Facebook, to provide mentorship from afar when it may be lacking locally. As the session came to a close, the adolescent Bolivian girl who attended with her mother promised us that she would hold fast to her professional dreams, no matter how remote they seemed. This was when we all knew the panel had hit its mark: to instill in others the courage and inspiration to chase after what they set their sights on. Because if we could do it, so could they. *[![hlzwmp_D_400x400](http://blog.womensurgeons.org/wp-content/uploads/2025/06/hlzwmp_D_400x400-300x300.jpeg)](%5Bsiteurl%5D/wp-content/uploads/2016/03/hlzwmp_D_400x400.jpeg)Post-Graduate Fellow in Global Health, Northwestern University Feinberg School of Medicine, Arthur Tracy Cabot Fellow, Harvard Center for Surgery and Public Health, Brigham and Women’s Hospital, General Surgery Resident, New York Presbyterian Hospital-Columbia* *For those interested in joining the trans-continental, Spanish WhatsApp group of women surgeons, please reach out to the author on Twitter @KickAsana or post in the comments section below.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, education, leadership, resources, women --- ### [Beautiful Girl, You Can Do Hard Things](https://blog.womensurgeons.org/beautiful-girl-you-can-do-hard-things/) **Published:** March 20, 2016 **Author:** Blog Team **Content:** *By Brittany Bankhead-Kendall* I saw that quote on my favorite Facebook group recently, called “Physician Moms Group” (or “PMG”). This is a group of women who, like all of us, are just trying to “do” life every day. Because of our integrity and intellect, we are trying to do it better than anyone else. I think that’s from a “Type A” personality, combined with leadership & wanting to be perfect at absolutely everything. Make sure the kids are happy, our finances are in order, our trip to Disney World is fun, the house is clean, the co-workers aren’t mad we’re on maternity leave, ensure we are the go-to specialist, the spouse feels loved, and the list goes on. But don’t let any one of these Jenga pieces fall! As women in medicine, and especially as women in surgery, our formidable years in training teach us how to be strong and courageous. For some reason, we occasionally feel as if we should lose parts of ourselves. That maybe, we lose our soft approach to speaking with families. Or that we should be brash in the trauma bay to make people to listen to us. Maybe it is that we feel obligated to look on new interns with disgust when they say a wrong answer. Perhaps, we feel we should only [dress in the frumpiest (yes, that’s a word) of clothes in order to not ](https://www.womensurgeons.org/polka-dots-checks-and-stripes-does-gender-expression-matter/) draw attention to anything besides our intellect. Do not ever cry! Do not wear cute shoes! Do not let “them” see you cower! But since when did being beautiful, and being a woman, and being all the beautiful things about being a woman, become a bad thing? Since when did things like kindness, and generosity, and the ability to multitask like a **BOSS,** become perceived as less important attributes of our profession? I think if we consider the mentors that have come before us, the ones that we truly respect and admire, they are all of these attractive qualities AND they are phenomenal surgeons. There is a trauma/acute care woman surgeon at a community teaching hospital. During a trauma activation with a teenager whose Glasgow Coma Scale is rapidly deteriorating as fast as his blood pressure is, she is calm, cool, and collected while she firmly but kindly tells everyone in the room what to do. And we listen. The next day, she does a robotic case in the operating room in the morning, and then takes her boys to the zoo in the afternoon, regardless of the talk that may happen as she walks out of the hospital. She tells me, “This is the perfect kind of day.” And I listen. The hard, complex cases and the hard, crashing traumas? No doubt we can do THOSE hard things. But the mean co-workers? The eye-rolling staff? The judging administration? The sometimes annoyed-with-us family at home? We can do that, too. And we can do it with kindness, and with joy. We can do it with a woman’s touch, together. Because beautiful girl, you CAN do hard things. *[![IMG_2650](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_2650-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/03/IMG_2650.jpg)Brittany Bankhead-Kendall, M.Sc., M.D. is a PGY2 general surgery resident at St. Joseph Mercy Oakland in Pontiac, Michigan. She obtained her M.D. from Ross University School of Medicine, her M.Sc. from Barry University in Biomedical Science, and studied Biomedical Science and Spanish at Texas A&M University. She is currently completing a fellowship with the “Association of Surgical Education Surgical Education Research Fellowship” program and is the General Surgery representative for her local Graduate Medical Education Council. She plans to pursue a career in trauma/critical care, and acute care surgery. She enjoys clinical research in trauma and surgical education, and has presented her work at multiple regional & national conferences. In her personal time she enjoys spending time with her family and church, interior design, financial planning, and international travel.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, gender differences, professionalism, residency, resources, women **Tags:** Food4Thought --- ### [On being a mom, surgeon, and wife - or surgeon, mom, and wife – or…](https://blog.womensurgeons.org/on-being-a-mom-surgeon-and-wife/) **Published:** March 23, 2016 **Author:** Blog Team **Content:** *By Chris Hardesty* The worst moment in 2015 was the morning my 2 year old started crying when he realized I was leaving for work. I’d heard this would happen and expected it, but the pit in my stomach was worse than I anticipated, the temptation to stay home tugged like a wave pulling me under the water, and I matched his tears when I got into my Jeep. It sucked. I rationalized I was going to an important job helping other kids, that Jack would be over it quickly, and that millions of other moms/kids had been through this. But it still sucked. “Work-life balance” is that overly used term for the elusive perfect schedule. It has been touted as something we should all work for, but I have yet to meet anyone – male or female – who has achieved it. My first goal in writing this is to tell you to abandon the idea that we can ever actually get there. Pretending it is a goal that can actually be achieved only serves to frustrate you when you never achieve it – especially if you’re a surgeon (an overachiever). My second goal is to give you both philosophical and practical tips to help you work toward finding an acceptable amount of happiness in how YOU live your life. Philosophically: Decide what you want your life to be like in and outside of medicine. Do you want kids? Does your partner? Do you want to work full time or part time? Is it important that you are a frequent contributor to your community or could you be happy not being involved in the PTA/church groups/social organizations? How important is an academic career (national committees and presentations) to you? Practically: Having an understanding partner is crucial – my husband is a saint for what he allows me to do, but I recognize this and I recognize HIM for it. The number one most important thing in our life is a shared calendar. My husband and I put anything important to us on this calendar as soon as we are aware of it. Call nights, his soccer games, any trips, dinner meetings, kid appointments, etc get blocked out so we can plan appropriately. This includes figuring out when I might need to cancel a clinic so I can be somewhere. The earlier I know, the better chance I have of making it to important non-medical events. The next most important thing is to realize that this is 2016 and we don’t live in an old-school world. I have given lectures with my son in a baby carrier, he rounds with me on weekends, and I have the ability to complete and sign charts from home. I do not have to separate my home and work worlds the way my older colleagues did. Even the time in the car, as Jack and I drive to and from the hospital, is worthwhile. [![carrier 3](%5Bsiteurl%5D/wp-content/uploads/2016/03/carrier-3-300x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/03/carrier-3.jpg)*Chris’ take on multi-tasking* My next best piece of advice is to [say yes](https://www.womensurgeons.org/inhale-exhale-say-yes/) to things that will help your career or your patients, but [no](https://www.womensurgeons.org/saying-no/) to things that will only suck up your time. Lots of people will want things from you, but they are not all necessary. Finally, let go of the feeling that you are a bad person if you don’t do everything yourself. I felt ridiculous hiring a house cleaner (snobby, even) but I value my time with Jack more than I value the money I spend every two weeks. I order my groceries online and pick them up at the store. I have a nurse to deal with prescriptions, phone call returning, and filling out paperwork. In reality, there will be times when your patients’ needs come first. That’s the nature of being a surgeon. Understanding this and helping your family understand it will decrease (but probably not eliminate) tears shed by you *and* your family. *[![hardesty-christina-18563](http://blog.womensurgeons.org/wp-content/uploads/2025/06/hardesty-christina-18563-126x200.png)](%5Bsiteurl%5D/wp-content/uploads/2016/03/hardesty-christina-18563.png)Christina K. Hardesty, MD, is a pediatric orthopaedic surgeon at University Hospitals Rainbow Babies & Children’s Hospital. She is Assistant Professor of Orthopaedics and Adjunct Professor of Pediatrics at Case Western Reserve University School of Medicine. Her special interests include cerebral palsy, scoliosis and spinal deformity correction, neuromuscular disorders, pediatric sports injuries, spasticity and spina bifida.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, family life, resources, self-care --- ### [Greening the OR](https://blog.womensurgeons.org/aws-green-or/) **Published:** March 28, 2016 **Author:** Blog Team **Content:** *By Abigail Forbes* As a medical student I have learned to seek out opportunities that will foster my journey through medical school and facilitate my goal of becoming a surgeon. The Go Green Contest is one of those many opportunities I came across through AWS. I gained an invaluable mentor and was able to promote a great cause: benefitting our environment. Students and residents should take advantage of this opportunity! When I was formulating a ‘green solution’ to submit, I benefitted from my surgeon mentor’s knowledge. Additionally, I was able to communicate my commitment and wide interests in the medical field. I found this unique interaction with faculty that allowed me to stand out as a medical student and to explore the possibilities and process of improving healthcare in my community. Together, we were able to outline an educational plan to train medical students about operating room procedures by saving unused opened gloves, suture, gowns, and drapes, further promoting environmental conscientiousness in the operating room. I would recommend contacting a surgeon at your institution and sharing your interest in submitting an idea for this competition. They will undoubtedly be willing to collaborate with you by offering suggestions from their professional experience and feedback for your ideas. Should you win, you will be recognized at the AWS national conference, and gain yet another opportunity to learn and grow as a future surgeon. Plus a 200$ prize is a great bonus! **Submissions can be sent to abbyforbes826@gmail.com by 5:00 PM EST Friday, April 3rd.** You can start by looking here for inspiration: - <https://practicegreenhealth.org/initiatives/greening-operating-room> - [Greening the OR Competition Details](%5Bsiteurl%5D/wp-content/uploads/2016/03/2016-AWS-Green-OR-1.pdf) *![AF post](http://blog.womensurgeons.org/wp-content/uploads/2025/06/AF-post-177x300.png)Abigail Forbes is a third year medical student at University of Texas Medical Branch in Galveston, Texas. She completed her undergraduate degree at Baylor University where shediscovered her passion for anatomy and went directly into medical school wanting to pursue surgery. She is active in her Plastic & Reconstructive Surgery Interest Group and helped found the UTMB Association of Women Surgeons student chapter. Her research interests involve improving patient distress and hypertrophic scarring after burn injuries.Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, education, medical students, resources **Tags:** Food4Thought --- ### [The Other Nine Percent](https://blog.womensurgeons.org/nine-percent/) **Published:** March 30, 2016 **Author:** Blog Team **Content:** *By Miriam D. Weisberg* The United States Preventative Services Task Force and American Cancer Society advocate the importance of Papanicolaou tests (Pap test) as effective screening for cervical cancer prevention. Since the introduction of Pap tests, there has been a decline in cervical cancer deaths by 50%. These statistics are a proud reflection of the impact early detection has had over the past 30 years. [USPTF guideline revisions](http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening) now recommend Pap tests once every 3 years for women over 21, and only once every 5 years after the age of 30. [Despite the success of early detection](https://www.womensurgeons.org/cervical-cancer/), the new guidelines are decreasing the frequency of examination. Is the leniency of these guidelines a risk factor for the next generation of young women? The guideline revisions are based on the correlation between HPV and development of cervical cancer, which accounts for 91% of cervical cancers every year.. Unlike self-breast exams for breast cancer, there are no methods for women to detect a precancerous lesion on their cervix, which may be missed in the other 9% of the at-risk population. In 2009, a busy single mom went to her gynecologist and had a normal Pap. On a Friday night in 2011, she was rushed to the emergency room on the verge of hypovolemic shock. An exploratory surgery the next day confirmed HPV-negative Stage 3b cervical cancer and aggressive treatment was started immediately. Any working single mother knows putting herself first is a foreign concept. There are always reasons to push personal items further down the to do list. Health maintenance is inevitably one of these items. Maybe you are moving your son into college this year or it’s your daughter’s birthday. Rescheduling your medical appointments is a simple solution to making space in your schedule, but there just never seem to be enough hours in the day. So you may miss your Pap this year. It has already been three years since the last one, but you feel it can wait a little bit longer. Gynecological cancers are unfortunately overshadowed by breast cancer in the social media world of women’s health. I am an advocate for gynecologic cancer prevention because my mom was one of the 9% HPV-negative cervical cancers. That story was my mother’s experience with cervical cancer. This piece was written in honor and celebration of reaching her fifth year in remission this March. ![Mimi and her mom, cervical cancer survivor and the other 9%](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Untitled-241x300.png)Mimi and her mom, cervical cancer survivor and the other 9% As medical professionals we may not always be able to change recommendations for screening, but as educated women in society we can be a voice for each other. **My message for you is to be an advocate for your patients, your loves ones, and most importantly, for yourself.** *Miriam (Mimi) Weisberg is originally from Miami Fl and is now entering her third year at the Herbert Wertheim College of Medicine in her hometown. She is a student advocate for women interested in a surgical career. She has been interested in surgery since the age of 16, and is supported by her mother, sister and mentor, an orthopedic surgeon at Miami’s Nicklaus Children’s hospital.* *The author of this post was given permission to disclose her mother’s personal story. Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, resources, self-care --- ### [Medical Students Petition to End Step 2 Clinical Skills Exam](https://blog.womensurgeons.org/medical-students-petition-to-end-step-2-clinical-skills-exam/) **Published:** April 4, 2016 **Author:** Blog Team **Content:** *By Nickey Jafari* Recently, several students at Harvard Medical School started a [petition](http://endstep2cs.com/) to eliminate the national clinical skills exam for US medical graduates, a requirement they regard as an unnecessary expense providing little to no educational purpose or benefit to future patients. They argue that the high cost of the exam, combined with the very low number of medical students that fail, results in an undue burden to medical students. Indeed, USMLE cites a [pass rate](http://www.usmle.org/performance-data/default.aspx#2014_step-2-cs) of 96% for first-time takers of Step 2CS. While the students behind this movement have not yet spoken directly with the NBME, members of the medical community who have encountered the petition have exhibited no real pushback to the idea of ending the Step 2 Clinical Skills Exam. Over 14,000 individuals have already signed their petition. We interviewed Carolyn Treasure, a 4th year medical student at Harvard, and one of the leaders of this effort: *Q: How did you get involved with End Step 2CS? What triggered your interest in starting this petition?* A: Christopher Henderson, a fellow fourth year at HMS galvanized about 5 of us to this effort. We all were interested in starting this petition to help fellow medical students. This test is redundant and low value. We felt it was pretty obvious to us both before and after we took it. However, we decide to wait to start this petition until after each of us had taken the exam. We hope this collaborative effort helps future generations of medical students. *Q: In your opinion, outside of Step 2CS, are there any other good examples of an unnecessary cost in our medical education?* A: There are a lot of examples of unnecessary or excessive cost or, more accurately, pricing. But that is outside the scope of this petition. However, I do believe as medical students and future physicians our generation needs to start questioning the system more: why do we have to do said things? Does it really have any educational benefit? Is it cost effective or evidence based? Hopefully this is an example that will encourage our peers and colleagues to critically think about the cost vs. benefit of medical education requirements, as well as other stipulations throughout training and practice. You can read more here: - <https://www.statnews.com/2016/03/11/medical-students-exam/> - <http://www.thecrimson.com/article/2016/3/25/medical-school-students-petition/> - <http://in-training.org/endstep2cs-interview-with-initiative-founder-and-usmle-representative-10887> *[](%5Bsiteurl%5D/wp-content/uploads/2016/04/Carolyn_Treasure_3.jpeg)[![Carolyn_Treasure_3](%5Bsiteurl%5D/wp-content/uploads/2016/04/Carolyn_Treasure_3-220x300.jpeg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/Carolyn_Treasure_3.jpeg)Carolyn Treasure is a fourth year medical student at Harvard. She, along with Christopher Henderson, Ben Rome, Ben Brush, Lydia Flier and Samia Osman, launched the petition to End Step 2CS in March 2016.*![AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg](http://blog.womensurgeons.org/wp-content/uploads/2025/06/AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg-296x296.jpg)*Nickey Jafari is a 2nd year medical student at the University of Kansas School of Medicine. She was born in Tehran, raised in Kansas, and attended Drake University in Iowa for her Bachelor’s degree in International Relations and Biochemistry. She is passionate about global health and is interested in how better access to and quality of surgery can help tackle disparities in outcomes.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, medical students **Tags:** Food4 --- ### [Distracted Driving](https://blog.womensurgeons.org/distracted-driving/) **Published:** April 6, 2016 **Author:** Blog Team **Content:** *By Stephanie Bonne* As a trauma surgeon, my main academic interest has been injury prevention. It just makes sense to me – the easiest trauma to recover from is the one that never happened to begin with. This takes on many forms, from violence prevention to safety, to addressing the problems at the intersection of poverty, education, and injury. As part of this mission, I have occasional speaking engagements in the community. Last year, I was asked to speak at my state’s highway safety coalition meeting about distracted driving. I prepared a powerpoint full of statistics and videos, and stood in front of several hundred people, emphasizing the dangers of distracted driving and how important it was for everyone to spread the word. But like most physicians, I was terrible about practicing what I was preaching. It started with checking text messages at stop lights, but got worse from there. A glance from the road to my screen when I was driving to see who just texted me, a quick check of my inbox to make sure it wasn’t anything urgent. Pretty soon I was writing full emails while sitting in stopped, or sometimes not-so-stopped, traffic. And then it happened. I was about a mile from home, coming back from a quick run to the store. Sitting at a stoplight, I was looking at an email my assistant had sent. It seemed like something kind of important, like I might need to call her, and I was trying to finish reading when the light turned and I rolled into the intersection. A block later, lights and sirens behind me. “Officer, I’m not sure what I did.” I rushed through the last 5 minutes in my mind. I know I wasn’t speeding. Was my taillight out? Had the light turned from yellow to red as I was going through the intersection? It occurred to me that I didn’t really know if the light had changed, because I wasn’t paying attention. How terrifying. “You were texting and driving. I don’t usually pull people over for this, but you were not even looking at the road. I’ll let you off with a warning.” He glanced at the empty car seats in my back seat. “Don’t you dare do this with the kids in the car.” *Silence.* [![Distracted driving, just don't do it! ](%5Bsiteurl%5D/wp-content/uploads/2016/04/IMG_42481-261x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/IMG_42481.jpg)Distracted driving, just don’t do it! How embarrassing. In one experience I was, sanctimoniously standing in front of hundreds of concerned citizens, and in another I was so distracted I actually got pulled over. When I told the officer that I was a trauma surgeon, he commiserated. Yes, he said. Sometimes he texts and drives too. And then he sees someone like me and is reminded how very dangerous it is, and stops for awhile. But it creeps back in over time. April is distracted driving awareness month, let’s all make the commitment to stop distracted driving. **It can wait**. If you feel the urge to reach for your phone – **stop**. Think of your family and your patients, or think of me and this ridiculous photo I’ve included below, with my ticket. Put your phone out of reach when you get in the car, if it’s that hard for you. If it’s an emergency, use your Bluetooth technology and call, don’t text. While driving and talking on the phone is still dangerous, it’s not nearly as dangerous as texting. And don’t do the worst thing of all – voice recognition technology. Because proofreading the text you just recorded is the most dangerous form of texting and driving. You are no good to your family or your patients if you are dead. It’s serious. Don’t do it. *[![BonneS_4095_72](http://blog.womensurgeons.org/wp-content/uploads/2025/06/BonneS_4095_72-140x210.jpg)](%5Bsiteurl%5D/wp-content/uploads/2014/02/BonneS_4095_72.jpg)Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force. Dr. Bonne is the current Communications Chair for the AWS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, parenting, resources --- ### [#SurgStory(ies): Why do we do it?](https://blog.womensurgeons.org/surgstory/) **Published:** April 10, 2016 **Author:** Blog Team **Content:** *By Joel Adler (with special guests Niraj Gusani and Heather Yeo)* **Rise of Twitter in Surgery:** It’s no secret that there is a growing community of medical students, surgeons-in-training, and surgeons on Twitter. Many use Twitter and other social media to keep up on news, connect with colleagues, and access the latest medical innovations and data, or promote their own research. But Twitter can also be a source of inspiration and a fantastic way to share ideas and stories (140 characters at a time). **\#SurgStory:** This past week, in the midst of a normal exchange, a discussion about being inspired by mentors to choose surgery as a career led to the beginning of the [\#SurgStory](https://twitter.com/search?q=%23SurgStory&src=tyah) hashtag. The idea quickly caught on as surgeons contributed their own stories about a moment when it all clicked and they knew they had to become a surgeon or about a key role model whose behavior they wanted to emulate. More and more surgeons joined in, shared their stories, and asked others to share theirs. The flood of #SurgStory(ies) that followed was inspiring. **SurgStory Themes:** A number of consistent themes emerged, some predictable and some not. Not surprisingly, many identified particularly formative moments. Most of these were great moments in the operating room, often as a medical student or well before (a particularly memorable operation, the beauty of anatomy, or participating in the procedure), but many came from interactions with surgeons outside of the operating room or personal encounters with surgical disease. A remarkable number volunteered that they never intended to become surgeons and “saved surgery for last” or did it early to “get it out of the way”, but soon fell in love with it and changed career plans. > My [\#SurgStory](https://twitter.com/hashtag/SurgStory?src=hash&ref_src=twsrc%5Etfw): Entered [@RushUniversity](https://twitter.com/RushUniversity?ref_src=twsrc%5Etfw) for peds, did surgery clerkship first, fell in love with it & thus began my vascular surg career! > > — Julie Freischlag, MD (@JFreischlag) [April 6, 2016](https://twitter.com/JFreischlag/status/717824240049721344?ref_src=twsrc%5Etfw) Of course, plenty of participants just always knew that they would be surgeons: Perhaps the best part of #SurgStory was the thread of **mentorship**. Through this conversation on Twitter, many were able to share their experience with mentors and how they shared their craft: Many senior surgeons (often not on Twitter) were mentioned and thanked by name for being great role models. But these mentorship relationships were most certainly not limited to interactions with attending surgeons. Many spoke to the profound impact that residents and fellows have on medical student education and career choice. And, of course, there were some who didn’t fall in love during the first try, but stuck around long enough to figure out that surgery was the right thing for them. \#SurgStory has been well received because it provides a short, concise avenue to share our collective experience and explain why we love what we do. It is an honor and a privilege to be a surgeon. Through these tweets, we have been able to share our experiences, and our love of the job not only with each other, but also, we hope, with future surgeons. It is wonderful to see why so many people [\#ChooseSurgery](https://twitter.com/hashtag/ChooseSurgery?src=hash) as a career. We hope that people will continue to share their inspiration with us and with others. Submit your own #SurgStory! To see the accumulated tweets, either search for [\#SurgStory](https://twitter.com/search?q=%23SurgStory&src=typd) or view the [Storify](https://storify.com/joeladler/surgstory). [![Joel_Adler_1576](%5Bsiteurl%5D/wp-content/uploads/2016/04/Joel_Adler_1576-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/Joel_Adler_1576.jpg)*Joel T. Adler, MD, MPH, is a resident in general surgery at Massachusetts General Hospital in Boston. He plans to complete a fellowship in transplant surgery. His research focuses on disparities, decision making, and quality metrics in solid organ transplantation. He can be found on Twitter @joeladler.* [![GusaniNiraj_pp](%5Bsiteurl%5D/wp-content/uploads/2016/04/GusaniNiraj_pp-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/GusaniNiraj_pp.jpg)*Niraj J. Gusani, MD is Associate Professor in the Departments of Surgery, Medicine, and Public Health Sciences at the Penn State College of Medicine and serves as Director of the multidisciplinary Program for Liver, Pancreas, and Foregut Tumors in the Penn State Cancer Institute. He is active on Twitter (@NirajGusani), with over 5000 followers.* ![Heather Yeo](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Heather-Yeo-225x300.jpg)*Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College – NewYork-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research and is focused on surgical outcomes and quality improvement in Gastrointestinal Cancer Surgery. She tweets. You can follow her @heatheryeomd.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, leadership, medical students, mentorship, professionalism, residency, resources, training **Tags:** Food4Thought --- ### [Equal pay for equal work: It’s our time](https://blog.womensurgeons.org/equal-pay-for-equal-work/) **Published:** April 11, 2016 **Author:** Blog Team **Content:** *By Amalia Cochran* Let me start with some simple facts. Female surgeons have the same training as male surgeons; we go to medical school, we spend the same amount of time in residency, we sit for the same board exams. However, if you compare the earnings of full-time female surgeons to our male colleagues annually, [we make 24% less](http://www.medscape.com/features/slideshow/compensation/2016/generalsurgery#page=6). Here’s a question for you: Do you believe that this is right? The reality is that pay equity is a family issue; when women aren’t paid equitably, over our lifetimes we make anywhere from $700,000 to $2 million less than men. That’s not ideal for the [economy](https://www.whitehouse.gov/sites/default/files/equalpay/equal_pay_task_force_progress_report_june_2013_new.pdf), and it’s definitely not good for families. Pay equity also results in a more engaged workforce. It’s important to me as the current President of the Association of Women Surgeons to make people aware of this pay equity gap; everyone I have mentioned it to is surprised by it, and since we didn’t train 24% less (or take boards that were 24% less intensive) no one seems to think this is okay. And while awareness is important, it’s also important to understand what you can do about pay parity. The AWS will prepare a white paper on this later in the year (stay tuned for a) but I didn’t want to leave you without some strategies to get started. Here are a few ideas, compliments of the [AAUW](http://www.aauw.org/files/2013/11/AAUW-Pay-Equity-Resource-Kit-2013Nov-nsa.pdf). - Ask for, or generate, a workplace pay audit. - Encourage policies that support equity - Flexibility and family-friendly policies for men and women - Seek better benefits that benefit everyone - Family and medical leave, health insurance, emergency family care, and scheduling meetings that don’t intrude on family activities benefit everyone - Write a letter to the editor or op-ed, or ask for a commentary time on local media Other things you can do: - Educate yourself- [Catalyst](http://www.catalyst.org/issues/pay-gap) has great information, as does Evelyn Murphy’s [WAGE project](http://www.wageproject.org/) - Sponsor a workshop to educate your mentees and your peers about negotiation techniques - Share this blog post! - Options are limited only by your imagination! *April 12 is Equal Pay Day in the US* ; for those not familiar with the idea, it’s the day of the year when women’s pay from the last year plus the first 3 1/2 months of this year equal what men made last year. I hope that you’ll use this week as an opportunity to speak out and to talk about #fairpay. It’s time, and we simply can’t wait. To highlight the disparity, **the Association of Women Surgeons will reduce the cost of a regular annual membership by 24% for new members who join between Equal Pay Day (April 12) and the end of May**. **[Join AWS today!](https://www.womensurgeons.org/join-aws/)** [![AmaliaCochran](http://blog.womensurgeons.org/wp-content/uploads/2025/06/AmaliaCochran-160x224.jpeg)](%5Bsiteurl%5D/wp-content/uploads/2014/04/AmaliaCochran.jpeg) *Amalia Cochran, MD, FACS, FCCM is President of AWS and Associate Professor of Surgery Vice Chair of Education and Professionalism at the University of Utah, Department of Surgery.* *This post originally appeared on Dr. Cochran’s blog, [Life in the Wild West](http://www.amaliacochranmd.com/we-cant-wait/).* **Categories:** advocacy, career development, gender differences, women --- ### [The Start of a New AWS Chapter](https://blog.womensurgeons.org/the-start-of-a-new-aws-chapter/) **Published:** April 18, 2016 **Author:** Blog Team **Content:** *By Sarah Armenia* One of the best aspects of AWS is the amazing support its members in training and practice and committees show medical student members. I have experienced this support firsthand at the annual conference and as a member of the national medical student committee. This year, I also had the opportunity to join with other women at my medical school to start a new AWS chapter at New Jersey Medical School. Many people frequently asked me why AWS was a necessary addition, given that our school already had several surgery interest groups. This was the perfect opportunity to show my peers, who were unfamiliar with AWS, just how instrumental the organization can be in nurturing the interests of female medical students interested in surgery. The members of AWS span all levels of training and each individual uses their experience to help others about to encounter similar milestones along the way. We captured the essence of this continuing mentorship at our chapter’s first event, “Debunking Myths about Surgery.” We hosted a question and answer panel where third and fourth year medical students spoke about their experiences on surgery rotations and applying to residency programs. We also co-sponsored a dinner with the American Medical Women’s Association to introduce female medical students to the faculty in a forum where they could ask questions about different specialties and their experiences while in training. As we planned our first events as a new chapter, it was immediately obvious how dedicated AWS faculty members are to providing mentorship and guidance to medical students. We were fortunate to have Dr. Stephanie Bonne become our faculty advisor, who is incredibly invested in the organization and its promotion on social media. In addition, our Chair of Surgery, Dr. Anne Mosenthal, is one of 16 [female Chairs of Surgery throughout the country](https://www.womensurgeons.org/in-practice/leaders-in-surgery/) and also supports the mission of AWS. Their direct support of the chapter showed how approachable AWS members can be in establishing mentorship relationships and guiding the direction of the chapter. Being a member of AWS has been instrumental in connecting me with inspiring women surgeons and I look forward to building this new AWS chapter along with my peers. For more information about starting your own AWS chapter at your medical school, please follow this [link](https://www.womensurgeons.org/student-section/medical-school-chapters/). *[![Untitled](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Untitled-240x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/04/Untitled.png)Sarah Armenia is a member of the AWS Medical Student Committee and is a first year medical student at Rutgers New Jersey Medical School. She is passionate about transplant surgery and surgical disparities research.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** education, leadership, medical students, mentorship, resources **Tags:** Food4Thought --- ### [DRIVING](https://blog.womensurgeons.org/driving/) **Published:** April 20, 2016 **Author:** Blog Team **Content:** *By Marie Crandall* *“I’ll just answer this one text…”, “One sec, let me look for my hands-free…” “Damn this train, I’ve got a sick patient waiting in the ER…”* It seems like I should be preaching to the choir, that surgeons would know better than to text and drive, or tweet and drive, or any kind of distracted driving. But we don’t. Every year we lose surgeons to distracted driving or other distracted drivers. So, for [Distracted Driving Awareness Month](http://fox59.com/2016/04/06/national-distracted-driving-awareness-month-headlines-april-road-safety-program/), I thought I would make a plea for safety, so that none of us becomes one of the over 3000 people killed or 400,000 people injured each year due to distracted driving. It is part of who we are, our vocation, to be immediately available to our patients, our residents. I remember before cell phones when you’d have to find a pay phone to return calls if you were away from home, or ask a generous shop or restaurant owner to let you use their phone. Now, with cell phones, we can always be available. But at what cost? [Being on the phone increases the likelihood of being in a crash fourfold, even with handsfree devices.](http://www.nejm.org/doi/full/10.1056/NEJM199702133360701?keytype2=tf_ipsecsha&ijkey=528893d04c64b14922a9ed7cf508db3e68e723c9) And texting complicated messages has to be at least as dangerous. Maybe the only people who make news when they tweet and die are famous plastic surgeons (Heidi Montag’s surgeon Dr.Frank Ryan), but I’m fairly sure your friends and family will miss you if you die (and your partners, as they have to cover your calls and clinic). I’m hoping that AWS readers would be sensible enough to always use seatbelts, and would certainly use car seats for their children. But I am nearly 100% sure that most, if not all, of us have practiced unsafe driving, in some form or another. Texting, speeding dangerously, rolling stop signs while in a hurry, driving post-call and exhausted, who hasn’t done those things? But, seriously, don’t. And you certainly don’t want to make the list of “[grimly ironic texting-while-driving car crashes.”](http://thoughtcatalog.com/jim-goad/2014/06/10-grimly-ironic-texting-while-driving-car-crashes/) On that uplifting note, here are some rules: 1. Always wear your seatbelt. 2. If you are going to talk and drive, obtain a Bluetooth connection or handsfree device for your car. Take the 20 seconds to put it on before you start your car. There are no convincing data to support it, but it seems logical. 3. If you’re tired post-call, find a place to take a nap before you drive. 4. Always wear your seatbelt. 5. If you need to have a long or serious conversation, you WILL be distracted. Time to pull over or ask the other party to call you back in a few. 6. The train is faster and bigger than you are. 7. Always wear your seatbelt. **Thanks and stay alive.**[![PEO-20100604-01-Physician-Photos Portraits taken of physicians for the Physician Refferral Directories, both printed and on-line for Kathryn Lowry. Photographer, Laura Brown. Drop-In Session.](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Crandall-MD-Marie-2010-NMFF-214x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/Crandall-MD-Marie-2010-NMFF.jpg)*Marie Crandall, MD, MPH, FACS is the Medical Director of Research and Professor of Surgery at the University of Florida College of Medicine Jacksonville. She is an active health services researcher and advocate for environmental and social justice.Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** resources, self-care --- ### [Entering the Surgical Profession](https://blog.womensurgeons.org/entering-the-surgical-profession/) **Published:** April 24, 2016 **Author:** Blog Team **Content:** *By Rogette Esteve* Recently, I found myself in Danbury, CT searching for a new apartment. It made me pause for a moment and reflect on the fact that I will be starting general surgery residency in just a few short months at Danbury Hospital. If you had asked me back in college, when I was still a pre-med freshman, what I thought of surgery, I would have quickly answered, “*Oh no*, I want a life! I want a family!” [![download](%5Bsiteurl%5D/wp-content/uploads/2016/04/download-178x284.jpeg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/download.jpeg)Thank God I was introduced to the [AWS Pocket Mentor](https://www.womensurgeons.org/about-us/resourcelibrary/publications-ebooks/) toward the end of college!t forever changed my perspective on becoming a surgeon. I was amazed there was an established organization for female surgeons – by female surgeons. As a medical student, I am fortunate to have attended a number of AWS Conferences . Each time, I have been floored by the outstanding surgeons I have met. The women I met were able to not only “have a life” but also excel in their respective fields, despite the inherent challenges female surgeons face. I know that my own journey will not be easy; in fact, I have no idea how challenging it will be. My current view of surgery is the one seen through the eyes of a medical student. I know thet steep surgical learning curve is ahead. However, I have an incredible support system behind me. Furthermore, revisiting excellent resources like the AWS Pocket Mentor will be immensely important to me, as I progress through residency and beyond. So Danbury, *here I come*. *[![Rogette Esteve](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Rogette-Esteve-237x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/Rogette-Esteve.jpg)Rogette Esteve is a 4th year medical student at The Ohio State University College of Medicine who enjoys salsa dancing and dodgeball. She will be entering a general surgery residency at Danbury Hospital in CT this June.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, medical students, residency, resources **Tags:** Food4Thought --- ### [At the Crossroads in Surgical Education](https://blog.womensurgeons.org/at-the-crossroads-in-surgical-education/) **Published:** April 28, 2016 **Author:** Blog Team **Content:** [![Dr. Heather Yeo and her father.](%5Bsiteurl%5D/wp-content/uploads/2016/04/hy-pic-300x225.png)](%5Bsiteurl%5D/wp-content/uploads/2016/04/hy-pic.png)Dr. Heather Yeo and her father. Over the last 4 decades since my father completed his training as a general surgeon at UC Irvine, the training system has changed significantly. Residents no longer have the autonomy they once had, time is at a premium, work hours are closely regulated, there is increased pressure to generate revenue and work quickly, the medical legal system is increasingly complex, and there is an increase in the variety and type of skills needed to perform many surgical procedures—all of which must be learned in a relatively short training period. Early this month the Association for Surgical Educators (ASE) and the Association of Program Directors in Surgery (APDS) hosted surgical education week where leaders in surgical education talked about moving the system forward and adjusting to many of the current changes and challenges. It is clear large changes must happen. In fact, just this week (4/25/16) the American Board of Surgery issued a statement on their goals for “Residency Redesign”: *We currently envision a framework built upon a general surgical “Core,” followed by additional training in general surgery or a surgical subspecialty (“Plus” years), as is currently done in existing Early Specialization Programs. This structure would have the following characteristics:* - *Learner-dependent education, rather than educator-dependent* - *Competency-based assessment tools, i.e., not relying solely on number of cases to measure competency* - *A structure such as Entrustable Professional Activities (EPAs), in which modules are embedded with defined actions to gauge progression and completion* - *Enhanced surgical experience with greater early operative exposure, both in numbers and complexity* - *Faculty development to enrich teaching and assessment of technical skills and competence both in and out of the operating room* - *Curricular and evaluation standards in the Plus years of training, including in the surgical specialties, to build collaboratively a seamless path from the Core into these years* [*Here is more on their statement.* ](https://absurgery.org/default.jsp?news_resredesign0416) As someone who researched surgical education and attrition during surgical residency, as a RWJ Clinical scholar, the way we train and retain surgeons has always interested me. As an academic surgeon, I believe it is our duty to pay attention to how and who we train to be our next generation of surgeons. Already leaders such as @meklingensmith and @amaliacochran have made great strides in understanding how to move our training programs forward, but there is much work to be done. Recently, I have started conversations with some of our academic leaders from around the country and it is clear that certain things need to happen to face several issues on the horizon. 1. We need to improve skills training and assessment in and outside of the OR 2. We need to assess readiness for practice 3. We need to use and adjust to new technologies 4. We need to encourage talented individuals to join surgery, and support those who are skilled and motivated in the appropriate way I believe the Board’s statement is a good start towards drawing attention and clarifying these goals. It will be important to learn from leaders in other professions and specialties as we move forward, as well as to critically evaluate current strategies. This is a critical time in general surgery and involvement is needed from within and outside our profession. Resources: *[APDS](http://apds.org/) [ASE](https://surgicaleducation.com/)* [*ABS*](http://absurgery.org/) *[![Heather Yeo](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Heather-Yeo-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/04/Heather-Yeo.jpg)Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College – NewYork-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research and is focused on surgical outcomes and quality improvement in Gastrointestinal Cancer Surgery. She tweets. You can follow her @heatheryeomd.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [The American College of Surgeons Leadership and Advocacy Summit](https://blog.womensurgeons.org/acs-leadership-advocacy/) **Published:** May 5, 2016 **Author:** Blog Team **Content:** **An Inside Look from a Resident Attendee** *By Erin M Garvey* Over 500 surgeons attended the ACS Leadership and Advocacy Summit from April 9th to April 12th in Washington DC, and nearly 70 of those attendees were residents and fellows. This was my first time attending the Summit, and I was truly blown away by the quality of the educational content, the value of political advocacy and the plethora of networking opportunities. The leadership portion of the course was full of excellent content ranging from conflict management and cultural dexterity to improving emotional intelligence. Dr. Adil H. Haider, MPH, MD, FACS from the Center for Surgery and Public Health recommended everyone visit the website for [Project Implicit](https://implicit.harvard.edu/implicit/) and take an Implicit Association Test. Some of my favorite quotes from the day include: - “We judge ourselves by our best intentions but judge others by their actions” –Kurt O’Brien, MHROD University of Washington School of Medicine - “It is no longer enough to just take good care of your own patients, but we, as a profession, need to take good care of all patients” – Susan Moffatt-Bruce, BSc, MD, PhD, MBOE, FACS, FRCS (C), Ohio State University The Advocacy portion of the Summit was the big draw for me. While I am a huge Olivia Pope and Scandal fan, I had not previously taken a very active role in political advocacy and felt it was time to get informed and involved. April 11th was dedicated to arming Summit attendees with the details of pertinent medical legislation and preparing them for effective communication with legislators. According to a congressional survey, in person visits with constituents are the most influential way to interact with members of congress. Key strategies include: clearly defining the problem at hand while also sharing a pertinent patient story, having one or two key points, and reiterating that you are advocating with the patient’s best interest in mind. Over the course of the final day, 217 meetings between surgeon attendees and congressional offices occurred! While in DC, I was working on a podcast for the Resident and Associate Society Communications Committee, and I reached out to all of the resident and fellow attendees for their feedback on the Summit. In addition to meeting many new peers, I was also able to interact with the College leadership including Dr. David Hoyt, Executive Director of the American College of Surgeons and Dr. Patricia Turner, Director of the Division of Member Services, both of whom were delighted to have so many trainee attendees present. Networking was a breeze during meeting breaks, as well as at the social events, which included a beautiful evening dinner on the top floor of The Hay Adams Hotel, during which there was a keynote address by Chris Matthews, detailing his predictions for the 2016 election.. When I asked Dr. Hoyt what advice he would give to residents and fellows who were not able to attend, he said, “Come next year!” I myself hope to be back next year as well. *![GarveyFellowshipPhoto](http://blog.womensurgeons.org/wp-content/uploads/2025/06/GarveyFellowshipPhoto--214x300.jpg)Erin Garvey is a PGY-5 general surgery resident at the Mayo Clinic in Arizona. She is also the Chair of the Communications Committee for the American College of Surgeons Resident and Associate Society.Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, resources, training --- ### [Unconscious Bias Twitter Chat](https://blog.womensurgeons.org/unconscious-bias-twitter-chat/) **Published:** May 11, 2016 **Author:** Blog Team **Content:** **Save the Date** (Put it in your calendar, as you read this post!): **May 24 8 PM EST** *Twitter chat with Amalia Cochran about unconscious bias.* Dr. Cochran will be hosting a virtual chat on Twitter about unconscious bias using the #AWSChat. For some background on her perspectives on the changing state of women in surgery, read [“The times, they are a-changin'”](http://www.amaliacochranmd.com/the-times-they-are-a-changin/.). Unconscious biases are most likely something all of us have or will experience as women in medicine and surgery. The nuances of being aware of and interacting with unconscious biases can be challenging through our professional lifetimes. The AWS blogging team is excited about the [\#AWSChat](https://twitter.com/hashtag/AWSChat?src=hash) and we hope to see you there! *More information about participating in an AWS Twitter chat:* A Twitter chat is where a group of Twitter users meet at a pre-determined time to discuss a certain topic, using a designated hashtag (#) for each tweet contributed. A host or moderator, in this case [@AmaliaCochranMD](https://twitter.com/AmaliaCochranMD?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor) will pose questions to prompt responses from participants and encourage interaction among the group. Chats typically last an hour. Imagine a business networking event-but without a dress code and with a keyboard instead of a bar. The same social customs apply-courtesy and respect-and it’s a great way to meet new people with similar interests. There are Twitter chats in almost every industry imaginable. Joining our tweet chat is easy. 1\. Sign up for a Twitter account if you don’t already have one 2\. Download any one of the popular Twitter applications available online like Tweetdeck, Hootsuite or Tweetchat 3\. In your preferred Twitter application, create a search column with “#AWSChat” as the hashtag. 4\. Follow the moderator so that you can reply to tweets and retweet other comments and questions from participants. 5\. Enjoy! **Categories:** gender differences, leadership, networking, professionalism, resources, training, women --- ### [June is National Safety Month](https://blog.womensurgeons.org/national-safety-month/) **Published:** June 10, 2016 **Author:** Blog Team **Content:** As a trauma surgeon, I should be thinking about safety all the time, and writing about it should be easy. But when I really sat and thought about safety, I found that it’s more difficult than one might think. What does safety really mean to each of us? For me, safety first comes to mind for myself and my family. Is our home safe for my children? Are they safe when they go play at a friend’s house? What safety concerns do I have at work? Am I okay walking to my car? Next, I’m concerned about my patients. Are they safe to return home? What can I do to enhance the safety of their home or environment so they don’t become recidivists? All of these are important questions, and physical safety is regularly on my mind, given my job. But when asked to really consider safety and what it means, I thought there was much more to this, that may not be as apparent on an everyday basis. For example, what are my safe spaces to talk? Who do I trust and feel comfortable with? As a surgeon, who so often has to be brave and stoic in the face of overwhelming tragedy, where am I emotionally safe? What does that even mean? This month, as we explore safety, I encourage everyone to take a look at all the facets of safety in our lives, and examine where we can help ourselves and others become safer. Some things will be obvious – make sure your elderly parents aren’t getting on 2 story ladders to clean the gutters, right after they take their aspirin and Plavix. Encourage a disabled neighbor to install bathtub rails and remove loose rugs. Next time your child has a playdate, ask the parents if there is an unsecured [gun in the home](https://www.womensurgeons.org/a-persistent-beat-motherhood-and-urban-gun-violence/). All of these can save a life. But also, let’s make an effort to help one another be *emotionally safe*. Let’s expand the “safe space” that is the **Association of Women Surgeons,** so that all women surgeons can feel they have a network of support when it’s needed. Talk to your family and make sure they are emotionally safe with their partners and friends. Let’s examine our own relationships and make sure they are safe and healthy, and if not, that we are getting the help we need to build that trust. Let’s make sure we are asking and receiving the things we need to make our work lives emotionally safe and healthy. Surgeons need to set the example – that it’s an expectation that our work environments are safe spaces to share ideas, ask questions, and admit faults. This is essential to patient safety, trainee work environment, and professional advancement of women. Finally, as a nod to the news this very week: Talk to your sons. Make them understand that emotional and physical safety of women is their responsibility, too. Teaching respect for women and, indeed, for human dignity to all our children is at the root of curbing interpersonal violence and sexual assault, making the world a safer place for all. My challenge to readers: Take safety seriously, and think about all facets of safety. Speak up, be proactive. Please use the comments to tell me how you are promoting safety this month! [![Bonne-picb-0715-200x300](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Bonne-picb-0715-200x300-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/Bonne-picb-0715-200x300.jpg)*Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force. Dr. Bonne is the current Communications Chair for the AWS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, leadership, resources **Tags:** injury prevention, national safety month, safety, trauma --- ### [Look for the Helpers - A Surgeon-in-Training’s Thoughts on the Orlando Shooting](https://blog.womensurgeons.org/look-for-the-helpers/) **Published:** June 16, 2016 **Author:** Blog Team **Content:** *By Brittany Bankhead-Kendall* As events unfold and I wonder if some day my own trauma pager will have the words “mass casualty” on it, and on how sad that is, I am reminded of a great quote: > *“When I was a boy and I would see scary things in the news, my mother would say to me ‘Look for the helpers. You will always find people who are helping.'” -Fred Rogers* This is something that I try to teach my own child, and to remember myself. But when I begin to look around, for the helpers, I start to realize that I am the helper. We are the helpers. To be the person running towards the smoke to help at the Boston marathon… To fly to the ends of the Earth to help the less fortunate with their spiritual or physical needs… To write a letter to the trauma staff in Orlando & remind them there was a country praying & thinking about the guiding of their hands amongst chaos… To stand in an hours long line to donate blood in a time of need, or to be the nurse who administers the blood, or the physician who orders the blood. We grieve & we learn. But then, we unite & we help. And we hold our heads high, and live & love each other like we were born on this Earth to do. We do not let terrorism win. Here’s to Orlando. Here’s to humanity. Here’s to the helpers. Here’s to us. *[![00-Brittany-Bankhead-Kendall](http://blog.womensurgeons.org/wp-content/uploads/2025/06/00-Brittany-Bankhead-Kendall-238x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/09/00-Brittany-Bankhead-Kendall.jpg)Brittany Bankhead-Kendall, M.Sc., M.D. is a PGY2 general surgery resident at St. Joseph Mercy Oakland in Pontiac, Michigan. She obtained her M.D. from Ross University School of Medicine, her M.Sc. from Barry University in Biomedical Science, and studied Biomedical Science and Spanish at Texas A&M University. She is currently completing a fellowship with the “Association of Surgical Education Surgical Education Research Fellowship” program and is the General Surgery representative for her local Graduate Medical Education Council. She plans to pursue a career in trauma/critical care, and acute care surgery. She enjoys clinical research in trauma and surgical education, and has presented her work at multiple regional & national conferences. In her personal time she enjoys spending time with her family and church, interior design, financial planning, and international travel.* --- **Categories:** Uncategorized **Tags:** AWS, injury prevention, National News, national safety month, safety, trauma, WomenSurgeons --- ### [#AWSfood4thought : Here's to the Dads](https://blog.womensurgeons.org/awsfood4thought-to-the-dads/) **Published:** June 20, 2016 **Author:** Blog Team **Content:** *By Heather Logghe* This Father’s Day I would like to give special thanks to the dads who lovingly support their women surgeon partners. My husband, Chris, has been one of them. I embarked on my intern year when my daughter, Sierra, was only three months old. The journey never would have been possible without Chris, who left his “dream job” to fulfill the role of lead parent. Notably, three of my fellow female residents also had children cared for by stay-at-home dads. Just as their husbands had done for them, Chris’s love and support made the emotional and logistical challenges of residency surmountable. During orientation week when I was still nursing, requiring me to“pump” away from home for the first time, I found I had forgotten an essential part for the process; Chris brought it in without hesitation. He also delivered homemade meals when I was on call, while picking up a warm bottle for Sierra’s “dinner.” He kept our home life organized, while regularly texting messages of encouragement and adorable pictures of special moments with Sierra to help me feel connected despite being away at work. His efforts as a father and partner were and continue to be invaluable to my career. Beyond the immediate benefits to their partners’ careers, the sacrifices made by dads partnered with surgeons may have more far-reaching benefit. A [study](http://www.psychologicalscience.org/index.php/news/releases/dads-who-share-the-load-bolster-daughters-aspirations.html) by Alyssa Croft showed the strongest predictor of girls wanting to go into less traditional, potentially higher-paying careers was having fathers who helped with the housework. “Even when fathers publicly endorsed gender equality, if they retained a traditional division of labor at home, their daughters were more likely to envision themselves in traditionally female-dominant jobs, such as nurse, teacher, librarian or stay-at-home-mom.” Thus, male spouses of surgeons who “walk the walk” by contributing equally to domestic responsibilities (or even more than 50%, as is often the case), are likely to have a longer-lasting and more significant impact than dads who simply “talk the talk.” These brave and engaged fathers who dare to “break the mold” are role models for the next generation. I’ll never forget a comment my 8 year old niece made as she watched her two year old brother carefully hold a bottle for Sierra. She said, “You better learn how to do that Johny, because there’s a 50% chance you’ll marry a doctor some day and have to help at home.” While I’m not sure where she got her statistics, I was impressed by her 50/50 mindset. As co-workers, we don’t often have the chance to meet the partners who support our female or male colleagues behind the scenes. Rather, we tend to “feel” their presence and benefit from their support indirectly–such as when we enjoy the food they lovingly cook for their wives on call, or oogle over the cute kid pictures they text their wives. Most of the time, their job is thankless. And yet, they continue to do it anyway, 24 hours a day, 7 days a week, making it possible for their surgeon partners to be fully present with their patients. Here’s to the dads. [![HeatherLogghe](http://blog.womensurgeons.org/wp-content/uploads/2025/06/HeatherLogghe-215x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2013/11/HeatherLogghe.jpg)Heather Logghe, MD has completed two years of general surgery at the University of North Carolina, Chapel Hill. --- **Categories:** family life, gender differences, parenting, resources, self-care **Tags:** Father's Day --- ### [Finding Comfort in Silence](https://blog.womensurgeons.org/finding-comfort-in-silence/) **Published:** June 23, 2016 **Author:** Blog Team **Content:** *By Madeline Torres* It was another night in the SICU: 5:30 pm sign out, resident rounds, and dinner. As usual, I’d go into Mr. X’s room to examine him and make small talk with his wife but tonight she was not there. Mr. X was a 55-year-old otherwise healthy man who came in as trauma patient after a motor vehicle crash. His hospital course had been complicated by multiple surgeries, cardiac arrests, renal failure, and eventually a debilitating stroke. That night, he was in his usual state: with sluggish pupils that would respond to verbal stimuli and a slight movement of his left upper extremity. At around 10 PM, his nurse called me to evaluate him as his pupils were no longer reactive and his strength had decreased. I was scared and preoccupied, something was off and I did not know what it was. I also knew that he would likely not survive another stroke. We scanned his brain but found nothing to explain his change. At midnight, I received another call from the same nurse, this time his blood pressure was dropping. I quickly walked to his bedside, ordered a full set of labs and gave him fluids, followed by fresh frozen plasma. Despite our best efforts, he coded, the third time during his hospital course. Ten minutes of CPR and 2 pressors later, we stabilized him and called his wife to come in. As we waited for his wife to arrive, another trauma arrived at our emergency room, pulling everyone else away and, leaving me to deliver the bad news to Mr. X’s wife. As soon as she saw him, she broke into tears and I couldn’t help but shed some tears myself. I collected my thoughts, took a deep breath and proceeded to tell her a succinct recollection of the events of the last few hours. She continued to cry, sobbing inconsolably; I stood there speechless, there were no words or gestures I knew that could provide comfort. Shortly after, we called the chaplain and attempted a conversation about “what would your husband’s wishes be…” It was not an easy question to ask and it was one that brought on more tears. The more I talked, the more she cried. My last words were “I’m sorry.” I’m sorry for not being able to do more for your husband and even worse, for not knowing what to say. The next few minutes brought silence with intermittent sobbing as we all sat around Mr. Xs bedside. His daughters held his hand while his wife interspersed “I have to let go” in between her cries. As I sat there in silence, I saw the man they knew: a husband, a father, a friend and a companion. The silence was comforting because during that time there was nothing except Mr. X and his family; there was no pressure to make medical decisions, no pressure to let him go. The attending returned to continue this difficult end-of-life care conversation. I don’t remember what was said or discussed; all I know is when I returned two days later Mr. X was gone. The night he coded, his family and I found comfort in silence. As I finish my intern year, I think back to the night Mr X. coded and think of all the words I said and the ones I did not know how to find or say to comfort his family, but the silence we shared provided comfort if only for a few seconds. I encourage readers to try and share a moment of silence with their patients, allow time for news and events to sink it. Most importantly, be part of that silence and know that when we have nothing else to say there is comfort in silence. *[![Madeline Torres](http://blog.womensurgeons.org/wp-content/uploads/2025/06/blog-pic-160x240.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/06/blog-pic.jpg)* *Madeline B. Torres, M.D. is a general surgery resident at Penn State Milton S. Hershey Medical Center in Hershey, PA. She was born and raised in El Salvador, moved to the U.S. at the age of 9 years. She obtained her Bachelor of Science in Chemistry at the University of Colorado at Denver and her M.D. from the University of Utah School of Medicine. She enjoys movies, walks with her dog and the outdoors.* --- **Categories:** career development, education, medical students, professionalism, residency, training **Tags:** communication, end-of-life --- ### [Learning New Roles](https://blog.womensurgeons.org/learning-new-roles/) **Published:** July 1, 2016 **Author:** Blog Team **Content:** *By Joanelle A. Bailey, M.D.* My last call of my intern year is on June 30th, which means that I will be supervising the new incoming interns when they come to care for patients for their first time as physicians on the morning of July 1st. I have been thinking of the logistics for that day, specifically how important communication between team members will be as our roles on that morning will be changing. I remember my first day of residency, nearly one year ago, and how I had a rather idealistic view of how the first few weeks would go. I knew my year would be an arduous one, but I hoped to quickly become an efficient intern and an effective member of the patient care team. Many of my co-residents set a great example for my class and provided great advice and guidance. The best advice I got was to always go and see the patient, rather than try to resolve issues or answer questions over the phone. Not only was I able to better assess the patient’s status, but it allowed better communication with whomever had paged me, and I was able to put a face to a name I would see in the patient’s chart. However, that was not always the case; one more mid-level resident repeatedly disregarded my concerns, which I felt put patient care in jeopardy. This was, thankfully, a temporary situation as I initially struggled to navigate my role on the team, the hierarchy of a surgical residency, and the importance of safe patient care. One of my Chief Residents was a particularly great mentor, and I will forever remember the discussion we had during my third week of residency. He pointed out that not only was I learning how to be a good intern, but the junior resident on my team was now learning how to effectively fill his role, just as he himself was learning how to be an effective chief. From that conversation, I realized that all of us were navigating new roles and that effective communication was essential as we each recognized and improved our individual strengths andweaknesses in order to form a more cohesive team. I wanted to emulate those who were effective communicators. However, because of that conversation with my Chief, I realized it is also important to learn from those who were not as good at communication, since I would need to fill their roles in the future. Learning from both those I wanted to emulate as well as learning what qualities I did not wish to have in the future was a key realization to recognizing the value of my interactions with co-residents. As I am beginning my next year of residency, I realize how important it will be for me to have effective communication with the intern class, and to set a good example as their mid-level resident. As July approaches, I hope we can all reflect on our own communication styles, and try to remember what it was like when we were each in the positions of those we now lead. *[![Joanelle Bailey](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Bailey-214x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/06/Bailey.jpg)* *Joanelle A. Bailey, M.D. is a PGY-4 General Surgery Resident at Rutgers University – New Jersey Medical School in Newark, NJ. She is completing a second year of research in Surgical Critical Care, during which she has simultaneously pursued a Master in Public Health with a concentration in Biostatistics. She obtained her Medical Doctorate at Thomas Jefferson University in Philadelphia, PA. During medical school she worked as a paramedic in Yonkers, NY and as a technician in the Emergency Department at the Children’s Hospital of Philadelphia. She is passionate about Trauma Surgery and Surgical Critical Care. She enjoys traveling and has participated in multiple international volunteer missions. She enjoys running and eating pasta. Dr. Bailey grew up in New York; she has a twin sister and a nephew whom she sees as often as possible.* --- **Categories:** education, leadership, medical students, mentorship, residency, training **Tags:** communication --- ### [Thoughts on Being a Caregiver](https://blog.womensurgeons.org/being-a-caregiver/) **Published:** July 7, 2016 **Author:** Blog Team **Content:** *By Hilary Sanfey* Over the last few years I helped care for a very dear friend, a retired surgeon, who developed a progressive neurological illness shortly after turning sixty. It was challenging, not least because of the emotional investment and physical toll, but because I had to learn a whole new skill set. So many times as a surgeon in practice I had ordered meds (lots of meds- after all I was a transplant surgeon!). Some were taken with food, some on an empty stomach, some an hour after eating, some crushable, some not … Breathing treatments, physical therapy etc. without thinking of the time it takes to coordinate this regimen with the activities of daily living, not to mention how exhausting it was for the poor patient! Now I truly appreciate the little time I did spend observing the nursing staff at the bedside. *What advice do I have to offer about caring for a loved one?* - **Build a Support Network**: You may feel that you do not want to burden others, but in fact most people are willing to help if asked; they just need help in knowing what to do. Families, friends and [caregiver support](http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3328) groups provide a network of people who can help. - **Seek Help:** If it fits your budget, hiring [paid help](https://www.homeinstead.com/ppc/hisc-service-employment-brand/pages/home-instead-senior-care.aspx?adpos=1t1&gclid=Cj0KEQjwte27BRCM6vjIidHvnKQBEiQAC4MzreuP6eNAfxZ51gkpkgBe0mwLXS3kSD9ujLJHRxL96XcaAh0S8P8HAQ) can free up your time, so you can spend it in a more meaningful way. Often, in the rush of errands and medication schedules, quality time gets pushed to the bottom of the to-do list. Make a priority list of caring responsibilities, then take on the most important ones yourself, and try to find someone else (paid or unpaid) to [help out](http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3323) with the less important ones. - **Plan Meaningful Activities:** For someone who is housebound a trip to Church or to Starbucks is a treat that relieves the daily routine. Have a list ready for road trips; wheel chair, walker, toiletries, meds, special dietary needs etc. so that these outings can have some spontaneity. - **Communicate:** The first step in being able to communicate effectively is finding a way to understand and express emotions. Being a care partner can stir many, often conflicting feelings in both sides, such as guilt or frustration as well as pride. Talk to a counselor, or as I did to a trusted friend. An outlet of this kind can ease communication with a loved one, making it less charged and more meaningful. Furthermore, remember that communication may change when someone lives with a chronic illness. Because of the disease itself, people may respond more slowly than they used to, and gesture less often. It is important to really look at the individual when speaking and try to ask yes / no questions that can be answered by blinking, a hand squeeze or a thumbs up! - **Adapt to New Nutritional Needs:** Learn about proper nutrition and be [creative](http://www.livestrong.com/article/315485-diets-for-patients-with-dysphagia/) with making shakes, soups etc. If hand – mouth coordination is difficult then look online for utensils that are easier to use. I found a wonderful plate on amazon that keeps food warm for about 35 mins after a quick zap in the microwave and also a variety of mugs that are easier to hold and reduce spills. - **Mind New Safety Risks:** Take care to minimize the risk of falls by removing rugs, obstacles and ensuring that essentials are close to hand, such as phone, glasses etc. Be aware that sundowning may occur at night and if your loved one is alone in the bedroom, a baby monitor is a good way to alert caregivers of movement or distress. Also there are various [services](https://www.lifeline.philips.com/safety-solutions?utm_campaign=5526&origin=7_us_en_n5dm_google) that provide pendants or wristbands with a button that allow the individual to call for help. We used Lifeline and the cost for 24 hour availability was about $30 per month. Installing a baby monitor with video provided a way to monitor activity and provide security when I could not be in the room. The future will always be uncertain and how you pace yourself will clearly depend on the situation and the prognosis. I truly benefitted from the support of the [Home Hospice](http://moments.nhpco.org/find-a-hospice) staff who were there for me as well as for the patient in the final few weeks. Many times, the hospice staff arrived on our doorstep late at night to deliver meds or other necessities so that we would not have to go without overnight. Finally, the world did not come to an end because I was not in my office and missed a couple of deadlines or had to ask a colleague to assume an assignment; neither did my house fall to the ground because of the one inch of dust that covered every surface. As you struggle to find balance ask yourself, when he/she is no longer around which will I regret most: missed work opportunities or the time I could not be at their side? Do not underestimate the sense of peace that comes with supporting a loved one in the final days of their life, facilitating their last requests and allowing them to die in peace. It sustained me in the dark days that followed. *[![Sanfey 2015](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Sanfey-2015-300x298.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/06/Sanfey-2015.jpg)* *Dr. Sanfey served as President of the AWS national organization and the AWS Governor to the American College of Surgeons. Dr. Sanfey’s interest in the issues facing women surgeons has extended to research efforts, and she has authored multiple peer-reviewed publications addressing the training needs of male and female surgeons, gender differences, part-time training, perceptions of work-life balance, and mentorship. Having trained in an era and environment that did not have women surgeons, Dr. Sanfey chose to become an AWS member and work to ensure that young women today could achieve their personal and professional goals without the sacrifices that were necessary thirty years ago. Currently, is the Vice-Chair for Educational Affairs and is a Professor of Surgery at Southern Illinois University.* *If you have questions about being a caregiver, you may email Dr. Sanfey at hsanfey@siumed.edu.* --- **Categories:** family life, resources, self-care **Tags:** burnout, dysphagia, end-of-life, palliation, palliative care --- ### [Guilt](https://blog.womensurgeons.org/guilt/) **Published:** July 13, 2016 **Author:** Blog Team **Content:** *By JS* I recently completed a 1-year hospital based fellowship that is designed to provide faculty and staff with the expertise and skills needed to advance academic careers in medical education. While I originally applied for the fellowship in order to improve my teaching style, I was particularly drawn in by the wellness sessions. I learned about the high prevalence of physician burnout, which is 30-40% amongst American surgeons[1](http://link.springer.com/article/10.1245/s10434-007-9725-9) and the many [signs](http://bulletin.facs.org/2013/06/personalities-and-burnout/) to help recognize it in myself and in others. I also became more aware of the resources available to help someone who is dealing with burnout. As the only surgeon in the group, it quickly became obvious to me that many of the solutions to preventing burnout required time and rearranging one’s schedule, for example, to go to a yoga class or meet with a peer support person. Of course, the irony was not lost on the other participants that actually trying to make time to fit in more activities is part of the challenge to using these [resources](https://www.stepsforward.org/modules/improving-physician-resilience). One of my co-fellows pointed out how physicians often “can’t make time” for wellness until they are seriously ill. It is only when a physician has a significant change in their life, like cancer, or a heart attack, that they are able to free up time for daily radiation therapy or cardiac rehab. These stories have always bothered me, they suggest that work-life balance is as simple as getting one’s priorities straight and “making time” for friends, family, and self. Most of us want to give our patients everything we have because we care about them. It’s not as simple as choosing between “work” and “life.” The line is blurred when “work” includes helping people that you have gotten to know well and care about and who have entrusted you with their health/lives. What limits the time I have for my family and favorite activities is not that I am a workaholic or afraid that a colleague would see me leave for lunch. It is a little voice in my head that, despite it being well after “normal” work hours and knowing my patients are in stable condition with an in-house resident watching over them, still thinks “*Why do I get to be out in my garden at 7, enjoying a late summer sunset while those patients are still sitting in the hospital, waiting?”* Yes, that’s right, I feel *guilty* about it*.* For me, and I imagine others out there, ever since finishing my surgical training I have had a big component of guilt associated with my free time because there is a human on the other end, not feeling well. In fact, instead of trying to find more time for wellness I often wonder if I could have spent just a few more minutes with one of my patients or a few extra moments reading the latest journal article. So where does appropriate responsibility and work ethic cross the line into self-destructing guilt? Shortly after my fellowship session where we had discussed wellness, I had one of those life events when I really did need to cancel everything. My grandmother passed away unexpectedly and my mother needed support. I canceled a very full all day clinic to go to the funeral and stay overnight at my mom’s house the night before. One of my partners generously picked up a call that night at the last minute. And I didn’t feel guilty, not even for a second. I thought back to that fellowship session and again thought about what my non-surgeon colleagues had pointed out during that session and realized that they were right. In some ways, my grandmother’s death was what it took for me to be out of work and not feel guilty about it. So instead of trying to find ways to “make time” for those priorities I am trying to find a way to be guilt-free while using that time. Reference 1\. Shanafelt, T. Ann Surg Oncol (2008) 15: 400. doi:10.1245/s10434-007-9725-9 [![JS](http://blog.womensurgeons.org/wp-content/uploads/2025/06/JS-206x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/07/JS.jpg) *J.S. is a general surgeon from Boston, MA.* --- **Categories:** career development, family life, medical students, professionalism, residency, resources, self-care **Tags:** burnout, stress, work ethic, work-life balance --- ### [Physician, Heal Thyself: Recognizing and Understanding Burnout](https://blog.womensurgeons.org/healthyself/) **Published:** July 21, 2016 **Author:** Blog Team **Content:** *By Gabrielle Rieth* This topic seems particular relevant and timely for me and my classmates, as we are currently in the happy limbo-land that our school dubs “Research Block.” It takes place following our second year of medical school, sitting for the USMLE Step 1 examination, and just prior to beginning our tenure as mini-docs in the arduous final two “clinical” years of our undergraduate medical education. On some level, I anticipated what I’d find when I began researching this topic. The concepts of self-care, emotional welfare, and professional burnout are hot-button issues in the medical world. In April, Surgeon General Vivek Murthy[ brought it to national attention](http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/57280) in an interview at the annual meeting of the Association of Health Care Journalists. The culture of medicine was documented on the well-known website, [Humans of New York](http://www.humansofnewyork.com/post/145970814496/theres-a-strange-culture-in-medicine-people-are). A student at another medical school shared a candid commentary on her struggles with anxiety and mental health throughout her pre-clinical training. I read on. In just under the span of an hour, I’d amassed an assortment of 20 blog posts, digital news articles, and formal journal publications focused on the cultivation of well being in healthcare providers and provided strategies for detecting and dealing with burnout. Clearly this was more than just a “hot-button issue.” The more I researched, the more I realized that this phenomenon is ubiquitous in medical schools and hospitals across the country. So what is burnout? “Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.1” It’s like the phenomenon of the boiling frog: one majorly catastrophic transgression is enough for a trainee to realize there’s something off, but a long sequence of nearly imperceptible slights continues to build unchecked, until the weight of this collection becomes unbearable and the trainee succumbs to burnout. An article published in *World Psychiatry2* this month defined it as a psychological syndrome that develops in response to prolonged chronic interpersonal stressors on the job. The three key dimensions of this response are overwhelming exhaustion, feelings of cynicism, depersonalization, detachment from the job itself, and a sense of ineffectiveness and lack of accomplishment. The authors introduced the Malasch Burnout Inventory, a psychometric burnout measure which assessed all three elements. Some of the key signs of burnout include physical manifestations of the disease with musculoskeletal pain and depression as the most common problems. These can be followed by periods of vital exhaustion with instances of low energy, difficulty concentrating, irritability, emotional instability, dizziness, and sleep difficulties. Sometimes the symptoms are more insidious. *Psychology Today* reports [more subtle physical symptoms](https://www.psychologytoday.com/blog/high-octane-women/201311/the-tell-tale-signs-burnout-do-you-have-them) of burnout including chronic fatigue, insomnia, forgetfulness, impaired concentration and attention, increased illness, loss of appetite, anxiety, depression, and anger. Signs of cynicism and detachment include loss of enjoyment, pessimism, isolation, and detachment, while signs of ineffectiveness and lack of accomplishment include feelings of apathy and hopelessness, increased irritability, and a lack of productivity and poor performance. It is important to recognize (either in yourself or in a colleague) what it looks like, to take time to recover, and to prevent[ escalation](http://www.nytimes.com/2014/09/05/opinion/why-do-doctors-commit-suicide.html?_r=0). If you recognize these symptoms in either yourself or a friend, take action. Don’t try to wait it out or ignore the feelings, hoping they’ll dissipate on their own. Reach out and seek support from friends and family, or talk with your school’s counseling department. Take time to recharge! Obviously, this is easier said than done, but figuring out what makes you feel refreshed and renewed is a step in the right direction. Engaging in those activities is important and can help cultivate an attitude of[ resilience](http://in-training.org/resilience-medical-education-10945) that may make surviving the ebbs and flows in medical school more manageable. Here is a helpful [Resilience Prescription](%5Bsiteurl%5D/wp-content/uploads/2016/07/Resilience-Prescription-Promotion.pdf). Last, but certainly not least, if you or a colleague is struggling with thoughts of suicide, reach out. Talk to a friend or family member you trust or find out what’s available to you at your home institution. Most medical schools and hospitals have confidential and private resources for students and staff that may be feeling overwhelmed. The[ National Suicide Prevention Lifeline](http://www.suicidepreventionlifeline.org/) also operates 24/7 at 1-800-273-TALK (8255). Don’t isolate yourself. Don’t try to weather the storm alone. 1\. http://www.theatlantic.com/health/archive/2014/02/for-the-young-doctor-about-to-burn-out/284005/ 2\. Malasch C, Leiter MP. Understanding the Burnout Experience: Recent Research and Its Implications for Psychiatry. World Psychiatry 2016. 15: 103-111. *[![IMG_3855](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_3855-165x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/07/IMG_3855.jpg)Gabrielle Rieth, MS, is an third-year medical student at Case Western Reserve University School of Medicine. She is originally from the Albany, New York area and completed her undergraduate work at Cornell University before migrating to the midwest.* --- **Categories:** education, medical students, residency, resources, self-care --- ### [An Open Letter to Young Women Considering a Career in Surgery](https://blog.womensurgeons.org/open-letter-young-women-considering-surgery/) **Published:** July 29, 2016 **Author:** Blog Team **Content:** *This post originally appeared in [Hot Heels, Cool Kicks, & a Scalpel](https://heelskicksscalpel.com/2016/04/11/an-open-letter-to-young-women-considering-a-career-in-surgery/)* Dear Young Woman Considering a Career in Surgery, It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.” Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me *it’s just my life*. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that *I really loved surgery*. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time. And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of *nothing more exciting than surgery* as your professional passion. People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother. ##### \[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.\] The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever. Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday, remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all. So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent. Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity. So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require. Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career. With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole. ##### \[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.\] Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system). If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family. When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is *no perfect time to start a family*. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time. And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required, you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon. ##### \[NB: If you choose to not have children-by this I really mean *choose* as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.\] When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will. When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. *If you don’t love it and it can be done by someone else outsource it.* Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.) Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must *schedule elective you time*. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month. ##### \[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.\] Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters,*we can create a life strategy* that overcomes these perceived barriers for both a happy family life *and* a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from. I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete. Sincerely, [@surgeoninheels](https://heelskicksscalpel.wordpress.com/mentions/surgeoninheels/) Not just a token surgeon-mom-wife-runner PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/ PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/ PPPS. I have been fortunate for the last 10+ years to be a part of the American College of Surgeons Women in Surgery Committee working towards improved gender parity, opportunities for professional development, and better work life integration in our careers.<https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee> [![dg-strappys]()](https://heelskicksscalpel.files.wordpress.com/2013/10/dg-strappys.jpg)*About @surgeoninheels: I am an acute care surgeon specializing in trauma, emergency general surgery, and surgical critical care. I am married to an incredibly supportive husband who is the primary childcare provider, homemaker, and diy’er in our home. I began running with him two years ago and we plan to run many half marathons together. While navigating the abyss between work and our two children and small dog, I also do as much Zumba, Stott Pilates reformer, and shopping as I can.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, family life, gender differences, leadership, medical students, mentorship, parenting, residency, resources, self-care, training, women --- ### [The HPV Vaccination Debate](https://blog.womensurgeons.org/hpv-vaccine/) **Published:** August 5, 2016 **Author:** Blog Team **Content:** *By Nickey Jafari* It can be easy to take for granted important public health measures when we have no real memory of what they prevent. It is hard to think of a better example of this than vaccines. Smallpox was once [one of the world’s most devastating diseases](http://www.who.int/csr/disease/smallpox/en/). It was less than a hundred years ago when we elected a U.S. president who had been debilitated by polio. Now, with people believing more threat to be within vaccines than in what they protect against, we are having measles outbreaks, a disease we had [eradicated from the U.S. in 2000](http://www.cdc.gov/measles/cases-outbreaks.html). It is of no surprise a majority of the [Disneyland measles outbreak](http://time.com/3664553/disneyland-measles-antivaxxers/) victims were unvaccinated. We are in an age where presidential candidates, some despite their prestigious medical backgrounds, loudly debate the necessity of vaccines. They must have forgotten [the iron lung](http://amhistory.si.edu/polio/howpolio/ironlung.htm). While vaccines have helped conquer age-old plagues, they also have an important role in preventing disease processes we are still trying to understand, like cancer. It has been over a decade since the Gardasil vaccine became FDA-approved. Now it is used in more than one-hundred countries. Gardasil protects against multiple strains of Human Papillomavirus (HPV), strains that contribute to a majority of cervical, vulvar, anal, and penile cancers, but that’s not all. Increasing research shows that [HPV is contributing to the rise of head and neck cancers](http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(10)70017-6/abstract). I recently had a patient on my internal medicine clerkship with nasopharyngeal carcinoma and no history of alcohol and/or tobacco use. His cancer cells were HPV positive. So as a reminder, it is important for boys to get vaccinated, not just girls ([American Academy of Pediatrics](https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Recommends-HPV-Vaccines-For-Both-Males-and-Females.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token)). The interesting thing about the Gardasil debate is how not just the anti-vaxxer camp is against it. I have seen a lot of parents who agree with other scheduled vaccines be extremely apprehensive when it comes to Gardasil. After all, Hepatitis B can cause liver cancer, and can be sexually transmitted, but we still vaccinate children against it at birth. Here are some helpful facts for discussing the Gardasil debate: - One major obstacle to Gardasil vaccination is parents thinking it will cause their children to have increased amounts of sexual activity or earlier age of initial sexual contact. Physicians should reassure them that *this is simply not true.* A [study](http://pediatrics.aappublications.org/content/130/5/798) of 1398 girls from 2012 concluded “Receipt of HPV vaccine by 11- to 12-year-old girls was not associated with clinical markers of increased sexual activity–related outcomes, such as sexually transmitted diseases or pregnancy”. - As far as overall vaccine safety goes, please check out [this study](http://archpedi.jamanetwork.com/article.aspx?articleid=1363509) of 189,629 females who had at least 1 dose of Gardasil. - Some parents on my family medicine clerkship who are generally supportive of vaccination are concerned about one that “has not been around for a long time.” Besides it being FDA-approved for over a decade now, a lot of the other vaccines people do not object to nearly as much are even newer (e.g. [meningitis](http://www.webmd.com/children/vaccines/news/20141029/fda-approves-new-vaccine-to-protect-against-meningitis)). - Gardasil works. [Researchers have found that since the introduction of the HPV vaccine, infection rates have dropped by almost 50 percen](http://www.mayoclinic.org/diseases-conditions/cancer/expert-blog/hpv-vaccine-success/BGP-20056370)t. You can and should get the Gardasil vaccine up to age 26, regardless of previous sexual activity, but the earlier the better. While 11 or 12 seems too young for your child to be thinking about these things, that is because we *hope and pray* it is early, early enough to protect them prior to *any* HPV exposure. [Most men and women are infected with HPV at some point in their lives](http://my.clevelandclinic.org/health/diseases_conditions/hic_Understanding_HPV). Unless you believe your child will never engage in any sexual activity in the future, *please* vaccinate them early. It could save their life. [![AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg](http://blog.womensurgeons.org/wp-content/uploads/2025/06/AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg-296x296.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/01/AAEAAQAAAAAAAAT4AAAAJDBjYjNmMzkzLTRkZDAtNGNmMC1hMmFhLTk4YWIzYTRlNTI5Zg.jpg)Nickey Jafari is a 2nd year medical student at the University of Kansas School of Medicine. She was born in Tehran, raised in Kansas, and attended Drake University in Iowa for her Bachelor’s degree in International Relations and Biochemistry. She is passionate about global health and is interested in how better access to and quality of surgery can help tackle disparities in outcomes.*Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy --- ### [Looking Beyond 2016 for Women in Surgery](https://blog.womensurgeons.org/looking-beyond-2016/) **Published:** August 12, 2016 **Author:** Blog Team **Content:** *By Shree Agrawal* When I was seven years old, I remember sitting in front of the television watching in awe of Hillary and Bill Clinton at one of his presidential addresses. I grew up watching her transform into someone who broke the mold of what it meant to be a woman throughout her lifetime. In truth, I knew I wanted to be like her. At that time, there seemed to be so few modern female role models challenging conventional views of women in society. [![Hillary_Clinton_official_Secretary_of_State_portrait_crop](%5Bsiteurl%5D/wp-content/uploads/2016/08/Hillary_Clinton_official_Secretary_of_State_portrait_crop-240x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/08/Hillary_Clinton_official_Secretary_of_State_portrait_crop.jpg) I have taken some time to reflect on the meaning of being a citizen of a nation that has finally nominated a female candidate for President. Regardless of political views and our feelings about this presidential race, I think as women in surgery, we can appreciate the visible milestone of this election season. I would like to think in the next five, ten, and fifty years, more women will run for political office, create dynamic change as CEOs and entrepreneurs, and pursue careers in medicine, particularly in surgery. I hope Hillary Clinton is the first of many to be able to truly inspire and catalyze progress for women in surgery as we make small steps to diversify leadership roles and opportunities in our departments, medical schools, and academic institutions. I believe the glass ceiling within surgery is slowly [starting to](https://www.womensurgeons.org/membership/women-in-the-news/) [dissolve](https://www.womensurgeons.org/about-us/leadership/), as we recognize the valuable perspectives both women and men are able to bring to patient care through training and practice. Moreover, I am lucky to have now found even more female role models within medicine, who equally inspire, in my path through medical school. ***Where do you see women in surgery after 2016?*** *P.S. Curious about the future of women in surgery? Want to engage with a network of female mentors? **Register now for the [AWS Conference in Washington D.C. this October!](https://www.womensurgeons.org/about-us/conference/)*** *[![Shree_Agrawal_AWS_2016 (1)](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Shree_Agrawal_AWS_2016-1-240x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/08/Shree_Agrawal_AWS_2016-1.png)* *Shree is a third year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Prior to medical school, she performed prostate cancer research at the Cleveland Clinic and University Hospitals of Cleveland. Shree is passionate about clinical research surrounding patient decision-making and medical education. In her free time she enjoys blogging for the AWS blog, practicing yoga, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, gender differences, leadership, women --- ### [Social Media](https://blog.womensurgeons.org/social-media/) **Published:** August 18, 2016 **Author:** Blog Team **Content:** *By Stephanie Bonne* This month, AWS is exploring social media and it’s use. While I’m no expert and others have certainly had more experience, I have learned a great deal about social media use as I’ve participated in and managed the communications committee for AWS. You can read my how-to guide in this month’s Econnections, but here on the blog I’m discussing the ways in which social media has helped me personally. Facebook: I joined Facebook way back in 2007, and shortly thereafter realized that I needed to make sure my privacy settings were pretty tight if I was going to use it. As physicians, we are searchable to our patients and privacy is of utmost importance. More recently, however, private and secret groups on Facebook have enjoyed a fair bit of success and in these groups I’ve found support. There are groups for physicians, moms, surgeons, surgeon moms, and for nearly every outside interest I might have. These groups are useful for those who are planning events or executing causes. They are similar to the “chat rooms” of days gone by, but with better privacy. I recommend trying out Facebook just to be part of these groups, but just remember – things are never completely secure or anonymous. Twitter was much harder for me to “wrap my brain” around. But once I did, I find that it’s a great little tool for my soapbox. Follow me on twitter (@scrubbedin) and you will find everything from posts on women in surgery and trauma surgery to political support for my preferred candidates and comments on my most compelling issues. Follow me during meetings and you’ll find me connecting with colleagues and live posting the meeting for those at home. It’s been a great way to connect with colleagues and mentors and a nice icebreaker when I recognize fellow twitter users at networking events. I also recommend it for professional networking, but for me, it’s too public for personal photos, support, or open mentoring. I’ve never used Instagram (I hate selfies and photos of food) and occasionally use LinkedIn, but my husband, a business world guy, uses LinkedIn frequently and proficiently to make professional connections. There is definitely a future here, but it’s only as useful as the number of people using it, and LinkedIn has been slow to gain traction in the medical community. I’m going to stick with it though, as I find it useful to connect with those outside of medicine. You can follow AWS on any of the above social media platforms: **@womensurgeons**. Look for a private AWS facebook group for members only in the months to come! *[![Bonne-picb-0715-200x300](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Bonne-picb-0715-200x300-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/Bonne-picb-0715-200x300.jpg)Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care. Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit. She participates in the American College of Surgeons, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force. Dr. Bonne is the current Communications Chair for the AWS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter. She is a wife and mother to three young children.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Coming soon! AWS on Facebook](https://blog.womensurgeons.org/aws-facebook/) **Published:** August 25, 2016 **Author:** Blog Team **Content:** *By Cornelia Griggs* Like most surgical residents, I used to think of social media as an easy way to connect with friends, to discover interesting articles, and a way to occupy my hands during the (few) idle moments of my day. Whether it was scrolling through Instagram while waiting for an elevator or checking out articles on Facebook before I fell asleep at night, social media was just a casual time filler. Over the past year, however, social media has played an increasingly important role in my professional world. Shortly after I had my daughter in October, one of my attendings added me to a secret group on Facebook for surgeon mothers. The group is an offshoot of a hugely popular community that many of you may have heard about- the Physician Moms Group, which now has over 60,000 members. As Dr. Stephanie Bonne described in her [blog post](https://www.womensurgeons.org/social-media/) last week, these communities have created a (semi) protected space where physician and surgeon mothers can go to vent, seek advice, share tips and find other amusing and useful information about navigating life as a physician/surgeon mother. At first I was just a lurker in these groups, casually scanning through pages and posts while I was up nursing my daughter in the middle of the night. But as my maternity leave drew to a close, my anxieties about returning to the operating room loomed large. Pumping at work and in between cases seemed overwhelming if not impossible. The idea of being away from my daughter for twelve or more hours a day made me want to bawl. But suddenly I had found a group of women who had done it. These women had not only survived but appeared to have built happy families despite the demands of being surgeon. So I reached out. I sent a few Facebook messages and posted asking for tips on breastfeeding while in surgical residency. Within minutes, multiple women had written back to me and shared their stories. A resident from another program in Boston sent me her number and we bonded for over an hour about surgery, residency, motherhood, and the juggling act it takes to manage it all. She assured me that there would be days when I would miss my daughter so much that I would question my career choice. She also assured me that a few weeks back into residency I would find a new normal — that making it home to give my daughter her bath and put her to bed would feel like a little victory, just enough to keep me going. We comforted each other by reminding ourselves that residency is temporary and one day we would have a modicum of control over our schedules. Suddenly, the whole endeavor seemed not only possible but *manageable*. With this new community at my fingertips, I became motivated to get involved with the AWS and signed up to join the Communications Committee led by Dr. Stephanie Bonne and Dr. Heather Yeo. I co-hosted a mixer at my home for women medical students interested in surgery. When some of the students asked me how I was managing the transition back to residency with an infant at home, I was brutally honest. I was scared, overwhelmed and knew that the first few weeks away from my daughter would probably be torture. Now, almost three months into PGY-4, there are definitely days that I ache for the long, lazy days I spent with my daughter on maternity leave. When cases run late and I come home after she’s already asleep, I feel defeated. I open up Instagram and feel sorry for myself when I see posts from the “mom friends” I made on maternity leave. Many of them have more flexible jobs where they can take off days during the week. I’m overcome with “FOMO” (fear of missing out) when I see posts of them at the Boston Children’s museum or the sprinkler playground on a sunny day. given everything I’m missing out on at home, social media can sometimes make me question whether the path I’ve chosen is really worth it . But then I dream of the woman I hope my daughter will become some day. I know that I must lead by example if I want her to believe that she can set ambitious goals for herself and follow through with them. When I’m reaching hour 80 of my week and the fatigue makes me doubt my choices, I open up our Facebook group and look at pictures of all the women surgeons who have come before me. Surely if they can do it, I can do it too. These women are posting tips for passing the boards, the best shoes or music to have in the OR, or even just sharing little successes from their day. In this community I have found a small tribe of women who have walked in my clogs. While there are great women role models at my residency, somehow this online community feels more accessible. Our hope on the AWS communications committee is to create another group where all women surgeons and trainees, not just mothers, can come to find friendship, advice, support, and even a daily dose of humor from like-minded women across the country.. Be on the lookout on our Facebook page in the next month or two. If you have interest in joining our group, you can also reach out to me on Facebook, Instagram or Twitter (@cornelialg for Instagram and Twitter). I look forward to connecting with many of you! *[![C briggs](http://blog.womensurgeons.org/wp-content/uploads/2025/06/C-briggs-300x200.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/08/C-briggs.jpg)Cornelia Griggs, MD is a PGY-4 General Surgery resident at the Massachusetts General Hospital (MGH) in Boston, MA. She completed a surgical critical care fellowship at MGH from 2014-2015.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship, networking, parenting, resources --- ### [Beyond the Basics of Tweeting](https://blog.womensurgeons.org/beyond-the-basics-of-tweeting/) **Published:** September 1, 2016 **Author:** Blog Team **Content:** *By Heather Yeo* As we continue to explore social media in academic and clinical medicine at AWS this month we wanted to create a practical guide for physician clinicians and researchers interested in tweeting at academic meetings or participating in a tweet chat. This goes slightly above the [twitter basics](http://bulletin.facs.org/2016/06/the-surgeon-and-social-media-twitter-as-a-tool-for-practicing-surgeons/). For beginners, we recommend you also check out some [social media guidelines and best practices.](http://buff.ly/2aOsMAF) [![twitter pic](%5Bsiteurl%5D/wp-content/uploads/2016/09/twitter-pic-225x225.png)](%5Bsiteurl%5D/wp-content/uploads/2016/09/twitter-pic.png) **Why participate in live tweeting a meeting?** **Information sharing/learning** When you are at a conference with multiple presentations of interest, you cannot be in two rooms at once, twitter allows you to monitor what is being presented in other sessions. The benefit of twitter is having access to multiple presentations virtually, when you can only attend one room in reality. Twitter’s short 140 characters allow for easy spread of simple messages – like most headlines. To understand full research, you may still need to review methods, but at least you can get key points and info on authors who do work of interest to you. Twitter allows presenters to share their findings to people unable to be present at a conference. **Discussion between people interested in the topics** By using #(hashtags) individuals can follow topics that are of interest to them and have a discussion with other also interested (people both at the meeting and those who couldn’t attend) - **Networking** By “tweeting” and following tweets related to meetings you can find others with similar research interests, this can be great for collaborative research efforts. - **Lack of hierarchy** Personally, I think one of the most interesting things about twitter, is the accessibility it offers to young researchers to more experienced thought leaders. I am always a bit starstruck when a physician whose research/skill I respect responds to a tweet. Medicine itself is hierarchical, but social media offers opportunities to respectfully break down some of those barriers. **Guidelines for Meeting Tweeting** - **Warn your followers at the start of a meeting** If you are going to be live tweeting a meeting, it is a good idea to let your followers know so they can mute you if need be, or at least have an idea of why you are tweeting so much in a short amount of time. An example: Headed to #ACS2017 – planning on live tweeting – apologize in advance for the flurry of tweets for those not interested, feel free to mute. **Use the registered hashtag for the meeting** so it ends up in the right place. Symplur.com will have most of scientific meetings, you can also see the meeting stats there. Some upcoming meetings we hope you will consider tweeting about - \#AWS2016 – The 2016 Association of Women Surgeons Annual Meeting - \#ACSCC16 – The 2016 American College of Surgeons Clinical Congress 1. **Use Images to help to gain visibility** – but if you take pictures make sure you can read a slide or see the speaker 2. **Try to summarize the findings, acknowledge the presenter** (this can be done by tagging them using the @ sign-if it is at the start of a tweet use .@ or you tweet will only be visible to that person. 3. If your reply is of general interest may be better to retweet and comment attached to a specific tweet from another user. **Why participate in a tweet chat or journal club?** Many of the advantages are similar to participating in a meeting. - **Information sharing/learning** A tweet chat is a great way to share your ideas or research with people who are directly interested in a topic. You can reach larger audiences in a short amount of time. Top thought leaders come together and have a conversation. - **Networking – Some people have compared twitter to a large cocktail party with many conversations going on. By participating in a tweet chat you are discovering who at the party is interested in your topic/s of interest.** - ****Lack of hierarchy**** Again, here physicians (from med students to senior attendings), nurses, patients can all come together to talk about a topic on the same level. **Take Home Guidelines for participation in a Tweetchat** 1. It is okay to just “listen” or “lurk” – just type the name of the tweetchat (eg. #AWSchat) in your twitter search bar or click on the hashtag of the tweetchat you are interested in. 2. Let your followers know you will be participating – a flurry of random tweets can annoy people unless they know why you are tweeting, they can be beneficial if it is a topic of interest to people who are following you. 3. Introduce yourself or say hello to people you know on the chat. 4. Read the questions before hand, think before you tweet–more is not better. It is ok to have some pretyped tweets and send them at the appropriate time when a question is being discussed. 5. If you like other tweets retweet or like them. 6. Always tag the chat and the question number-it makes it easier to follow the conversation in the final transcript or when you are trying to respond to something it helps with context. HCLDR is a great weekly tweetchat focused on healthcare leaders. So you would use #HCLDR to have your tweet listed in their chat and type T1 (for 1st topic) or Q1 for first question at the start of your tweet. A reminder. Your tweets are searchable and generally not private, so do not post anything that you will regret later. Be professional, do not give personal medical advice. It is ok to have a personal component to your tweets, just know that the world is watching. Happy tweeting! We hope you join us at #AWS2016 in Washington D.C. this year! **[![heather yeo](http://blog.womensurgeons.org/wp-content/uploads/2025/06/heather-yeo-277x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/09/heather-yeo.jpg)** **Follow me on twitter @heatheryeomd** Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College and Assistant Attending Surgeon at New York-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo specializes in the comprehensive care of colorectal cancer patients as well as those patients with benign colorectal disease. She is particularly interested in the role of innovative technologies in patient care and is currently researching and developing mobile apps for surgical patients. *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, medical students, networking --- ### [Have You Thought About Your Ovaries Lately?](https://blog.womensurgeons.org/ovarian-cancer-awareness/) **Published:** September 9, 2016 **Author:** Blog Team **Content:** *By Shree Agrawal* This month, AWS is focusing on ovarian cancer awareness. But really, why does all of this matter? *Ovarian cancer is the leading cause of death from a gynecologic malignancy, [affecting thousands of women](https://www.ncbi.nlm.nih.gov/pubmed?term=24399786) each year–most commonly, among women who are 60 years or older. [![ovarian-cancer](%5Bsiteurl%5D/wp-content/uploads/2016/09/ovarian-cancer-300x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/09/ovarian-cancer.jpg)* Unsurprisingly, diagnosing ovarian cancer at an earlier stage strongly correlates with [improved disease outcomes](https://www.ncbi.nlm.nih.gov/pubmed?term=14586365). While pap smears and breast examinations are screening tools commonly expected during a gynecologic exam, screening for ovarian cancer specifically is less obvious. A thorough workup should be initiated within the context of any symptoms of pelvic or abdominal pain, increased abdominal size or abdominal bloating, urinary urgency/frequency, and early satiety. In addition a thorough physical exam, some additional tests may include CA-125 levels and/or pelvic ultrasonography. Regardless, everyone’s experience with prevention, screening, and potential intervention is a personal decision. Some talking points to bring up with your physician: - Consider discussing genetic testing or speaking with a genetic counselor, if you have a significant personal or family history. - Routine check-ups with a pelvic exam are essential for early detection, prior to symptom development. - Do not be afraid to get something checked out. - Sometimes it feels easy to brush something off as a minor or silly concern. If the thought keeps popping up in the back of your mind, what’s the harm in getting it looked out? An hour lost, a few moments spent scheduling, a small amount of emotional energy spent with worry, anxiety, and nervousness? - Don’t wait, just do it. *Resources for you and your loved ones:* [Treatment Guidelines for Ovarian Cancer](http://journals.lww.com/greenjournal/Fulltext/2013/06000/Adherence_to_Treatment_Guidelines_for_Ovarian.13.aspx)[Ovarian Cancer Glossary](http://www.acog.org/Patients/FAQs/Ovarian-Cancer#glossary)*[![Shree_Agrawal_AWS_2016 (1)](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Shree_Agrawal_AWS_2016-1-240x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/08/Shree_Agrawal_AWS_2016-1.png)Shree is a third year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Prior to medical school, she performed prostate cancer research at the Cleveland Clinic and University Hospitals of Cleveland. Shree is passionate about clinical research surrounding patient decision-making and medical education. In her free time she enjoys blogging for the AWS blog, practicing yoga, and boxing.Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, self-care --- ### [May We Never Forget](https://blog.womensurgeons.org/never-forget/) **Published:** September 11, 2016 **Author:** Blog Team **Content:** 15 years later it still seems as vivid as yesterday. I woke up to my daily radio show hosts speaking with panic and confusion. A plane had accidentally crashed into one of the twin towers. As my family and I gathered around the TV, newscasters around the country struggled to get information out. The American public watched in terror as a second airplane struck WTC. [![unnamed](%5Bsiteurl%5D/wp-content/uploads/2016/09/unnamed-157x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/09/unnamed.jpg)In that moment it became clear this was no accident. President Bush was reading to a group of school children, then we heard about flight 93, and witnessed the attack on the Pentagon. The world changed that day. I wish I could unsee some of those images, which still bring tears to my eyes. I think of the hatred, hopelessness, and pain inflicted upon us that day. When I recently visited the 9/11 memorial for the first time, I was pulled back into the memories of that day. I was struck by the juxtaposition of the emotions evoked in my memories with the beauty and calm of the memorial. No matter what nationality, religion, ethnicity any human could feel indignation at the attacks of 9/11. May we never forget. *[![minerva-romero-bio-pic1](http://blog.womensurgeons.org/wp-content/uploads/2025/06/minerva-romero-bio-pic1-292x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/minerva-romero-bio-pic1.jpg)* *Minerva A. Romero Arenas is a Fellow in Surgical Endocrinology at The UT MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.* *Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.* *She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.* Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** Food4Thought --- ### [Residency Applications: The Curriculum Vitae](https://blog.womensurgeons.org/residency-applications-cv/) **Published:** September 15, 2016 **Author:** Blog Team **Content:** *By Mary Brandt* This article originally appeared on Dr. Brandt’s blog, the [wellnessrounds](https://wellnessrounds.org/2016/04/04/residency-applications-the-curriculum-vitae/). ![student at computer](https://wellnessrounds.files.wordpress.com/2016/04/student-at-computer.jpg?w=584)Other than the personal statement, there is nothing more distressing to medical students applying for a residency than putting together a Curriculum Vitae (CV). **So, what exactly is a CV?** “The original Latin meaning of *curriculum* was a course, but of the kind that one runs around (it came from *currere*, to run). Even more recent — dating from 1902 — is *curriculum vitae*, literally “the course of one’s life” (from [World Wide Words](http://www.worldwidewords.org/topicalwords/tw-cur1.htm)) Your curriculum vitae is a document that serves as a summary of what you have accomplished as a professional. **What’s the difference between my CV and what I put on my ERAS application?![erasnav1](https://wellnessrounds.files.wordpress.com/2016/04/erasnav1.jpg?w=584)** Your CV and what you put in ERAS differ in two important ways – the content and the format. ERAS will generate a CV from the information you enter, but it’s not in a format that is usually used for a professional CV. In addition, the ERAS generated CV will not have the same information you will want on your CV. For example, ERAS “experiences” don’t translate well into a professional CV. **Why do I need a CV in addition to what I put into ERAS?** - You will need to give your CV to any faculty writing a letter of recommendation. - You may be asked to send a CV when applying for away electives. - It’s a good idea to take your CV with you on interviews to provide a copy to the program, especially if you have updated it since your application was submitted. - If and when you send emails to programs after you interview, it’s a good idea to attach your CV if it has changed at all. Bcc yourself when you do – if there is a problem with the email or the attachment, you’ll know it quickly. **What do I need to include in my CV and what should it look like?** There is no absolute “standard” format for a CV, both in content and in style, but there are some guidelines. In general, in addition to the “heading” with your name and contact information, the following sections (if they apply to you) should be included in the order they are listed. - Education (degrees, institutions) - +/- Place of Birth - +/- Citizenship - +/- Languages - Military service - Work experience (this is not summer jobs unless the pertain to your application i.e. don’t list being a waiter, etc!) - Volunteer experience (make sure it’s significant. There is no advantage to listing 20 things that all lasted a week or two …. again, unless it’s specifically related to your application… see “don’t pad your CV” below) - Other training (eg BLS, ACLS, special courses to learn a skill) - Professional memberships (including leadership positions, committees) - Honors and awards - Publications - Presentations - +/- Personal interests (drop after you match if you include it) ![mentoring brown]() **Categories:** career development, education, medical students, professionalism, resources --- ### [Navigating Your Surgical Career](https://blog.womensurgeons.org/navigating-your-surgical-career/) **Published:** September 23, 2016 **Author:** Blog Team **Content:** The AWS Clinical Practice Committee will be discussing Navigating Your Surgical Career: The AWS Guide to Success. Many of us only wish we could have had access to a resource like this at the beginning of our careers! It is a “must read.” We will discuss a few selected chapters on networking, mentoring, leadership skills, burnout and transitions. Please join us on **Monday (9/26)****,** **7:00 p.m. CST**. The AWS blogging team is excited about the [\#AWSChat](https://twitter.com/hashtag/AWSChat?src=hash) and we hope to see you there! *More information about participating in an AWS Twitter chat:* A Twitter chat is where a group of Twitter users meet at a pre-determined time to discuss a certain topic, using a designated hashtag (#) for each tweet contributed. Chats typically last an hour. Imagine a business networking event-but without a dress code and with a keyboard instead of a bar. The same social customs apply-courtesy and respect-and it’s a great way to meet new people with similar interests. There are Twitter chats in almost every industry imaginable. Joining our tweet chat is easy. 1\. Sign up for a Twitter account if you don’t already have one 2\. Download any one of the popular Twitter applications available online like Tweetdeck, Hootsuite or Tweetchat 3\. In your preferred Twitter application, create a search column with “#AWSChat” as the hashtag. 4\. Follow the moderator so that you can reply to tweets and retweet other comments and questions from participants. 5\. Enjoy! **Categories:** Uncategorized --- ### [Navigating Your Surgical Career-Recap!](https://blog.womensurgeons.org/career-awschat-recap/) **Published:** September 30, 2016 **Author:** Blog Team **Content:** *By Shree Agrawal* Hopefully many of you were following along on Twitter for the #AWSchat that happened this past Monday. If not, we summarize some highlights and pearls of wisdom from the virtual conversation on “Navigating Your Surgical Career.” You can also search #AWSchat on Twitter to see all tweets from Monday if you happened to miss it. [@MadelineBTorres](https://twitter.com/MadelineBTorres) also compiled a storify highlight reel to capture the essence of “Navigating Your Surgical Career” as shown here: > In case you missed our [\#AWSchat](https://twitter.com/hashtag/AWSchat?src=hash&ref_src=twsrc%5Etfw): [\#AWSchat](https://twitter.com/hashtag/AWSchat?src=hash&ref_src=twsrc%5Etfw) Navigating Your Surgical Career <https://t.co/ApHIMjch5P> via @madelinebtorres > > — WomenSurgeons (@WomenSurgeons) [September 27, 2016](https://twitter.com/WomenSurgeons/status/780576772819677184?ref_src=twsrc%5Etfw) We are featuring tweets with impact from Monday’s #AWSchat Tips for the networking spectrum from novice to professional: On advancing with the help of your network by defining your purpose, interests, strengths, and accomplishments and then sharing them: > Yes! But, don't wait around if they don't, it's ok to let people know what you are interested in, and that may be their work. [\#AWSchat](https://twitter.com/hashtag/AWSchat?src=hash&ref_src=twsrc%5Etfw) <https://t.co/Ti25Gn0oYr> > > — Heather Yeo MD (@heatheryeomd) [September 27, 2016](https://twitter.com/heatheryeomd/status/780566290792603648?ref_src=twsrc%5Etfw) When you observe burnout in yourself, peers, colleagues, and/or mentors, tips to cope and ultimately succeed as a surgeon: > Q7:Remember that which makes us great surgeons is our humanity. Be emotional. Be vulnerable. Be present. Care for pts. Care for you [\#awschat](https://twitter.com/hashtag/awschat?src=hash&ref_src=twsrc%5Etfw) > > — Meredith Barrett (@sparklyscalpel) [September 27, 2016](https://twitter.com/sparklyscalpel/status/780573119182434304?ref_src=twsrc%5Etfw) The strength of your abilities translates to the strength of your surgical team. It is worthwhile to connect with all colleagues to optimize communication within your practice: > Q1. Networking doesn't mean just with surgeons, take a minute to get to know colleagues at your institution [\#AWSchat](https://twitter.com/hashtag/AWSchat?src=hash&ref_src=twsrc%5Etfw) > > — Dr. Lillian Erdahl MD (@LillianErdahlMD) [September 27, 2016](https://twitter.com/LillianErdahlMD/status/780563021210931200?ref_src=twsrc%5Etfw) We hope you enjoyed our September #AWSchat! Comment below to continue the conversation about navigating your surgical career. Subscribe to the blog and follow @WomenSurgeons to find out about our next tweetchat! ![img_7449](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_7449-2-287x300.jpg)*Shree is a third year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Prior to medical school, she performed prostate cancer research at the Cleveland Clinic and University Hospitals of Cleveland. Shree is passionate about clinical research surrounding patient decision-making and medical education. In her free time she enjoys blogging for the AWS blog, practicing yoga, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Just Like Your Mother Told You](https://blog.womensurgeons.org/just-like-mom-told-you/) **Published:** October 7, 2016 **Author:** Blog Team **Content:** *By Kandace Peterson McGuire* I think, at this point in our lives, we have all realized that our mothers are/were very wise women. So what *did* your mother tell you when you were growing up? 1. Go to bed 2. Eat your fruits and vegetables 3. Get outside and run around 4. Everything in moderation (OK maybe my mom just told me this one, she was extra smart) When we were children, we listened to our mothers most of the time. So why, as adults, do we think we can discount the wise advice they gave us, especially when we might tell our children the exact same things? *“I don’t have time!” “Menopause is coming/has come and it’s a losing battle!” “I could be reading an article, finishing charts, writing a grant!”*We often don’t realize is that our mothers were 100% right, getting sleep, eating right and exercising are so important. Studies show that doing all the above makes us *more* effective at our jobs and happier. **The Path to Success:** Be RealisticYou are not going to go run a marathon tomorrow…or maybe ever. Start small and slow. Respect your body and give yourself rest when you need it (at least once a week!). Don’t start a routine with hour -long workouts if that doesn’t fit your schedule. A half an hour of vigorous exercise (whether its cardio or weights) is better than sitting on the couch!Do Something FunNot a huge fan of running? Don’t run! Play soccer with your kids, take a Zumba class, do Crossfit. If you don’t like your workout, you won’t stick with it. The same goes for food. Make small changes incorporating healthier choices into your diet. Be AccountableYour colleagues know how many patients you see, how many grants you have, how many papers you publish, how well your practice is doing. Make sure you crow about taking care of yourself too. Find a Facebook accountability group or workout with a friend. Start eating right with your partner. Use an online tracker for food intake. You will be amazed by how supportive people are when they are helping you achieve a goal. Don’t Get on the Scale This is not about pounds and inches. It’s about feeling better, having more energy and being more effective in everything you do. If Meyers-Briggs has, at any time, told you you have a ‘J’ personality, then you might need some measurable progress. Use whatever matters to you. Don’t Beat Yourself UpMissed a workout? Had a pumpkin spiced latte or a massive slice of chocolate cake? Stayed up until 2 for work (or play)? Who cares? It’s in the past! I have sabotaged myself so many times for stuff like this and let myself jump off the wagon for little bumps in the road. Forgetting about it and moving on has been on of my greatest gifts to myself. I once heard a really respected surgeon say, “If you’ll wake up at 4am to workout, you can wake up at 4am to write a grant”. If you’re writing at 4am, and you’ve lost your workout time. If you wake up at 4am to workout, then find another time to write your grant. When you’re 80, that workout will have been so much more important. Now make your mother proud and go outside and run around! *[![mcguire-unc-faculty-photo1_edited-1](http://blog.womensurgeons.org/wp-content/uploads/2025/06/McGuire-UNC-Faculty-Photo1_edited-1-214x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/10/McGuire-UNC-Faculty-Photo1_edited-1.jpg)* *Kandace Peterson McGuire is an Associate Professor of Surgery at the University of North Carolina. She serves as the Surgical Director of the Multidisciplinary Breast Cancer Program at the Lineberger Cancer Center. She lives in Chapel Hill with her husband, Phillip, and 7-year old son, Jackson. She does wake up at 4am to lift weights, kick-box or do high intensity interval training…not to write grants. Her professional interests include research into breast cancer in young women, women’s leadership and promoting healthy lifestyles in patients and providers.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Your AWS/ACS Social Media Guide](https://blog.womensurgeons.org/your-awsacs-social-media-guide/) **Published:** October 14, 2016 **Author:** Blog Team **Content:** *By the AWS Blog Subcommittee* We are looking forward to kicking off the Association of Women Surgeons Annual Meeting and American College of Surgeons Clinical Congress this weekend. This goes slightly above the [twitter basics](http://bulletin.facs.org/2016/06/the-surgeon-and-social-media-twitter-as-a-tool-for-practicing-surgeons/). For beginners, we recommend you also check out some [social media guidelines and best practices.](http://buff.ly/2aOsMAF) We cover some of the [essentials of tweeting](https://www.womensurgeons.org/beyond-the-basics-of-tweeting/) effectively during both conferences, but similar principles apply to other platforms like Facebook, LinkedIn, and Instagram. Be sure to hashtag/selfie/share with our guide below! **Guidelines for Meeting Tweeting** - **Warn your followers at the start of a meeting** If you are going to be live tweeting a meeting, it is a good idea to let your followers know so they can mute you if need be, or at least have an idea of why you are tweeting so much in a short amount of time. An example: Headed to #ACS2017 – planning on live tweeting – apologize in advance for the flurry of tweets for those not interested, feel free to mute. **Use the registered hashtag for the meeting** so it ends up in the right place. Symplur.com will have most of scientific meetings, you can also see the meeting stats there. Some upcoming meetings we hope you will consider tweeting about - \#AWS2016 – The 2016 Association of Women Surgeons Annual Meeting - \#ACSCC16 – The 2016 American College of Surgeons Clinical Congress 1. **Use Images to help to gain visibility** – but if you take pictures make sure you can read a slide or see the speaker 2. **Try to summarize the findings, acknowledge the presenter** (this can be done by tagging them using the @ sign-if it is at the start of a tweet use .@ or you tweet will only be visible to that person. 3. If your reply is of general interest may be better to retweet and comment attached to a specific tweet from another user. Again, here physicians (from med students to senior attendings), nurses, patients can all come together to talk about a topic on the same level. **Take Home Guidelines:** 1. It is okay to just “listen” or “lurk” – just type the name of the hashtag (eg. #AWS2016) in your twitter search bar or click on the hashtag of the conference you are interested in. 2. Let your followers know you will be participating – a flurry of random tweets can annoy people unless they know why you are tweeting, they can be beneficial if it is a topic of interest to people who are following you. 3. It is ok to have some pretyped tweets and send them at the appropriate time for a conference session. 4. If you like other tweets retweet or like them. A reminder. Your tweets are searchable and generally not private, so do not post anything that you will regret later. Be professional, do not give personal medical advice. It is ok to have a personal component to your tweets, just know that the world is watching. Happy tweeting! We hope you join us at #AWS2016 in Washington D.C. this year! *This post was adapted from Dr. Heather Yeo’s [guide to tweeting](https://www.womensurgeons.org/beyond-the-basics-of-tweeting/), previously featured on our blog.* **Categories:** Uncategorized --- ### [What It Means to Me To Be A Breast Cancer Surgeon](https://blog.womensurgeons.org/breast_cancer_surgeon/) **Published:** October 27, 2016 **Author:** Blog Team **Content:** *By Lillian Erdahl* I am often asked why I chose to pursue breast surgery out of all the surgical subspecialties. It took me a long time to find this career. When I was a little girl, I dreamed of growing up to be an actress. In high school, I realized that acting was fun, but my interest in biology and desire to make a difference in the lives of people suffering from disease led me to pursue a career in medicine, and eventually surgery. As an academic breast surgeon, I still play many roles in my work: technician, counselor, mentor, teacher, learner, researcher, and advocate.. Every day I learn more about the epidemiology and evolving treatment of cancer from working closely with partners in surgery and other disciplines. I continue to learn more about people and how cancer impacts their lives. *In a complex act of bringing together all of these roles, I try to think about identifying the important goals?* My first goal is to treat breast cancer so that the individual affected can live the life that she wants without being stopped by the cancer. My second goal is to limit the negative effects of treatment or to provide the patient with resources and treatments to cope with any side effects that occur. This requires understanding what is important to the woman or man I am treating. Once I know the patient’s goals and the roles that define her, I can combine those with my own goals for her cancer treatment. If she is a farmer, she may rely on her arm strength for her daily work. If she is a mother, she may want to do everything she can to be there for the important milestones in her child’s life. If she is a dancer, she may want her body to look normal in a leotard and have the flexibility to elegantly complete her port de bras. The algorithm for surgical options has several branch points and these are intimately related with the decisions for systemic and radiation therapy. In addition, family history, personal history, and genetic mutations impact the risk of future cancer and even the potential for different clinical trial enrollment. It makes scripting a treatment plan exciting but also more challenging for me and the patient. While there are challenges in successfully playing the role of surgeon treating breast cancer, I remember what it must be like to sit on the other side of that conversation. A woman who has recently found out that she has had cancer now has to make a life-altering decision in a one-hour office visit. How can she possibly consider everything she needs to in that brief time period? We must write the script together and it may take consultations with other specialists, return visits, and several revisions before we get it right. When the day of surgery finally arrives, we have rehearsed and revised as a team until we are ready for the performance. [![Photo taken by Amyrose Photography](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Erdahl_Pic2016-1-300x268.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/10/Erdahl_Pic2016-1.jpg)*Photo taken by Amyrose Photography* *Lillian Erdahl practices breast and general surgery at the University of Iowa. She serves as Associate Program Director in General Surgery as well as the head of the Iowa City VA Medical Center Breast Clinic. Her research interests include breast cancer prevention, faculty development, and simulation in teaching clinical examination.She completed her General Surgery residency at Penn State University including two-year research fellowship in surgical education. After residency, she also completed a one-year fellowship in breast surgical oncology at the Mayo Clinic in Rochester, MN. She is fluent in Spanish and completed a minor in Spanish while pursuing her BS in Biology at Iowa State University.Outside of the hospital, she enjoys yoga, cross-country skiing, cooking, and gardening. Her husband, two children, and cat help her to find joy in each moment of the day.* *She microblogs as @lillianerdahl supporting issues and organizations on social media where we all have an opportunity to make an impact. She would like to remind everyone to ask questions about how their donations benefit patients before giving money support breast cancer awareness.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [AWS Joins Instagram!](https://blog.womensurgeons.org/aws-joins-instagram/) **Published:** November 3, 2016 **Author:** Blog Team **Content:** *By Melany Hughes* *“A picture is worth a thousand words.”* *“Take a picture. It will last longer.”* *“Seeing is believing”* These clichés are ones we all know well. But today, we want the Association of Women Surgeons community to truly embrace them. The AWS has joined Instagram [(**@associationofwomensurgeons)**](https://www.instagram.com/associationofwomensurgeons/) and we want your photos. Whether at work or play, AWS wants to show the world how each of us works, lives and loves as women surgeons. Whether or not you are currently sharing photos in your personal social media accounts, we want to share those special, silly, serious moments with all of the AWS community. We are looking for photo submissions via email or messaging/tagging our Instagram account (@associationofwomensurgeons). [**FAQs**](https://www.instagram.com/about/faq/) **What is Instagram?** Instagram is an online mobile photo-sharing, video-sharing, and social networking service that enables its users to take pictures and videos, and share them either publicly or privately on the app, as well as through a variety of other social networking platforms, such as Facebook, Twitter, Tumblr, and Flickr. Instagram is a fun and quirky way to share your life with friends. Snap a photo with your mobile phone, then choose a filter to transform the image into a memory to keep around forever. **How much is the app?** $0.00 – available for free in the Apple App Store and Google Play store. **What does the “@” sign mean?** If you’re new to social media sites like Facebook, Twitter and Instagram, you may have heard of [“tagging”](http://www.bewebsmart.com/) but aren’t really sure what it means. Simply put, tagging identifies someone else in a post, photo or status update that you share. A tag can be used to notify someone that you have mentioned them in a post or a photo, and provides a link back to their profile. You can tag someone in a photo to identify them in the photo. You can tag someone in a status update to make sure that they see that post. On some social media sites you might see names preceded by the “@” symbol. The “@” symbol indicates that someone is tagged. For example if you want to get someone’s attention on Instagram you can tag them in a comment by entering their username preceded by “@”. You can also follow someone by searching their username with the “@”. [10 Instagram Cliches to Avoid: ](http://mashable.com/2013/10/09/instagram-cliches/) 1. Feet on the Beach [![selfie](%5Bsiteurl%5D/wp-content/uploads/2016/11/selfie-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/selfie.jpg)[![nail](%5Bsiteurl%5D/wp-content/uploads/2016/11/nail-248x186.png)](%5Bsiteurl%5D/wp-content/uploads/2016/11/nail.png)[![coffee](%5Bsiteurl%5D/wp-content/uploads/2016/11/coffee-298x298.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/coffee.jpg) 2. Clouds 3. Food Pictures 4. Nail Art 5. Inspirational Quotes 6. Tall Buildings Shot From the Ground 7. Coffee Art[![food](%5Bsiteurl%5D/wp-content/uploads/2016/11/Food-300x226.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/Food.jpg)[![clouds](%5Bsiteurl%5D/wp-content/uploads/2016/11/clouds-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/clouds.jpg) 8. Copies of Text Conversations 9. Bathroom Mirror Selfies 10. Sunsets On the other hand, here are some quotes, inspiring us to take a new “look” at our lives and hopefully shoot and share them with AWS: 1. “Only photograph what you love.” [![son](%5Bsiteurl%5D/wp-content/uploads/2016/11/son-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/son.jpg) 2. “It’s one thing to make a picture of what a person looks like, it’s another thing to make a portrait of who they are.” 3. “There is only you and your camera. The limitations in your photography are in yourself, for what we see is what we are.” 4. “The whole point of taking pictures is so that you don’t have to explain things with words.” 5. “To me, photography is an art of observation. It’s about finding something interesting in an ordinary place… I’ve found it has little to do with the things you see and everything to do with the way you see them.” 6. “Photography records the gamut of feelings written on the human face, the beauty of the earth and skies that man has inherited, and the wealth and confusion man has created. It is a major force in explaining man to man.” So we are looking to share those moments in your life that only another surgeon, researcher, student, teacher, mother, grandmother, daughter, sister or woman could understand on our **[@associationofwomensurgeons](https://www.instagram.com/associationofwomensurgeons/account)** *[![mch](http://blog.womensurgeons.org/wp-content/uploads/2025/06/MCH-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/MCH.jpg)Melany Hughes, MD, MPH is a 2005 graduate of the Howard University College of Medicine. She completed her General Surgery internship and residency at the Howard University Hospital in Washington, DC in June 2010. In the fall of 2010, with an interest in global and humanitarian medicine and surgery, she moved to New Orleans, LA to pursue a Master of Public Health Degree in Disaster Management and Emergency Preparedness at Tulane University (TU). While at TU she received a research appointment with the World Health Organization’s Center for Research on the Epidemiology of Disasters (WHO-CRED) in Brussels, Belgium. Her work specifically focused on the analysis of trauma and injury patterns seen after disaster events (both man-made and natural) and contributed to several multi-national collaborative research projects and publications. After completing her MPH degree in 2012 and with a continuing commitment to public service and humanitarian work she has served as a General Surgeon and Medical Officer with the U.S. Indian Health Service; providing healthcare to the Hopi and Navajo Nations in northwest Arizona. Dr. Hughes strives to practice “socially-conscious” general surgery and currently is employed as a private practice surgeon with Hafa Adai Specialist Group in Guam, USA* **Categories:** Uncategorized --- ### [Informatics and Surgery](https://blog.womensurgeons.org/informatics-and-surgery/) **Published:** November 12, 2016 **Author:** Blog Team **Content:** *By Jane Zhao* I am currently taking two years out from my general surgery residency to complete a clinical informatics fellowship. The most common question I am asked is: *What is clinical informatics?* Followed by: *That’s nice. But how is this relevant to surgery?* These are great questions. Let’s tackle them, one by one. **What is clinical informatics?** Clinical informatics is a multidisciplinary field with collaborative relationships between medicine and computer science, sociology, statistics, and engineering that leverages information science to improve health care. A main focus of the field has been on the application of electronic health records (EHR) systems and other health information technology (HIT) within the clinical setting. Other roles for clinical informatics can be found in the effective use of algorithms, devices, and system redesign to make health care processes work more efficiently while maintaining high quality patient care and safety. The discipline of clinical informatics is rapidly growing and evolving, in part aided by government mandates for universal adoption of EHR systems. **How is informatics relevant to surgery?** Historically, few surgeons have been involved in informatics, which is problematic because the interactions that surgeons have with HIT and EHR systems are different from that of other clinicians. Any time change is taking place within the health care system, surgeons need to be a part of the process to help maximize the benefit of these changes on surgical care. The following five areas are where applied clinical informatics have far-reaching implications for surgeons: **Workflow** Informatics can improve workflow with respect to patient care throughout preoperative, perioperative, and postoperative settings by optimization of scheduling and allocation of operating room resources, electronic order sets, outpatient and inpatient records, and integration of evidence-based guidelines with patient information. Numerous studies have shown that human factors, including human error, have the greatest influence on complications in surgery. Patient outcomes have improved considerably with increased surgeon compliance to implemented measures such as early feeding, optimal pain control, thromboembolic disease prophylaxis, glucose control, and use of perioperative beta-blockers. These are all examples of informatics working to minimize (or eliminate) human error! **Quality Improvement & Research** Traditional clinical research requires manual extraction of data from patient charts. These reviews are time consuming, costly, and typically involve single institutional datasets. Research that relies on coding can help researchers ask questions on a large scale but at the cost of relying on often error-prone claims data. Thanks to early informaticians, initiatives such as National Surgical Quality Improvement Project (NSQIP) have been implemented. [NSQIP](https://www.facs.org/quality-programs/acs-nsqip) is standardized, nationally validated, and risk-adjusted and has been universally lauded as high quality, allowing surgeon scientists to conduct reliable large-scale population studies. Moving forward, with so much genetic data tied to clinical charts, surgeon scientists have the ability to ask clinical questions that dig deep into the DNA level. Furthermore, the use of artificial intelligence such as machine learning can make data extraction can take place in a high throughput manner. **Precision Medicine** Informatics has brought bench to bedside by introducing clinical genomics and proteomics to the practice of medicine. We are confronted with technically and statistically complex data sets like never before and are faced with the challenge of trying to tailor this information to fit each patient’s unique clinical situation. Informatics transforms this cumbersome task into something manageable, so that personalized medicine can be provided without exception to all patients. This has tremendous implications in the way surgeons can counsel and treat patients with a variety of disease processes, most notably cancer. Our understanding of other heterogeneous diseases, such as inflammatory bowel disease, have also been significantly advanced due to precision medicine. For example, we know so much more about the [microbiome of the GI tract due to informatics](http://lsmarr.calit2.net/multimedia?vid=o3bhFtbXnUU). **Security** Cyber security is extraordinarily lax in medicine, far more than in many other professions, in large part due to the complexity of our EHR and HIT systems. Unfortunately, this means that patient information is highly susceptible to being used as ransomware if it falls into the wrong hands. Recent hospitals made [headlines](https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/) due to these types of attacks. All clinicians—and especially surgeons—need to be aware of the potential of the medical environment to be hacked. Anything that relies on coded data and a wired or wireless connection is susceptible to attack—meaning anything from the EHR to the supply tracker to the operating room scheduling system to patient vitals monitors to surgical implants—so surgeons need to be aware of and able to adapt to these situations, particularly if one occurs in the middle of an operation. **Simulation, Surgical Education, & Emerging Technology** Informatics is neat because it deals with the acquisition and interpretation of large quantities of data, which means that the principles of informatics can apply to just about anything the mind can think up. This makes informatics a wonderful tool for surgeon and patient education. For example, informatics can help us track information about the stress levels of the operating staff at specific time points during cases and analyze emerging patterns. This information can then be used for team building and patient safety by identifying which parts of the operation a surgeon feels least comfortable and may benefit from more practice via simulation, when noise levels should be lowered during critical parts of the surgery, and even when team members consistently want to speak up but do not and why. After surgery, informatics can be used to track the status of a patient’s recuperation with the use of fitness trackers to monitor post-operative ambulatory, pain, and nutrition status. Easy-to-use patient portals can facilitate patient-surgeon communication to avoid the unnecessary travel and wait time associated with a dedicated clinic visit. There you have it. Clinical Informatics and how it is relevant to surgery in a nutshell. I am enjoying every moment of my fellowship so far and encourage surgeons to think about all the ways informatics can be used to shape and enrich their clinical practice. I highly recommend checking out the profiles of two amazing women surgeon-informaticians [Gretchen Purcell Jackson, M.D, Ph.D.](https://www.mc.vanderbilt.edu/root/vumc.php?site=pedsurg&doc=13628), a pediatric surgeon at Vanderbilt University, and [Genevieve B. Melton-Meaux, M.D., Ph.D.](http://www.surgery.umn.edu/bio/surgery-faculty-a-z/genevieve-melton-meaux), a colorectal surgeon at the University of Minnesota. Both are pioneers and were visionary way ahead of their time, paving the way for other surgeons interested in clinical informatics. For surgical residents interested in pursuing a clinical informatics fellowship, the Clinical Informatics Fellowship at the University at Buffalo, State University of New York is a fully accredited two-year program through the ACGME. Funding is available for two spots annually. For more information, please visit the [official website](http://www.smbs.buffalo.edu/biomedicalinformatics/). **References** Chung CH, Levy S, Chaurand P, Carbone DP. Genomics and proteomics: Emerging technologies in clinical cancer research. Critical Reviews in Oncology/Hematology 2007;61(1):1-25. Elkin, PL. Human Factors Engineering in HI: So What? Who Cares? And What’s in It for You? Healthc Inform Res 2012;18(4):237-41. FitzHenry F, Murff HJ, Matheny ME, Gentry N, Fielstein EM, Brown SH, Reeves RM, Aronsky D, Elkin P, Messina VP, Speroff T. Exploring the Frontier of Electronic Health Record Surveillance: The Case of Post-Operative Complications. Med Care 2013;51(6):509-16. Melton GB. Biomedical and Health Informatics for Surgery. Advances in Surgery 2010;44:117-130. *Many thanks to Drs. Peter Elkin and Steven Schwaitzberg for their feedback in the early drafts of this blogpost.* *[![jane_zhao](http://blog.womensurgeons.org/wp-content/uploads/2025/06/jane_zhao-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/jane_zhao.jpg)Jane Zhao, M.D. is a* [*general surgery resident*](http://www.ubsurgeryresidency.com/) *and clinical informatics fellow at the University at Buffalo, State University at New York. She received her medical degree with a scholarly concentration in Clinical Quality, Safety, and Evidence-based Medicine from McGovern Medical School, the University of Texas Health Science Center at Houston and her bachelor’s degree from Vanderbilt University where she majored in Medicine, Health and Society. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award and was the founder and chair of the AWS Blog Subcommittee from 2013 to 2014.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Be Kind: A Self-Discovery to Self-Care](https://blog.womensurgeons.org/be-kind-self-care/) **Published:** November 18, 2016 **Author:** Blog Team **Content:** *By Shree Agrawal* “Self-care” is a buzzword I hear often, especially as both a medical student and a yogi. Wellness experts say nourishing yourself is the crux in your care of others, and even more so in your overall health. I have to admit, though, I have a few bad self-care habits. Tough weeks come in waves. From one week to the next, my version of self-care might transform from a yoga class or re-connecting with a friend to simply managing to focus on deep breathing to recenter and finding small rewards to look forward to at the end of the day. Over time, I have adopted a new mantra. *It is kindness.* While a routine self-care schedule works for some, I have learned it is difficult to anticipate my own needs during periods of high stress. I felt guilty and even more stressed if I was not able to participate in a self-care regimen. Remember, the goal of self-care is to feel well! *Take a moment, imagine you are talking to yourself, as a friend. How do you show kindness to your friend?* What is your response to your friend who hasn’t been able to see you for weeks and tells you they do have not had a break from a demanding schedule, feels terrible for not being able to spend time with their loved ones, or expresses they are running on empty? Is it support? Is it comfort? Do you respond with understanding and empathy? Were you less judgemental? In moments of other people’s darkness, we are more willing to offer support than in our own. When I started responding to myself with the type of kindness and understanding I would give to a friend experiencing an imbalance in life and work, I began to enjoy any small or large feats of self-care. If you cannot cook the meal you envisioned after a long day, or get that 5 mile run in after spending most of the week at work, respond with kindness. The same applies for when you cannot make a meeting or deadline because you needed a break from your work. I urge you to not feel guilty or distressed. Were you still able to do something to manage your stress levels? If so, congratulate yourself! If am able to successfully refocus my energy, I move on. When the wave has finally passed, I make time to do all the other things I love to do outside of my professional roles. **How do you define self-care? Please share some of your tips below in our comments section!** *[![img_7449](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_7449-2-287x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/09/IMG_7449-2.jpg)Shree is a third year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Prior to medical school, she performed prostate cancer research at the Cleveland Clinic and University Hospitals of Cleveland. Shree is passionate about clinical research surrounding patient decision-making and medical education. In her free time, she enjoys blogging on the AWS blog, practicing yoga, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [The Importance of Palliative Care for Surgeons](https://blog.womensurgeons.org/the-importance-of-palliative-care-for-surgeons/) **Published:** November 25, 2016 **Author:** Blog Team **Content:** There are times when a surgeon cannot offer treatment that will cure a disease or even alleviate symptoms. Palliative Care is about more than alleviating suffering at the end of life. It means using the patient’s goals to guide decisions about what treatment to provide. I first encountered Palliative Care when treating critically ill patients, but now the principles of Palliative Care inform how I provide care throughout my entire practice. The principles of Palliative Care for the surgeon, as defined by the [American College of Surgeons in 2005](https://www.facs.org/about-acs/statements/50-palliative-care), start with respect for patient dignity and autonomy. Whenever a surgeon cannot offer curative treatment or recommend a surgical intervention to treat a disease, she must ask what else can be offered to alleviate suffering. When discussing end-of-life issues, the focus of treatment often shifts to symptom management or prevention. Discussing end-of-life issues, however, should be considered in all care that a surgeon provides. Surgery often causes symptoms while curing or treating a disease process. Curing a disease is not the only important outcome, our patients tell us maintaining their quality of life cannot be overlooked.Each time a surgeon proposes an intervention, she must consider the symptoms that it may cause. Palliative Care teaches her to discourage interventions that are not likely to achieve a patient’s goals. While the principles of Palliative Care can often be applied to care provided by the surgeon, it is important to recognize that patients, families, and caregivers benefit from the involvement of palliative care providers. I request input from the palliative care team when a patient has a limited life expectancy, severe symptoms not improving with treatment, or when a surgical intervention may not be expected to cure a disease process or alleviate symptoms. Sometimes we discuss the options and decide to pursue a surgical intervention in keeping with specific goals. Sometimes we decide that the patient will be best served by pursuing hospice care. Most importantly, we work together to focus on the patient’s goals and symptoms. That is how Palliative Care helps me to provide patient-centered care. *[![erdahlpic](http://blog.womensurgeons.org/wp-content/uploads/2025/06/ErdahlPic-216x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/ErdahlPic.jpg)Lillian Erdahl practices breast and general surgery at the University of Iowa. She serves as Associate Program Director in General Surgery as well as the head of the Iowa City VA Medical Center Breast Clinic. Her research interests include breast cancer prevention, faculty development, and simulation in teaching clinical examination.She completed her General Surgery residency at Penn State University including two-year research fellowship in surgical education. After residency, she also completed a one-year fellowship in breast surgical oncology at the Mayo Clinic in Rochester, MN. She is fluent in Spanish and completed a minor in Spanish while pursuing her BS in Biology at Iowa State University.Outside of the hospital, she enjoys yoga, cross-country skiing, cooking, and gardening. Her husband, two children, and cat help her to find joy in each moment of the day.* *She microblogs as @lillianerdahl supporting issues and organizations on social media where we all have an opportunity to make an impact. She would like to remind everyone to ask questions about how their donations benefit patients before giving money support breast cancer awareness.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [The Road to Wellness](https://blog.womensurgeons.org/the-road-to-wellness/) **Published:** December 1, 2016 **Author:** Blog Team **Content:** *By Jaime Lewis* The road to wellness is often less than straight and narrow. Some stretches are full of potholes and construction barriers, causing delays, requiring tolls and taxes for passage, while other sections are smoothly paved, wide open, and headed straight into the sunset. However the journey proceeds I have found it is peppered with choices and opportunities to make myself a little happier, a bit healthier, and perhaps a little more “well”. Some moments it’s a choice of how to respond or react, how to understand my own emotions, or how to interpret the actions of another. Other days it’s making the choice to eat the healthier meal, to run the extra mile, to play with my children, or in my professional sphere- to finish up my charts, respond to a committee request, or spend a few extra moments with a resident. Recently I have worked to formulate goals which I believe will help me progress on my journey to wellness. While I may stumble along the way, I will strive to: 1. Understand my place in this world in the many roles I play. I will be true to myself and not pretend that I can be everything to everyone. 2. Focus my efforts where I believe I can make a difference and work to understand the opportunities and limitations as they exist. I will not try to change the world overnight. 3. Align my actions with my core values and central beliefs while allowing them to evolve. I will attempt to act in ways that are expressions of who I am rather than who I am expected to be. 4. Be physically active on a regular basis, eat a healthy diet of real food, and enjoy the benefits of relaxation and regeneration. I will relish my time running rather than regretting what I’m not otherwise doing. I will be mindful about the nourishment I choose. I will make time to rest. 5. Understand my own value and worth without comparing it to others. I will work to accept that my path is different and uniquely mine. It’s all about the journey. 6. Challenge myself when I need to grow and forgive myself when I have failed. I will not be satisfied with stagnancy and will give my heart time and space to heal when necessary. And I will remind myself that in order to care for others, I must be well myself. And the lessons I learn will be used to help my family, friends, and patients care for themselves and others. As we head into this holiday season and the New Year is upon us, I wish that all of you may find a little wellness each day in the hustle and bustle of it all. *Namaste.* ![jaimelewis](http://blog.womensurgeons.org/wp-content/uploads/2025/06/JaimeLewis-179x251.jpg)*Jaime Lewis practices breast surgery at the University of Cincinnati where she also completed her general surgery residency. After residency, she also completed a one-year fellowship in breast surgical oncology at the Moffitt Cancer Center. Outside of the hospital, she enjoys running, cooking, and time with her family.* --- **Categories:** career development, medical students, parenting, professionalism, residency, self-care **Tags:** development --- ### [Lending A Helping (and Hygienic) Hand](https://blog.womensurgeons.org/hand-hygiene/) **Published:** December 8, 2016 **Author:** Blog Team **Content:** *By Faith Robertson* If you were to take a stroll through the hospital, you would witness scrub-adorned healthcare providers, a flurry of white coats and stethoscopes, and a plethora of wall-mounted hand sanitizer dispensers. No patients come to the hospital with the intent of acquiring an illness.Yet approximately [1 in 25 patients](http://www.cdc.gov/hai/surveillance/index.html) develops at least one healthcare-associated infection during their visit. Unfortunately, the hands that are meant cure are often the culprits. For example, during early morning rounds, a team of residents, medical students, nurses, PAs, and maybe an attending or two, will see upwards of 20 patients in an hour. There are countless handshake introductions, laying of hands for bedside exams, incision inspections, staple removals, and more. The skin-to-skin contact between patients and care teams as they move from room-to-room has been linked to numerous outbreaks of MRSA, VRE, and other infectious pathogens. However, doctors and nurses use of alcohol-based handrub has been shown to [reduce hand bacteria by 95-99%](https://www.ncbi.nlm.nih.gov/pubmed/25560015). Consequently, hospital protocols and the Joint Commission require healthcare workers to use an alcohol-based handrub, and/or wash hands with soap and water, both before and after contact with a patient or a patient’s environment. Seems simple, right? [![faith_image_1](%5Bsiteurl%5D/wp-content/uploads/2016/12/Faith_Image_1-300x257.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/12/Faith_Image_1.jpg)Actually, while the adherence rates have increased over time with the help of publicity, strategic goals, rewards, and special incentives,barriers to complying with proper hand hygiene remain. [Publically available data](http://qualityandsafety.massgeneral.org/measures/hygiene.aspx?id=282) from Massachusetts General Hospital, where I’m presently working, shows that >90% of healthcare providers and volunteers comply with proper hand hygiene *after* patient interaction , fewer individuals consistently clean their hands *prior* to patient contact (data from 2009-2015). For surgeons, there is even greater need to respect the dangerous potential of germs, dating back to [Joseph Lister’s](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468637/) theory in 1867 that germs led to surgical site infections. Surgeons have an additional responsibility to follow sterile hand techniques prior to every procedure. Even before we glove in preparation for our incision, we keep our nails to <1/4 inch in length, ensure our polish is not chipped, remove our rings, and chose between chlorhexidine gluconate, iodophor, or para-chlorometaxylenol (PMCX) scrub brush packages, or a “dry” foam scrub (which may be more effective, according to a [2015 study in the Journal of Microbiology, Immunology and Infection](https://www.ncbi.nlm.nih.gov/pubmed/24064290)). We stand at the sink, running a song in our heads, or anticipating steps of the upcoming surgery while meticulously completing the ritual, a symbol of our dedication to protect the patient from harm. We scrub as our mentors taught us, and we set examples for those who look up to us. Though, there may be a downside to this excessive cleaning. In September 2016, Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research said: “In fact, some data suggests that antibacterial ingredients may do more harm than good over the long-term.” Multiple antibacterial production companies did not provide sufficient data for the safety of all ingredients in their products. The FDA has brought this concern to light and is mandating that many companies to accrue data on the safety and efficacy of these cleaning products in the next year. Three of the ingredients under scrutiny are benzalkonium chloride, benzethonium chloride, PCMX (listed above as one of the surgical scrub agents). The products will remain on the market until next year’s review and forthcoming data will clarify any risks of antibacterial agents. Overall, hospital-acquired infections can greatly impact our patients, and we have a role as providers to maintain good hygiene practices and positively impact the culture of hygiene within the hospital. How are you doing? Are you above the 90% national benchmark for hand hygiene? If not, what is the barrier? Whether you were rushed between patients and omitted that sanitizing pump between rooms, or your hands are sensitive to the alcohol-based handwash so you lather less, I encourage you to extend a helping hand that is [95-99%](https://www.ncbi.nlm.nih.gov/pubmed/25560015) more pathogen free. *[![faith_image_2](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Faith_Image_2-213x251.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/12/Faith_Image_2.jpg)Faith Robertson is a 3rd year student at Harvard Medical School and is the Vice Chair of the AWS National Medical Student Committee. She plans to pursue a Master of Public Health next year, before applying into neurosurgery with aspirations to continue global surgery work throughout her career.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Maximizing a Research Year: 6 Things You Should Know as a Medical Student](https://blog.womensurgeons.org/maximizing-a-research-year-6-things-you-should-know-as-a-medical-student/) **Published:** December 14, 2016 **Author:** Blog Team **Content:** *By Shree Agrawal* While most of my classmates have been completing clinical clerkships as third year medical students, I have instead spent the past six months performing clinical research. One of the most commonly asked questions by students exploring a research year is how to establish an efficient and productive research agenda to avoid wasting a year in medical school. These are some of the key pieces of advice I have compiled from my personal experiences to help make a research year effective **6 Tips You Should Know as a Medical Student Before Starting a Research Year:** 1. **Find mentors early!** I cannot overemphasize the importance of these connections. Mentors can either offer you research opportunities or help you find potential Principal Investigators (PIs) who may have research projects that align with your research focus. Further, a conversation with a mentor, with whom you have an established relationship, will help you articulate the direction you want to pursue within a research year to meet your ultimate career goals. 2. **Know the research coordinator(s), program coordinator(s), parking services, credentialing offices, etc. in advance.** A common mistake is waste time while waiting for approval and credentialing that could be done in advance of the official research term. Starting this process as early as possible will ensure you can dive into projects at the very beginning of your research year. 3. **Create an action plan.** -Address your main goals for your research year -What projects do you want to complete during this time? -Establish a proposed timeline you anticipate for each of your experiments, data collection, and data analyses -What are potential setbacks or hurdles? It is helpful to create, at minimum, a general plan for your year with important dates and deadlines to share with your PI. This facilitates a mutual understanding of goals, demonstrates respect of your [mentor’s time](http://womensurgeons.blogspot.com/2013/10/lean-in-book-review-discussion-part-two.html), and ensures your mentors will pencil in time to help review your work when necessary (especially around abstract deadlines!). 1. **Stay busy!** It is misleading to think research years as opposed to clinical clerkships have more downtime. Though major long-term projects may provide a flexible schedule, have multiple ongoing short-term projects to switch focus when you have completed major tasks or have free time. 2. **Create an accountability system.** This may vary for your experience, but create a weekly system to either meet with your PI, resident, fellow, and/or research coordinator to go over weekly progress and future steps. Frequent check-ins foster efficiency and allow you to communicate both successes and obstacles with your research efforts. Many research groups have weekly or bi-weekly meetings – make sure you attend and participate! -Meet with your Dean on a regular basis, if possible. They are especially helpful in case you experience a roadblock in establishing a research year or are not accomplishing as much as you had planned. 3. **Find rewards.** When a project has a long timeline, it is easy to fall into a mindset of never feeling accomplished after putting in many hours towards a smaller goal. Research unfortunately is not accomplished overnight. Find small incentives to keep you motivated through the year. Please tweet @WomenSurgeons or @ShreeAgrawal21 with #AWSresearchtips to share your tips for an efficient and productive research year while in medical school! *[![shree](http://blog.womensurgeons.org/wp-content/uploads/2025/06/shree-287x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/11/shree.jpg)Shree is a third year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Prior to medical school, she performed prostate cancer research at the Cleveland Clinic and University Hospitals of Cleveland. Shree is passionate about clinical research surrounding patient decision-making and medical education. In her free time, she enjoys blogging on the AWS blog, practicing yoga, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Equal Pay for Better Outcomes?](https://blog.womensurgeons.org/equal-pay-for-better-outcomes/) **Published:** December 23, 2016 **Author:** Blog Team **Content:** *By Nickey Jafari* Earlier this year, an attending surgeon commented that my AWS fleece was “sexist”. I highlighted the number of female surgical department chairs (16) as one example of why promoting women in surgery is still critical. He responded that the numbers were so vastly unequal because “women don’t want to be department chairs.” I then told him about the AWS conference in D.C., where I was surrounded by titans of surgery. Yes, they were *also* women– a fact that should not negate their accomplishments. I told him about [Dr. Patricia Numann](https://www.womensurgeons.org/about-us/aws-foundation-awards/more-about-patricia-numann/), a former President of the American College of Surgeons, and founder of AWS. He could not be swayed to recognize women who wanted to visibly lead within surgery, who have earned the benchmarks typically meeting those of men in similar or superior positions. A surgeon who I greatly admire put it more eloquently than I myself could: *“There is no inherent racism/sexism/discrimination in the promotion of an underrepresented group because it is by definition underrepresented and does not have the social or political power to systematically discriminate against those who are.”* It will be an uphill battle to convince those who do not see the gender inequity within surgery from training to leadership, but we can continue to be armed with new studies and *hard facts* to aid us in this discussion. While women make up half of medical school students, they still are around one-third of practicing physicians and lag behind in both pay and promotion. A recent JAMA [study](http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2532788) of over 10,000 academic physicians found significant disparities in compensation across medical specialties. “Female neurosurgeons and cardiothoracic surgeons and women in other surgical subspecialties made roughly $44,000 less than comparable men in those fields.” These differences in pay exist even after researchers corrected for factors such as age, experience, faculty rank, and specialty. **Equal pay for equal work** is as logical of a demand as ever, but these pay disparities become an even tougher pill to swallow considering another recent JAMA [study](http://www.npr.org/sections/health-shots/2016/12/19/506144346/patients-cared-for-by-female-doctors-fare-better-than-those-treated-by-men) demonstrating patient outcomes were better when the treating physician was a female internist. It concluded that “approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.” Until healthcare centers recognize the strengths diversity brings to the care delivered to patients, our ability to optimize patient outcomes will continue to be compromised. *[![nickey](http://blog.womensurgeons.org/wp-content/uploads/2025/06/nickey-296x296.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/12/nickey.jpg)Nickey* *Jafari is a third year medical student at the University of Kansas. She is interested in surgery and hopes to find a niche where that interest can intersect with her passion for global health.* **Categories:** Uncategorized --- ### [How to Avoid Burnout as an MS3](https://blog.womensurgeons.org/avoid-burnout/) **Published:** December 29, 2016 **Author:** Blog Team **Content:** *By Nina Shank* Most medical students have probably heard before at some point in their lives that it is always advisable to have a plan B. In fact, as a medical student, one can never be too careful while navigating medical school and then residency. Whether it’s having a plan B to medical school or to your ideal residency program, back-up plans can mean the choice between employment and unemployment. As a third-year medical student, when it comes to being as productive as possible, I have found that it isn’t enough to just have plan B, but to have plans C, D *and* E come along for the ride as well. During this whirlwind of a year, medical students are incredibly susceptible to the “Mighty M3 Meltdown,” and reassuring oneself by setting realistic goals to avoid burnout can save a great deal of stress. For example, my plan A might have been to get honor evaluations on a rotation, ace the shelf, get to the hospital early and leave late, complete research projects on the side, exercise regularly, make all right dietary choices, keep up my hobbies and somehow also be the perfect, present spouse, and do it all with not a single hair out of place. Plan B is to do all of those things except perhaps the gym and the diet. I have to admit, trying to follow either plan drove me nearly up the wall when I began my year of clinical rotations. All that happened was that I soon ran out of steam. This year is a completely different beast from M1 or M2, when I was more easily able to stick to my plans A or B. This year medical students function in a manner determined by someone else’s, usually the medical team’s needs, and they have to be much more adaptable that they’ve had to before. Personally, if I am on surgery and finding myself running out of steam, perhaps that means I need to adopt plan C for now, which might mean being flexible on the diet for a little while, instead of plan A. In the end, I avoid burning out, and as a bonus, get to keep my sanity. Perhaps I’m on a rotation that no matter how hard you try, you just can’t seem to get those stellar evaluations you were hoping for. It’s in your best interest to accept this, be flexible and move on to plan D, which may entail forgoing the evaluations, instead crushing (or trying to crush) the shelf to boost your grade, keeping up your hobbies, spending time with your family and doing some research. This year has really taught me that maturely dealing with perceived failures and allowing for some laxity in my ‘plans’ in the end has made me more proficient and protected me from burnout. As they say, this journey of ours from student to physician is a marathon, not a sprint, so I choose to embrace the imperfections and stay the course even if it means having a plan E day. *[![img_3769](http://blog.womensurgeons.org/wp-content/uploads/2025/06/IMG_3769-169x300.png)](%5Bsiteurl%5D/wp-content/uploads/2016/12/IMG_3769.png)Nina Shank is a third year medical student at Tulane University School of Medicine, who grew up in Mumbai, India and came to America in 2008 to attend University of Virginia. After completing her undergraduate degree, she worked as an ER scribe and phlebotomist while applying to medical schools. She is currently working towards her MD as well as a Master’s of Science in Anatomy, and is very passionate about pursuing a surgical career. As a former leader of the Rudolph Matas Surgical Society student group at Tulane, she is most excited to be a part of the AWS student committee and help future female surgeons everywhere reach their goals.Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Dressing Your Best, Inside Out](https://blog.womensurgeons.org/dressing-your-best-inside-out/) **Published:** January 5, 2017 **Author:** Blog Team **Content:** *By: Natalie Tully* Every year after the post-midnight New Year’s celebrations wind down, we each start the all-too familiar process of declaring resolutions for the coming twelve months. In that spirit, I hope to explore ideas (most old, but perhaps a few you haven’t heard) and encourage some of you to put on your best self in 2017- mind, body, and wardrobe. **Dressing your best-literally** Fair warning: most of my clothing is sportswear and I prefer the DMV and the Dentist to going clothes shopping. That said, this is something I struggle with but have found strategies that result in me feeling more confident in professional situations without excessive strain. 1. **Err on the Conservative-**Yes, you’ve heard this *ad nauseum*, but no matter your career stage or if it’s an interview, clinic, or social event, you never want your clothing to distract from *you.* If you question your outfit’s appropriateness, either change or double check with someone else. You don’t have to wear a Muumuu, but do focus on well-fitting clothes that present a great you. 2. **Comfort adds to Confidence-** Feeling comfortable in your clothes can help you feel comfortable in your own skin and contribute to your overall confidence. Finding clothes that fit you and your style comfortably can help you to feel at ease. If you’re not the type to define ‘your style’ (I call mine Gym Clothes Chic), finding a few pieces that you *love* can be a great way to dip your toes in the water. 3. **Form, but Function-** Whether it’s shoes, a skirt, or any other piece of clothing, you should like the way it looks, and looks on you. One caveat to that, however, is that it’s important to balance that form with functionality- probably most notably with shoes. These are some themes that help me to feel professional and confident without sacrificing my femininity. If you’re looking for more specific fashion advice, particularly for interview apparel there is a great blog post at [Love and The Sky](http://www.loveandthesky.com/home/2015/8/25/what-to-wear-to-residency-interviews) covering this topic. **Putting your best foot forward** Putting on your best self goes much deeper than your clothing-and one important facet of dressing your best is taking care of the body wearing the clothes. The demanding schedule of this field can make it challenging and sometimes impossible to maintain a diet and exercise routine-but giving your body a leg up where possible can have wide-ranging benefits. 1. **Small Steps to Bigger Change-**Whether it’s taking the stairs in the hospital, adding an extra block to your evening walk, or playing tag with your kids or pets-exercise does not have to take place in the gym or on the running trail. What is most important is not the duration, intensity or frequency of your exercise-but simply doing it. 2. **Fuel your Success-**3am graham cracker and peanut butter sandwiches washed down with coffee or juice are a reality of this field. Eating better can range from meal prepping on a day off, having one whole-food-only day a week, or even just replacing one candy bar with an apple-little changes add up. Find the modifications that fit in with your life and needs, and you will likely find them more palatable to maintain. 3. **The Pizza and Couch Cleanse-**This is the part where you forget those two previous points briefly. When your body needs a break, listen. Everyone gets sick, has sleepless nights, or can even be injured- give your body a chance to heal before making it worse. Additionally, enjoy the foods you love, and when you honestly don’t have the energy to cook, don’t-forcing healthy food and cooking on yourself will make you hate them. Our bodies are the machines that we use to make our work and lives happen, so it only makes sense to keep them in the best working order possible. This is a time of year when many people are looking to change their bodies, but shooting for improved wellness over a dress size or scale number is a far more important goal. **Your most important look is your outlook** The start of the year is always a little bittersweet for me-it represents the return to work/school and the stress that it and the tasks ahead in the year bring. Battling stress and negativity is a constant challenge-one I struggle with mightily-but the way you see into the mirror is the foundation of how others see everything on the outside. 1. **Breathe, just breathe-** Taking even a few seconds at the beginning of the day, during stressful moments, or in the car at home can be profoundly beneficial in dealing with acutely stressful situations as well as dampening general stress. Building this habit into your daily routine is a great change by itself or as part of building a meditation practice. 2. **Check your boxes, fill your buckets-**All of us have seemingly endless to-do lists-it’s so important not to feel enslaved or entrapped by them. Give yourself credit for accomplishing each task, and use it to build toward successive tasks in your day (H/T to [this](https://www.youtube.com/watch?v=pxBQLFLei70) speech). Use this momentum to get through your day, but keep track of your mental ‘buckets’ so that you can find ways to replenish your stores. 3. **Small bricks build big buildings-**It’s so easy to let little failures chip away at our confidence and spirit, forcing us to put on a defensive front simply to survive. Allow yourself infinitesimally small victories, and use them to reassure yourself in times of doubt and to build a stronger foundation for your own sense of well-being. A very wise person once told me never to give rent-free space in your head to anyone or anything. Working toward a more positive outlook and sense of self are critical steps to creating a stable framework on which to build a healthy body and perch clothes that add to your positive image and confidence, and contribute to putting on your best, most well self for this new year. *[![headshot](http://blog.womensurgeons.org/wp-content/uploads/2025/06/headshot-243x277.png)](%5Bsiteurl%5D/wp-content/uploads/2017/01/headshot.png)Natalie is a 2nd year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. Before starting medical school, she received her bachelors of science degree at the University of Texas at Austin followed by two years working in basic science research at Baylor College of Medicine. Natalie hopes to pursue a career in surgery, and has particular interest in applying her dual degree in Pediatric or Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her dog, Sadie.* Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** education, family life, gender differences, medical students, parenting, self-care, women **Tags:** AWS, ILookLikeASurgeon, stress, work-life balance --- ### [A cancer of young women](https://blog.womensurgeons.org/a-cancer-of-young-women/) **Published:** January 12, 2017 **Author:** Blog Team **Content:** *By Minerva Romero Arenas* The new year brings with it a time to reflect on the past, the present, and the future. Inspired by the writers the past few weeks, I also took the opportunity to reflect on what I have learned during my first few months in fellowship training in surgical endocrinology. What an appropriate time to share some reflections, considering January is thyroid cancer awareness month I chose to focus on my experience with thyroid cancer patients. **I have seen a lot of young patients.** Thyroid cancer is on the rise and is now the[ 8th most common cancer in the US](https://seer.cancer.gov/statfacts/html/thyro.html), and the number 1 cancer amongst young women (under age 25). Radiation exposure is one of the most common risk factors, while having family history also plays a role in [specific types](http://endocrinediseases.org/thyroid/cancer_medullary.shtml) of thyroid cancer. While symptoms may be attributable to mass effect (“compressive symptoms”), many patients are asymptomatic. Many young women have come in after noticing a lump in their neck during their daily facial care routine, during a routine prenatal visit, or when a loved one noted their neck looked different. While the majority of thyroid cancer is indolent, the big C word is still scary for anyone – especially when treatments starts with [undergoing surgery](http://endocrinediseases.org/thyroid/cancer_papillary.shtml#5). As one of my faculty mentioned one day, “the majority of cases are not aggressive. But it is a cancer, and we will treat it with the respect it deserves.” Taking care of so many young female patients – some of whom are my age or younger – has already had an impact on me. I am inspired by their courage, the trust they place in our surgical team, and their determination to simply “do well.” I find that taking care of these patients actually given me inspiration. **They make me want to be the best doctor and surgeon I can be.** Why? Because my best work will mean that they can get back to their regular life more quickly – some want to continue to sing in their church choir, others just want to get back to work, others need to be able to take care of their families (yes, yelling at the kids included). Thus, I am thankful. Thankful for the privilege to participate in their care. Thankful for the opportunity to learn from them. Thankful for their trust during one of the most stressful and vulnerable events in patients’ lives – thankful to be a surgeon. *Minerva A. Rome[![minerva-romero-bio-pic1](http://blog.womensurgeons.org/wp-content/uploads/2025/06/minerva-romero-bio-pic1-292x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/12/minerva-romero-bio-pic1.jpg)ro Arenas is a Fellow in Surgical Endocrinology at The UT MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.* *Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.* *She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.* Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, self-care, training, women **Tags:** AWS, cancer, ILookLikeASurgeon, stress, thyroid --- ### [Never overdressed](https://blog.womensurgeons.org/neveroverdressed/) **Published:** January 19, 2017 **Author:** Blog Team **Content:** A resident’s perspective on dressing for success *By: Danielle Henry* The New Year brings new goals and personal improvement is always on the list of priorities. This month we are exploring the impact of professional attire on professional and personal achievement. Oscar Wilde once said, **“You can never be overdressed or overeducated.”** I have taken this to mean, you should never stop learning and can never be overdressed when you look your best. We are in a profession where we are always learning, and even though we wear scrubs often, we can still find ways to look our best. **Ditch the scrubs when you can** – When given the option to wear something other than scrubs, I always take the opportunity. One example is when I am presenting at the Morbidity and Mortality (M&M) conference I will often wear business professional attire. It is not required at my institution, however I have found that dressing up accomplishes the following: it makes me feel more confident at the podium, that changes my body language during the presentation, therefore improving the quality of delivery of the presentation. Coupled with a well-prepared presentation, dressing up makes even the worst complication look just a little better. **Accessorize** – Since a vast majority of time is spent in scrubs during my training, I will admit that it can sometimes be difficult to stay true to my mantra. My mentor in medical school gave me great advice about accessorizing, like wearing a cute headband or a string of pearls. This can automatically improve the way you feel, the way you look and the way others perceive you. I am never short of compliments on how nice I look when wearing my pearls. Socks are another way I find to accessorize on a more personal level, which can elevate my mood on certain days. If I am on a particularly challenging service or preparing to perform a challenging case, I put on my “Notes to Self” socks that say, “you are smiling” or “you are confident”. With all that being said, when given the chance to dress nicely, go the extra mile and “overdress”; this will make you feel better and you will ultimately do better. Style is personal, and so is success! Define your own success, dress for it and reach for the sky! *[![DanielleHenry](http://blog.womensurgeons.org/wp-content/uploads/2025/06/DanielleHenry-190x283.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/01/DanielleHenry.jpg)Danielle Henry is a chief resident at Orlando Health General Surgery Residency Program and currently serves as the administrative chief resident. She is planning to pursue her passion with a career in breast oncology after residency. She completed her Medical Doctorate at Florida State University and Baccalaureate degree in Applied Physiology and Kinesiology at the University of Florida. She enjoys playing soccer, a good game of scrabble and time at the beach. She also enjoys community service projects and mentoring medical students.* --- **Categories:** career development, education, leadership, medical students, professionalism, residency, training **Tags:** dress code, whattowear --- ### [To Look in the Mirror and Not See Further than My Neck](https://blog.womensurgeons.org/to-look-in-the-mirror-and-not-see-further-than-my-neck/) **Published:** January 25, 2017 **Author:** Blog Team **Content:** *By: Natalie Tully* January is Thyroid Cancer Awareness Month. As you may have read in an earlier blog [post](https://www.womensurgeons.org/a-cancer-of-young-women/), thyroid cancer is the most prevalent cancer in young women under 25. This is the story of one of those young women. It was June of 2011, and I had just come home to Pennsylvania for summer vacation after completing my sophomore year at the University of Texas (and *finally* passing organic chemistry). In an effort to get back in shape for our family beach vacation (and after six months of eating like a nineteen-year-old college student does), I went out for a bike ride. Naturally, I was drenched in sweat when I got home and decided to give my mom a sweaty hug-a move she wasn’t exactly keen on. As we play-fought, I turned my head to the side and instantaneously, she went from mom to nurse. She saw a lump protruding from my neck and rapidly went about evaluating it. She decided that the Otolaryngologist I was scheduled to see later that week (nothing says summer vacation like getting your nose cauterized) would need to examine it as well. Fast forward through that appointment, an ultrasound, and an FNA-all of which lent increasing evidence to suggest the mass might be malignant. A few weeks later, I found myself in pre-op (with a *wicked* sunburn I got to protest the ordeal) about to go in for either a lobectomy if the mass was benign, or a total thyroidectomy if it was concerning for cancer. I awoke afterwards to a drain coming out of my neck, and spent the next day in my room, trying to digest that the mass was malignant and they’d taken the whole gland. My oncologist (also my neighbor) came in to tell me that the pathology report indicated that the tumor had been papillary thyroid cancer, follicular variant. That meant that when I got released that afternoon to go back to the beach for family vacation, I’d need to start a low iodine diet. Missing out on my favorite foods made the diet seem nothing short of exasperating. Eventually, I got through the diet and took the I-131 dose-followed by five days of isolation (during which I became addicted to How I Met Your Mother, and my mom served me meals on a silver platter at my bedroom door). At the end of the week, my whole body scan was clear indicating the radioactive iodine treatment was complete. Two days later, I found myself on a flight back to Austin to start my junior year of college. My whole experience of being a cancer patient lasted about 5 weeks from discovery to completion of treatment, which had some pros and cons. On the plus side, I had early-stage disease that was treated quickly and without complications, but the rapid timeline didn’t leave me much time to process what was going on. There were some lingering issues, not having an established endocrinologist being one of them (hypothyroidism + college classes + job=not good). By and large, I was able to return to my life mostly uninterrupted with not much more than a scar on my neck as a reminder. I feel *profoundly* fortunate for my cancer experience-I was surrounded by people who cared enough about me to let me be angry at them, because they knew far better than I did what was at stake. So there it is, my mostly tame cancer story. Today, I’m a (mostly) normal 25 year old who takes a pill every morning and has to get bloodwork/scans every so often-really not a bad setup in comparison to a lot of medical conditions. In conclusion, I’d like to share a few thoughts about thyroid cancer that may be helpful to providers: 1. **There is not a simple way to ‘prevent’ Thyroid Cancer-** Exposure to ionizing radiation is a known risk factor-but very hard to modify for most patients.There are common-sense steps to improve detection of early disease. Not everyone is lucky enough to have an observant and persistent mother to find their lump for them. Whether it’s breast awareness, thyroid awareness, or anything else-be *aware* of your body and *act* when it something doesn’t feel right. 2. **Atkins and Paleo ain’t got nothin on Low Iodine**-Thanks to salt being in *everything*, and most of that salt being iodized, almost anything in a package is off-limits. In time, I’ve come to appreciate what being on the diet did for my awareness of eating whole foods, but at the time, it was the bane of my existence. Take time to [read](http://www.thyca.org/pap-fol/lowiodinediet/) up on the diet to understand (and help counsel) your patients when you prescribe it. 3. **Yes, Thyroid Cancer is a ‘good cancer’ to have**–*But you still have cancer*. Look at this post-almost six years later and I can remember details down to the scrubs that my nurses were wearing. It’s an emotional event, even if the long-term prognosis is very good. Be mindful of this when diagnosing and treating all of your patients-any diagnosis is a big deal for them. *Natalie Tully is an [![headshot](http://blog.womensurgeons.org/wp-content/uploads/2025/06/headshot-243x277.png)](%5Bsiteurl%5D/wp-content/uploads/2017/01/headshot.png)MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. Before starting medical school, she received her bachelors of science degree at the University of Texas at Austin followed by two years working in basic science research at Baylor College of Medicine. Natalie hopes to pursue a career in surgery, and has particular interest in applying her dual degree in Pediatric or Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her dog, Sadie. Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, gender differences, medical students, parenting, self-care, women **Tags:** Awareness, Healthcare, medstudents, stress, thyroid, Thyroid Cancer, Wellness --- ### [Reflections on the Women’s March](https://blog.womensurgeons.org/reflections-on-the-womens-march/) **Published:** January 30, 2017 **Author:** Blog Team **Content:** As a resident of Washington DC, I had a “front-row seat” to the Women’s March that took place on Saturday Jan 21, not just here in DC but in hundreds of cities around the country and the world. With humble grassroots origins, it has been billed as the largest one-day protest in U.S. history. It was an awesome display of solidarity and a tribute to the power of peaceful assembly in our democracy. ![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/March_DC-300x169.jpg)It is clear that many different concerns compelled women to participate in the March. While there are undoubtedly AWS members on both sides of divisive issues like abortion, immigration reform, gun control, and others, the core message of the march was one every woman should be able to get behind: equality, respect, and dignity for all women. Equal pay for equal work. Equality of opportunity. The right to be safe in own bodies, without the specter of sexual harassment in the workplace. For our daughters to live in a world free of sexual assault. As one woman put it, “things we thought we were done marching for, but apparently are not.” The AWS tagline is ***Engage, Empower, Excel***. The March certainly engaged an extraordinary number of women of all ages! While not all the protest signs were as polite as this one, my favorite was carried by a girl who looked to be about ten years old: “Girls with dreams become women with vision.” The overriding collective message of the march was: Women Count. We Matter. The visible and notably peaceful gathering of nearly half a million women in DC alone, many in pink knitted hats, cannot be ignored or dismissed. Women’s rights are civil rights. We will be vigilant. And as Margaret Mead put it, “*Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”* AJ Copeland, MD, FACS **Categories:** advocacy, gender differences, leadership, women --- ### [The Osteopathic Match Day](https://blog.womensurgeons.org/do-match-day/) **Published:** February 2, 2017 **Author:** Blog Team **Content:** *By Aileen Larson and Grace DeHoff* Every spring, fourth year medical students anxiously await “Match Day”. Students in both allopathic (MD) and osteopathic (DO) programs submit a rank list of their favorite residency programs and order them according to their preference. Residency programs also create a list of their top students and rank them accordingly. For allopathic medical students, Match Day is typically the third Friday in March. Every February, osteopathic medical students also await their fate in a similar match algorithm. This year the [DO Match Day](https://www.natmatch.com/aoairp/) is held on February 6th, 2017. As an osteopathic student, there are many choices to make when applying for residency programs. While the MD match is open to both MD and DO students, the DO match is exclusively for DO students and organized under the American Osteopathic Association (AOA) National Matching Services Inc. A student may decide to attempt the match only in allopathic programs, in which case they withdraw their application from the AOA match and continue with the [National Resident Matching Program](http://www.nrmp.org) (NRMP) in March. However, if they decide to stay with the AOA match and end up matching in a program in February, their application is automatically withdrawn from the NRMP match. If an osteopathic student does not match in February, they can decide to “scramble” for an unfilled AOA residency spot or wait for the NRMP match results in March. Osteopathic medical students undergo a similar application process for the AOA residency programs. Many programs require osteopathic medical students to spend two to four weeks at a residency program “auditioning” to be considered for an interview. Osteopathic medical students must travel around the country for four to five months in the fall of their 4th year completing an audition rotation at programs of their choice. Expenses related to these rotations are typically paid out of pocket by the medical student. An “audition” rotation is very similar to a “sub-internship” rotation in regards to student responsibilities and there are minimal differences between the two. Recently, the ACGME decided that all residency programs (allopathic and osteopathic residencies) will be accredited under the Single GME Accreditation System (SAS) by 2020. Unfortunately, some AOA residency programs are closing their doors on osteopathic students this year due to limited resources to meet the new accreditation requirements. Many of these programs are either in smaller communities, rural hospitals or are smaller surgical subspecialty programs. As an osteopathic student, navigating these changes presents a unique set of challenges. Those AOA residency programs that are 5+ year programs, including all general surgery and other surgical specialty programs, had to apply for a pre-accreditation application by January 1st 2017 to participate in this year’s match. Those that did not apply will not be accepting osteopathic students this year. Osteopathic students also need to understand that they are taking a leap of faith when selecting a program that has not received full accreditation yet but only a pre-accreditation approval. There are many important decisions that medical students face when deciding a specialty. For those students who choose an osteopathic path from the beginning and now facing new obstacles with the single accreditation system, I wanted to give encouragement to osteopathic students and show our support for them in the upcoming match in February. *Aileen Lars[![](%5Bsiteurl%5D/wp-content/uploads/2017/02/AileenLarsonPic-150x150.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/02/AileenLarsonPic.jpg)on is a fourth year osteopathic medical student at Pacific Northwest University in Yakima, WA and currently finishing her rotations in Portland, OR. She is pursuing otolaryngology and facial plastic surgery and participating in the AOA Match. She is on the Student Osteopathic Surgical Association National Board and is the West Representative on the Association of Women Surgeons National Medical Student Committee. In her free time, she likes to practice hot yoga, snowboard and spend time with her husband and her two dogs.* *Grace D[![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/grace-202x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/02/grace.jpg)eHoff is a third year osteopathic medical student at Pacific Northwest University and is interested in pursuing a career in Neurosurgery. She is a Denver, CO native but currently lives in Boise, ID with her husband and one-year-old son. She is the Diversity Chair with the National Medical Student Committee for the Association of Women Surgeons. In her free time, she enjoys running and has completed several half marathons and relay races.* --- **Categories:** career development, education, medical students, residency, training, women **Tags:** AOA, DO, Match, NRMP, Osteopathic --- ### [Strategies for Fighting Subtle Sexism in the Workplace](https://blog.womensurgeons.org/fighting-sexism-workplace/) **Published:** February 8, 2017 **Author:** Blog Team **Content:** *By Arghavan Salles, MD, PhD* I was (am) a math nerd. Math was always my favorite subject in school, and I was pretty darn good at it. Sometime in high school I noticed that people found my interest in math to be surprising because I’m a woman. I went on to major in engineering, another male-dominated field. Not to brag (ok, maybe a little), but I was always at the top of my class. When I went into medicine, and later surgery, I was prepared for the pattern to hold. Even though surgery is a field in which men outnumber women, why should that stop me from achieving and leading? It didn’t take long in my surgical training to realize how naïve I was. I had left the meritocracy of school and entered the real world. During my intern year, while scrubbed with an older male surgeon, he said to me, “I’m not sure why we train women to become surgeons. They just want to go off and have babies.” He thought he was making conversation, with no insight into how offensive his comment was. Later in my residency, a male faculty member responded to a female faculty member’s concern about a patient by saying, “What’s with the hysteria?” Every woman surgeon has stories like these as well as some that are more harmful and more outrageous. While overt gender discrimination is becoming less and less common, gender bias continues to exist. Along with other factors, gender bias is one reason that there are still fewer women than men going into surgery. Women surgeons, like their non-surgical colleagues, face obstacles each step of the way with few women reaching the highest ranks. Data from the [AAMC](https://members.aamc.org/eweb/upload/The%20State%20of%20Women%20in%20Academic%20Medicine%202013-2014%20FINAL.pdf) (Table 1) show that the proportion of women who are full professors in medicine broadly is more than double the proportion of women who are full professors in surgery. *Table 1. Percentage of women by rank* | | **Medicine** | **Surgery** | |---|---|---| | **Residents** | 46 | 38 | | **Assistant Professor** | 44 | 25 | | **Associate Professor** | 34 | 19 | | **Full Professor** | 21 | 10 | | **Department Chair** | 15 | [10](http://jamanetwork.com/journals/jamasurgery/fullarticle/1678067) | Just like lawyers and engineers, women physicians and [surgeons make less money](https://www.womensurgeons.org/2017-statement-on-gender-salary-equity/) than their male colleagues. On the whole, [women make 78 cents for every dollar men earn](http://nwlc.org/wp-content/uploads/2015/08/closing_the_wage_gap_is_crucial_for_woc_and_their_families_2015.pdf). The disparity is even worse for women of color who make as little as 56 cents for every dollar white, non-Hispanic men earn. Among general surgeons, women make, on average, $83,000 per year [less than their male colleagues](http://www.medscape.com/features/slideshow/compensation/2016/generalsurgery#page=6). Rather than despair in these stark facts, though, Jessica Bennett’s *Feminist Fight Club* empowers women to, as the title says, fight back. Bennett describes a gathering of friends and their efforts to support each other through their gender-related workplace struggles. Along the way, she puts names to the common experiences all women share. For example, she describes the bropropriator—a man who takes credit for another’s work by “presenting the ideas of his team as his own, accepting credit for an idea that wasn’t his, or sometimes even doing nothing at all and still ending up with the credit—a convenient reality of being born male, where credit is assumed.” The reader learns this and other new vocabulary: manterrupting (think Kanye West at the VMAs), the permassistant (women’s tendencies to take on tasks, such as note taking, which are not valued by others), the impost-her (feeling like an imposter even when you are qualified—or more than qualified!), femlightenment (being open-minded about women in leadership positions so they actually have a chance to succeed), femulate him (even when lacking confidence, do what a man would do—fake it!). From the very beginning with the definition of subtle sexism (“the kind of sexism that makes you wonder, Am I actually just crazy? \[No, you are not\]”), Bennett gives us labels we can use to start fighting back. Please join us in discussing these ideas and more in our upcoming tweetchat, February 13, 2017 at 8 pm EST with the hashtag #AWSchat. I’ll also be sharing some of my favorite quotes and data (yes, data!) from the book. [![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Picture-252x300.png)](%5Bsiteurl%5D/wp-content/uploads/2017/02/Picture.png) *Dr. Salles completed medical school, residency, and her PhD at Stanford University. She finished her formal training with a fellowship in Minimally Invasive Surgery where she has stayed on as faculty. Her dissertation research focused on negative stereotypes about women in surgery and how those affect women training to become surgeons. Her current research focuses on diversity in medicine as well as physician wellness. She invites you to follow her on Twitter @arghavan\_salles.* --- **Categories:** gender differences, women **Tags:** fighting strategies, sexism, workplace --- ### [Dinner Thoughts?](https://blog.womensurgeons.org/dinner-thoughts/) **Published:** February 10, 2017 **Author:** Blog Team **Content:** *By Jean Miner, MD* “Dinner thoughts?” This is the text I all too frequently send my husband while leaving the hospital after a full day of surgery or clinic. As a doctor, the virtues of exercising and eating healthy is something I routinely discuss with my patients. But, personally as a surgeon juggling a career, various committees and a family (with twin toddlers) it is much easier said than done. However, I have learned a few tricks to maintain a healthier diet. Is it perfect? **No**. Is it doable? **Yes**. First, I got **tech savvy** and educated myself. I took advantage of websites and apps that allowed me to search nutritional data for fresh and packaged foods and even restaurant dishes. I joined a recipe website and created a virtual recipe box which now has over 200 recipes catalogued and available at my fingertips. Not just are the recipes sorted by the occasions, there are filters to search through them based on time needed to make a dish and necessary ingredients. So handy after a late night shift but so much healthier than pre-packaged meals I would have popped in the microwave otherwise! Next, I started to **plan ahead.** Before, because we waited until the last minute before deciding what we were going to eat, we would inevitably end up with restaurant take-out or scrounging through the pantry. The former being less healthy and the latter leaving me unsatisfied (leading to late night snacking). As I started planning my meals, we made it a habit to take some time out on Sunday mornings to look through our recipes, plan for the week ahead and shop early before the crowds start. If there is any prep work that I can accomplish ahead of time, I do it on the weekend. Often, we will cook double recipes allowing leftovers to be brought for lunch the next day or stored in our freezer. Despite my hospital providing food for us, I still typically pack my lunch the night before with plenty of options for me depending on my time and mood. This keeps me from starving myself or eating the pastries always available in the OR lounge. Also, if you are like me and often rush out in the morning forgetting your lunch, put your keys on top of it in the fridge – I promise you will remember it! Finally, when everything was working for us we decided to take it to the next level and start **splurging**. The purchase of a freezer allowed us to store pre-made meals and proteins for those days when cooking is out of the question but defrosting is not. With all the extra space, next came a vacuum sealer to help store our goodies. Recently, we have begun utilizing food delivery services about once a month. Personally, I prefer those where I can choose the recipes and they deliver the pre-portioned ingredients to me. It allows me to cook and try new recipes most of which take less than 45 minutes. From a healthy standpoint, it is perfect because the nutritional data is posted next to the recipes when choosing. For friends of mine who don’t love to cook there are companies which will deliver precooked healthy meals to your house. By adopting these changes, our meals are healthier and more importantly……the dinner stress is gone. **Nutritional Apps/Websites:** My Food Diary My Plate Fitbit **Recipe Apps/Websites:** Allrecipes Yummly Foodnetwork **Food delivery services:** Plated Hello Fresh Blue Apron A few of my favorite cooking tips/tricks…….. - Save all of your vegetable scraps in a gallon bag and store in your freezer. When it is full, pour into a large pot, cover with water, bring to a boil and simmer for 45 minutes. Strain and you have your own delicious, no sodium vegetable broth. (The same can be done with shrimp heads or the remnants of a rotisserie chicken) - Whenever you have leftover rice, freeze it. It defrosts well and is perfect for a healthy fried rice dish (cold rice works better). [ http://www.slenderkitchen.com/recipe/healthy-fried-rice](http://www.slenderkitchen.com/recipe/healthy-fried-rice) - Buy and cook in season. Not only are the fruits and vegetables fresher but cheaper.[ https://snaped.fns.usda.gov/seasonal-produce-guide](https://snaped.fns.usda.gov/seasonal-produce-guide) [![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/JeanMiner_4c-002-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/02/JeanMiner_4c-002.jpg)*Jean Miner is an Assistant Professor at the University of Central Florida College of Medicine and a Surgical Attending with Florida Hospital’s General Surgery Residency. She has a Masters in Medical Education Leadership from the University of New England. Her work life is in equilibrium with her personal life as a mother of three girls who loves spending time with her husband and family traveling the country and world. In her “spare time” she loves to cook, be outdoors and read as many books as she can.* --- **Categories:** self-care **Tags:** cooking, nutrition --- ### [World Cancer Day](https://blog.womensurgeons.org/world-cancer-day/) **Published:** February 15, 2017 **Author:** Blog Team **Content:** *By Ainhoa Costas Chavarri, MD, MPH, FACS* Last week I gave a chat on breast cancer to a Rwandan women’s sewing cooperative group. As I spoke, via a local surgery resident who acted as translator, the women listened but remained steadfast at their wooden stations, cutting fabric, threading needles, and throwing stitches. When we got to the part where I touched my hand to my chest, mimicking a breast exam, however, they all immediately stopped what they were doing and began giggling. “What is it?” I asked Grace, the resident translator. “Well,” she said, smiling, they are saying, “you want us to check ourselves?” February 4, 2017 was [World Cancer Day](http://www.worldcancerday.org/about/2016-2018-world-cancer-day-campaign). Under the theme of [\#WeCanICan](https://twitter.com/search?q=%23WeCanICan&lang=en) people all around the world showed their support in real life and online by hosting events, posting on social media, sharing stories and spreading awareness. Many of you might have noticed while scrolling through your twitter or facebook feeds. Some of you may have even participated in activities at your clinic or hospital, supporting patients, promoting cancer awareness and treatment. But be honest with me- how many of you paused on that day to think about yourselves? As surgeons, we spend our lives caring for others. We barter our sleep, meals and even personal time for the wellbeing of our patients. We pride ourselves on being tough- faster than a speeding scalpel, stronger than an internal prosthesis, able to leap a trauma bay in a single bound! But the problem is that cancer doesn’t care how strong we think we are. Cancer affects us all. [Each year, 14.1 million new cases are detected and 8.2 million people die of cancer](http://www.worldcancerday.org/about). The statistics are staggering, and yet personal. In those numbers we find [our colleagues](https://www.womensurgeons.org/food-for-thought-when-the-doctor-becomes-the-patient/), [our family members](https://www.womensurgeons.org/nine-percent/), and sometimes even [ourselves](https://www.womensurgeons.org/tag/thyroid-cancer/). It’s time then, that we surgeons start taking better care of each other. World Cancer Day is a chance to reflect on what you can do, make a pledge and take action**.** This year I ask that you make it a self-pledge and take the time to ‘check yourselves.’ Get that mammogram, start that exercise routine, schedule that colonoscopy. Enlist a friend or colleague- bonus points if you join forces with another busy superpower surgical colleague. Back in the sewing room, I asked, “how many of you have children?” An almost unanimous show of hands. “And do you notice if something happens to your child?” I continued. Grace translated and the women laughed. “Even the smallest thing,” one lady who spoke English ventured, “even a scratch, we notice.” “And who is checking on you? This is why I need you to check yourselves. If no one is checking on you like you check on your children, then you have to check yourselves. Your lives are just as important.” The women nodded, the message understood. [![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Ainhoa-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/02/Ainhoa.jpg) *Dr. Ainhoa Costas Chavarri is a General Surgeon and Hand Surgeon who does full-time academic #globalsurgery. She has been living and working in Rwanda for the past four years, teaching Rwandan surgery residents and medical students as part of the Human Resources for Health Program. Much of her practice involves taking care of patients with breast cancer and gastric cancer. She enjoys foreign films, modern art, poetry and the beaches on her home island of Puerto Rico. (twitter: @ainhoac63)* --- **Categories:** self-care **Tags:** cancer, cancer awareness, self-care, world cancer day --- ### [How do you take care of YOU?](https://blog.womensurgeons.org/how-do-you-take-care-of-you/) **Published:** February 23, 2017 **Author:** Blog Team **Content:** *By Patricia Martinez Quinones, MD* As over-achieving female physicians we strive for perfection in all aspects of our lives. We are not satisfied with being mothers, wives, daughters, (insert noun here). We aim to be good mothers, good wives, good daughters, etc. Besides the pressure we place on ourselves we also took an oath to take care adequately for the sick, but how can we take care of our patients if we don’t know how to take care of ourselves? With the demands of general surgery residency, a husband and household, I did not consider my well-being a priority. I slowly found my physical, emotional and mental health starting to deteriorate. I grew up in Puerto Rico, where cardiovascular disease and diabetes are two of the three most common causes of death. All of my grandparents have had complications of heart disease, diabetes and obesity. In an attempt to prevent these complications in myself I changed my lifestyle. I embarked on a health and well-being journey. I am sharing with you some of what I have learned and done along the way. My first step on this journey was a diet overhaul. I was eating cafeteria food, or fast food at least three to four days a week. I made a commitment to myself that I would only buy lunch once a week. I tried meal subscription delivery services (for more information refer to Dr. Miner’s recent blog post) and learned new recipes that I have now incorporated. Eventually I settled on meal prepping as my go-to. I pick one day a week (my off-day usually) and prepare several vegetables, grains and at least two different protein sources. This change led to improved eating habits, extra free time on weeknights and one less thing to worry about. Not only did my diet undergo a much-needed overhaul, but so did my non-existent self-care routine. Fearing burnout, as I have seen in some of my colleagues I tried to find ways to cope with stress. I settled on the idea of a “self-care week.” For an entire week, I did one thing a day that would allow me to relax and improve my overall sense of self. The week kicked off with a trip to the salon for a pedicure. During the week I also started reading a fiction novel, had a massage and even a dreaded visit to the dentist, who I must admit I hadn’t been to since starting residency. My “self-care week” felt like a vacation, although I invested about an hour a day. I realized how little emphasis I was placing on me-time and how a few minutes a day could lead to an improved version of me. My journey of self-care continues. I’ve learned to prioritize my health, along with that of my patients. This has translated into improved relationships with my family and co-workers. Taking an entire “self-care week” often is not plausible for most, but I do hope that my experience inspires you to do something you enjoy and learn to take care of you. --- *Patricia Ma[![](%5Bsiteurl%5D/wp-content/uploads/2017/02/Dr-Patricia-Marinez-Quinones-240x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/02/Dr-Patricia-Marinez-Quinones.jpg)rtinez Quinones is a general surgery resident at the Medical College of Georgia at Augusta University. She is a wife and doggy-mom who is on a well-being inspired journey to learn self-care. She is interested in trauma and critical care and academic medicine. She hopes to inspire other female residents and medical students to learn how to take care of themselves as well as their patients – and themselves.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Negotiating Your Worth](https://blog.womensurgeons.org/negotiating-your-worth/) **Published:** March 9, 2017 **Author:** Blog Team **Content:** *By Melany Hughes* **Hiring Entity** “No. That won’t work for us.” **Job-Seeking Physician** “Ok, that’s fine then.” *I’m not going to cry. I’m not going to cry. Ugh, are those tears? Am I crying? Did they notice?* **Hiring Entity** “Do you need a minute?” **Job-Seeking Physician** *Noooooooooooooooooo* In our worst nightmares, this is the scenario we think could unfold if we dare make demands during contract and business negotiations. Of course, in reality, it will never happen but the fear of lacking control and losing dignity can be so strong that it compels contract seekers to make no demands and to agree to everything that is proposed; just because it is easier. Women have a tendency to internalize all the cultural, societal, religious and historical characterizations that define us as the “fairer” sex. But let me make it clear that although there is a time and a place for taking a backseat, meetings with potential employers at the negotiation table should not be one of them. It may seem hard to make demands when you feel that you are approaching the contract process from a place of inferiority. You may even feel that you lack sufficient knowledge to leverage any control in the process. But you have to muster the confidence to serve as your own advocate. I attend annual meetings and conferences for medical professionals and the horror stories people tell regarding their contracts and work situations would make your hair stand on end. The situations can be downright criminal when there are special circumstances like visa requirements, malpractice settlements or negative hospital inquiries, etc. I know a very competent practicing female surgeon who makes under $100,000 and was required to cover the hospital surgery call schedule 24 hours a day for 4 months at two 200+bed hospitals all for the promise of a sponsorship for a US green card and permanent residency. It is mind-boggling that this beautiful, brilliant, hard-working woman did not think that she was worth more and even more disturbing that despite all our medical training, we are not provided with more business savvy and insight. Happily, through some back-door nudging that I am proud to say I encouraged, she was able to get her contract renegotiated and is living with a slightly better quality of life. But you cannot trust that contract renegotiation will be an option. Sometimes, it is two years later and you are so burnt out that leaving active practice seems a viable option. Medical school and residency don’t include business classes. In certain cultures, women in the forefront making demands is frowned upon. It is clear that medical training should include more education that relates to contracts and contract negotiation, reimbursement, incentives, malpractice coverage, billing, etc. It’s preposterous that the first time you hear about a non-compete clause or tail coverage is when you are signing the next few years of your life away. So how do we do this? How do we even approach this? 1. You are a trained professional. You are a “hot” commodity! You are doing them and their patient population a favor by working for them. You do want to let them know what you can do for them and their practice. You should approach this process and the contract negotiations from a presumed position of power. 2. Be sure you understand your own desires and needs (lifestyle, family plans, desired salary range, geographic preferences, career interests, work schedule, paid research hours, tenure options, etc). 3. As a new graduate/physician, you will need to make some compromises to get more experience. But do not give up everything. Keep your soul! If you need two weekends every month to go river rafting or skiing or want two weeks in summer to travel through southeast Asia, then make sure you negotiate for that. 4. MAKE A LIST. For first-time negotiations, renegotiation or any changes, do not approach the meeting without a written list of both needs you have and compromises you are willing to make to come to a satisfactory agreement. For my last contract re-up, my current employer just took one look at the list and agreed to every single thing. 5. Read and Empower Yourself. Here are some suggestions: - Women Don’t Ask: Negotiation and the Gender Divide by Linda Babcock and Sara Laschever - Getting More: How You Can Negotiate to Succeed in Work and Life by Stuart Diamond - [AWS Job Negotiations Resource](https://www.womensurgeons.org/about-us/resourcelibrary/career-development-resource/job-negotiations/) by Dr. Margaret Dunn - Read the AWS Navigating Your Surgical Career Guide 6. Have walkaway terms 7. Lastly, make sure you have a contract lawyer familiar with physician contracts. --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/03/MCH-300x225-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/MCH-300x225.jpg)Melany Hughes, MD, MPH is a 2005 graduate of the Howard University College of Medicine. She completed her General Surgery internship and residency in 2010 at Howard University. She received a Master of Public Health Degree in Disaster Management and Emergency Preparedness (MPH) from Tulane University (TU) in 2012. While at TU she received a research appointment with the World Health Organization’s Center for Research on the Epidemiology of Disasters (WHO-CRED) in Brussels, Belgium. Her work focused on the analysis of both man-made and natural disaster-related trauma and injury patterns resulting in contributions to several multi-national collaborative research projects and publications. Following completion of her MPH degree, and with a continuing commitment to public service and humanitarian work, she served as a General Surgeon and Medical Officer with the U.S. Indian Health Service; providing healthcare to the Hopi and Navajo Nations in northwest Arizona. Dr. Hughes strives to practice “socially-conscious” general surgery and is currently employed as a private practice surgeon with Hafa Adai Specialist Group in Guam, USA.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Barriers to Hispanic Healthcare](https://blog.womensurgeons.org/barriers-hispanic/) **Published:** April 7, 2017 **Author:** Blog Team **Content:** *By Madeline Torres* Halfway through fourth year of medical school, my mother became acutely ill and was eventually diagnosed with a chronic condition. She was initially hesitant to seek medical care, attributing her symptoms to longer work hours leading to a delay in her diagnosis. Many times I wondered why she delayed seeking medical care, finally concluding that my mother had fallen victim to the common barriers many Hispanics face when accessing healthcare. These barriers include lack of health insurance, immigration status, language and cultural barriers to name a few. Let’s talk about lack of health insurance. In 2015, the[ Census Bureau revealed that only 47% of Hispanics reported having private insurance](https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64). In 2014, the[ Pew Hispanic Center](http://www.pewresearch.org/fact-tank/2014/09/26/higher-share-of-hispanic-immigrants-than-u-s-born-lack-health-insurance/) reported 25% of Hispanics lacked health insurance that is nearly double compared to the 14% reported by the general population. When we break this number down by immigration status, 60% of undocumented Hispanics reported having no health insurance while 28% of documented Hispanics reported no health insurance according to the [2007 Pew Hispanic Center Survey](http://www.pewhispanic.org/2009/09/25/hispanics-health-insurance-and-health-care-access/). The reasons for lack of health insurance among Hispanics are complex, in 2000 Monheit and Vistness1 found that 42% of non-elderly Hispanics had employer-provided insurance compared to the 71% of their non-elderly white counterparts. Similarly, 56% of Hispanic male workers were offered health insurance compared to 62% of their male counterparts. Hispanics are also more common to have jobs in small firms, seasonal jobs and part time all of which have less probability of offering health insurance. The [Commonwealth Fund](http://www.commonwealthfund.org/~/media/files/publications/fund-report/2000/dec/barriers-to-health-coverage-for-hispanic-workers--focus-group-findings/perry_barriers_425-pdf.pdf) released the findings of focus groups that listed cost of insurance and concern over immigration status as primary reasons for not obtaining coverage. Immigration status is also a barrier to seeking services and obtaining health insurance coverage. It limits access and discourages seeking services. Public health assistance programs for low-income families such as Medicaid and the State Children’s Health Insurance Program (SCHIP) are not available to undocumented families. Furthermore, those same programs are often times unavailable to newly naturalized families or may jeopardize their ability to apply for citizenship2. Language also plays a major component in access to healthcare. I can remember watching countless times when my mother did not understand the question being asked and the provider struggle to understand her answer. Some Hispanic patients are not fluent in English or would be more comfortable discussing health issues in their primary language. Many fear discrimination because of their accent. The inability to communicate well with their doctor also prevents patients from understanding health care information. Lastly, Cultural beliefs contribute to the how, when, and where Hispanic seek medical care. Growing up in El Salvador, I recall eating fresh Papaya for breakfast to prevent and even treat GI worms. Even after immigrating to the U.S. my mother would seek home remedies for common ailments such as using oregano for stomachaches and chamomile tea for menstrual cramps. Depression, anxiety and other mental health problems are rarely mentioned due to the associated taboo with mental illness. By now, you may be wondering what you can do to help facilitate the care of your Hispanic or other minority patients. I encourage you to be cognizant of cost when dealing with this and any patient population. Many patients cannot afford testing and/or imaging. Ask yourself, “How will this test change my management?” In addition, look for ways to minimize prescription drug cost: prescribe generics-NPH insulin is cheaper than brand-name insulin, for example. If you suspect there may be a language barrier, ask your patient if they would like a translator, most hospitals have translator phone services available free of cost to the patient. Provide them with information in their preferred language and ensure they are able to read. Lastly, engage patients in their care. Ask if they would agree to take a prescription medication, don’t assume that prescribing ensures compliance and provide safe alternatives when possible. 1\. Monheit AC, Vistnes JP. Race/ethnicity and health insurance status: 1987 and 1996. Medical Care Research and Review. 2000;57(Suppl 1):11–35. 2\. Escarce JJ, Kapur K. Access to and Quality of Health Care. In: National Research Council (US) Panel on Hispanics in the United States; Tienda M, Mitchell F, editors. Hispanics and the Future of America. Washington (DC): National Academies Press (US); 2006. 10 --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/04/torres-254x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/04/torres.jpg)Madeline B. Torres, M.D. is a general surgery resident at the Penn State Milton S. Hershey Medical Center in Hershey, PA. She will start a research fellowship in surgical oncology the National Cancer Institute (NCI) this summer.* *Dr. Torres was born and raised in El Salvador and immigrated to the United States with her mother and brother at the age of nine. She then went on to obtain her B.S. in chemistry from the University of Colorado at Denver and earned her MD from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors.* *Her interests include surgical education, surgical oncology, work-life balance and encouraging women and minorities to pursue surgery and other careers in medicine.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [My First Delivery Was My Own: A Medical Student’s Journey into Motherhood](https://blog.womensurgeons.org/first-delivery/) **Published:** May 11, 2017 **Author:** Blog Team **Content:** *By Grace K DeHoff, MS III* I had my first child in November of my 2nd year of medical school. My husband and I tried to plan for a winter break baby but were surprised a little earlier. With plenty of open communication with my school, an unbelievable support system in my husband and my classmates, and more multitasking than I ever knew was possible, I had my child and was able to return to school full time after two weeks off. I was able to make up the missed work over Christmas break. The experience taught me a lot about why so few women decide to have children during medical school. Unfortunately, the alternative to waiting until after residency leaves many women delaying pregnancy to their their late 30s to 40s. Complication rates, infertility and genetic disorders all increase with increasing maternal age. This leaves female physicians with a difficult decision in terms of attempting to balance a career as a physician and the desire to have a family. This piece is meant to highlight this struggle and my own journey with my decision to have a baby in the thick of medical school. **Challenges women in medicine face with family life** My mentor, a male neurosurgeon, once told me I needed to have my children while in medical school. When I asked him why I needed to have kids in medical school he explained that as a woman I would face a challenge that none of my male colleagues would face, especially in[![](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracenurse-202x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracenurse.jpg) the field of neurosurgery. I would most likely be in the minority as a female in the program. In addition, if I had a child during residency, when I left for the labor and recovery, my colleagues would be faced with picking up my workload and shifts, resulting in probable resentment from them. They would be working while I was home with my baby. They would be getting more hours in the OR, seeing more cases, honing their skills as surgeons, and adding to their resumes by further expanding their experiences. Meanwhile, I would be at home, knowing that I was falling behind in my program, which would drive me to return to work to get back on track sooner than when most new mothers usually return to work. He posited I’d then face continuous guilt over leaving my child and missing out on the joys of being a mother. The thought of motherhood in medical school still terrified me, how would I have the time?! Though he drew a very simplified scenario with many assumptions, I took it to heart and did constantly wonder about how I would manage to have both a family and a career I loved. Even if I do not end up in neurosurgery, I knew any residency, particularly a surgical one would pose a significant challenge on creating a family. Regardless of the residency, there is only a finite amount of time any resident can take off in a calendar year before they are considered to have missed too much to graduate on time and are required to repeat a year or complete a research year. In the best scenario, it is quite possible for a woman to have a baby and get back to work in only a matter of days or weeks. From our experiences in medicine, unfortunately we know that best case scenarios don’t always happen. For those women who do not have the optimal pregnancies, deliveries and recoveries, they face the very real possibility of sacrificing their medical education and accepting that they have fallen behind and must take time off to graduate later than expected. This can have longer term consequences affecting finances, future job offers and marital stress. **Medical school policies for time off** Most medical schools have no official maternity leave policy in place, owing to the changing curriculum throughout medical schools. In the vast majority of US osteopathic and allopathic schools, the first two years are didactic years requiring lecture attendance and regular exams. It is challenging to have a child during this time because of the rigorous schedule and lack of time available to make up missed work. Some schools will allow a certain amount of time off–usually no more than 2 weeks before requiring an official Leave of [![](%5Bsiteurl%5D/wp-content/uploads/2017/05/studybuddy-300x248.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/studybuddy.jpg)Absence. Others require students to either take a full year off or to complete a research project during their postpartum period without an option for attempting to keep up with the required schoolwork. My school, Pacific Northwest University of Health Sciences, was more lenient in their policy. The time off that I took for my postpartum period was excused as an “illness” would be and the coursework was understood to be made up at the end of the academic year before I would be eligible to take my board exams. The clinical years in the last half of medical school are out of the classroom and occur on the wards with variable schedules and hours. Again, each school is different in how they handle requests for time off during this period. Some schools have established electives appropriate for time needed both pre and post partum. Certain medical schools schools permit a breastfeeding elective to support a pregnancy. My school allows up to 6 weeks of a newborn elective (available to both mothers and fathers) as long as the student’s child is less than 1-year-old. In the absence of any of these options, many students will save vacation time, taken as a maternity leave; others will pack their schedules with light rotations, like research rotations to allow flexibility and less clinical responsibilities and to create more time during the newborn period. In general, there seems to be more flexibility for having a child in the last two years of school when compared to the first two. **Breast feeding time commitments** The American Academy of Pediatrics recommends all infants be breastfed exclusively for the first 6 months of life. For new mothers attempting to breastfeed, this introduces a major time challenge, especially upon returning to work in any field. On average, an infant eats every 2-3 hours around the clock or roughly eight times in a 24-hour period. The amount of time the baby spends actually at the breast varies greatly, but averages to about 20-30 minutes. In addition to the physical time it takes to nurse or pump, a mother in medical training must also factor in her study schedule around her nursing schedule. I found myself pushing past natural study breaks in my study schedule to wait until I nursed, using the time to nurse as a study break. [![](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracepump-267x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracepump.jpg)On long days on the medical school campus, I would take a headset intended for those hard of hearing to use during lecture so that I could continue to listen to the lecture while I pumped in a separate room. This allowed me to still hear the information, but it was impossible to take notes or do any active learning while I pumped since it’s actually a pretty hands-on task. I would often have to be very careful about my exam schedule and change my pumping times to ensure I would not have to leave an exam to pump because that would result in time lost from the exam. Additional factors such as the baggage needed to pump, logistics of storing cold milk and the stress of making sure I produced enough milk every day to send with my son to daycare the next day, were some of the biggest challenges of being a mom in medicine. I know plenty of women who chose not to nurse for long or even at all due to these difficulties. Even so, their time commitment was no less than mine, but without the obstacles to pumping during the day. I think any time saved from the decision to formula feed comes specifically from the pumping time commitment. **Male colleague responses** I was on my first rotation as a third year medical student when I found myself with a male resident who had four children, his last child was born within only a few months of beginning his first year of medical school. He went on to tell me that he “completely” understood how difficult it was to have a baby in medical school. When I hesitantly pointed out the difference between becoming a father in [![](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracedesk-210x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracedesk.jpg)medical school versus a mother in medical school, he scoffed and said that he had taken his fair share of the midnight feedings, enough to understand the difficulties of being a new mother. His response hurt me more than I cared to admit and though I know his attitude is not representative of all fathers, the comment left me feeling resentful and intolerant of my male colleagues. In reflecting on this topic, it is difficult to tell any father that he doesn’t understand what it’s like to be a parent, and to a point, it’s impossible. Fathers are invaluable pieces of the family dynamic and I would never have been successful without my son’s father in our lives. Men often want to be valued for their contribution in parenting, which they justly deserve. Women want the same thing. We want support and recognition for the role that we play in carrying, birthing, and nursing a child. Mothers in medicine keep the same schedules as fathers in medicine, the same workload and the same standards, but the gestational and postpartum part of our parenting journey cannot be ignored or brushed off. **“Statistics” When women have a baby in medicine** In an unofficial Facebook survey taken in a private group of physician moms totaling over 61,000 members, over 2000\* women responded to the question “when did you have your first child?”. Of those respondents, only 15% of them had their first child in medical school. 25% of women waited until residency and 25% waited until they were in an attending position. The remaining 35% had their child outside of these time frames. These statistics reflect that women chose to have children all throughout their medical education and career and no one time seems to be better than another. The challenge can significantly affect family planning and many female physicians and students feel that waiting sometimes up to 10+ years after beginning medical school to actually start a family is their best option. **Policy Change** As a whole, medical schools in the US do tend to support women who decide to start a family while in school. There are a variety of options available to help students complete their studies on time and most schools are willing to be flexible so long as there is open communication along the way. The women who choose to take on motherhood and medical school are often some of the most driven [![](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracebaby-209x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/gracebaby.jpg)and hardest working students, but even so, a little help can go a long way. Schools can encourage and support mothers by providing lactation rooms, providing child support resources and being a child friendly campus. Many schools allow children to be on campus but do not allow them within the lecture halls during class time. Some schools allow the option of following along with lectures remotely, which can be invaluable with a newborn. There are even schools that provide childcare on campus for parents! As a new mother who is not able to be a stay at home mom, childcare is probably the most important planning point in terms of successfully returning to school after having a baby. Planning early for daycares and inquiring about waitlists as well as the minimum age that the baby must be before they can start is an essential part of your family planning. In medical school the financial burdens often make hiring a nanny or in home child care too expensive but enroll family and friends to help out in the early stages. If you plan on nursing, make inquires early about nursing accommodations at your school. Be sure to see how far away nursing rooms are from classrooms to be factored into your pumping schedule. The combination of a newborn and medical school will definitely cut into dedicated study time so the most honest reflection you must make before embarking on this joint path is whether you are in good academic standing and not struggling to be in good standing. If you are a borderline student, having a baby can easily tip you below the passing line. At the end of the day, every second as both a student and a mother is worth it in my humble opinion. [![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/pie-300x255.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/pie.jpg) \*Statistics: Total number of respondents: 2037 \*\* This survey specifically asked only about when women had their first child to attempt to determine when women felt prepared enough to start a family. --- **Categories:** career development, family life, gender differences, medical students, mentorship, self-care, training, women **Tags:** Moms in Medicine, Mother's Day --- ### [Life in an Instant](https://blog.womensurgeons.org/life-instant/) **Published:** May 17, 2017 **Author:** Blog Team **Content:** *By Sasha Adams, MD* I am a multi-tasker. I thrive in chaos. Managing multiple projects, people, jumbled schedules – that’s when I’m on my game. And that’s a good thing, because I’m a surgeon, a wife, and a mother of 2 wonderful kids. I have an amazing husband who is an incredible stay-at-home Dad, but there is always more to do. So I multi-task: 2am waiting for my OR case to start, I jump on my phone and order diapers, confident that they will be delivered before we run out in 2 days. I check my emails (both work and home!) and rapidly respond while walking down the hall from the OR to my office. During morning checkout, I hear reference to a book I should probably read, and surreptitiously jump on my phone and order it for my Kindle app within a minute. Heading back to the office, I look at the calendar and notice the kids birthday party next weekend! Quickly I go online and order the gift so it’s delivered in time! All this while being on the go! Like I said, I thrive in chaos-[\#Ilooklikeasurgeon](https://twitter.com/hashtag/ilooklikeasurgeon?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Ehashtag)!! We live in a world where technology has made this possible: if you think of it – you can get it done, check it off your list, and move on to the next task. It’s all about instant gratification. At work, however, I see a different kind of instant, and it is not gratifying. I’m a trauma surgeon so I see how in an instant, lives and families are changed forever. A moment of distraction while driving leads to an MVC, and they come to me, facing injury, or even mortality, the loss of loved ones, the shattered dreams of the future. I see the shock and pain in the eyes of the families that come wide-eyed to the ER, anxious and afraid to hear if their loved one is okay. As I tell them what has happened, I watch their well-planned, organized, happy world crumble around them. My heart breaks for them, and sometimes I cry with them. Some of their stories haunt me for years. In the Trauma Bay, there is no judgement, just resuscitation of the injured patient. But the stories unfold over the coming days. Yes – some are obviously intoxicated, but others seemingly innocent. Headed to /from work or dinner, some on the phone. “I never saw the other guy”, or “I just looked down for a second”. In 2014, over 400,000 people were injured from [distracted driving](http://distracteddriveraccidents.com/25-shocking-distracted-driving-statistics/), and over 3,000 were killed. 78% of them were on the phone, and although the “novice” drivers (15-19yo) get a lot of attention in the media, they are only 20% of the problem. The other 80% of us “experienced” drivers think we can just look down for a few seconds and we’ll be fine. But 4 seconds at 60 mph is the distance of a football field! So as I drive to work this morning, my mind starts running – what do I have planned today – meetings, cases, appointments, catching up on the ever-behind notes, wondering how many emails are waiting for me. I should check on the patient from yesterday. The To-Do list grows as I quickly become preoccupied with my day before I even arrive. The multi-tasker in me is awake and on the move! Suddenly my phone notifies me of an incoming email. What could it be this early in the morning? Can’t be good. As I reach for my phone, one of those faces come to mind – a life changed in an instant of distraction. I see the faces of the family looking at their loved one in my Trauma Bay, damaged, hurt, with an uncertain future. The multi-tasker in me takes a breath and pauses. I put down the phone. Now is the time to focus on driving. I turn on the radio and sing along, enjoying the sunrise over the Texas landscape and my 20 minutes of off-the-grid peace while I watch carefully for the other drivers who don’t have the benefit (or curse) of knowing what can happen when they aren’t focused on the road around them. The chaos can wait. --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/05/adams-258x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/adams.jpg)Dr. Adams is a Trauma Critical Care surgeon at the McGovern Medical School in Houston, TX. In addition to her clinical duties at the Level 1 Trauma Center, she runs the Surgical Clerkship for rotating 3rd year medical students, and is an inaugural Society leader and advisor for the McGovern Society, mentoring 8-10 students per year throughout their med school career. Dr. Adams’ research is focused on improving the care of geriatric trauma patients, through earlier identification of those at increased risk, changes to inpatient care practices, and early rehabilitation efforts to improve long term outcomes.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [#AWSEASTChat Wrapup](https://blog.womensurgeons.org/awseastchat-wrapup/) **Published:** June 9, 2017 **Author:** Blog Team **Content:** By Lillian Erdahl, MD The Association of Women Surgeons hosted its first joint tweetchat this week joined by the Eastern Association for the Surgery of Trauma. Paula Ferrada, chair of the EAST Mentoring Committee hosted the chat joined by guests and EAST past-presidents Nicole Stassen and Kimberly Nagy. If you missed the chat, you can read this #storify for a recap of the #AWSEASTchat: <https://storify.com/lillianerdahl/awseastchat-5937c42b5f3db4ab638f6bab#publicize> As highlighted in Heather Yeo’s recent blog post1, the topic chosen was mentorship which is an integral part of the missions of both professional organizations. We know that mentorship and sponsorship are important to professional success for all surgeons. According to a research letter published in JAMA Internal Medicine, women in academic medicine appear to receive less sponsorship from mentors then their male colleagues2. Partnering with another professional organization to discuss such mentorship in a surgical career provides a broader perspective on how mentors and mentees can contribute to successful relationships. Working with EAST is a natural fit for AWS which has ongoing partnerships with other surgical organizations to promote equity in surgery. I am excited to see that our social media engagement continues to increase with each chat that we host. If you are looking to participate as a mentor or mentee for EAST or AWS, please visit their websites to learn more.3,4 1. <https://www.womensurgeons.org/may-is-mentorship-month/> 2. [Patton EW, Griffith KA, Jones RD, et al. Differences in Mentor-Mentee Sponsorship in Male vs Female Recipients of National Institutes of Health Grants. JAMA Intern Med. 2017;177(4):580-582.](https://www.ncbi.nlm.nih.gov/pubmed/28241219) 3. <https://www.east.org/news-and-events/news-details/76/east-mentoring-program-call-for-mentors-mentees> 4. <https://www.womensurgeons.org/in-practice/mentorship/> **Categories:** Uncategorized --- ### [A Medical Student’s Perspective: Reflections and Lessons from Rural Surgery](https://blog.womensurgeons.org/rural-surgery/) **Published:** June 17, 2017 **Author:** Blog Team **Content:** By Kaylynn Purdy I am, as far as anybody is aware, the first person from my small mining town in British Columbia to go to medical school. Growing up, my town was often in a state of physician shortage.We relied on a few long-term physicians who spent their entire careers there, but the rest seemed to come and go like the seasons. Whenever we lacked physicians, the suffering and frustrations in my community was evident.The rural doctor shortage in Canada is part of what motivated me to pursue a career in medicine. I wanted to serve the often-forgotten rural/remote communities, much like my hometown in Canada. Early in my second year of medical school, I felt like I had won the medical student lottery. I had gotten my top choice for my first month-long “Integrated Community Experience” in a rural town in Northern Ontario with a population of about 10,000 people. I chose this town because it was one of the few rural Northern communities that had a fully functional operating room (OR) staffed by GP anesthetists, one general surgeon and another general surgeon with a specialization in vascular surgery. Students were expected to spend at least one day per week in the OR, and often, as first assistant. As a newly minted MS2, the prospect of being a first assist was both exciting and terrifying. It was during this month that I discovered my love for surgery. Yet, it wasn’t until well into my third year of medical school that I began to appreciate what it truly means to be a rural surgeon. It was a Saturday night when I got a call for an emergency appendectomy that was to happen in about 20 minutes. My only regret that night was not eating dinner sooner. As I rushed out the door of the retirement apartment complex I was assigned to live in for the month, I stuffed a granola bar in my mouth and waved hello and goodbye to an elderly woman walking outside with her dog. It was Halloween weekend and I frantically scraped frost off my car, worried that I would be too late to scrub in. I sprinted up the 4 flights of stairs to the OR, feeling the grooves worn into each step by the catholic nurses, who ran the hospital in a bygone era, under my feet. One of the scrub nurses was setting up- she let me know that the surgeon was waiting in the doctor’s lounge and that the patient would be coming up from the ER soon. Being an old hospital and modeled after a more male-dominated medical profession, the doctor’s lounge was also the men’s changing room. I cautiously opened the door, fearing I might see something I didn’t want to see, and saw the surgeon sitting on the couch eating baby carrots. He gestured for me to sit, and offered me a carrot. Given that he was known to rarely acknowledge the presence of medical students, I felt as though this gesture was a sign of appreciation for coming in when the rest of my colleagues had gone home for the weekend. We chatted about cycling, and doping in le Tour until the patient was in the OR. As we walked out of the lounge he looked at one of the scrub nurses and said “Kaylynn is going to drive the camera tonight.” I didn’t even know what that meant at the time as this was the first laparoscopic surgery that I had scrubbed in for. In true rural medicine form, I also had the opportunity to learn how to administer anesthetic, put in the patient’s Foley catheter and then shave his abdomen before it was finally time to scrub. Since that day, I have come to see scrubbing as a moment of calm and meditation, a moment to collect myself before walking into the OR. It is my three minutes of tranquility to calm my nerves. I focused on controlling the camera like it was the only thing that mattered in the world. Soon my nervousness dissolved and I was fully engrossed in what was unfolding on the screen before me. It was like being absorbed into a Netter’s textbook. Time stood still. As the appendix was removed, I was asked to take a “sweep” look at the rest of the abdomen. The gallbladder was massive, inflamed and angry looking. The patient was just a teenage boy and of course being Canadian, also a hockey player. That night he had both his gallbladder and appendix removed. I felt simultaneously devastated for him, but in awe of what I had just witnessed and had been a part of at 11pm on a Saturday night. At the time, I was on a high from the surgery itself. As I reflect on that night more than a year later, however, the awe of the surgery is less, but a different kind of amazement has replaced it. To me, it is almost magical that a surgery team can be called in from home and ready to operate in 20 minutes.With one surgeon on holidays, the other was at the beck and call of the people of his community 24/7. During my month-long placement, this single surgeon was the keeper and protector of health for an entire community. The respect that that the community has for its surgeons was incredible, because without them they would have to travel to a regional centre hours away for a surgical consultation, to have a wound checked, or to take care of a sick child. No matter the size or centre that a surgeon practices in, there are uniting features of surgeons across the world. These include being able to quickly gain the confidence of your patients, trusting your gut and your training, knowing when to push the boundaries in a “Hail Mary” situation and knowing your limits. In rural surgery, these characteristics seem to be even more important, as there is often no back-up, nobody to call in for help. In rural surgery and rural medicine, often it is just you, your small team of people who are also your friends, and your patient who just might be your neighbor or an old high school teacher. There is simultaneous isolation and profound intimacy in rural surgery. Some people might consider rural surgeons the “Cowboys” (and Cowgirls) of medicine because of how they try to save a life with limited resources. These surgeons feel compelled to try to reduce the suffering and burden that is imposed when patients are forced to seek care far from home. After living and breathing rural surgery for a month, then spending eight months of my clerkship in a semi-remote city, I see these surgeons as the quiet heroes of medicine. Nobody tweets about them, they didn’t just publish the latest research about cancer or develop a new technique to improve healing after bowel resections. They don’t work at prestigious university hospitals, but they are on call often for weeks at a time, ready to operate and ready to serve. They are often the hearts of the hospital and the lifeblood of a community. They are what allows people to retire and grow old in their communities knowing that they will have reliable essential medical/surgical care at home when they need it. I might not be a rural surgeon “when I grow up,” but I hope to one day be a pillar in my own hospital and community. I hope that my surgical team are also my friends and that I think of each patient like my neighbor and not just as a case. I still have the picture of the gallbladder from that Saturday night surgery. I kept it because it is a reminder of who and what I want to be one day: A surgeon who places her community before all else. --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/06/kaylnn-239x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/06/kaylnn.jpg)Kaylynn Purdy is now a 4th year medical student at the Northern Ontario School of Medicine in Thunder Bay, Canada. She hopes to pursue a career in Neurosurgery with a focus on timely access to surgical services. When not in the OR, she can be found skiing in the winter or out riding her bike in the warmer months.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Success is a Journey](https://blog.womensurgeons.org/success-journey/) **Published:** July 20, 2017 **Author:** Blog Team **Content:** *By Jaime D. Lewis, MD* Advancement up the academic ladder from grade school through college and medical school was measured by meeting well-defined milestones along a smooth and narrow pathway. Residency and fellowship introduced some variability but were accompanied by a similarly transparent structure of progression. The end of formal training felt as if I had embarked on a journey along a rocky, winding trail through dark fog aided variably by an old compass that occasionally pointed northward, or at least somewhere in the general vicinity. When I became faculty, this experience and the loss of an unambiguous measuring stick was quite disorienting leading me to feel as if I had I lost my ability to gauge my progress and my achievement of success or descent towards failure. Through time, work, self-reflection, and connection, I am once again on a trail that I know is moving onward and upward. And as part of my plan for progress and career development, I have had the fantastic opportunity to spend the last four days as a participant in the [AAMC Early Career Women Faculty Leadership Seminar](https://www.aamc.org/members/leadership/catalog/323134/earlycareerwomenfacultyleadershipdevelopmentseminar.html). This seminar has provided me with the time, space, and tools to really consider what I want to achieve in surgery and academic medicine. I have started to let go of what is not success for me and stopped comparing myself to colleagues and mentor. Determination of success is ultimately a very personal measure. I do know that my success requires that I understand and acknowledge what motivates and inspires me and what is core to my being. Central to my success is a commitment to my husband and children that they will always be my first priorities, a choice which is not negotiable. There is nothing in this world of greater importance and I will always be there when they need me. I better understand those components of my work that motivate me to continue my career in academic medicine. I am motivated to cultivate and expand my mentorship network and will continue to pursue strategic relationships with those who can provide guidance along the way. And I am committed to support and educate those who will succeed me as my biggest accomplishments always evolve from meaningful relationships. Finally, success requires that I have a strong sense of self and that I am true to that self. I will endorse my talents and opportunities and pursue those activities that fuel my passions. And I will continue to take the time I need for reflection, recovery, and growth on a regular basis. > You only live once, but if you do it right, once is enough. > -Mae West --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/07/lewis-183x252.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/07/lewis.jpg)Jaime D. Lewis MD is an Assistant Professor of Surgery and Assistant Medical Student Clerkship Director at the University of Cincinnati where she also completed her general surgery residency. After residency, she completed a fellowship in breast surgical oncology at the Moffitt Cancer Center. Her clinical interests include malignant breast diseases, oncofertility. Her research interests are ever developing. Outside of the hospital, she enjoys running, yoga, and time with her family.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Golden August](https://blog.womensurgeons.org/golden-august/) **Published:** August 24, 2017 **Author:** Blog Team **Content:** *By Camila R. Guetter* Created in 1992 by the World Alliance for Breastfeeding Action (WABA), the [**World Breastfeeding Week**](http://worldbreastfeedingweek.org/) completed its 25th edition this year. During the first week of August, campaigns and partnerships take place in order to support and raise awareness on the importance of breastfeeding. It is an international effort that currently involves 150 countries.[![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/gold-236x218.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/gold.jpg) This year, to celebrate World Breastfeeding Week’s 25th anniversary, the Brazilian government announced the expansion of this campaign from a single week to a whole month dedicated to the cause, the [**Golden August**](http://www.sbp.com.br/imprensa/detalhe/nid/pediatras-lancam-o-agosto-dourado-mes-para-estimular-e-apoiar-o-aleitamento-materno-no-brasil/). Initiatives include public talks and events, community meetings, advertising on the media, and illuminating monuments and buildings with golden lights. All in an effort to spread even more knowledge and awareness about breastfeeding in Brazil. The name “Golden August” relates to the fact that breastfeeding is the gold standard for newborn feeding. Compared to Pink October initiatives for Breast Cancer, it intends to make society aware that breastfeeding is a primary preventive measure for many diseases, for both mom and child. As I go through my OB/GYN rotation in medical school, I now understand the extent and importance of the benefits of breastfeeding. For mothers, breastfeeding contributes to postpartum weight loss \[[2](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508512/),[3](https://www.ncbi.nlm.nih.gov/pubmed/19064514)\]. It has also demonstrated risk reduction on ovarian cancer \[[4](https://www.ncbi.nlm.nih.gov/pubmed/24998548)\], endometrial cancer \[[5](https://www.ncbi.nlm.nih.gov/pubmed/28486362),[6](https://www.ncbi.nlm.nih.gov/pubmed/26384296)\], and aggressive inflammatory and invasive forms of breast cancer \[[7](http://www.jcancer.org/v08p1726),[8](https://www.ncbi.nlm.nih.gov/pubmed/28818244)\]. When it comes to the newborn, breastfeeding plays an important role in the development of the dental arches \[[9](https://www.ncbi.nlm.nih.gov/pubmed/26140303),[10](https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-934)\], speech, and breathing. It is also a protective factor for allergies \[[11](https://www.ncbi.nlm.nih.gov/pubmed/26192405)\], infections \[[12](https://www.ncbi.nlm.nih.gov/pubmed/26249674),[13](http://apps.who.int/iris/bitstream/10665/79198/1/9789241505307_eng.pdf),[14](http://onlinelibrary.wiley.com/doi/10.1111/apa.13151/full)\], gastrointestinal illnesses \[[13](http://apps.who.int/iris/bitstream/10665/79198/1/9789241505307_eng.pdf)\] such as gluten intolerance, obesity \[[15](http://onlinelibrary.wiley.com/doi/10.1111/apa.13136/references)\], and reduces neonatal mortality \[[16](http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30536-0.pdf)\]. Last but not least, it contributes to the effective bond between mother and child. Another recent [blog](https://www.womensurgeons.org/breast-best/) by Nickey Jafari highlights more the benefits of breastfeeding. Given all the well-known benefits of breastfeeding to both mother and newborn, the WHO recommends exclusive breastfeeding for at least the first six months after the birth of the newborn. Nevertheless, this practice still encounters many barriers worldwide, mainly due to lack of information. Globally, only 38% of newborns receive breast milk until six months of age. The goal set by WHO is to increase this [number](http://www.who.int/topics/breastfeeding/en/) to 50% by 2025. Discrimination and criticism over breastfeeding in public is still a major issue in Brazil. In this regard, the Golden August has partnered with public and private companies to empower their employees who are new mothers. Some companies now offer special rooms for breastfeeding, showing recognition of its importance. They offer private and adequate environments for mother-infant interactions and bonding as well as for pumping breast milk, if needed, during work hours. These conditions may lead to less work absenteeism as they improve the ability for women to return to their work routine more easily. They also maintain breastfeeding as a unique and special experience, as it should be. Happy Golden August to all parents out there! --- **Categories:** advocacy, current events, education, family life, gender differences, parenting, self-care, women **Tags:** Breastfeeding, Golden August --- ### [For When the Pipe Bursts](https://blog.womensurgeons.org/pipe-bursts/) **Published:** August 30, 2017 **Author:** Blog Team **Content:** *By Shree Agrawal* Approximately [half](https://www.google.com/url?q=https://members.aamc.org/eweb/upload/Diversity%2520in%2520Medical%2520Education%2520Facts%2520and%2520Figures%25202012.pdf&sa=D&ust=1504125253773000&usg=AFQjCNHsBSRfUsm6aPGmRerIjUj3dJBOzA) of matriculated medical students identify as female with numbers in surgical training steadily increasing to potentially also account for [half](https://www.google.com/url?q=https://www.womensurgeons.org/Connections/Women%2520in%2520Surgery%2520Residency.pdf&sa=D&ust=1504125253773000&usg=AFQjCNFljwcT3kolVqdRvJgZpBMB8-SiKw) of postgraduate trainees. Unfortunately, these figures are still dismal for underrepresented minorities, who at the medical school level may, at best, represent one in twelve students. I can only hope this changes for my underrepresented peers in my lifetime as we continue to redefine the culture of medicine. Within AWS and in medical training, the metaphor of “building a pipeline” represents creating greater access and entry to medicine among women and underrepresented minorities. In this context, I often wonder about the students and trainees who currently have the courage to enter fields in which the majority is homogenous. Advances in gender equality and diversity representation within [other fields](https://www.aamc.org/data/workforce/reports/458712/1-3-chart.html) of medicine, such as pediatrics, OB/GYN, psychiatry, and geriatrics, has not yet translated to inclusion in leadership and academic positions. I believe mentorship is key to addressing this paucity of diverse role models. This brings me to some of the great posts I have recently seen on Twitter about mentorship within academic surgery. My feed has been populated with retweeted clips, links, or visual abstracts from Dr. Caprice Greenberg’s address,[ “Sticky Floors and Glass Ceilings”](https://academicsurgicalcongress.org/aas-2017-president-address-caprice-greenberg-md-mph/), Dr. Keith Lillemoe’s address, [“Surgical Mentorship: A Great Tradition, But Can We Do Better for the Next Generation?”](http://journals.lww.com/annalsofsurgery/Citation/2017/09000/Surgical_Mentorship___A_Great_Tradition,_But_Can.2.aspx), and [“Characteristics of Effective Mentorship for Academic Surgeons: A Grounded Theory Model,”](https://www.google.com/url?q=http://journals.lww.com/annalsofsurgery/Abstract/publishahead/Characteristics_of_Effective_Mentorship_for.95932.aspx?platform%3Dhootsuite&sa=D&ust=1504125253770000&usg=AFQjCNF_HEYfdhfwvkwu92P5Tb-GxhcRMQ) by Drs. Amalia Cochran, William B. Elder, and Leigh A. Neumayer. In 2017, I view these pieces to be the first sign of preparation for when the pipeline to surgery eventually bursts. As more diverse medical students develop interest in surgery, dynamic and supportive mentorship becomes even more essential. From Drs. Cochran, Elder, and Neumayer’s work, four major themes for effective mentorship emerged: the need for multiple mentors at different points in a professional lifetime, mentors who provide strategic advising, who are unselfish in their attitude, and engage with diverse mentees. In addition to these basic principles, self-awareness of implicit bias and efforts to reduce its effect, as stated in Dr. Greenberg’s talk, is paramount in effective mentoring, especially of non-traditional mentees. In medical school, this may translate to finding a mentor who is willing to meet often and create plans for successfully matching or perhaps engaging in academic research. An unselfish attitude may be a sincere interest in helping achieve one’s potential, regardless of institutional interests or personal/professional gains for the mentor. Finding mentors who engage with diverse mentees does not mean identifying faculty members who represent similar backgrounds, but finding someone who understands distinct challenges faced by students from wide-ranging backgrounds. A single mentor may not be able to espouse all of these characteristics, but finding individuals who can contribute in each area facilitates personal and professional development. What are your strategies for identifying and establishing effective mentee-mentor relationships in your medical training? --- *[![](%5Bsiteurl%5D/wp-content/uploads/2015/03/Shree-Headshot-0061-1-238x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/03/Shree-Headshot-0061-1.jpg)Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and serving as the Chair of the AWS National Medical Student Committee. Shree is passionate about research surrounding patient decision-making and medical education. In her free time, she enjoys blogging for AWS, practicing yoga, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [So you want to be a Surgeon in the United States? 6 Tips to Succeed as an International Medical Graduate (IMG)](https://blog.womensurgeons.org/surgeon-img/) **Published:** September 28, 2017 **Author:** Blog Team **Content:** 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: 1. **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. 2. **Learn the system:** Do everything you can to understand the system you are trying to enter. Surgery is a very fast paced specialty and it is unforgiving to those who are slow to catch up. The goal for foreign medical students intending to start their residency should be to be at the same level as a US 4th year medical students. You are not necessarily behind on the clinical knowledge, however the medical students here know how the system works-right from electronic medical systems to how patient care works. To get upto speed familiarize yourself with the lingo. Observe how everyone behaves in their work environment. It does not matter what country you come from, things are different in the United States. As a trainee, you need to be able to hit the road running when you start. Your preparation will go a long way. 3. **Find a mentor:** A common piece of advice you will get right from the beginning is to “find a mentor who can guide you”. I cannot stress this enough. Your life will become much easier if you find someone who has been in the same place as you recently. It may be a student from your country who has successfully matched into a residency program or an attending who now has a successful setup. This person may not necessarily be the mentor you are looking for, but they will be your first step to finding one. Ask questions, ask for help. Many people want to help and will even go out of their way if you just ask them. This is especially helpful as you start talking to your potential mentors. The surgeons you meet are busy people who wear multiple hats in their careers and personal lives. They are open to mentoring you as long as you prove that you are in this for the long haul. You are also not limited to one person. You should work with several mentors to achieve your goals. Your motivation will show through in your actions. 4. **Value your uniqueness:** One of the worst pieces of advice I received when I first landed in this country was, “make sure you do not tell people what you went through in India. The clinical community will not appreciate it and will think you are not adequately-trained and incompetent”. For the next 3 months I wallowed in doubt and self-hatred. It showed in my interactions with people. I came across as an under-confident individual who was unsure of herself. Very quickly I realized that my approach was wrong. My experiences were unique, and for the most part doctors and surgeons were curious to hear about how I practiced medicine back home. At institutes such as Hopkins and Harvard, I have been working with and learning from the surgeons who share my goal of making the surgical systems better in my country. At every step they want to learn about my experiences to effectively understand the changes that are needed. This experience has taught me it is very important to find a mentor who will appreciate your unique experiences and will encourage you to learn new things while being yourself. 5. **Speak up and take a risk**. While working towards my MPH at Hopkins, I was looking for a job. I had heard that one of my professors was looking for a student to help out with his project. But his requirements for the job were very specific. I didn’t have the technical skills that were needed for the job but I had enrolled in classes to learn them at the very moment the job was being advertised. The fear of not getting the position was crippling and I hesitated even to approach the professor. When one of my friends heard about my dilemma she gave me advice that has completely changed my life. She said to me, “You may not get the job if you ask him, but if you do not ask you will definitely not get the job”. Since then, I have made this my mantra. There have been many moments when I have been turned away, but there have been many more when people have gone out of their way to help me out. All that stood between me and them was my willingness to ask for help. It is by speaking up I have found the best of my mentors. Oh and for those of you still wondering-I did get the job! 6. **Don’t fake it.** Insincere stories, praises, gifts and fake accents? Just…no! Being a foreign medical graduate in the US is tough. Being a foreign medical graduate AND a surgeon in the US is even tougher. So, if you want to be a good resident and a successful surgeon, work hard, reach out for help, be genuine and embrace your uniqueness. --- *Sristi Sharma MD, MPH is a General Surgery Resident at University of Colorado, Denver. She is a previous Paul Farmer Global Surgery Research Associate, Harvard Medical School, a graduate of Johns Hopkins University and a proud alum of Sikkim Manipal University, India. She is an passionate about advocating for global surgery. She was born in the Himalayas and is a Gorkha to the core.* *Twitter: @drsristisharma* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, education, medical students, mentorship, networking, residency, training --- ### [Implicit Bias](https://blog.womensurgeons.org/implicit-bias/) **Published:** October 4, 2017 **Author:** Blog Team **Content:** 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 are still underrepresented in academic medicine. I took the gender-science IAT and was surprised to learn that I had a moderate unconscious preference for women in liberal arts and men in science. I did counter that with a moderate association with male with family and female with career. These results did surprise me, but point out the fact that implicit bias runs deep and it’s not something that we can really control. The times are changing, but how can we get at something unconscious? Is there hope? I think so. Thinking of implicit bias made me think of 2 things that happened to me recently, one of which really fills me with hope for the future. The first was a pretty typical story. I had some time between cases and met a colleague in the café for lunch. She is also a female surgeon (urologist) and we were both in scrubs with our bouffant caps on. As we enjoyed our lunch, an elderly couple came in. The gentleman was in a wheelchair and his wife was trying to navigate between the tables. We came to her assistance clearing the tables out of the way so they could enjoy their lunch. She of course thanked us for our trouble and asked, as so often happens, if we were nurses. “No,” we replied, “we are surgeons here.” This situation is not a new one to anyone, and despite the widespread appearance on social medial of the “I look like a surgeon” campaign, all too often male nurses are confused for physicians and women in medicine are assumed to be nurses. The second situation was a much more surprising one. I was leaving the hospital after a long day in the operating room on the same evening that there was a One Direction concert playing at the stadium. As you might imagine, campus was filled with quite young One Direction fans and my car was parked between the hospital and the stadium. As I left work in my scrubs (please don’t tell anyone—I know I’m not supposed to!), I saw some very cute kids, a boy and a girl who I assumed were siblings, who couldn’t have been more than 5 or 6. They were hurrying to the concert carrying their carefully crafted signs. As I walked up behind them the little boy turned around, saw me in my scrubs, and said to his sister “Look, a surgeon!” That was certainly a first for me! It renewed my faith that these stereotypes can be broken. We are not born with implicit bias. It is learned. And if we can adopt these biases, then I am sure we can employ strategies to address them. The first part is in recognizing the problem figuring out how to overcome our unconscious biases. The other key part is focusing on our young people, who have not yet developed these biases, and help them to keep an open mind. --- *Doreen Agnese, MD is Associate Professor of Clinical Surgery in the Division of Surgical Oncology at The Ohio State University. She was born and raised in New Jersey. She attended Drew University in Madison, NJ, and completed medical school and surgical residency training at Rutgers Medical School in Piscataway/New Brunswick, NJ. Dr. Agnese completed a surgical oncology fellowship and training in clinical cancer genetics at The Ohio State University. Her clinical practices focuses on care of patients with breast cancer and melanoma and those with significant personal or family history of cancer. She cycles in Pelotonia every year to raise money for cancer research.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** education, gender differences, professionalism **Tags:** ILookLikeASurgeon, Women in Surgery, women of color, WomenSurgeons --- ### [The Fastest Growing Cancer in the USA](https://blog.womensurgeons.org/thyroid-cancer/) **Published:** October 12, 2017 **Author:** Blog Team **Content:** *By Anya Costeloe, DO* In honor of thyroid cancer awareness month just wrapping up, I will give a brief overview of the epidemiology, diagnosis and treatment of thyroid cancer. In terms of incidence, thyroid cancer is the fastest increasing cancer in the USA. The [number of cases](https://seer.cancer.gov/statfacts/html/thyro.html) has tripled over the last 30 years. Women have a significantly higher incidence of thyroid cancer than men; about 75% of thyroid cancers occur in women. Other risk factors for thyroid cancer include increasing age, history of radiation exposure (especially if at a young age), iodine deficiency and family history. Approximately 5-10% of thyroid cancers are hereditary. The four main types of thyroid cancer are papillary (60-70% of all thyroid cancers), follicular (10%), medullary (3%) and anaplastic (<1%). [The US Preventative Medicine Task ](https://jamanetwork.com/journals/jama/fullarticle/2625325)force recommended against routine screening for thyroid cancer starting in May 2017. However, physical examination of the neck is still an important part of a yearly wellness exam and any palpable thyroid nodules should be further investigated with a thyroid ultrasound. **How does thyroid cancer present?** Thyroid cancer most commonly presents as a painless, palpable solitary nodule. It is typically asymptomatic but patients may present with a feeling of fullness in the neck, hoarseness, a change in voice quality, difficulty swallowing and tightness in the lower neck. Thyroid stimulating hormone (TSH) level is a sensitive measure of hyperthyroidism or hypothyroidism, however, thyroid malignancy cannot be diagnosed or ruled out based on it. Hyperthyroidism can be caused by a “hot” nodule, meaning it is producing thyroid hormones and usually hot nodules are benign. **How is it diagnosed?** When a patients has a suspicious nodule, the first step in the diagnosis is a fine needle aspiration biopsy (FNA). A pathologist will look at the cells from the FNA to determine whether the nodule is malignant and determine what type of cancer is it. It is not uncommon for the FNA to be inconclusive, which means that cancer can’t be ruled out. Previously, these patients would have a total thyroidectomy. However, in 2011 a new test called the [Afirma Thyroid FNA Analysis](https://www.veracyte.com/our-products/afirma) was created. This test reduces the diagnostic uncertainty in patients with inconclusive FNA results. **How do you treat thyroid cancer?** In almost all types of thyroid cancer except for thyroid lymphoma,the main treatment for is surgery . Usually a thyroidectomy is performed, but in some cases a thyroid lobectomy may be done, in which only half of the thyroid is taken out. If the cancer has spread to any lymph nodes, then a neck dissection will be done to remove those nodes. After the thyroid is removed, patients need to take thyroid hormone replacement tablets because they no longer have the cells that make this hormone. In papillary and follicular types of thyroid cancer, replacement hormones are important because they tell your body that there are sufficient thyroid hormone levels. This prevents the re-growth of cancer cells. Another form of treatment is radioactive iodine, which is taken up by thyroid cells after being swallowed in pill form. It is toxic to the thyroid cells. It is used in papillary and follicular types of cancer and it is usually used in addition to surgery. **What’s the prognosis for patients with thyroid cancer?** The prognosis for different kinds of thyroid cancer varies, however, thyroid cancer has a good prognosis overall, [98.2% survival at 5-years](https://seer.cancer.gov/statfacts/html/thyro.html). - For follicular and papillary cancers age is the most important prognostic factor and patients younger than 45 have a better prognosis. - Age is not as important in medullary cancer. Patients with medullary cancer that has not spread beyond the thyroid have a 95% 10-year survival. - Patients with medullary cancer that has spread to the lymph nodes have a 75% 10-year survival. - Survival decreases dramatically if there are metastases, which is why early detection and treatment are so important. *Check out the following websites for more information about thyroid cancer:*<https://www.thyroid.org/thyroid-cancer><https://www.cancer.gov/types/thyroid/patient/thyroid-treatment-pdq><http://www.thyca.org/how-to-help/awareness/><https://www.veracyte.com/our-products/afirma>*References*Haugen, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. Jan 2016, 26(1): 1-133.*![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Anya-200x300.png)Anya Costeloe, DO is a first year otolaryngology resident at St. John Providence in Michigan. She was born in Russia and immigrated to the US when she was seven years old. Dr. Costeloe received a bachelor’s degree at University of Colorado, Boulder in molecular, cellular and developmental biology and in Spanish. She attended medical school at Western University of Health Sciences College of Osteopathic Medicine in California. Outside of medicine, Dr. Costeloe enjoys traveling, snowboarding, hiking and yoga.* **Categories:** advocacy **Tags:** thyroid, Thyroid Cancer --- ### [When Disaster Strikes](https://blog.womensurgeons.org/when-disaster-strikes/) **Published:** October 15, 2017 **Author:** Blog Team **Content:** *By Dr. Minerva Romero Arenas* [\#HoustonStrong](https://twitter.com/search?q=%23HoustonStrong&src=typd&lang=en) [\#HurricaneIrma](https://twitter.com/search?q=%23HurricaneIrma&src=tyah&lang=en) [\#FuerzaMéxico](https://twitter.com/search?q=%23FuerzaMexico&src=tyah&lang=en) [\#PRstrong](https://twitter.com/search?q=%23PRStrong&src=tyah&lang=en) [\#VegasStrong](https://twitter.com/search?q=%23VegasStrong&src=typd&lang=en) Our world has been in the midst of what seems like an endless series of tragedies. This blog started out as an idea to write about how I was inspired and proud of the goodwill shown by my fellow Houstonians (and other Texans and [neighbors](https://www.nytimes.com/2017/08/30/us/cajun-navy-brings-its-rescue-fleet-to-houstons-flood-zone.html)) in the aftermath of hurricane Harvey. Much like this [love letter](https://www.vogue.com/article/houston-strong-hurricane-harvey). Much like my colleague’s reminder to [look for the helpers](http://www.womensurgeons.org/look-for-the-helpers/) when disaster strikes. However, it quickly became a seemingly insurmountable task. Just as I was trying to pen a few lines, another disaster was brewing in the Atlantic. Then the earthquakes hit México. Another set of hurricanes. Yet another mass shooting. Staying safe. Trying to help. Then trying to keep up with everyone’s safety and figuring out how to help in the aftermath. Donate. Volunteer. Meteorological maps seemed like something that could only have come out of a Hollywood blockbuster. I can’t imagine that I would find it essential to follow @NWSNHC, @SismologicoMX, or @weatherchannel? And if I never have to sleep with an eye open for flash flood warnings or tornado warnings… it may be too soon. To be quite honest, there were a lot of days the past 6 weeks that seem like a blur. Thankfully, I had my work to help keep my mind (and hands) occupied! I am thankful for the teamwork shown at our hospital, where 1 in 3 employees were affected. Colleagues swam to work, camped out for days unable to assess the safety of their own families or homes, and everyone who boldly came back to offer relief as soon as it was reasonable to do so. It was amazing to see the “good neighbor” spirit that was showcased from Houston to the world – an example to be seen again in tragedy after tragedy. On a personal note, I have found a way to turn these events into a positive by taking time to reflect on everything. I have made more time than before to actually consider important questions like, am I okay? Am I putting my best effort to live a meaningful life? How can I be part of the solution? Have I done everything I can to help others? I am thankful for the human spirit and solidarity that continues to shine through disaster after disaster. I am thankful more of our ACS leadership continues to engage in [meaningful discussion about firearm injuries](http://bulletin.facs.org/2017/10/a-consensus-based-approach-to-firearm-injury/). Most of all I am thankful for my colleagues, friends, and \*my family\* – their compassion, determination, and strength is truly inspiring and figuratively and literally helped me “weather the storm.” *A message from the AWS Blog Team: This is the first in a series of blogs from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.* *![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/Romero-Arenas-Minerva-Color-214x300.jpg)Minerva A. Romero Arenas is an Endocrine & General Surgeon joining the faculty at the University of Texas Rio Grande Valley. She completed a fellowship in Oncologic Surgical Endocrinology at the UT MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.* --- **Categories:** advocacy, current events, leadership, professionalism, self-care **Tags:** Food4Thought, injury prevention, stress, Wellness, work ethic --- ### [The Ideal Team Player](https://blog.womensurgeons.org/the-ideal-team-player/) **Published:** October 19, 2017 **Author:** Blog Team **Content:** *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 and building the ideal team. Based on the importance of this topic, we will be hosting a tweetchat on November 27th focused on Leadership and The Ideal Team Player. Three virtues, humility, hunger, and people smarts, are what we look for in those alongside of us taking care of patients, in our office, on a committee and even at home. - Humility: Characterized by lack of excessive ego or concerns about status. Humble team players share credit and emphasize team over self. - Hunger: Defined by self motivation and diligence. Hungry team players are always looking for more things to do and learn. - People Smarts: Depicted by possessing common sense about people. Smart team players are intuitive around the subtleties of group dynamics and the impact of their words and actions. What do we do when we lead a team with members deficient in one, two or maybe all three areas? Should we give up on them? Are we able to teach these qualities or is it nature vs nurture? If we want to be good and effective leaders, we need to try and help our team members before kicking them to the curb. First, we should assess our colleagues to establish where they rank on the three traits. As both team leaders and members, we should do this ourselves. Other key members of the team can (and should) also be included. Next, we meet with the teammate to discuss our findings and develop a game plan. Often when there are deficiencies identified, people are unaware and improvements can be made just by bringing it to their attention. For more challenging situations, we need to set small achievable goals paired with frequent feedback. Finally, after a set period of time, we must reassess the situation and determine if we now have a set of ideal team players. If not, just like in professional sports, we must consider trading members to other teams where they would be a better fit and acquiring new players that fit the project. Most importantly, we also need to turn the microscope on ourselves. Are we good team players? Most of us would like to think we are, but it is definitely worth a few minutes of self-reflection or use of a self-assessment tool in determining if we are indeed good team members. Or just like we did with our own team, we can ask a leader or mentor to evaluate us. After identifying areas to improve, we need to set our own goals based on the three virtues. If humility or people smarts are issues, we need to make a point to listen and learn more about our team members. This allows us to exercise humility but also gain insight into our counterparts as we take the time to hear their opinions. Hunger can be more difficult to achieve without an interest in the project. If this is a deficient area, we must consider alternative methods for achieving the same outcomes with a process that will motivate us. Or we may need to request off of a project in exchange for one which inspires us to do our best work. Ultimately, for the development of a high performing team ALL members should embody the virtues of humility, hunger and people smarts and the process of building our team can be as enlightening as what we accomplish together. Please join the CPC on November 27 at 8pm EST for a tweetchat on “The Ideal Team Player” to discuss your own strategies and experience as a leader and ideal team player. ![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/teamplayer-300x281.jpg) https://www.tablegroup.com/books/ideal-team-player --- **Categories:** career development, education, leadership, mentorship, networking, professionalism, resources, training **Tags:** Ideal Team Player, Teamwork --- ### [Hand ties & Heartbreak: My Experiences as a Puerto Rican Surgical Residency Applicant during Hurricane Maria](https://blog.womensurgeons.org/handties-heartbreak-pr/) **Published:** November 1, 2017 **Author:** Blog Team **Content:** *By Mariela Martinez* News channels have been flooded with images of the devastation caused by hurricane María in Puerto Rico. There are numerous stories about the damages to the health system, infrastructure and economy of the Island. Yet, have you wondered what it was like for Puerto Ricans who experienced this devastating storm? I am a medical student from Puerto Rico and this is my story. **Hurricane Maria made Landfall in Puerto Rico** It was 4:00am and I was wide awake for the fourth day in a row. My mind filled with despair as images of the beautiful island I call home were replaced with destruction. I made another frantic attempt to call them one more time. No success. Calling my loved ones had become a stubborn attempt to restore some normalcy in my life and to re-establish a sense of balance, to pretend this disaster never happened. I was completing surgical “away rotations” in mainland US when on September 20, 2017, my life changed completely. Hurricane Maria, a [category V storm](http://www.nhc.noaa.gov/aboutsshws.php) plowed through Puerto Rico causing massive destruction. The delicate power and communications systems in the Island could not withstand the harsh winds and collapsed. Puerto Rico became silent and dark during the aftermath, and I watched in horror from afar as images of the Island showed my home in a state of destruction. I saw buildings collapse and families lose their homes. Places that were all too familiar to me become unrecognizable. The green scenery that characterizes the *Isla del Encanto* was substituted by murky brown as trees were stripped of their leaves and mud replaced grass. **No communication** In the midst of all this destruction I could not communicate with my loves ones to know if they were safe. I kept calling frantically in an effort to somehow get a response from their phones. When I finally heard their voice in the answering machine, I was transported back to a state of calm and completeness, and for a split second I forgot that it had been more than 4 days without knowing if they were safe. While I am safe in the continental US, the destruction of my home breaks my heart while I watch all that I know be torn to the ground. I watch in horror as supplies begin to dwindle and basic needs such as water become scarce. In the midst of all this uncertainty, all I have from my loved ones is silence… no familiar voices, no reassurance. There is no worse feeling of helplessness than knowing that your loved ones are going through the worse moment in their lives and you can’t help. There is no greater sorrow than the uncertainty of not knowing what is needed by those you love in moments of disaster. **Shifting my focus** As I undergo this painful process of uncertainty for the future of my home and those I love, I suddenly become more aware of others’ misfortunes. Suddenly the cystectomy patient in room 1425 becomes the mother of two who is struggling with depression. I begin to develop a greater sense of what is needed from me as student and I begin to focus my energy on helping patients recuperate. I follow their progress as if they were my own family members, I speak with them as if I was speaking to those I miss dearly back home. They open up their greatest fears and concerns as I also share my own. During the time I spent without being able to confirm the wellbeing of my loved ones I was able to witness hope being restored in the life of a cancer patient who underwent major surgery and the devotion of loved ones during her challenging moments. This terrible experience taught me that sorrow unites people and that we can make a positive impact in the lives of patients despite our own personal struggles. I learned that a good stress relief technique was practicing my hand ties. When I felt the sense of despair taking over me, surgeon hand ties helped my mind focus on a different activity and refocused my energy on the task at hand. I devoted my time and energy to learning as much as I could, to keep my mind occupied. I was having excellent days in the operating room and great interactions with my patients, yet at night I stayed up and cried. My mind was ridden with guilt, with being too tired to answer those late night calls, for being “too busy” to call and hear my family’s voice when I had the chance. The pain of knowing that once I returned home, it wouldn’t be the same beautiful place that I was born and raised in was truly devastating. **The Aftermath of Maria** When I finally heard from my loved ones their words were almost as painful as their silence. “*We love you and we miss you, but don’t come back.*” They went on to tell me how essentials like food and water had become scarce, how they had to spend the whole day in line for gas, how banks were limiting the amount of cash given per family, how overwhelming the darkness was at night and how difficult (if not impossible) it was to fly out of Puerto Rico after the hurricane. I heard that my best friend’s family lost their house after the hurricane, how supermarkets were empty, patients in the critical care unit were dying due to lack of electricity, and all these things seemed surreal to me. It almost felt like I left Puerto Rico in 2017 and was going to return to an island that was now in the 1900s. Maria was called the [fifth strongest storm to hit the United States](https://earthobservatory.nasa.gov/IOTD/view.php?id=91004&linkId=42560784) and its landfall was described by Jeff Weber, a meteorologist from the National Center for Atmospheric Research, “as if a [50-to 60-mile- wide tornado](https://www.vox.com/science-and-health/2017/9/21/16345176/hurricane-maria-2017-puerto-rico-san-juan-meteorology-wind-rain-power) raged across Puerto Rico, like a buzz saw”. If hurricane Maria was rough, the [aftermath](https://www.cnbc.com/2017/09/25/puerto-rico-struggles-with-aftermath-of-hurricane-maria.html) has been even more devastating. There were parts of Puerto Rico that [saw 30 inches of rain in one day](https://www.theatlantic.com/science/archive/2017/10/what-happened-in-puerto-rico-a-timeline-of-hurricane-maria/541956/), the equivalent of the amount Houston received over three days during hurricane Harvey. A total of 48 people died during the storm and the death tolls continue to rise exponentially as power and water continue to dwindle. One month after hurricane Maria, more than [one-third of Puerto Rico households (about one million people) ](http://time.com/4988841/puerto-rico-hurricane-maria-numbers-recovery/)still lack running water. This has caused communities to search for water at local streams and water wells exposing themselves to water-borne diseases such as Leptospirosis. At least [seventy six cases of suspected Leptospirosis ](http://www.cnn.com/2017/10/24/health/leptospirosis-puerto-rico/index.html)and two confirmed deaths have been reported by Dr. Carmen Deseda, state epidemiologist of Puerto Rico. Meanwhile, hospitals are currently operating with back-up generators. Roughly three million Puerto Ricans still lack power because [less than 20% of Puerto Rico’s power grid has been restored](http://time.com/4988841/puerto-rico-hurricane-maria-numbers-recovery/). Photos have surfaced of [surgeons operating with cellphones as flashlights](http://www.slate.com/articles/health_and_science/medical_examiner/2017/10/puerto_rico_is_still_in_crisis.html) due to sudden malfunctions with the hospital generators. Communications continue to be challenging within and outside the Island as [seventy five percent of cell phone antennas are still down](http://time.com/4988841/puerto-rico-hurricane-maria-numbers-recovery/). There are people still living in their [houses without a roof ](https://www.cnbc.com/2017/09/25/puerto-rico-struggles-with-aftermath-of-hurricane-maria.html)fearing that they won’t receive the help they need if they abandon their homes. Physicians have had to discharge patients knowing that they will probably live on the street because they lost all of their belongings. As I learned more and more about the devastation and the aftermath of Maria, my desire to serve has become stronger and deeper. **The Road Ahead** After undergoing some of the worst moments in my life I am convinced that this has made me a stronger person and better surgical residency candidate. Now I know I have the resilience and the dedication to overcome any challenges thrown at me during my surgical training. We have a long road to recovery but this experience has allowed us to remember we have the strength needed to overcome the challenges we are facing as a country. Our hearts are torn for the loss, the devastation, the catastrophe that is going on in our island. We encourage you to help us rebuild our country by supporting local organizations in [Puerto Rico and by joining relief groups](https://www.nytimes.com/2017/09/22/world/americas/hurricane-maria-donate-charity.html). We will never forget that fateful week of September 20, 2017 and it will inevitably change the history of our island forever but I am optimistic that together we can restore the health of the Island. As a medical student trained in Puerto Rico during this critical time in our history, it will likely take time to emotionally recover from this experience, but I am confident that it has helped me become more sensitive, empathic, and more dedicated to my future patients. After all, like my brother said the first time I spoke with him after the hurricane, “después de la tormenta sale el sol (the sun will always come out after the storm).” For now, I keep my head up high and continue carrying my suitcase from one airport to another as I travel for interviews hoping for the light at the end of the tunnel, not only for me but for all of those back home who are suffering. *A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.* ![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/MarielaMartinez_Photo-275x300.jpg) **Categories:** advocacy, current events, medical students, parenting, resources, self-care **Tags:** AWSFood4Thought, HurricaneMaria --- ### [Lessons About Healing After Hurricane Harvey](https://blog.womensurgeons.org/lessons-healing-after-harvey/) **Published:** November 6, 2017 **Author:** Blog Team **Content:** *By Jackie Olive* I hail from the foothills of Los Angeles County, where natural disaster comes in the form of forest fires and droughts. Having lived in Houston for over four years for college and now medical school, I’ve learned that disaster here comes in practically the opposite form. Hurricane Harvey was the first significant tropical storm that I have experienced. Initially, my colleagues and I hadn’t predicted the magnitude of the devastation that our city and neighboring Texas coastline would ultimately face. I remember we first became worried when we heard of friends who were leaving town and grocery stores that had completely empty shelves. We later became shocked when we couldn’t leave our homes because the water levels had dangerously risen and cars had been deserted in the middle of streets. The immediate aftermath of the hurricane was devastating, as homes were destroyed, families relocated, and stress levels rose high. However, the road to recovery appeared bright, as the volunteer response was overwhelming, even to the point of being in excess at times. Temporary shelters at George R. Brown Convention Center and NRG Stadium actually had to send potential volunteers away. The positive energy and generous spirit of the Houston community were palpable, and it was absolutely vital to cultivate such camaraderie in these most trying of circumstances. We may think that the biggest hurdle has been overcome. After all, months have passed since the hurricane wreaked immense physical damage on our city. Yet, I’ve learned to appreciate that healing is a dynamic and lengthy process. Sustainable recovery of this kind requires months, even years. As members of a service-oriented profession like medicine, we anticipate the days when we can discharge our patients after witnessing their labs return to normal or wounds fade. And as surgeons and surgical trainees, we, in particular, feel encouraged when the procedure goes well and we are able to acknowledge the immediate fix and patient’s relief of symptoms. Subsequently, however, what happens after he or she is discharged? Where is home? How will he get there? Who will take care of her if there is a complication? I observe a parallel between post-operative care at some public hospitals and post-Harvey relief efforts: those with fewer resources, including various indigent groups, have a longer road to recovery. Houston’s diversity is one of its strengths, but we must also recognize that it comes with a heightened responsibility to maintain the health of this community. We are continuing to rebuild homes on the ground in Houston, but I would like to offer the opportunity for others to help in a variety of ways. Most charities prefer monetary donations, as these are more flexible to accommodate changing needs. Please visit this [site](http://www.npr.org/sections/thetwo-way/2017/08/28/546745827/looking-to-help-those-affected-by-harvey-here-s-a-list) for specific references to organizations that are supporting the post-Harvey relief effort. I am personally also raising funds for the hurricane relief efforts as I train for the Houston Marathon in January 2018. Any form of support is dearly appreciated and will make a positive long-term impact on our community! Ultimately, while donations of this kind are always welcomed and productive, it is also important to care for one another on a daily basis. It shouldn’t take a tragedy to build compassion and empower generous acts. I’m humbled by what’s already been done to rebuild our amazing city, and I hope that we may all stay engaged in the future stages of healing from Harvey and other natural disasters throughout the world. *A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.* *![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/JackieOlive-259x300.png)Jackie K. Olive is a first-year medical student at Baylor College of Medicine. She graduated from Rice University in May 2017 with degrees in biological sciences and policy studies. Jackie is an aspiring surgeon and researches surgical outcomes and therapies in cardiac regeneration. She is also passionate about healthcare and public health advocacy initiatives.* Twitter: [@JackieKOlive](http://twitter.com/jackiekolive) Blog: [jackiekolive.com](https://seedoteachjackieo.wordpress.com/) --- **Categories:** advocacy, current events, leadership, medical students, mentorship, professionalism, self-care **Tags:** AWSFood4Thought --- ### [AWS 2017: A Few Ships By The Bay](https://blog.womensurgeons.org/aws-2017/) **Published:** November 9, 2017 **Author:** Blog Team **Content:** The AWS Conference on October 21st was a full day with a scientific session, professional development panels, and a broad range of networking opportunities that originated as a simple sign for a breakfast with women surgeons 36 years ago. This year we took mindfulness and self-care from the abstract into practice with a yoga session and run along the San Diego Embarcadero. With the excitement buzzing around the day’s events, I deeply appreciated having a moment to appreciate the sunrise and to sync breaths with other attendees. This past year we accomplished new milestones and new trends on social media. We had the opportunity to realize how much better we truly are together. The conference made broad use of multimedia, including an introductory [video](https://drive.google.com/file/d/0B0o15H78oRnscGNJeXZVd1phVGc/view) by student member Emily Chen. Members’ academic endeavors were highlighted in the [Starr Research forum](https://www.womensurgeons.org/2017-starr-forum/), AWS/AJS Best Manuscript Session, and a presentation from AWS Foundation Fellowship Awardee, Dr. Nasreen Vohra. Projects from a broad range of topics were presented, including “SOX9 in irradiated rectal cancer: a potential marker for tumor regression?, and Evaluation of TRB-N0224”, by Lindsay Nowak, “Improving Outcomes with Minimally Invasive Aortic Valve Replacements” by Anna Olds, and “A Chemically Modified Curcumin for Osteoarthritis Treatment” by Josephine Coury. Likewise, the resident forum featured excellent [projects](%5Bsiteurl%5D/wp-content/uploads/2017/07/Conference_Program.pdf) from a variety of surgical research areas. To complete the scientific session, Dr. Nasreen Vohra spoke about the project she’ll be working on with the [AWSF Ethicon Fellowship](https://www.womensurgeons.org/about-us/aws-foundation-awards/#AWSFfellowship) “Relationship between the transcriptional profile of the sentinel lymph node and outcomes in triple negative breast cancer”. The keynote speaker, Lara Hogan, Vice President of Engineering at Kickstarter, challenged us to “Be a Mentor, Find a Sponsor”. She encouraged all in attendance to critically evaluate how we seek out and provide professional guidance and support. She spoke to the value and crucial need for senior surgeons to sponsor their trainees and more junior surgeons for leadership positions. While the seat women earn at often unfriendly tables, she underscored She highlighted that for surgery to move toward gender equity, there must be increased sponsorship but also self-assertion that women belong at the table based on merit. There is a reason why we are the Association of Women Surgeons, why we are not tied to a country or geographic region. It is because our international collective of members experience the same themes globally as women in medicine. The global panel on women in surgery highlighted the social exclusion, implicit bias, challenges in mentorship, and pathways to promotion we all inevitably encounter in the spectrum of medical training. Featured speakers included: Dr. Suad Abdul (Kuwait), Dr. Ainhoa Costas-Chavarri (Rwanda), Dr. Vikisha Fripp (USA), Dr. Avril Hutch (Ireland), Dr. Kazumi Kawase (Japan), Dr. Sherry Wren (USA), and Dr. Cheng Har Yi (Malaysia). The official conference activities ended with a networking event in the new-for-2017 “Surgeon’s Lounge”- with a ribbon cutting ceremony by AWS President Celeste Hollands. The event offered a unique opportunity for all attendees to relax and network with each other and with our generous corporate sponsors. Following the conclusion of the conference, residents and medical students headed to a local restaurant for a taco-infused mixer. Medical Student and Resident Committee Chairs [Shree Agrawal](https://www.womensurgeons.org/shree-agrawal-2/) and [Andrea Merrill](https://www.womensurgeons.org/andrea-merrill-md/) spoke to the group to welcome all to San Diego and to encourage anyone interested in becoming more involved with AWS to take take the leap in becoming a member and make their mark on AWS. As the day ended and American College of Surgeons Clinical Congress (ACSCC) began, AWS members continued to show the incredible work they are doing in advancing the surgical field, having myriad presentations, panel discussions, and leadership positions given by members. To highlight this and make use of the “Amplification” strategy used by other groups of women, appearances by AWS members were posted with [\#AWSatACS](https://twitter.com/search?q=%23AWSatACS&src=typd). This allowed for an extra level of visibility of the number of women speaking at ACSCC, and as a result, greater visibility both of each individual’s message and of women as leaders in surgery overall. Another trend that began during the Congress was a surgical [\#HeForShe](https://twitter.com/hashtag/heforshe?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Ehashtag)– which started by [Tom Varghese](https://twitter.com/tomvarghesejr?lang=en) joining AWS subsequently followed by many other male surgical colleagues. The AWS conference’s close temporal and spatial relationship to ACSCC provided opportunities to engage with our biggest allies in our plans moving forward. As the Clinical Congress continued on, there were myriad wonderful moments for women in surgery-Dr. Barbara Bass being installed as the 3rd female President of the College, Dr. Eileen Bulger installed as the first female chair of the Committee on Trauma, and Drs. Leigh Neumayer and Diana Farmer installed as the Chairs of the Board of Regents and the Board of Governors, respectively, just to name a few. On the evening of October 23rd, AWS held it’s AWS Foundation awards dinner, recognizing remarkable accomplishments by members at the medical student, resident, and attending level, as well as non-member allies. It was a truly spectacular evening celebrating how far we’ve come as women in surgery and reaffirming our commitment to the AWS mission. The next morning, AWS activities wrapped up with our annual Stryker Networking Breakfast, in honor of the origins of AWS and Dr. Pat Numann’s original breakfast meetings. The morning gave those still in town one last chance to come together in an informal setting and network…or be gently encouraged to take on one more [AWS](%20info@womensurgeons.org) committee project. This was my second ACSCC and my first of what I hope to be many AWS conferences, and for all of the things I imagined the experience would be, somehow it exceeded them. AWS seeks to inspire, encourage and enable women to realize their professional and personal goals. For at least this n=1, I left San Diego inspired by the accomplishments and ongoing work of #Sheroes I was surrounded by, encouraged by friends new and old, and enabled by new opportunities to lead and to pursue a career in this field, so that someday I may have the joy and privilege of being a surgeon. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/Tully-Natalie-150x150.jpg)*Natalie Tully is a 3rd year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. She plans to pursue a career in surgery, and has particular interest in applying her dual degree in Surgical Research, Pediatric, and Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her 4-legged study buddy, Sadie.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [When the Storm Clears: A New Perspective](https://blog.womensurgeons.org/when-the-storm-clears-a-new-perspective/) **Published:** November 19, 2017 **Author:** Blog Team **Content:** For 14 days after Hurricane Maria hit Puerto Rico, I had no way of knowing if my parents were dead or alive. *They’re fine*, I told myself. Our house is not in a flood-prone area. The roof and walls are solid, and won’t blow away. *I’m sure they’re ok,* I replied to the rising tide of emails, texts, and phone calls from concerned friends and colleagues – *there’s just no lines of communication*. *I’m sure they’re fine, they have to be,* I reassured myself, resting my hand on my second trimester and growing belly. I grew up in Puerto Rico. Every summer my mother would unearth the [free NOAA hurricane tracking map](http://www.nhc.noaa.gov/tracking_charts.shtml) and place it on the bulletin board we had hanging in our kitchen. She’d catch the coordinates on TV or the radio and my brother and I would fight over who got to place the pushpins on the map. Pin by pin, every morning we followed the hurricane’s trajectory, and then went about our school day. As surgeons, we live with similar daily acknowledgements of looming potential complications. We learn anatomical variations and control for risk factors, following the steps that will hopefully see the twin storms of morbidity and mortality veer off course. [When I last heard my mother’s voice](https://www.womensurgeons.org/handties-heartbreak-pr/), we were going down a checklist: *batteries?* Check. *Electronics charged?* Check. *Radio? Canned food? Water?* Check. *Candles?* *Mama? Mama?* For the next two weeks the only things I could pretend to control were the news and my Facebook feed. It was devastating to watch: 3.4 million Americans living on the island [without water, electricity, and telecommunications](https://www.vox.com/science-and-health/2017/9/26/16365994/hurricane-maria-2017-puerto-rico-san-juan-humanitarian-disaster-electricty-fuel-flights-facts). The images of massive destruction and flooding filtering through unable to fully capture the scale of this humanitarian disaster. [Even after 40 days,](https://www.nytimes.com/2017/10/24/us/hurricane-maria-puerto-rico-coping.html) the statistics are mind-numbing: less than 30% of all people have electricity and ~70% have access to drinking water. More heartbreaking, however, is the reality down at the individual level – stories of families that are still without food, of people washing their clothes in and drinking from polluted water sources, and in hospitals, surgeries compromised as the power goes out in the OR. On Facebook, there was a new-found sense of community: my Puerto Rican friends and I ranted over government officials placing politics above human lives, commiserated over losses, and celebrated whenever any of us had good news. Finally, it was my turn: 14 days after we’d lost contact, my mother called to say she was in the hospital. A small inflamed area had morphed into an angry abscess, necessitating an I&D and IV antibiotics. “It’s like being at a spa,” she proclaimed, ecstatic, “they have light here and clean water and wifi…that’s how I was able to call you.” She had been seriously considering, she also revealed, traveling to Colombia. *Colombia? Para que?* Well, she explained, I’ve always wanted to go – and your father and I, we have worked so hard, we did all these things to prepare for the hurricane, for the worst, and still we suffered all these unforeseen problems*. Y sabes que?* I think we need to put in just as much effort into living. *A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email* [*blog@womensurgeons.org*](mailto:blog@womensurgeons.org)*.* --- *![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/AinhoaCostas-e1518714003194-138x150.jpg)Dr. Ainhoa Costas Chavarri is a General Surgeon and Hand Surgeon who does full-time academic #globalsurgery. She has been living and working in Rwanda for the past four and half years, teaching Rwandan surgery residents and medical students as part of the Human Resources for Health Program. Her focus is on surgical oncology, especially breast and gastric cancer. She enjoys foreign films, modern art, poetry and now more than ever, the beaches of her home island of Puerto Rico. You can follow her on twitter: [@ainhoac63](http://twitter.com/@ainhoac63)* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Lessons from the Michigan Women’s Surgery Collaborative (MWSC) Women in Surgery Leadership Development Conference](https://blog.womensurgeons.org/mwsc/) **Published:** December 14, 2017 **Author:** Blog Team **Content:** Growing up I never idolized traditional movie stars and celebrities; my heroes came in the form of Hillary Clinton, Mia Hamm and Kerri Strug, women who through hard work persevered and succeeded in their careers. As I matured and shifted into the field of surgery, new heroes emerged. These heroes were women who had paved the way for me to be where I am now, women who took the first steps to demonstrate that women deserve leadership roles in surgery, women such as Dr. Julie Freischlag. I have to admit, I was a bit “star struck” during my residency interview with her at Johns Hopkins. So when I saw the all-star lineup of Drs. Julie Freischlag, Rebecca Minter, Melina Kibbe, Amalia Cochran, Aurora Pryor, Heena Santry, Julie Ann Sosa, and Sandra Wong a the Women in Surgery Leadership Development Conference run by the Michigan Women’s Surgery Collaborative (MWSC) I knew I had to attend. This is a very exciting time to be a woman in surgery. While things are still far from where they need to be, many events have laid the groundwork for tangible future change. Twitter and social media campaigns such as [\#ILookLikeASurgeon](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=0ahUKEwjDqMvGlojYAhVFxoMKHR6vD-IQgFQIKA&url=https%3A%2F%2Ftwitter.com%2Fhashtag%2Filooklikeasurgeon%3Fref_src%3Dtwsrc%255Egoogle%257Ctwcamp%255Eserp%257Ctwgr%255Ehashtag&usg=AOvVaw3_w38ZFf2TFg23ENhJ1ZND), [\#NYerORCoverChallenge](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=0ahUKEwjrjtbQlojYAhVq4IMKHWSzDhIQgFQIKA&url=https%3A%2F%2Ftwitter.com%2Fhashtag%2Fnyerorcoverchallenge%3Fref_src%3Dtwsrc%255Egoogle%257Ctwcamp%255Eserp%257Ctwgr%255Ehashtag&usg=AOvVaw3onEOUiX9EkFeH6ZuFBN-I) and [\#HeforShe](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=0ahUKEwjn1c_ilojYAhWh8oMKHZ0vBJcQgFQIKA&url=https%3A%2F%2Ftwitter.com%2Fhashtag%2Fheforshe%3Fref_src%3Dtwsrc%255Egoogle%257Ctwcamp%255Eserp%257Ctwgr%255Ehashtag&usg=AOvVaw00GuWUX32Gdq2yxnQCgt3l) have brought much awareness to implicit gender bias in surgery, which is certainly the first step. This was further highlighted in the captivating [AAS Presidential Address](https://academicsurgicalcongress.org/aas-2017-president-address-caprice-greenberg-md-mph/) by Caprice Greenberg in February 2017. In 2014, there were 4 women chairs of surgery in the United States. Today, there are 20. The gender pay gap has become a more prominent issue with a joint American College of Surgeons and AWS [Statement](https://www.facs.org/about-acs/statements/101-gender-salary-equity) on gender salary equity this past summer. With all of these changes occurring so rapidly in the past few years, we seem to be approaching a “tipping point” to achieve equality for women in surgery. One way to get past the tipping point is to teach women surgeons, early on, the skills they need to become leaders. This was the goal of the MWSC’s Women in Surgery Leadership Development Conference held early November in below-freezing temperatures in Michigan. The MWSC was founded in 2016 by Drs. Dana Telem, Dawn Coleman, Janet Dombrowski, Erika Newman, Jennifer Waljee, and Gurjit Sandhu. As Dr. Telem explains it, “It started as a conversation between us \[…\] about how we never really felt gender until we started approaching mid-career shifts. We wanted to address the issue of advancement of women in surgery since it is not just a pipeline issue.The goal is to figure out how we promote each other and how we develop the essential skills we need to get to the next step and \[..\] how do we disseminate this knowledge to others.” It wasn’t just about addressing issues facing women in surgery. It was born out of the idea of creating leadership. Conference registration was free for attendees and completely funded by the University of Michigan Department of Surgery (incredible visible support [\#HeforShe](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=0ahUKEwjn1c_ilojYAhWh8oMKHZ0vBJcQgFQIKA&url=https%3A%2F%2Ftwitter.com%2Fhashtag%2Fheforshe%3Fref_src%3Dtwsrc%255Egoogle%257Ctwcamp%255Eserp%257Ctwgr%255Ehashtag&usg=AOvVaw00GuWUX32Gdq2yxnQCgt3l)!!!). All section heads also sponsored travel scholarships. I was lucky to win one of these scholarships via a Twitter contest. The first day of the 2-day conference focused on self-improvement with a session entitled “From Surviving to Thriving”. We learned tips for resilience from Dr. Dawn Coleman who talked about both individual and system-level strategies for preventing burnout. Dr. Erika Newman shared personal stories to exemplify how to maintain interpersonal relationships, both personal and professional, to help your career soar. Next we moved on to personal wellness advices from Dr. Amalia Cochran. “Be strategic in your yes’s and definitive in your no’s; every yes is a no to something else in your life,” she advised. Surgical education scientist Dr. Gurjit Sandhu talked about pushing yourself out of your comfort zones to find your zone of proximal development and grow. Finally, women-in-surgery champion, Dr. Justin Dimick, gave a talk on amplification and sponsorship. The first night ended with a networking reception where I got to meet some of my surgery “heroes”! The next day focused on giving us tools to become an effective leader. All participants were asked to fill out behavior surveys prior to the conference to analyze our personal and leadership styles and our conflict management styles. Executive coach, Janet Dombrowski , then used the results of our surveys to give two interactive talks about how to harness our leadership and conflict management styles to be effective leaders. Her advice can be summed up by tweeter extraordinaire, Dr. Susan Pitt: ![](http://blog.womensurgeons.org/wp-content/uploads/2017/12/sqp1-300x290.jpg) ![](http://blog.womensurgeons.org/wp-content/uploads/2017/12/sqp2-300x285.jpg) Interspersed with Janet’s talks, we heard from women trailblazers in surgery who have succeeded in becoming leaders in the field: Drs. Jennifer Waljee, Aurora Pryor, Julie Ann Sosa, Rebecca Minter, Sandra Wong, Melina Kibbe, Heena Santry, Rebecca Minter, Julie Freischlag, and Amalia Cochran. The list reads like a “who’s who” of women in surgery! Each shared their personal hard-earned advice for advancing in surgery, ranging from topics of negotiation and conflict-management to navigating career challenges. The talks can best be summed up with the amazing [visual abstracts](https://drive.google.com/file/d/1U5ySYhaI5vwy6M3dW5sqGwg-AJNASHAP/view?usp=sharing) created (on the spot!) by University of Michigan resident, Chelsea Harris. ![](http://blog.womensurgeons.org/wp-content/uploads/2017/12/freishlag-300x173.jpg) ![](http://blog.womensurgeons.org/wp-content/uploads/2025/06/jasosa-300x175.jpg) While there have been many conferences dedicated to women in surgery, many have focused mostly on defining the issues that women face (such as gender bias, pay gaps, etc.). This conference was unique as its goal was to give junior women in surgery the tools to overcome these problems in order to achieve leadership roles. To say I left the conference inspired would be an understatement. There was so much positive energy buzzing throughout the entire conference. Everyone was genuinely supportive of each other and dedicated to the mission of advancing women in surgery. The strategies we learned for communication and conflict management are tools I have already started incorporating into my everyday life as a chief resident. The rest, I will keep in my mind as I start searching for my first job in the next few years. And in the meantime, I will remain in awe of the opportunity to meet some of my real-life heroes! [@JFreischlag](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiC6bnUmojYAhUr_4MKHTs1DjkQFggrMAA&url=https%3A%2F%2Ftwitter.com%2Fjfreischlag%3Flang%3Den&usg=AOvVaw3TvzNmv1SFift5M1p42pMU) [@MinterWiscSurg](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwj0ldDimojYAhUl9YMKHZdsDSkQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Fminterwiscsurg%3Flang%3Den&usg=AOvVaw3mtJwT-wWvjTT3w5JsRNX1) [@kibbemr](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjOgu7qmojYAhVo5oMKHaeUDCQQ6F4IKTAA&url=https%3A%2F%2Ftwitter.com%2Fkibbemr%3Fref_src%3Dtwsrc%255Egoogle%257Ctwcamp%255Eserp%257Ctwgr%255Eauthor&usg=AOvVaw2bJlZY77X1wvbmh_cUezbK) [@AmaliaCochranMD](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiyweDxmojYAhXM34MKHUS6D-UQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Famaliacochranmd%3Flang%3Den&usg=AOvVaw2CyD778SPgzc9xbz1nJsS4) [@AuroraPryor](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwicg5b5mojYAhUk6oMKHZ54C7YQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Faurorapryor%3Flang%3Den&usg=AOvVaw02m-rqQbm9yCz6sKvISS8_) [@heenastat](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwi9vcz_mojYAhWo6YMKHQbZASAQFggwMAE&url=https%3A%2F%2Ftwitter.com%2Fheenastat%3Flang%3Den&usg=AOvVaw3FlhPOMh6XQpphH-rQKHws) [@Jasosamd](https://twitter.com/jasosamd?lang=en) [@sandralwong](https://twitter.com/sandralwong?lang=en) [@MIchiganWSC](https://twitter.com/michiganwsc?lang=ar) [@DanaTelem](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwikyp3Gm4jYAhVE7oMKHbPSB8EQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Fdanatelem%3Flang%3Den&usg=AOvVaw3zTsYuxjLnVYNYAzXQ1K5i) [@ColemanDM\_vasc](https://twitter.com/colemandm_vasc) [@JCDAdvisors](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjqvoL6m4jYAhUK9YMKHZvJAaQQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Fjcdadvisors%3Flang%3Den&usg=AOvVaw3DWZf1KcL8zxN9EYr9RHXM) (Janet Dombrowski) [@EAdamsNewmanMD](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwi2tvmGnIjYAhVl1oMKHdfLAJsQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Feadamsnewmanmd%3Flang%3Den&usg=AOvVaw1trm-ziZp39ACNrEsw-4oH) [@waljeejenn](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiPqpmPnIjYAhXkxYMKHYeUCtEQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Fwaljeejenn%3Flang%3Den&usg=AOvVaw3YoWsaTu66oUSdztSJ2vQP) [@GSandhuSurgEd](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiK-7SbnIjYAhXM7YMKHTUNAxUQFggpMAA&url=https%3A%2F%2Ftwitter.com%2Fgsandhusurged%3Flang%3Den&usg=AOvVaw0Ru_3A6GFez_SUlbMSnWti) [@CAHarrisMD](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiasbfevYjYAhUFzoMKHYLgBS4QFggpMAA&url=https%3A%2F%2Ftwitter.com%2Fcaharrismd&usg=AOvVaw0zuvl0dBoxQv_Ob8Vf4Kjo) [@JDimick1](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjCnajvvYjYAhWKwYMKHbKkB5sQ6F4IKTAA&url=https%3A%2F%2Ftwitter.com%2Fjdimick1%3Fref_src%3Dtwsrc%255Egoogle%257Ctwcamp%255Eserp%257Ctwgr%255Eauthor&usg=AOvVaw1xkDTsPZaH_cOdBiJqwdTu) --- **Categories:** Uncategorized --- ### [A New Year - A New You?](https://blog.womensurgeons.org/new-you/) **Published:** January 11, 2018 **Author:** Blog Team **Content:** Every year close to half of Americans make New Year’s Resolutions. They commit to losing weight, eating healthy, exercising more, going to bed earlier, and on and on. Many of these types of resolutions revolve around improving health and wellness. As surgeons and as women, we surely benefit from these types of resolutions. But we should also ask ourselves, what resolutions can I make at work? So you’re probably asking, “What do you mean, ‘work resolutions’?” In my mind, work resolutions can come in many forms. Some work resolutions may lead to improved wellness by creating time for activities outside of work, like exercise or travel. Perhaps you could master a few shortcuts within the electronic health record to speed up orders and documentation. Maybe you could fully plan your week to take advantage of small periods of down time, thereby improving productivity. Or maybe you could finally master email management, so email doesn’t take over your life (ughh!). Your work resolutions could also involve incorporating small efforts towards wellness into your daily activities that may increase your productivity. Could you meditate at lunch? Take the stairs every day? Or do push-ups and wall sits between cases? You could download an app with a short workout that you do once or twice a day between meetings. I’ve been enjoying my morning and afternoon 7-minute high-intensity interval training (HIIT) workouts so far. Can you say, “burpees and mountain climbers?” Other types of work resolutions may involve patient care. You could resolve to improve patient communication or education by making any number of interventions, such as adding a new pamphlet in clinic or learning the teach back technique. You could even make a concerted effort to listen better. I know I’m frequently distracted by noises or other thoughts when I’m in clinic. Alternatively, you could resolve to trying make each of your patients laugh on rounds. After all, laughter is the best medicine. Work resolutions could also involve learning or research. Perhaps you would like to read more or write more manuscripts. Maybe you would like to review articles in a timelier manner. Hopefully, by now, you can see the endless possibilities for resolutions in all facets of work and are encouraged to try incorporating one or several into your new year. We all know that not all resolutions are successful, but we can help ourselves out. According to experts in the field, to help make your resolutions a reality, consider using these strategies: - Make the resolution specific (i.e., ‘I will finish my charts within 24 hours of clinic,’ instead of ‘I will finish my charting sooner.’) - Make the resolution realistic (i.e., Don’t resolve to read one surgical text each month when you only read one textbook last year.) - Have a strategy and a metric for evaluating your success (i.e., Keep track of every time your patient laughs on rounds and check your progress on Fridays.) Ultimately, the resolution also needs to be important to you, your work, and/or your patients. Sharing the resolution with a friend or colleague may also keep you accountable and contribute to your success. In this New Year, whether you pursue a resolution or not, consider incorporating strategies for building resilience and satisfaction at work, improving your wellness, and decreasing your risk for burnout. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2018/01/pitt-150x150.jpg) *Susan C. Pitt, MD, MPHS is an Assistant Professor of Endocrine Surgery at the University of Wisconsin. In addition to her clinical practice, Dr. Pitt is a health services researcher focused on reducing unnecessary surgical care and overtreatment. While she always strives to eat healthier, exercise more, and go to sleep earlier, Dr. Pitt’s “work resolutions” involve implementing strategies to make more space for her research and better manage her energy. She is looking forward to the challenge.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Parental Leave for Surgeons](https://blog.womensurgeons.org/parental-leave-for-surgeons/) **Published:** February 18, 2018 **Author:** Blog Team **Content:** By Virginia R. Litle MD and Mara B. Antonoff MD **Our upcoming Tweet Chat will take place on Monday February 26th, 8 pm ET.** “Take your full maternity leave,” writes Myriam Curet in [Navigating Your Surgical Career: The AWS Guide to Success](http://www.womensurgeons.org/page/Publications). In what other fields do women have to be reminded to take what they are owed? Why would we not take full maternity leave? What is full maternity leave? It depends where you live. In Canada, Scandinavia or Japan that could be one year. In the U.S. it is a minimum of six to eight weeks of paid leave. Why is there such variability? There is a spectrum of cultural differences about optimal duration for parental bonding, about time to initiate external childcare, about availability of extended family support. This is not unique to surgeons. What is unique to surgeons is that there are multiple internal and external pressures to return to work after the birth or adoption of a child. Internal pressures include our strong work ethic, which is both a friend (*that’s how we got to where we are*) and a foe (*that’s why we don’t always take what we’re legally allotted*). Our commitment to our patients and our clinical partners represent another way in which our strong work ethic can act against us. We do however allow others to take care of our patients all the time: when not on call, when on vacation, when attending society meetings. It’s a slight sign of hubris to think that only we can take care of our own patients or only we are qualified to manage a particular clinical problem. Another factor creating pressure unique to surgeons include a concern that we will be unable to maintain our operative skill set if we take too much time off. That maximum time one should be away from practice likely varies between types of surgical specialties but it is universally accepted that we must practice to practice well. Nonetheless, this concern might be lessened by recognizing that a considerable number of surgical residents take breaks in their clinical activity to pursue research and routinely matriculate back into the operating room after being away for sometimes several years. Early return to work after maternity leave may also reflect the perception (and probable reality in many instances) that if you snooze you lose. You won’t be selected for a departmental committee or position because of a misperceived lack of availability or interest. These concerns certainly apply to other fields and are also a societal challenge, as highlighted in the book “Lean In” (and the topic of a [previous AWS blog](http://blog.womensurgeons.org/women/lean-in-book-review-discussion-part-two/)). There is a gray zone between these described internal pressures and the external pressures which we also face. We experience self-derived internal commitment to our partners, but they can provide external “peer” pressure to share the workload with call and clinic. There are concrete external pressures unique to surgery, which include potential loss of referrals, loss of block time in the operating room, and the inability to achieve clinical volume goals to maintain a salary or bonus potential. *Policy and Reality: Time to Align What We Should Take with What We Do Take* These are institutional challenges that can be changed by institutional leaders. However, in order to establish a new norm, leaders need to hear from surgical voices. It is not that there isn’t a consensus on the minimum amount of time mothers should take; [the AWS has a policy on maternity leav](https://womensurgeons.site-ym.com/page/ResouceCenter#Family)e for residents and faculty. The issue, rather, is that there is a lack of procedural consensus: some surgeons only take two – four weeks. Why is there variability? Because women likely only take what they were reasonably able or allowed to take. Ultimately, it’s very personal, as we describe in our own experiences below. Personal experiences vary but emotions surrounding the circumstances are similar. At the time of parental leave, we both felt that any leave (ours or that of our partners) was a gift, albeit an opaque gift that passed in a blur. There was pressure to get back to work, the feeling of not wanting to let anyone down, or to be forgotten during leave, can be very daunting. However, with hindsight, it’s interesting to look back and wonder if, perhaps, it would have been healthier to have more time, and if there might have been ways to make the transitions back to work with growing families easier. Between the two of us, we’ve taken six maternity leaves, ranging in duration from 4 to 12 weeks. Some of the shortest leaves were after complicated deliveries with preterm infants being sent to daycare, to enable us to get back to work as soon as possible. Some of our leaves were partially paid at anywhere from 50-70%, and some were unpaid. Some call obligations during leave were passed on to our partners, while others were “made up” beforehand. Our spouses took between 3 days-2 weeks off of work to support us, again, some of it fully paid and some unpaid. There clearly exists a broad range of parental leave policies based on whether one is in training or out in practice, based on one’s employer, and based on one’s practice. *Importance of Parental Leave for Surgeons* So why is this topic important to discuss? We truly believe that surgeons need to be supported both in and out of the operating room. Surgeons may commit vast periods of their lives to their training and to the care of patients, but they also have lives of their own, which are unfortunately all too often neglected. We want to support surgeons as members of their families, recognizing that it will also benefit our patients. Happy, healthy surgeons perform better on the job. Moreover, there are a number of touted benefits to having a surgeon who is also a parent, acknowledging that some of the traits (both acquired and innate) that help one succeed as a parent are also incredibly valuable in the field of medicine. In addition, recognizing that women remain under-represented in a number of surgical specialties, we want to encourage the best and brightest trainees to enter our fields. To do so, we must show them support, modeling for them that parenthood and successful careers in surgery are not mutually exclusive. This aspect is not only important for encouraging women to enter surgical fields; it’s also quite relevant for men who desire to have families. Lastly, this topic of parental leave merits our attention as part of a broader scope of piqued interest in surgeon well-being. It is time to change the dialogue regarding the issues of physician health, family engagement, and clinician happiness, conceding that these areas have been long neglected. *Monday’s TweetChat* We look forward to addressing many of the issues highlighted here in our upcoming Tweet Chat. During this chat, we hope to provide an environment in which those who have taken parental leave can share their experiences, and those who are curious about what it might be like to have children as a surgeon or surgeon-in-training can get their questions answered. We are engaging in this critical discussion in order to identify some of the barriers to surgeons successfully taking work leave and subsequently re-entering the workforce, with the ultimate goal of eventually creating a culture that nurtures and enables those surgeons desiring to grow their families. **Our upcoming Tweet Chat will take place on Monday February 26th, 8 pm ET.** Who should participate? We are eager to have a well-rounded discussion, with opinions from surgeons who have had children and those who hope to do so, those who have covered for partners on leave, and those who may have taken parental leave in other fields of practice. This conversation pertains to women and to men, to those who have labored and delivered, as well as to those who adopt, use a surrogate, and have same-sex partners who bear children. There are so many voices relevant to this chat, and we hope to hear from you all! We look forward to welcoming you to the first AWS-WTS join Tweet Chat, covering the topic of Parental Leave for Surgeons. We plan to cover the following topics: 1. ***What are the obstacles to surgeons taking parental leave?*** There may be a number of challenges, related to one’s skills, one’s clinical practice, and one’s finances, not to mention our own concerns—valid or not—regarding perceptions of others. 2. ***What are the unique aspects of surgical practice that may make parental leave different compared to other medical specialties?*** The way that our clinics and inpatient services work, not to mention our call schedules, are somewhat different than those of clinicians in non-surgical fields. All of these issues can impact the ease of taking a parental leave. 3. ***What are the goals of parental leave?*** Here we will consider the needs of mothers after delivery, as well as those of babies, fathers, adoptive parents, and all others involved in bringing a new baby into the world. 4. ***How can we best support re-entry after parental leave?*** This is an important issue for all surgeons coming back to work, and there may be unique caveats after complicated deliveries or pre-term deliveries, which we know happen more frequently following surgeons’ pregnancies. **The joint TweetChat with @WomenInThoracic will be 2/26/18 at 8 pm ET. To participate, be sure to follow the moderator for this chat, @maraantonoff, and to tag all of your tweets with the hashtag #AWSChat.** --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/02/antonoff-e1518993173334.jpg) Dr. Mara Antonoff is a mother of 4 and Assistant Professor in Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center. She is the Website Editor and Social Media Director for Women in Thoracic Surgery. At MD Anderson, Dr. Antonoff is also the Associate Program Director for the Thoracic Surgery Training Program. Her twitter handle is @MaraAntonoff.* ![](http://blog.womensurgeons.org/wp-content/uploads/2018/02/Litle-Virginia-184x184.jpg) *Dr. Virginia Litle is a mother of 3 and Professor of Surgery at Boston University School of Medicine. She is a Past President of the Women in Thoracic Surgery. At BU, Dr. Litle holds the titles of Director of the Center of Minimally Invasive Esophageal Therapies; Director of the Barrett’s Esophageal Program; and Director of Thoracic Surgery Clinical Research. Her twitter handle is @WtsPres* **Categories:** Uncategorized --- ### [In the Moment](https://blog.womensurgeons.org/in-the-moment/) **Published:** March 1, 2018 **Author:** Blog Team **Content:** I had reached a point when I knew that something had to give. I could no longer listen to the constant “would haves/could haves/should haves” and “when I become a\_\_\_\_\_\_, when I reach\_\_\_\_\_\_, when I no longer \_\_\_\_\_\_, when I finish\_\_\_\_\_\_” that screamed in my mind drowning out the potential to fully participate in life at hand. The opportunities to fully engage and experience the here and now were increasingly lost. ***“Live the actual moment. Only this actual moment is life.” – Thích Nhất Hạnh*** Serendipitously, I was invited to spend three days immersed in a mind-body facilitator course with a group of multidisciplinary professionals from several colleges at the University of Cincinnati. The training, lodging at a beautiful rural hotel in Amish country Ohio, and gourmet meals were free (supported by grant funding). The catch? Commit to facilitating at least one 9 week Mind-Body Skills course [annually](https://www.med.uc.edu/integrative/student-faculty-wellness/mind-body-skills) for professional students. After serious consideration and discussion with my husband regarding my desire to attend and participate in what I anticipated to be an incredibly meaningful activity and my sincere concerns about making yet another long term commitment, I decided to attend. ***“Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Jon Kabat Zinn*** The course started on a Thursday evening and I had a full day of cases lines up before I could depart. My first patient that morning had undergone neoadjuvant chemotherapy for locally advanced breast cancer with a good clinical response. However, when I saw her in pre-op she stated that felt the mass in her breast growing back. After examining her, I was also concerned. After finishing my cases, I went to her room before leaving to tell her that the sentinel lymph nodes biopsied had been positive, multiple of them were positive. Yes, even after the chemotherapy. I had completed her axillary lymph node dissection. She understood and expressed obvious fear in her eyes but also a deep strength and courage to move forward regardless of the outcome. I left the hospital feeling the weight of the day on my shoulders. ***“That’s life: starting over, one breath at a time.” – Sharon Salzberg*** I was the last to arrive at the hotel about an away a little late. My navigation application mixed up the directions only about a mile from the hotel leading me on a short detour through the rolling hills of the countryside. The hotel owner saw me pull up knowing that I was the late straggler. He pointed me to the restaurant where the others were already preparing for dinner while he kindly carried my bags to my room. As I walked into dinner and was introduced to the others with whom I would sit and work for the next three days, I found myself more than a little unsure of why I had come. I was glad to see three other women physicians at the table. But I didn’t know how I could relate to the pharmacists, architects, basic science professors, nurses, and lawyers also in attendance. And I was quite sure that I was the only one ([the imposter](http://www.nejm.org/doi/full/10.1056/NEJMp1702010)) who had come to the course because I was struggling to find peace in my own life. ***“Don’t believe everything you think. Thoughts are just that – thoughts.” – Allan Lokos*** As the weekend passed, I realized that most of us were attending for similar reasons. We, the professors, needed these skills just as much as our students in order to manage stress and foster well-being. We spent the weekend practicing meditation, guided imagery, journaling, biofeedback, and yoga among other mind-body approaches. While I was far from an expert in the practices at the end of the weekend, I knew that I had gained skills that would allow me to provide our students with exposure to the tools. Medical training and practice is so incredibly difficult and often the external rewards aren’t enough to sustain us. We must be able to find the internal satisfaction and peace to continue moving forward. ***“You can’t stop the waves, but you can learn to surf.” – Jon Kabat-Zinn*** Fast forward one year, and I readily admit I continue to struggle with making mind-body practices habitual. However, I use the [Calm](https://www.calm.com/) app on a somewhat regular basis and my children do as well (at least, they like to listen to the sleep stories). I try to journal, but fall short of my goals here also. My most mindful activity is running, and am committed to [participating](https://www.amazon.com/s/ref=nb_sb_ss_i_2_18?url=search-alias%3Dstripbooks&field-keywords=run+for+your+life+mindful+running+for+a+happy+life&sprefix=run+for+your+life+%2Cstripbooks%2C148&crid=O81QJYE29XED) nearly daily. And despite my shortcomings, I have noticed a change in myself, in my ability to be present, to experience without judging. ***“Take a walk outside – it will serve you far more than pacing around in your mind.”*** ***― Rasheed Ogunlaru*** I am now facilitating my second Mind-Body skills class with another group of ten medical and pharmacy students. The reasons why they chose to participate in the course are similar. They are struggling with the time commitment, the disengagement from families, friends, or themselves, wondering if it’s all “worth it”. They worry about future challenges, regret mistakes made in the past, and mull over potential lost opportunities both behind them and yet to come. They feel that they rarely experience the moment. Then in our two hours together as we practice our skills for the session, they notice their minds and breathing slow down. And during our time together the stresses fade and we are fully engaged in the present. ***“In today’s rush, we all think too much — seek too much — want too much —*** ***and forget about the joy of just being.” – Eckhart Tolle*** Yesterday I was informed that my patient is dying. I had last seen her a few months ago when I diagnosed her recurrence only weeks after she completed radiation therapy. The cancer progressed rapidly, unwilling to compromise with efforts to slow it down. She and her family now understood that time was short and they were ready to move to hospice. I sat for a few moments at her bedside and prayed for her and for her family to experience peace. I hugged her brother and asked him to give my regards to their mother who had finally gone home to rest. I stepped into the hallway and tearfully thanked her nurse for the compassionate care she was providing. No expectations, no judgement, only awareness and acceptance for what it is. ***“Everything that has a beginning has an ending. Make your peace with that and all will be well.” – Jack Kornfield*** Listening to: [Angel Love by Aeoliah](https://www.youtube.com/watch?v=AhWNUdlOh8o) --- *![](http://blog.womensurgeons.org/wp-content/uploads/2018/02/jlewis-300x196.jpg)Jaime D. Lewis practices breast surgery at the University of Cincinnati College of Medicine in Cincinnati, Ohio where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. In addition to taking her of her beloved patients, Dr. Lewis is committed to improving the wellness and professional development opportunities of the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys running, cooking, and time with her family.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [What Does it Mean to be an Advocate? Reflections from the ACS Leadership and Advocacy Summit 2025](https://blog.womensurgeons.org/what-does-it-mean-to-be-an-advocate-reflections-from-the-acs-leadership-and-advocacy-summit-2025-2/) **Published:** June 6, 2025 **Author:** Blog Team **Content:** By Shannon F.R. Small, MD, FACS The word “advocate” can mean a variety of things, especially within the medical field. Most commonly, patients are asked to designate their own advocate, someone to speak for them. Hospitals may employ dedicated advocates to aid patients in navigating the complex medical system. Medical staff may ask for representatives to serve as advocates towards hospital leadership. I consider myself an advocate for my patients, for the students and residents I mentor, and for my colleagues. Recently, I discovered a new dimension of advocacy when I attended my first American College of Surgeons’ Leadership and Advocacy Summit. This annual meeting brings together medical students, residents, and attending surgeons from across the country for sessions focused on leadership development and health policy. The Summit culminates in a visit to Capitol Hill, where each state delegation meets with congressional representatives to discuss key legislative priorities supported by the American College of Surgeons’ Professional Political Action Committee (ACSPA-SurgeonsPAC). This year, these priorities included increased funding for the **CDC’s Injury and Violence Prevention Program**, reauthorization of the **Dr. Lorna Breen Health Care Provider Protection Act**—which has already supported over 250,000 healthcare workers through mental health initiatives—improvements in cancer care and access, and support for addressing neglected surgical conditions. For the first time since becoming a Fellow of the American College of Surgeons, I felt that the organization was actively advocating *for* me and *on behalf of* causes I care deeply about. The experience was eye-opening and reaffirmed the importance of organized advocacy in medicine. I would strongly encourage young surgeons, residents, and medical students to attend this annual event at least once, if possible, as it offers a powerful perspective on how we, as surgeons, can influence meaningful change beyond the bedside on behalf of ourselves and our patients. In today’s rapidly shifting landscape, the mission to provide equitable, compassionate care to *all* patients—regardless of their nationality, ethnicity, sexual orientation, gender identity, or beliefs—has increasingly been misconstrued or dismissed as “woke” ideology. Attending this Summit reaffirmed that the American College of Surgeons, as the largest surgical organization in the world, remains committed to its core values and continues to advocate for *all* patients. Words like “diversity”, “inclusion,” and “equity” are **not** political buzzwords; they are the foundational values on which the ACS was built, and they remain central to its mission today. These principles are not only ethical – they are essential to delivering high-quality, patient-centered care. We are currently living through uncertain and often troubling times. I choose to believe in unity over division – that advocacy for the rights and dignity of all people will bring us closer together. That science and evidence-based practice will continue to guide our decisions. That the Hippocratic Oath – the vow to “not permit considerations of race, religion, nationality, party, politics, or social standing to intervene between my duty and my patient” will prevail. I remain hopeful and I remain steadfast in my belief in the power of advocacy. *To learn more about ACSPA-SurgeonsPAC, please visit*[ *https://www.surgeonspac.org/about-surgeonspac/*](https://www.surgeonspac.org/about-surgeonspac/) *My blog reflects my own opinions. I do not speak as a representative of the ACS, ACSPA-SurgeonsPAC, AWS, or Yale University. My statements are entirely my own.* ![](https://blog.womensurgeons.org/wp-content/uploads/2025/06/2025-01-10-Shannon-Small--scaled.jpg) **Dr. Shannon F.R. Small** is an Assistant Professor of Surgery at the Yale School of Medicine and a Trauma/Critical Care/Acute Care Surgeon in the Department of Surgery at Lawrence + Memorial Hospital. She is passionate about delivering compassionate, equitable care guided by the golden rule and finds deep meaning in supporting patients and families during critical moments. A wife, mother, and mentor, Dr. Small is committed to inclusive excellence in medicine and improving access to care. Her research focuses on patient outcomes and issues facing minorities and women. **Categories:** advocacy, awareness, diversity and inclusion, leadership, resources, Underrepresented in medicine, URiM, women **Tags:** advocacy, ILookLikeASurgeon --- ### [Scalpels and Strings: Similarities between the Orchestra and the OR](https://blog.womensurgeons.org/scalpels-and-strings-similarities-between-the-orchestra-and-the-or/) **Published:** June 4, 2025 **Author:** Blog Team **Content:** **By Dr. Sruti Cheruvu** Some of the earliest lessons I learned that helped prepare me to be a surgeon came from the orchestra. I played violin and viola in my school and regional orchestras throughout high school. Some of my fondest memories are of working on Mozart, Tchaikovsky, and Shostakovich – learning my pieces inside and out through hours of practice. It was often grueling but deeply gratifying. I made friends from across sections, including fellow string players and wind and brass musicians. We would share parts and swap cues to see how our different parts fit together. I often leaned over to ask the concertmaster or the cellist sitting next to me if I could look at their score to understand how my part fit into the bigger picture. If our director gave a cue for the clarinets before our entrance, I would write that part into my music. These small connections turned out to be essential – they taught me to listen, anticipate, and collaborate. Sometimes, we rehearsed in small groups outside of class to run difficult sections and help each other improve. The more we worked together, the more I understood everyone’s role in the orchestra – and how the roles could shift between who played the melody and who carried support. Our playing became sharper, and we lifted each other to bring our pieces to life together. Years later, as I began medical school and took my first steps in clinical training, I was surprised to see how, in many ways, the orchestra and the operating room echo each other. Surgeons require the same intense practice and preparation as musicians. Preparing for cases is much like preparing for a concerto – it requires intense preparation, including studying the details, and being able to anticipate any potential complications that may arise. Just as musicians must know their pieces inside and out, I have learned to do the same with my patients on the floors and in the OR. Furthermore, patient care is always a team effort – whether it involves working with other residents and attendings, nurses, or anesthesiologists. There are seldom solo acts in surgery. From the time morning sign-out begins, communication is key. We learn the “what” and “why” of everyone’s roles and responsibilities so that we can all work together. In the operating room, we collaborate with anesthesiologists and surgeons from various subspecialties. Although I may not have a firsthand understanding of everyone’s specific responsibilities, I need to know enough to collaborate seamlessly as part of a team. Though my relationship with music has shifted from the orchestra to smaller spaces, the lessons I have learned from music remain central to how I approach learning surgery. Both music and surgery demand discipline, dedication, and, ultimately, collaboration. In the case of surgery, it all serves one goal: to provide better patient care, which we continually strive to do better every day. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/06/svruti.png) **Sruti Cheruvu** is an incoming preliminary PGY-1 surgical resident at Geisinger Medical Center. She is a recent graduate of Rutgers Robert Wood Johnson Medical School and received her MD in May of 2025. @scheruvu75 (for Twitter) and @sruti.cheruvu (for Instagram) **Categories:** medical students, practice, reflection, residency, self-care, training, URiM, women **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [A Surgical Resident’s Journey to Authenticity](https://blog.womensurgeons.org/a-surgical-residents-journey-to-authenticity/) **Published:** June 1, 2025 **Author:** Blog Team **Content:** **By Dr. Steven Xie** *This is a special edition blog post presented in partnership with the* [*Association of Out Surgeons and Allies*](https://www.outsurgeons.org/) *in celebration of Pride Month.* Every member of the LGBTQ+ community has a unique story and journey in coming out. Often, coming out isn’t a single moment, but a continuous process of choosing to live authentically, sometimes in spaces that are not built or ready for it. Growing up at the intersection of being Asian American and gay, I internalized the idea that my identity was something to hide–something I should be ashamed of. There was a deep fear of disappointing my family, whose ideology likely stemmed from the cultural silence around queerness, and their fear of what being gay meant for my future. I immersed myself in academics, kept my head buried in books, hoping academic success would protect me from shame. I viewed excellence as a shield, that if I could be “good enough”, being gay wouldn’t be so bad. However, deep down, I was slowly disconnecting from myself. The longer I stayed closeted, the further I drifted away from joy. It wasn’t until matriculating into medical school when I was surrounded by new communities, open-minded people, and perspectives, that I started to reconsider what living authentically could look like. I started to come out in small, but intentional ways. Each time, and with proper support and acceptance, the fear that had crippled me for more than two decades began to fade little by little. The more I was embraced, the more I flourished and succeeded in school. I felt lighter, freer, and for the first time, overwhelmingly happy and proud of where I was in life. Then came residency applications. I had fallen in love with general surgery throughout my time as a third-year medical student. Everything pointed me towards the specialty, except I had hesitations: would I be accepted as a gay man in a field that can be rigid and unwelcoming? Would programs view me differently? I looked for LGBTQ+ representation within surgery and found little at the time. I struggled to seek mentorship from LGBTQ+ surgeons. Despite the hesitations, I did not want to go back into hiding. After all the progress I’d made, hiding this important aspect of my identity during the application cycle felt like betraying myself. Inevitably, I made the decision to come out again, this time in my personal statement. I shared this truth because it was so critical to my being and how I envisioned myself shaping and influencing the future of academic surgery. I shared it knowing that it may close some doors, but I trusted it would leave other doors open. I wanted to match at an institution that embraced all of me. Today, I’m proud to be a surgical resident at a program that has supported me fully – as an aspiring endocrine surgeon and as a gay Asian American. Being out has not only made me a better surgical resident, but it’s also allowed me to be the mentor to other LGBTQ+ students I once needed. I’ve now had the privilege of guiding other students who, like me, questioned their space within medicine and surgery. Everyone’s path is different. Not everyone can or should feel pressured to come out during their application cycle. But I encourage all LGBTQ+ applicants to ask programs the tough questions regarding DEI efforts, LGBTQ+ representation, and support systems that are in place. I dream of a future where these questions don’t need to be asked, where medical students do not have to wonder if they will be viewed differently because of sexual orientation. Until then, visibility matters. Representation matters. Pride matters. Your truth matters, however and whenever you decide to share it. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/dsc_3400.jpg) **About the Author** Dr. Xie is a 4th year general surgery resident at the University of Michigan. He is passionate about the recruitment and retention of LGBTQ+ medical students in general surgery and providing mentorship to LGBTQ+ medical students. Academically, he is interested in pursuing endocrine surgery fellowship and is researching the impact of limited English proficiency on patient outcomes and experiences during surgical encounters. **Categories:** awareness, career development, diversity and inclusion, reflection, residency, Underrepresented in medicine, URiM --- ### [Two Worlds, One Marriage: The Reality of Being an Asian Female Doctor with a Non-Medical Husband](https://blog.womensurgeons.org/two-worlds-one-marriage-the-reality-of-being-an-asian-female-doctor-with-a-non-medical-husband/) **Published:** May 30, 2025 **Author:** Blog Team **Content:** By Ching Man Carmen Tong, DO *This is a special edition blog post presented in partnership with the* [*Society of Asian Academic Surgeons*](https://www.asiansurgeon.org/) *in celebration of Asian American and Pacific Islander Heritage (AAPI) Month.* When I was asked to contribute an article for the AWS blog during AAPI month, I thought to myself– what possible musings can I offer to the readers that could be enlightening and potentially useful? Then I realized– I’m not only an Asian woman, and a doctor, but I’m an Asian female doctor married to a white male who works outside the medical profession. It is an experience full of nuance, complexity, and mutual understanding. To understand our journey and marriage, it is important for me to describe just how different my husband, Brett, and I are. Not only do we come from different cultural backgrounds – I’m Chinese and he’s Irish and Spanish – but we also have very different personalities. Growing up in America as a first-generation immigrant in a conservative Asian household, I’ve been taught to keep my head down and be polite, which has made me more introverted and reserved (with arguably no survival skills if there is an apocalypse). Brett, however, is charismatic and outgoing, with the distinct ability to carry on any conversation during dinner, from the intricacies of beer brewing to how sump pumps work. In the hospital, despite my credentials and training, I often have to confront the usual assumptions: that I’m a nurse, that I’m too young to be the attending, etc. My husband, on the other hand, who works for a major quick-service restaurant chain, moves through the world with a very different experience. He doesn’t get second-guessed in meetings or asked to “prove” his role. He certainly doesn’t have to respond to statements like, “Your English is better than I thought.” We have many differences, both personally and professionally, but we learned early on to focus on common ground. In a world that often tries to draw lines between identities, we choose instead to celebrate where they intersect. I’d like to share with you 5 key points we have learned to make our unique relationship work: 1. **Open and frequent communication, when we’re both emotionally and mentally available.** A strong relationship, especially one that spans cultural and professional worlds, requires intentional work. We found that airing our frustrations before they become resentments is essential. We also found that having difficult conversations when I’m tired from work or being on call is unproductive and usually leads to defensive attitudes and anger. Now, we “schedule” these conversations – yes, it sounds cold and calculated – but by allowing for emotional and mental readiness, these “share and repair” sessions let us ask questions and listen with generosity and grace. Whether it’s about career choices, family obligations, or how we divide household responsibilities, we talk early and often. 2. **Set boundaries early on.** This sounds like a no-brainer, but I come from a background where expectations run deep and saying “no” feels unnatural. However, cultural and emotional boundaries matter. This applies to my family and my work. My husband has helped me understand that boundaries aren’t walls; they’re tools for protecting our time, energy, and connection. Conversely, I’ve taught him that sometimes, honoring family or pursuing a work passion means going the extra mile – even when it’s temporarily inconvenient. 3. **Find creative solutions for work-life integration.** Work-life integration is a constant negotiation. My job bleeds into nights, weekends, and holidays. His world is more structured—9 to 5, predictable deadlines, and paid time off. Our rhythms are different, but we’ve learned to sync where it matters. We plan with intention, guard our time, and extend grace when one of us is overwhelmed. We have a shared calendar, and I adjust my clinic and OR to end when his day ends. I often schedule telehealth visits on days when he works from home, so that I can conduct those visits in our home office and have additional face time with each other. 4. **When it comes to spending time together, quality over quantity.** As doctors, we are incredibly attached to our phones and computers: answering the unending number of messages from our patients, reviewing lab results, and prepping for the next day. When it’s after hours and I’m not on call, I now intentionally put my phone away in a different room to be more present and focused on our time together. Before bed, we spend time talking about our day instead of doomscrolling through social media. We have found that 30 minutes of intentional, focused time together provides deeper connections than 3 hours of distracted interaction. 5. **Seek a supportive culture at work**. I am exceedingly lucky that my department chair and division chief are both Asian, with the added bonus that my division chief is also female and married to a non-doctor. When I asked for options to adjust my clinical responsibilities to better align with my husband’s ever-changing work travel schedule, instead of asking me to conform to the existing work structure, they helped me brainstorm creative solutions and connected me with colleagues within and outside my institution to provide different perspectives. Having an open dialogue with my superiors provided me with psychological safety to address brewing concerns before they led to resentment and burnout. Now, as I step into the next phase of my career as a mid-career faculty member, I’m feeling more energized and eager to focus on my academic passions while ensuring that my home life continues to thrive. For me, the differences in profession and culture are actually a reprieve from preconceived societal norms. We can forge our own path and create our own customs and way of life according to what’s important for us. Culturally, we’ve learned to honor our differences while finding harmony in our shared values. Together, we’ve created a fusion of traditions and practices that reflect both our cultures. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/TONG-prof-photo-1-scaled.jpg) ***Carmen Tong, DO,*** *is a pediatric urologist and director of pediatric robotic surgery at Children’s of Alabama. Dr. Tong did her urology residency at Einstein Healthcare Network in Philadelphia and completed her fellowship in pediatric urology at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville. Dr. Tong’s clinical practice and research is dedicated to sexual and reproductive health in individuals with spina bifida, kidney stones, renal trauma and minimally invasive surgery in children. She is a member of the Urology Care Foundation Technology & Publications Committee, The American Academy of Pediatrics Surgical Advisory Panel Rural Health Workgroup and the American College of Surgeons NSQIP-Pediatric Specialty Advisory Council for Pediatric Urology. She is the chair of the American Urological Association (AUA) Young Urologists Committee and a section editor of the AUA Core Curriculum.* **Categories:** family life, guest blog, self-care, URiM, women **Tags:** AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Finding Joy in Food and Culture During Residency](https://blog.womensurgeons.org/finding-joy-in-food-and-culture-during-residency/) **Published:** May 28, 2025 **Author:** Blog Team **Content:** By Dr. Victoria Prete *This is a special edition blog post presented in partnership with the Society of Asian Academic Surgeons in celebration of Asian American and Pacific Islander Heritage Month.* ‘Let food be thy medicine and medicine be thy food’ is a sentiment commonly attributed to Hippocrates and often preached in medicine, but rarely followed by residents and fellows. The stress of training, combined with limited time and access to quality food, makes prioritizing delicious meals difficult if not impossible. Like most first- and second-generation Asian-Americans, much of my life revolves around sharing food as part of a community. While I sacrifice much of myself to training, I hold onto my love of food and this link to my heritage. Food plays a pivotal role in Asian culture, serving as more than sustenance for the body; food provides a means of replenishing the soul. Throughout my life, my mother showed support using the primary love language of many Asian parents, food. She, like many immigrants, overcame the barriers of war and poverty. She experienced malnutrition and food scarcity that, because of her, I will never know. My mother immigrated to the US following mass genocide in her country. She never completed high school and often expressed guilt at being unable to help me with schoolwork and applications. Through food, she demonstrates unyielding support. Starting residency, I moved to Mississippi and now live over 1,000 miles away from my family. Food provides a conduit for caring, traversing distance and time. My mother visits every few months; each time she brings 10 pounds of dried beef and any food unavailable locally. She once brought 20 mangos because “they were the perfect level of sweetness.” During her visits, she hosts a giant hot-pot night for me and my co-residents. She takes immense pride in her culinary skills, spending over a day preparing each meal. At these dinners, she sits integral to my success and happiness; In a room full of doctors teaching them how to enjoy hot pot, she listens as we discuss medicine, life, and our daily struggles. My mother taught me to cook at a young age, and I attempt to emulate her in my daily life. However, relocating for residency significantly changed my culinary landscape. Previously, I lived in places with a robust Asian population. For training, I moved to a city with an Asian population of <1%. Accustomed to a plethora of Asian restaurants and stores, it feels foreign to have a singular option for the foods I consider comfort cuisine. Despite these limitations, some of my best memories from residency involve sharing homemade dishes with colleagues. I take pleasure in making sweets for special occasions or planning potlucks for the holidays. To celebrate the end of a rotation, I spent two days making Bánh Xèo because my team asked to experience Khmer food. For Chinese New Year, my all-female night team came over to try dim sum for the first time. In these moments that lie at the intersection of food and culture, I feel immeasurable support and acceptance. Resident wellness is often discussed but remains elusive. The ACGME emphasizes initiatives that support psychological, emotional, and physical well-being. For me, eating and sharing classic Asian cuisine encompasses each aspect of wellness. Surgical residency requires commitment and sacrifice. Therefore, identifying elements that remind you of yourself outside of medicine remains paramount to wellness, whether that be food, music, art, sports, or anything in between. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/headshot.jpg) **About the Author: Dr. Victoria Prete** Victoria Prete is a fourth-year General Surgery Resident at the University of Mississippi Medical Center in Jackson, MS. Victoria is originally from Massachusetts and attended the University of Massachusetts Medical School. She is a proud first-generation Asian-American and comes from a long line of amazing cooks. She learned to cook from two of the most influential women in her life, her mother and her aunt. These two resilient women scrounged for herbs and spices during the Khmer Rouge to help feed themselves and the other prisoners in the forced labor camp where they were held captive. Through food, they emphasized the importance of physical nourishment, as well as caring for others. **Categories:** diversity and inclusion, family life, Fellows, guest blog, reflection, residency, self-care, URiM, women **Tags:** AWSBlog, residency, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Training Your Subconscious Mind in Residency](https://blog.womensurgeons.org/training-your-subconscious-mind-in-residency/) **Published:** May 27, 2025 **Author:** Blog Team **Content:** **By Dr. Anupama Singh** *This is a special edition blog post presented in partnership with the Society of Asian Academic Surgeons in celebration of Asian American and Pacific Islander Heritage Month.* Training my subconscious mind and building mental fortitude is a vital skill I learned at the start of my surgical residency. It molded me into a calmer person capable of adapting to any challenging situation and instilled in me a growth mindset that benefits me in all areas of my life, not just in residency. I wasn’t always like this. In high school, my friends and family labeled me as a “high-functioning anxious person.” I remember being unbothered by it. I still got the good grades and it didn’t matter if these achievements were the result of sleepless nights and spiraling, anxious thoughts that were trying to predict every outcome. That mentality was challenged when I started surgical residency, especially when I became a PGY-2. I had to find ways to ground myself during stressful moments and transform self-doubt into self-confidence as I grew into a senior role. Reading is an important hobby of mine, and I fortunately came across *The Power of Now* by Eckhart Tolle and *Atomic Habits* by James Clear. That’s when I started to learn about how our mind operates and the science behind positivity and visualization. See, we don’t usually have a hard time grasping things that we can assess using our five senses. We are limited by our conscious mind. The subconscious mind, however, operates in the background and influences all aspects of who we are and the decisions we make. For many of us, it’s an enigma. Although they might seem like two separate entities, both the conscious and the subconscious mind work in harmony. Our conscious daily habits contribute to how our subconscious starts to operate, which in turn influences our future decisions. This synergy is also why the top performers of the world emphasize the importance of positive self-talk. How you speak to yourself greatly influences your background operating system and becomes ingrained into your psyche. Visualization, self-reflection, mindfulness, and meditation are all powerful, effective tools that work together and have been used for generations to train the mind and reduce stress. They apply to all of us and transcend religion, job occupation, socioeconomic status, etc. There are a myriad of ways I engage in these practices in residency. For instance, I visualize each step of a procedure starting from patient positioning to undraping. This is like athletes visualizing their winning moment or like speakers rehearsing a talk. This technique is incredibly effective because the same regions of our brain are activated and the same neural connections are formed when we visualize versus when we actually perform a task, thus boosting self-confidence and decreasing the stress that is often incited by the “unknown.” At the end of my rotations, I self-reflect via journaling to identify areas of weaknesses, which ensures my continued growth and provides a framework for obtaining specific feedback. I also keep track of how I have improved upon each weakness. Residency can be very overwhelming, and at times it can make us feel like our performance is constantly suboptimal. So, keeping a list and reflecting on those small successes can be very motivating! I view mindfulness and meditation as the encompassing umbrella tools that can strengthen visualization and self-reflection practices. Meditation improves my focus and awareness, which in turn allows me to be more present on a daily basis (a.k.a. mindfulness). Even five minutes of daily practice is enough to reap the benefits. Since residency started, I have spent every morning before work enjoying my coffee in silence. This small moment of peace tempers any negative emotions that arise throughout the day. These are simply some tools that have contributed significantly to my growth as a doctor and person overall and I encourage everyone to try these practices at least once. When incorporated into our lives as habits rather than occasional practices, these tools have the power to transform our minds and strengthen our potential. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/Singh_Image.jpg) **About the Author: Dr. Anupama Singh** I am a third-year general surgery resident at the University of Massachusetts Memorial Medical Center in Worcester, MA and will be applying for a thoracic surgery fellowship this upcoming year. My interests in medicine include mentorship, clinical outcomes research (particularly regarding optimizing outcomes for elderly patients) and improving care for vulnerable populations. Outside of medicine, I enjoy reading books of all genres, creating artwork, volunteering via Boston Cares, hiking with my dog and spending time with my loved ones. Twitter: @anupama\_singh1 **Categories:** awareness, career development, health, professionalism, reflection, residency, self-care, training, URiM, women --- ### [As a female surgeon, can I actually have a child-and when?](https://blog.womensurgeons.org/as-a-female-surgeon-can-i-actually-have-a-child-and-when/) **Published:** May 21, 2025 **Author:** Blog Team **Content:** **by Dr. Deepa Patel** *This is a special edition blog post presented in partnership with the Society of Asian Academic Surgeons in celebration of Asian American and Pacific Islander Heritage Month. Female surgeons serving a dual role as mothers are no longer a rarity, as over one third of us have a child during residency. Despite these statistics, I continue to hear that many female medical students avoid careers in surgery as they think that pursuing such a career would hinder their ability to have children. Hearing these concerns surprises me. I have always considered my career a top priority but did know that at some point, I also wanted children. I never considered these goals in opposition. As a young attending about to have her first child within 2 years of finishing a colorectal fellowship, I have found that balancing pregnancy with a career is possible-but needs to be approached with some consideration. ***So when is the best time to have a child?*** Advanced maternal age (considered 35 years or older) has been associated with infertility, cesarean delivery (longer recovery time), low birth-weight infants, and neonatal intensive care unit admission. Compared to residents, however, attendings have significantly more financial resources and more flexibility to shape their daily schedules (but still must worry about lost referrals and discontinuity of patient care during maternity leave). Residents, while younger (and often not of advanced maternal age), do not have quite this level of freedom. However, the American Board of Surgery (ABS) does allow 6 weeks off per year in either of the last 2 years of residency without prior approval. Residents can also take an additional 2 weeks off during the first 3 years of residency to accommodate medical conditions including pregnancy. In addition, options exist to extend chief year through the end of August or to extend 5 years of clinical residency to 6, although this requires prior approval from the ABS. I did see multiple residents have children during elective research years taken in the middle of residency. Others considered saving eggs during their residency/fellowship years, although I personally did not as my insurance at the time did not cover assisted fertility procedures. ***Is pregnancy difficult?*** Each woman’s experience is wildly different. Nobody will be able to predict your individual experience-including you. Prior to pregnancy, I never had a serious medical condition that precluded or limited my ability to work. I subsequently think that I did not take concerns associated with pregnancy seriously. While it has been quite possible to work through the majority of my pregnancy, I did personally find abdominal cramping and round ligament syndrome to impede adequate sleep for multiple months (warm packs and chamomile tea just prior to bedtime were tremendously helpful for me). Other women report the following: first trimester-morning sickness, nausea, emesis, and fatigue; second trimester-more frequent urination, increased reflux, round ligament pain, lower extremity cramps; third trimester-constipation, edema, back pain, insomnia, and carpal tunnel syndrome. These symptoms sound minor but can actually be quite debilitating when they happen to a severe extent on a daily basis (and especially if you have not frequently experienced them before). ***Practical Considerations*** I do have to admit that I only considered certain aspects of advanced planning associated with pregnancy more recently. I only point out the following because I did not immediately consider them when I was planning my pregnancy: – When will I stop taking general surgery call? (1 month prior to my expected due date? A few days prior to my expected due date?) How long will I stop taking general surgery call for? (1 month after birth? 3 months?) – When will I stop booking cases? My OB-Gyn suggested stopping “longer” cases after the 37th gestational week. – How will I maintain a specific number of relative value units? How important is earning a productivity bonus for this year (if that is part of your pay/job structure/contract)? If the bonus is important, do I want to increase/double up my call shifts when I return to work? – Who will manage my patients while I am away? – How will I regain referrals when I come back? – Should I have negotiated a maternity leave into my contract when initially signing? – Will-and how-will I monitor my cumulative radiation exposure during pregnancy? (Most state guidelines consider exposures under 50 mrem/month to be a safe dose, which corresponds to 100-1,000 fluoroscopic examinations of 5 minutes each.) As a woman, it is your right to have a child/children if you so choose. Nobody should make you feel otherwise. However, on a practical note, it is also important to notify your partners early of the above considerations and to express gratitude for their flexibility and willingness to cover you. Remember to eat, stay hydrated, relax between cases, sit in the OR (if possible), and have others lift patients if needed. Despite the additional considerations involved, pregnancy has been an incredibly rewarding experience. I am incredibly excited to have my first child within the next 2 to 3 weeks. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/dr-patel.png) **About the Author** Deepa Patel is currently a general surgeon in Chicago, Illinois. After graduating from medical school in Newark, New Jersey, she completed her General Surgery residency in Mobile, Alabama as well as a Minimally Invasive Colorectal Fellowship in Houston, Texas. **Categories:** awareness, education, family life, gender differences, health, parenting, reflection, resources, URiM, women --- ### [Dancing Into Destiny: The Unexpected Paths That Shape Us](https://blog.womensurgeons.org/dancing-into-destiny-the-unexpected-paths-that-shape-us/) **Published:** May 20, 2025 **Author:** Blog Team **Content:** **By Dr. Chi Zhang** ***This is a special edition blog post presented in partnership with the Society of Asian Academic Surgeons in celebration of Asian American and Pacific Islander Heritage Month.*** I was objectively terrible at dancing. My limbs felt too long, and my footwork betrayed even the simplest beat. My parents quickly unenrolled me from ballet. This was only partially because of my pleading, but they were probably relieved to no longer suffer second-hand embarrassment. While I thought my dancing career was over at the ripe age of 7, my dancing inabilities returned to haunt me when I was invited to be a part of my friend’s quinceañera. Out of obligation, and perhaps some curiosity, I accepted, unaware that this would be a turning point in my life. Unaware yet that a similar transformation would lead me to a life in the operating room. At rehearsal, as music pulsed through the room and vibrant dresses twirled, I stood stiffly in a corner, hoping to become one with the wall. A few brave souls tried the choreography with me, but I stumbled more than I stepped. Fueled by quiet determination, a bruised ego, and a need to succeed, I signed up for ballroom dance lessons. I expected mild improvement. I did not expect to fall in love. The first few lessons were awkward, but over time, the music transformed from noise to a melodic partner, and I grew more confident. It did not come easily. I worked hard, practiced for hours, studied choreography, and failed repeatedly. The quinceañera went off without a hitch, and surprisingly, I found myself joining the competitive ballroom team once I enrolled in college. Somehow, this previous source of shame became a source of strength. My partner and I went on to compete at multiple competitions throughout the years, we won (a lot!!), and we even became coaches within our club. Life tends to rhyme, and my journey through medical school unfolded in much the same way. I never planned to become a surgeon. I entered medical school thinking I would go into internal medicine. Surgery seemed too intense, too detached, too unlike me. At the beginning of my surgery rotation, I was just trying to survive. But the more I was immersed, the more I was proven wrong – there was never enough time in the day to explore the artistry within the science, and the coordination between the teams was far from detached. The elegant flow of operations felt strangely like a dance – one I decided I had to learn. The parallels between learning to dance and learning to operate surprised me. Both demanded focus, endurance, precision, and creativity. Both required me to push past discomfort and embarrassment, to embrace steep learning curves, and to trust that effort could transform ability. Just as I would once stand awkwardly on a dance floor, I now stood at the operating table—calm, ready, and confident in the rhythm of my hands. Neither of these passions were part of the plan. But life has a way of revealing hidden callings. The key was being open-minded—saying yes even when I felt unqualified, curious even when I felt afraid. Passion does not come as a thunderbolt. It arrives in a quiet decision to show up, again and again, until it begins to feel like home. I’ve learned that opportunity disguises itself as discomfort. By leaning into those moments, strife becomes strength. In the operating room or on the dance floor, I found my rhythm. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/red-ballroom-dress.jpg) **About the Author: Dr. Chi Zhang** I am a current PGY 4 at the Mayo Clinic in Arizona and future minimally invasive surgeon. I received my undergraduate degree from the University of Virginia and my medical degree from Geisel School of Medicine at Dartmouth. I am an assistant professor in health services research, with focus on outcomes and quality of life studies. In my retirement from competitive ballroom dancing, I have channeled my creativity to baking, filling the resident lounge with homemade breads, pastries, and desserts. **Categories:** health, medical students, reflection, self-care, women --- ### [Challenges Females Face in Medicine](https://blog.womensurgeons.org/challenges-females-face-in-medicine/) **Published:** May 7, 2025 **Author:** Blog Team **Content:** By Camellia Russell Biological sex is an unchangeable aspect of who we are, yet it continues to shape the opportunities we encounter throughout life. Despite progress, many cultures and societies still espouse old-fashioned beliefs about gender roles, especially when it comes to leadership. In particular, women are often expected to prioritize home life over career ambitions, with roles like “leader” or “surgeon” still largely reserved for men in many fields. Medicine, in particular, has needed to evolve faster. While women now make up approximately 20-25% of surgeons in the United States, this percentage still needs to be equitable. Women surgeons often face daily challenges, from juggling demanding work schedules with motherhood and family to battling deep-seated biases. Also, many patients may look at female surgeons as less capable or skilled than their male counterparts due to long-standing gender stereotypes. According to research from the University of Kansas, women in academic medicine are less likely to be promoted than their male peers. Women are 24% less likely than men to gain promotion to associate professor, 23% less apt to achieve full professor status, and 54% less likely to become department chairs. These statistics are a stark reminder that women must strive harder than men to prove themselves capable. Furthermore, even with that extra effort, promotion is still being determined for many females in academics. Additionally, male colleagues may further hinder women’s advancement by subverting their authority and disputing their decisions. According to psychologists, this systematic bias can bring about what is known as “learned helplessness.” When women keep running up against barriers and see no tangible progress after all their hard work, they will despair, eventually either dropping out of their careers or scaling back their efforts to match the kind of minimal performance that produces results. This culture of discrimination not only affects the women fighting to succeed today but also sends a damaging message to the younger generation. Without female role models in leadership positions, young women find it harder to visualize themselves holding down those posts, and the cycle of non representation persists. Such deeply ingrained bias not only affects career advancement but can also subject women to lasting psychological damage. The stereotypes and expectations imposed on women give rise to discrimination, harassment, and a pervasive erosion of trust within the profession. Hence, current female medicine leaders are responsible for breaking free from these constraints. They can create a more inclusive and empowering environment by changing public perceptions, mentoring the next generation, and challenging outdated norms. As Steve Jobs said, “The people who are crazy enough to think they can change the world are the ones who do.” Women in medicine should keep dreaming big, never give up, and redefine what is impossible. **Resources** Kimber P. Richter, Ph.D., MPH, K., Clark, M.S, L., Wick, Ph.D, J. A., Cruvinel, Ph.D, E., Durham, Ph.D, D., Shaw, M.D, P., Shih, M.D, G. H., Befort, Ph.D, C. A., & Simari, M.D., R. D. (2020, November 25). Women in academic medicine remain less likely to be promoted, according to a KU medical center study in Nejm. University of Kansas Medical Center. https://www.kumc.edu/about/news/news-archive/nejm-women.html ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/Russell.png) **Bio: Camellia Russell** is a passionate medical student and emerging leader in podiatric medicine, known for her holistic, interdisciplinary approach to care. She received her bachelor’s degree from UCLA, and she is currently pursuing her doctorate degree at Temple University’s College of Podiatric Medicine. Camellia has presented nationally recognized research on diabetic foot care and actively leads community health initiatives focused on education and prevention. Fluent in three languages and deeply committed to equity, she aims to transform care delivery for underserved populations through innovation, advocacy, and compassionate leadership. Instagram: @camelliainmed **Categories:** advocacy, awareness, gender differences, URiM, women --- ### [Breaking Barriers: Women in Cardiac Surgery](https://blog.womensurgeons.org/breaking-barriers-women-in-cardiac-surgery/) **Published:** May 1, 2025 **Author:** Blog Team **Content:** This is a special edition blog post presented in partnership with the [Society of Asian Academic Surgeons](https://www.asiansurgeon.org/) in celebration of Asian American and Pacific Islander Heritage Month. By Dr. Hina Inam ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/SAAS-Blog-Image-1.png) “Women cannot be cardiac surgeons. We have bets on when you will leave.” These were the words of an attending, said just a few days after I joined the Cardiothoracic Surgery Residency. I was stepping into a field where women were a rare sight, and the expectation was clear—I would not last. But I was determined to prove them wrong. I worked hard, showed what I was made of, and ultimately became the first female cardiac surgeon to graduate from my institute. It wasn’t just about proving myself; it was about paving the way for those who would follow. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/SAAS-Blog-Image-2.png) Since then, the landscape has started to shift. Dr. Sara Iqbal became the second female cardiac surgeon to graduate from our program. Today, we have two aspiring female CT surgery residents in their first and second years, breaking through the same barriers. My interns—Drs. Aiman, Huma, and Sara Hussain—have now graduated as female cardiac surgeons, and the next in line, Drs. Fakiha, Rida, Soha, and Aruba are on their way. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/SAAS-Blog-Image-3.png) I come from a low- and middle-income country (LMIC) where female cardiac surgeons are not just rare—they are almost unheard of. The first step was graduating but the bigger challenge was inspiring and mentoring young women who dared to dream of a career in cardiac surgery. Yet, the battle is not over. In my part of the world, people are used to seeing older men as cardiac surgeons. When I step into an operating room, I am often mistaken for being too young to be the surgeon in charge. Changing this perception is the next step. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/SAAS-Blog-Image-4.png) This is not just about me—it is about transforming the future of cardiac surgery. It is about normalizing the presence of women in this field and ensuring that young female surgeons do not have to fight the same battles alone. To every woman who has been told she does not belong in surgery, let this be a reminder: You do. And we are here to stay. \#WomenInSurgery #CardiacSurgery #BreakingBarriers #FutureIsFemale #Leadership #MentorshipMatters #RepresentationMatters ![](https://blog.womensurgeons.org/wp-content/uploads/2025/05/headshot.png) **Categories:** advocacy, awareness, career development, diversity and inclusion, education, gender differences, global surgery, guest blog, leadership, mentorship, URiM, women **Tags:** AAPIMonth, BreakingBarriers, ILookLikeASurgeon, leadership, RepresentationMatters, womeninsurgery, WomenSurgeons --- ### [Developing a resource for breastfeeding surgeons- a learning experience for all](https://blog.womensurgeons.org/developing-a-resource-for-breastfeeding-surgeons-a-learning-experience-for-all/) **Published:** April 25, 2025 **Author:** Blog Team **Content:** By Dr. Carly Clark I am embarrassed to say that until recently, I had no grasp of the demands of breastfeeding. Like most residents, I’ve struggled to keep up with the academic load, manage stress, and deal with personal life challenges amid a busy training program. Yet I have no experience with pregnancy or breastfeeding during this process. When asked to collaborate on a project aimed at breastfeeding surgeons, I was excited to help. I thought this would be a great way for me to learn more about transitioning from maternity leave back to work and accommodating a pumping schedule. As a Type A personality, I was ready to take notes and prepare myself for the future. Developing this project opened my eyes to just how many tasks a new mother, let alone a surgeon, must manage. As most of you reading this probably already know, surgeon mothers have unpredictable hours, limited breaks, and poor access to lactation resources such as equipment at work, storage for milk, and locations to pump. Breastfeeding is recommended by pediatricians and the WHO, but no educational resources are directed specifically to surgeons. **I am hopeful that the resource we developed not only helps new mothers but also raises awareness of the barriers to success that female surgeons so often humbly overcome.** Our module serves as a multimedia resource with demonstration videos, links, and personal stories from those who have experienced pregnancy and breastfeeding. **Topics include pumping locations, wearable pumps, pumping in the operating room or in between cases/clinic patients, breastmilk storage, hydration/caloric intake, finding time to pump or feed, as well as strategies for defining success.** As an otolaryngologist, the clinic plays a large role in my day, including various procedures, as well as a range of short operative procedures with quick turnover to multi-hour operative cases. Breastfeeding otolaryngologists are pulled in many directions during the workday, including for emergencies, such as airways. However, due to the lack of any similar program currently, we have broadened the audience to include all breastfeeding surgeons. We have highlighted the stories of three surgeons: an otolaryngologist, a cardiac surgeon, and a general surgery resident. In developing this resource, **it was inspiring to hear each perspective on how they approached the logistics of pumping and on their personal growth throughout the journey.** The pressure placed on mothers to pump for a set amount of time, and to achieve this task with a busy OR and clinic schedule, is something I never appreciated. It is truly a part-time job to pump every 3 hours, hydrate, and maintain an appropriate caloric intake. I am grateful for the strides these women have made in normalizing the process and their openness about the obstacles that most breastfeeding surgeons will likely face. **AUTHOR BIO** Carly Clark is a PGY-4 Otolaryngology- Head and Neck Surgery resident at the University of Kentucky. She graduated with a Bachelor of Arts degree in political science from Tulane University and then completed medical school at the Joan C. Edwards Marshall University School of Medicine. She plans to practice comprehensive Otolaryngology when she graduates from residency. She enjoys cooking for the people she loves and spending time outdoors. [![Slide that says: A tutorial series for breastfeeding surgeons START ](https://blog.womensurgeons.org/wp-content/uploads/2025/04/clark-1.png)“>](https://medicine.uky.edu/departments/ent/tutorial-series-breastfeeding-surgeons) [Tutorial Series for Breastfeeding Surgeons](https://medicine.uky.edu/departments/ent/tutorial-series-breastfeeding-surgeons) ![](https://blog.womensurgeons.org/wp-content/uploads/2025/04/clark-2.png) ![Slide that says: More product information Madela Symphony breast pump Spectra S1 and S2 breast pump Willow 3.0 breast pump Elvie breast pump *This list is not exhaustive, there are multiple types within each brand and updates to come University of Kentucky logo](https://blog.womensurgeons.org/wp-content/uploads/2025/04/image.png) **Categories:** Uncategorized --- ### [Fertility Preservation and Family Planning in Surgical Training: Highlights from a Much-Needed Discussion](https://blog.womensurgeons.org/fertility-preservation-and-family-planning-in-surgical-training-highlights-from-a-much-needed-discussion/) **Published:** April 17, 2025 **Author:** Blog Team **Content:** **Authors:** Nensi M. Ruzgar, Camila R. Guetter, Natalia Correa, Jessica Millar, Jessica Means, Kelsey Romatoski, Brooke Golisch, Pietro Bortoletto **Affiliations:** 1. Nensi M. Ruzgar, MD, MHS – Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA 2. Camila R. Guetter, MD, MPH – Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA 3. Natalia Correa, MD – University of Miami Holy Cross Hospital, Fort Lauderdale, FL, USA 4. Jessica Millar, MD – University of Michigan, Ann Arbor, MI 5. Jessica Means, MD – Beth Israel Deaconess Medical Center, Boston, MA 6. Kelsey Romatoski, MD – Beth Israel Deaconess Medical Center, Boston, MA 7. Brooke Golisch, MD, MS – Northwestern University Feinberg School of Medicine, Chicago, IL 8. Pietro Bortoletto, MD, MSc – Boston IVF, Waltham, MA; Beth Israel Deaconess Medical Center, Boston, MA On Nov 12th, the Association of Women Surgeons Resident and Fellow 2024 Webinar Series offered a valuable discussion on fertility preservation and family planning for surgical trainees. Hosted by AWS, the session featured a talk by Dr. Pietro Bortoletto, a Reproductive Medicine Specialist at Boston IVF and Beth Israel Deaconess Medical Center Department of Obstetrics and Gynecology, followed by a Q&A panel of surgical trainees including Drs. Jessica Means, Kelsey Romatoski, and Brooke Golisch. The session aimed to explore the challenges faced by trainees in balancing their demanding careers with reproductive health decisions and resources available. Dr. Bortoletto discussed various assisted reproduction methods, including egg harvesting, cryopreservation, in vitro fertilization (IVF), and artificial insemination. Egg retrieval involves using a needle under ultrasound guidance to collect eggs, which are then cryopreserved or fertilized in a lab with the resulting embryos cryopreserved or implanted into the uterus. IVF and embryo cryopreservation are proactive ways to potentially preserve future fertility. Preimplantation Genetic Testing (PGT) screens embryos for genetic conditions before implantation. Artificial insemination methods like intrauterine insemination (IUI) offer alternatives for those facing male factor infertility, as well as those with same sex partners or who are not partnered. During the panel portion of the event, surgical trainees shared their personal experiences with seeking fertility treatment while in training. Their stories highlighted the deeply personal decision to pursue fertility preservation and how it is influenced by both professional and financial considerations. Many panelists turned to co-residents, faculty, and social media for guidance. While not all programs offer fertility preservation, some provide financial assistance or healthcare coverage to help offset the high costs of these treatments, motivating some trainees to pursue these options. The panel also discussed the challenges of finding time for fertility treatments while maintaining the demanding schedule of surgical training. Daily procedures or tests required for fertility preservation can conflict with call shifts or operating room time. However, several panelists were able to manage by working with their program directors and scheduling treatments during less demanding rotations, such as research blocks. Other systemic factors were also addressed, such as training timelines that lead to delayed childbearing and age-related fertility concerns. Access to fertility preservation resources varies significantly between programs, with discrepancies in insurance coverage, availability, and institutional support. Trainees often struggle to find clear and transparent information about fertility benefits, which complicates decision-making. To address these issues, the discussion emphasized the need for advocacy from surgical organizations like AWS and ACS. These organizations should push for improved access to fertility preservation resources, more equitable policies, and greater transparency regarding fertility benefits in training programs. Fertility preservation education should be seen as an essential part of surgical residency training, allowing residents to make informed choices about their reproductive health without compromising their career advancement. In conclusion, the webinar highlighted the importance of supporting surgical trainees in navigating reproductive health decisions. By advocating for systemic change and improved access to fertility preservation resources, surgical training programs would create a more inclusive environment where trainees can make informed decisions about both their professional and personal futures. Anyone interested in the topic can access the recording of the session on the AWS online webinar library or attend one of our upcoming webinars (link to sign up here). ![Residents at the 2024 AWS Annual Conference](https://blog.womensurgeons.org/wp-content/uploads/2025/04/AWS-Residents.png) **Author Bio:** ![Dr. Ruzgar headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/04/ruzgar.png) Nensi Ruzgar is a general surgery resident at Beth Israel Deaconess Medical Center, completing her residency research years at Dana-Farber Cancer Institute. She serves as a Regional Liaison on the AWS Resident and Fellow Committee. She is proud to have worked on this blog post with other members from the Resident and Fellow Committee (Drs. Guetter, Correa, and Millar) as well as our wonderful webinar speakers (Drs. Bortoletto, Means, Romatoski, and Golisch). **Categories:** awareness, family life, medical students, residency, resources, self-care, training, URiM, women --- ### [Delving into The Fourth Trimester and Beyond Lectures](https://blog.womensurgeons.org/delving-into-the-fourth-trimester-and-beyond-lectures/) **Published:** April 9, 2025 **Author:** Blog Team **Content:** By Anna Hargrave, DO This past August, we had an incredible series of lectures and panel groups discussing “The Fourth Trimester and Beyond.” The Fourth Trimester is the twelve week period after giving birth, which is particularly critical to all of our women surgeons. The demands of a new baby compete with clinical responsibilities and career goals, and become challenging to balance. While this series was aimed to female surgeons starting or expanding families, the lessons I learned can be applied to all female surgeons including those without children. Some of my key reflections from the month of Surgeons’ Career and Leadership Professional Education Lecture Series (SCALPELS) are shared with you in the following paragraphs. To learn more from these phenomenal female surgeons, you can tune into the [recorded August lectures](https://www.womensurgeons.org/past-webinar-library)! Dr. Amy Vertrees, a general surgeon and veteran who served 17 years with deployments in Afghanistan and Iraq, joined us on August 15th, 2024. She shared how the roles of a mother and surgeon require constant reevaluation. With these reevaluations, it is important to acknowledge and manage the emotions appropriately, as you will likely feel overwhelmed or guilty for disappointing someone. She also provided clear instructions on how to set boundaries with an example, as this is a concept often discussed but never as clear as her explanation! Note: Dr. Vertrees is also known for creating the BOSS Business of Surgery Series, a multifaceted company that has a podcast, blog, and coaching series. Her website (<https://www.bosssurgery.com/site/about>) is a great resource that I encourage you to check out. Dr. Sonya Sloan is an orthopedic surgeon, philanthropist, and author of The Rules of Medicine, and spoke on August 22nd, 2024. She gave stellar advice on how to establish a healthy support network (including a therapist!), as this will advance our professional and personal lives (in the Fourth Trimester and Beyond). Her emphasis on mental health was appreciated, as the challenges for women in surgery are endless. Bonus – her advice on how to network at conferences was phenomenal! Our panel on August 8th, 2024 was filled with 3 amazing role models, Drs. Maria Altieri, Randaline Barnett, and Caitlin Halbert. Dr. Altieri is a minimally invasive and bariatric surgeon and the section chief of GI Surgery and Director of Bariatric Surgery at Pennsylvania Hospital at the University of Pennsylvania in addition to being a mother of 4. She provided some insider tips on how to build your support network and find childcare as a busy surgeon with multiple kids in different cities! She also discussed the importance of outsourcing, without guilt, as you cannot be everywhere at once, and must let go of your own unrealistic expectations. Dr. Barnett advocates for women in neurosurgery and more accessible healthcare, as she is a neurosurgeon-farmer in Kentucky. Recently, she completed a pediatric neurosurgery fellowship while raising her young daughter. I appreciated her advice: give yourself some grace while focusing more on what fills your cup. She discussed how surgical training is filled with seasons of hard work and moments of difficulty but also so many amazing moments, and this reflection will help keep your perspective as you enter challenging moments of training. Dr. Halbert, an accomplished bariatric and foregut surgeon and the president of Women’s Leadership in Surgery, emphasized that you are not defined by your career choice. You can be a mom, a daughter, a surgeon, a person with hobbies outside of the professional realm. Each of these roles requires your time and you will never be equally good at them all at once, but this helps provide perspective and cope with difficult cases and challenging work situations. In summary, all of our speakers and panelists provided insight into balancing the demands of a growing family and the clinical responsibilities of a surgeon. We learned the importance of setting boundaries, building a healthy support network, and outsourcing tasks. Also, this series reminded me of an important message: give yourself some grace and remember that you are not defined solely by your career successes or failures. I hope you all take advantage of these recorded lectures and learn from these phenomenal talented women surgeons! ![](https://blog.womensurgeons.org/wp-content/uploads/2025/04/anna-hargrave-final-headshot.png) **Anna Hargrave, DO** Dr. Anna Hargrave is a current preliminary general surgery resident at SSM Health Saint Louis University and completed medical school at University of Pikeville, Kentucky College of Osteopathic Medicine. She enjoys exploring new coffee shops and listening to audiobooks and true crime podcasts! **Categories:** awareness, career development, family life, parenting, resources, self-care, Underrepresented in medicine, URiM, women --- ### [Protecting Your Surgical Career During Workplace Conflicts](https://blog.womensurgeons.org/protecting-your-surgical-career-during-workplace-conflicts/) **Published:** April 2, 2025 **Author:** Blog Team **Content:** by Andrea L. Merrill, MD Imagine yourself several years into your first job as a surgery attending. Things have been going well, but occasionally, you hear from your division chief that a nurse has complained about your “behavior.” Your chief hasn’t given you specific details, and no formal complaints have been made. To your dismay, your division chief has not asked *you* how communication and interprofessional interactions have been with the nursing staff as necessary context to receiving those complaints. You aren’t concerned because you have heard stories about male colleagues yelling, swearing, and demeaning learners, which you never do. Additionally, you rationalize that your RVU’s are high, your patient satisfaction scores are above average, the learner evaluations are favorable, and you are publishing research in peer review journals – you’re a rock star and untouchable. Then one day, you express concern about a patient safety issue with suggestions for improvement. Or, you speak up about the mistreatment of a resident. Or perhaps, you have a patient complication despite providing the standard of care. Out of the blue, you receive an email about a meeting with the Department Chair and are put on “administrative leave” while an investigation into your behavior and practice is covertly conducted. You are assured the investigation will be fair, and you’ll be involved, but no one ever talks to you to get your side of the story. Your administrative leave drags on for several months until one day, another meeting is called, and you are abruptly terminated without due process. Because your administrative leave was longer than 30 days, your institution is obligated to report this to the National Practitioner Data Bank (NPDB). You apply for other jobs but face challenges getting credentialed due to the NPDB report. You begin to worry you may never practice again after dedicating yourself to becoming a surgeon. **If you think the scenario above could never happen to you, this article is for you.** Unfortunately, there aren’t good data to know exactly how often this scenario occurs, but it is more common than you think. As physicians going through workplace injustices like these, we don’t often talk about them due to shame and embarrassment, or having signed a non-disclosure agreement (NDA). It is estimated that at least 10% of peer review investigations are “sham peer reviews” and that peer review is being weaponized rather than used to ensure the standard of care.1 A recent study by Medscape showed that 56% of physicians are worried that peer reviews could be misused to punish them.2 Anecdotally, I have seen a huge increase in women reporting sudden termination for reasons such as “fit”, “behavior”, “communication style”, “professionalism”, or in retaliation to whistleblower claims. Most of us went into surgery for altruistic reasons. In addition to being surgeons, many of us are advocates for a patient’s right to have quality care in a safe and respectful environment. We assume others in our workplaces have similar intentions and will listen when we speak up about quality and safety concerns. All too often, this is not the case, and for many in leadership roles, the bottom line is financial or driven by insecurity and/or ego. We are all at risk of experiencing some version of the above scenarios, and unfortunately, every one of us is expendable.3 This is true no matter what practice environment type you practice in. There are some basic frameworks for how to protect yourself below. 1. **Review all your contracts and hospital, foundation, and/or medical staff bylaws (aka the rules & regulations that govern all your practice environments)** 2. **Do not attend a “Surprise” AKA “Ambush” Meeting without preparation (i.e. seek out peer support and legal counsel immediately)** 3. **Be aware of how Sham Peer Review is weaponized against surgeons4–7** 4. **Understand when to retain a lawyer** When you are experiencing workplace injustice, you may feel isolated and alone. You may be forbidden from talking to your colleagues about the situation. This is a common corporate medical playbook strategy used to keep surgeons from being empowered and exactly why the organization Physician Just Equity (PJE) was founded by Dr. Pringl Miller. PJE is a 501(c)3 organization made up of 50 physicians who are dedicated to preserving justice in medicine.8 Everyone in PJE has experienced workplace injustices and is now giving back by helping others. PJE provides free, confidential peer support in teams upon request by physicians in need. Additionally, PJE is collecting data on the workplace trajectory of women in surgery after workplace conflicts, as there is a lack of data in this area. The collective has supported 150 peers since February 2021. To learn more about the PJE peer support initiative, read the Research Letter [here.](https://link.springer.com/article/10.1007/s11606-023-08092-9) In 2024 alone, 43 peers were supported, a 159% increase in requests from 2023. 74.4% of those supported self-identified as women, and 53.5% were in surgical disciplines. If you or someone you know is experiencing a workplace conflict, please reach out to PJE via the website contact page at[ https://physicianjustequity.org/contact/](https://physicianjustequity.org/contact/). For more detailed information about how to protect yourself consider purchasing the PJE Guidebook [**here**](https://mailchi.mp/uic/pjeguidebook2025). References: 1. Pfifferling JH, Meyer DN, Wang CJ. Sham peer review: perversions of a powerful process. *Physician Exec*. 2008;34(5):24-29. 2. McKenna J. [Seeking Fairness and Real Guidance: Medscape Physicians and Peer Reviews Report 2024](https://www.medscape.com/slideshow/2024-doctor-peer-reviews-6017750?icd=login_success_email_match_norm#9). Medscape. 1204/2024. Accessed February 16, 2025. 3. Miller P. [Breaking the ‘corporate medical playbook’ that silences physicians’ reports of inequity](https://www.statnews.com/2022/09/08/breaking-the-corporate-medical-playbook-silencing-physicians-reports-inequity/). STAT. September 8, 2022. Accessed February 18, 2024. 4. Huntoon LR. [Sham peer review: Resources for physicians. AAPS \| Association of American Physicians and Surgeons](https://aapsonline.org/sham-peer-review-resources-for-physicians/). November 17, 2023. Accessed February 16, 2025. 5. Huntoon LR. [Sham peer review: Recognizing possible early warning signs](https://www.jpands.org/vol16no3/huntoon.pdf). 2011. Accessed February 16, 2025. 6. American Medical Women’s Association, Physician Just Equity. *What Is Physician Peer Review*.; 2022. 7. O’Connell T. [The sham peer review: a hidden contributor to the doctor shortage](https://kevinmd.com/2024/07/the-sham-peer-review-a-hidden-contributor-to-the-doctor-shortage.html). Kevinmd.com. July 30, 2024. Accessed February 16, 2025. 8. [Physician Just Equity](https://physicianjustequity.org/). 2025. Accessed February 16, 2025. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/04/Dr.-Merrill.png) **Dr. Andrea Merrill** is a surgical oncologist specializing in breast surgery, currently practicing in Charlottesville, VA. She completed her medical education at Tufts University, followed by a general surgery residency at Massachusetts General Hospital and a surgical oncology fellowship at Ohio State University. Beyond her clinical duties, Dr. Merrill is passionate about narrative medicine, surgical ergonomics, and advocating for physician rights and workplace equity. Through her work with Physician Just Equity (PJE), she lends her expertise to guide and support fellow physicians facing workplace conflicts related to discrimination and gender bias. Dr. Merrill’s commitment to equitable treatment in the medical profession drives her contributions to enhancing workplace justice and mentorship in healthcare. **Categories:** awareness, career development, professionalism, URiM **Tags:** career tips --- ### [Finding Balance in the Midst of Threats and Chaos: A Journey of Self-Care, Passion, and Community](https://blog.womensurgeons.org/finding-balance-in-the-midst-of-threats-and-chaos-a-journey-of-self-care-passion-and-community/) **Published:** March 31, 2025 **Author:** Blog Team **Content:** by Dr. Carla Pugh, Past-President of The Society of Black Academic Surgeons In today’s climate, where social issues often leave us feeling drained, maintaining a sense of balance can be a challenge. When asked how the current climate is affecting them, a few SBAS leaders shared their thoughts. Dr. Carla Pugh, Past-President of SBAS started the conversation by noting that self-care is a must and invited her fellow SBAS colleagues to share a few examples. Dr. Adrienne Cobb shared her deep love for plants, particularly her two Monstera deliciosa. Caring for her plants in Wisconsin’s tough climate requires patience and strategic effort, which Adrienne has mastered. Her enthusiasm for plant care not only connects her to nature but also provides a calming space in her life. It’s clear that nurturing something to grow brings a sense of fulfillment and peace. “Taking care of my plants has become a meditation of sorts,” she said. Dr. Cobb’s passion for baking also emerged as a form of self-care. She explained how baking had been a therapeutic outlet during stressful times in her life including her studies for Step One. “Baking allows me to set it and forget it” she shared. Whether it’s a chocolate whiskey bundt cake or a classic Southern pound cake, baking is a way to share joy and creativity with those around her. Dr. Crystal Johnson-Mann brought an additional perspective, drawing strength from her family life and her role as a coach. Coaching her eldest son, who is a natural athlete, has been an especially meaningful way for her to balance her personal goals with the needs of her family. Dr. Johnson-Mann expressed the importance of teaching her children how to deal with perfectionism, a trait she has struggled with herself. She has learned that while wellness is vital, it can sometimes take a backseat to life’s responsibilities, especially when her husband travels for work. Nonetheless, she finds joy in her children’s growth and their shared love for sports. Finding community, especially in times when life feels overwhelming, was a key topic. Dr. Cobb shared how she found a sense of belonging in a grant-writing circle, and Dr. Johnson-Mann reflected on rejoining her sorority’s graduate chapter despite her busy schedule. Both found strength in these communities, which provided a sense of sisterhood and support, underscoring the importance of nurturing relationships with like-minded individuals. The conversation ended with an inspiring commitment to prioritizing wellness, balance, and joy in everyday life. By focusing on what nourishes them—whether it’s tending to plants, baking, family activities, or community—they reminded themselves that it’s possible to create a life where personal passions and self-care coexist, even in the busiest of times. Their discussion was a reminder that, amidst the chaos, it’s essential to look after ourselves, lean into our passions, and cherish the communities that sustain us. As they continue on their journeys, one thing is clear: no matter how hectic life gets, it’s possible to cultivate balance and wellness through meaningful connections, creativity, and self-care. ![Dr. Adrienne Cobb smiles at the camera.](https://blog.womensurgeons.org/wp-content/uploads/2025/03/Cobb.png) **Adrienne Cobb, M.D., MS** Dr. Adrienne Cobb is a native of Indianapolis and graduated from Lawrence North High School. She then went on to complete her undergraduate studies at DePauw University majoring in Biochemistry and Spanish. She had long set her sights on a career in medicine and matriculated to Indiana University School of Medicine. She completed a residency in General Surgery at Loyola University Medical Center in Chicago, IL. During residency she developed a passion for breast cancer care. She completed her Breast Surgical Oncology Fellowship at MD Anderson Cancer Center in Houston, TX. Dr. Cobb is now Assistant Professor of Surgery at the Medical College of Wisconsin. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/02/Johnson-Mann_Crystal.jpg) **Crystal N Johnson-Mann, MD, MPH, FACS, FASMBS** Dr Crystal Johnson-Mann was born in a small town in South Carolina. She went to University of South Carolina in Columbia for her undergraduate training and played on the varsity volleyball team. Dr. Johnson-Mann is a proud graduate of the MUSC College of Medicine and General Surgery Residency Program. She completed a minimally invasive surgery fellowship at the University of Virginia Health System, after her surgical residency at MUSC. She is an Assistant Professor of Minimally Invasive and Bariatric Surgery at UF Health Bariatric Surgery Center – Shands Hospital and is a passionate health disparities advocate. ![Dr. Carla Pugh in the operating room](https://blog.womensurgeons.org/wp-content/uploads/2025/03/Dr.-Pugh.png) **Carla M. Pugh, MD, PhD, FACS, MAMSE** Dr Carla Pugh was born in Berkeley California and went to the University of California at Berkeley for her undergraduate degree in Neuroscience. She then went to Howard University for medical school and stayed at Howard for her surgical residency. Dr. Pugh then went to Stanford University and obtained a PhD in education and technology. Currently, Dr Pugh is the Thomas Krummel Professor of Surgery at Stanford, Vice-Chair of Innovation and Director of the Technology Enabled Clinical Improvement Center. Her clinical specialty is Acute Care Surgery. **Categories:** diversity and inclusion, family life, guest blog, reflection, resources, self-care, Underrepresented in medicine, URiM, women --- ### [Food for Thought – Culinary Adventures in Medical School](https://blog.womensurgeons.org/food-for-thought-culinary-adventures-in-medical-school/) **Published:** March 19, 2025 **Author:** Blog Team **Content:** By Gizelle Francis Medical school is notorious for its long hours, relentless studying, and the ever-present pressure to perform. Amidst this, finding time for hobbies can seem almost impossible. For me, however, cooking and baking have become more than just hobbies—they are a sanctuary. As a medical student, I discovered that the kitchen offers a creative outlet that balances the intensity of my studies while nurturing a deeper connection to my well-being. ***Cooking as an Art and Science*** For me, cooking isn’t just about putting food on the table; it’s an art form and a science, much like medicine. There’s a certain satisfaction in transforming raw ingredients into a meal that not only nourishes, but also brings people together. The same meticulousness that I apply to learning anatomy or understanding complex surgical procedures translates into my approach to cooking. Each ingredient has a role, and it’s fascinating how a little adjustment in seasoning or technique can change an entire dish—just like how small adjustments in a treatment plan can dramatically improve patient outcomes. Baking, on the other hand, satisfies my need for precision. It’s a discipline that leaves little room for error—measurements need to be exact, temperatures controlled, and timing impeccable. It’s very much like the procedural aspects of surgery. When you’re baking, there’s a rhythm to the process and once the ingredients are in the oven, you wait, trusting that you’ve done everything right. ***The Therapeutic Side of Cooking*** One of the most valuable lessons I’ve learned in medical school is the importance of balance. The constant demands can easily consume you, leaving little room for personal time or relaxation. For me, cooking and baking are therapeutic. After a long day in the hospital or studying, heading to the kitchen to prepare a homemade meal or bake a dessert allows me to reset. The aroma of fresh ingredients and the satisfaction of creating something from scratch helps me unwind. Even during the busiest rotations, I’ve found ways to integrate my culinary passion into my life. Whether it’s meal prepping for the week ahead or spending an afternoon experimenting with new recipes, cooking gives me a sense of control. ***Sharing the Joy*** Food has always played an important role in my family and culture and that love has followed me into medical school. I often find myself bringing family or friends together through my cooking. There’s something profoundly rewarding about feeding others, especially when it sparks conversations and connections. In many ways, sharing food mirrors the reasons I went into medicine: to bring comfort and care to others. ***Culinary Lessons in Medicine*** Ultimately, the lessons I’ve learned from cooking and baking have enriched my journey through medical school. They’ve taught me patience, attention to detail, and the importance of balancing creativity with precision—qualities that are essential for becoming a surgeon. These culinary adventures have provided me with a much-needed outlet and a reminder that even in the most demanding career paths, there’s always room for passion and creativity. So, whether I’m practicing my skills in the operating room or crafting the perfect tiramisu, I’ve learned that there’s a place for art and science in everything we do. Food, much like medicine, is a way to heal and connect— that’s something I’ll carry with me throughout my medical career. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/03/gizelle-francis.jpeg) **About the Author: Gizelle Francis BSc** Gizelle is a fourth year medical student at Dalhousie University in Halifax, Nova Scotia, CA. She has a passion for otolaryngology and the artistic side of surgery. Outside of medicine, Gizelle enjoys cooking and baking, finding solace and creativity in the kitchen amidst the demands of medical school. Growing up in a family where food played a significant role in culture and connection, Gizelle continues to carry that tradition, experimenting with traditional Lebanese recipes as well as new ones including fresh pasta. Beyond cooking, she is also passionate about crafting, knitting, and spending time with family. @gizellefrancis, @foodforthought.hfx **Categories:** education, medical students, reflection, self-care --- ### [From Passion to Purpose: My Journey as a 22-Year-Old Mexican Woman Towards General Surgery](https://blog.womensurgeons.org/from-passion-to-purpose-my-journey-as-a-22-year-old-mexican-woman-towards-general-surgery/) **Published:** March 12, 2025 **Author:** Blog Team **Content:** by Paula Nieto Passion is a powerful engine that drives us toward our goals and dreams. When it is directed toward the well-being of others, it transforms into a meaningful purpose. As a 22-year-old woman in Mexico, my aspiration to specialize in general surgery is deeply rooted in the desire to serve others and make a difference in their lives. Currently, I am conducting a year of research to deepen my understanding of the field and enhance my skills as I prepare for my future in surgery. My family background, through which I have been involved for ten years with the association Amigo-Tez, supporting children from low-income communities in Mexico, has greatly shaped my perspective on medicine and medical practice. **A Legacy of Service** I come from a family that has dedicated its life to serving others. Since I was young, I have witnessed the impact we can have on people’s lives. Seeing how our work has improved the health, education, and well-being of children has taught me the true meaning of empathy and compassion. This family environment has been fundamental in shaping my character and has solidified my desire to pursue a career in medicine. **Discovering My Passion for Surgery** During my year of medical internship at the Mexican Social Security Institute, I had the opportunity to discover my passion for surgery. Working alongside several surgeons, I learned not only the technical skills required but also the importance of patient care before, during, and after surgery. Each experience in the operating room reinforced my commitment to this specialty, as I witnessed firsthand the profound impact that surgical interventions can have on patients’ lives. One day, while listening to a podcast by Jay Shetty at home, I heard a phrase that resonated deeply with me: “Your passion becomes purpose when you use it to help others.” This idea has become a mantra in my life and has reinforced my commitment to surgery as a form of community service. **The Importance of Serving Others** The essence of medicine lies in service. Every patient has a story, a family, and a future that can be affected by our work. As I learn and practice surgery, I strive to understand each patient as a unique individual. I am a firm believer that service and empathy are crucial for maintaining focus and the human aspect of a career in medicine, which is demanding in many ways. Throughout my journey, I have learned that by prioritizing the needs of others, I not only contribute to their well-being but also keep my own motivation alive. The challenges we face as medical professionals can often feel overwhelming, but when we approach our work with compassion and a genuine desire to help, we can navigate these obstacles while preserving our humanity. **Challenging Gender Stereotypes and Looking Towards the Future** As a woman in the field of surgery, I am aware of the challenges this path entails. However, my focus is on the importance of diversity in medicine. By aspiring to become a general surgeon, I seek not only to open doors for myself but also for other women who wish to follow this path. As I approach the application stage for the general surgery specialty, I feel a mix of excitement and responsibility. I am eager to learn, grow, and contribute to the field of surgery in Mexico. ![Pau Nieto Headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/03/Pau-Nieto-1.png) **About the Author** I am Paula Berenice Nieto García, 22 years old, born in Mexico City. I studied medicine at Anáhuac University in Querétaro. Currently, I am completing a research year at the Mexican Ophthalmology Institute in Queretaro City and preparing for the specialty exam. I would like to enter general surgery in Mexico and subsequently pursue bariatric surgery. In my free time, I enjoy running while listening to music and spending time with my family and friends. **Categories:** career development, education, family life, global surgery, hispanic heritage, reflection, research, training, URiM, women --- ### [The Intersection of Queerness and Womanhood in Surgical Residency](https://blog.womensurgeons.org/the-intersection-of-queerness-and-womanhood-in-surgical-residency/) **Published:** March 5, 2025 **Author:** Blog Team **Content:** By Dr. Sarah Klapman I’m getting married this August. I didn’t grow up planning my wedding, so I find it’s less about fairy tales and more about spreadsheets. In fairness, that could also be because I’m a second-year general surgery resident. There’s something therapeutic about embracing the lace of it all – about expecting the medical world to take you seriously whether you’re talking ball gowns or bowels. It can be freeing to be overtly feminine in surgery. And that would be the whole story – except when people ask “who’s the lucky guy?”, there’s a pause where I decide whether this is another opportunity to come out or an awkward moment best avoided. The woman I’m marrying is a knock-out, and I’m so proud to be hers, but sometimes it’s 5:30 am and I’m trying to pre-round and just because The Ring is swinging on a chain around my neck doesn’t mean there’s time to explain why I’ll never have a husband. We were taught about the hidden curriculum in medical school: no one needed a PowerPoint to know that women – and pretty much everyone who isn’t a straight white cisgender able-bodied male – has a harder time in medicine. Assessing the intersectionality of those identities, however, was beyond the scope of our lectures. And by the time I started residency, it was clear that “soft skills” and feminist critiques of medical culture were no longer a priority. In the 2019 American Medical Association Colleges data, women comprised only 22% of General Surgeons, my field of study. Other surgical specialties were even more male-dominated. While there are no studies quantifying the number of queer surgeons, a 2021 study in JAMA found that queer female medical students were more likely to pursue surgical careers than their straight counterparts. As the number of women going into medicine continues to increase, it stands to reason that a disproportionate number of queer women will end up in surgical residency. My experience as a queer female surgical resident has been predominantly positive. But I also move through residency – and the world – in subtly different ways from my female co-residents. The main difference for me is in patient relationships. Because of my queerness, I know what it’s like to feel isolated and othered, and I see those feelings in my patients. Women surgeons are asked to do emotional labour our male counterparts would never consider, and we have to learn to say no. But being Queer helps me love all parts of myself – my empathy and patience sometimes get in the way of those 5:30 am rounds, but I love them anyway. When patients respond with deep gratitude to even brief moments of human connection, how can I help but wonder if surgery is getting its priorities wrong? Medicine is a powerful social institution with a vested interest in standing still. Our predecessors fought their way in. Now queerness – with its focus on criticality and radical self-acceptance – is an essential tool in our arsenal for change, in residency and beyond. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/03/klapman.jpeg) **About the Author** Sarah Klapman (she/her) is a second-year General Surgery resident at Queen’s University in Ontario, Canada. Before entering medicine, she trained as an opera singer and did a master’s in music neuroscience. She is excited to bring these experiences to her work in surgery. **Categories:** advocacy, awareness, family life, gender differences, residency, Underrepresented in medicine, URiM, women --- ### [Navigating Conference Networking & Presenting as a Medical Student](https://blog.womensurgeons.org/navigating-conference-networking-presenting-as-a-medical-student/) **Published:** March 4, 2025 **Author:** Blog Team **Content:** by Rachel Akers, MS I vividly remember my first medical school conference. I left the library, suitcase and poster tube in hand, and hopped into an Uber to O’Hare. A few hours later, I was somewhere across the Atlantic, heading towards Berlin. I stood in front of my poster, hoping that no one had any questions beyond my knowledge base as a medical student. I’ve attended many more conferences since, and I’m here to share what I’ve learned. **Fully engage with the conference** Find sessions that interest you. Many conferences have event apps that allow attendees to preview scheduled forums. Don’t be afraid to ask questions! Our knowledge may not be as advanced as others, but everyone starts somewhere. It’s okay to ask questions, you’re there to learn. **Exhaust all options for funding** Talking about money can seem taboo, but many research grants have travel funding. Don’t be afraid to discuss this with your primary investigator. Medical schools often have some form of expense reimbursement for professional development. Check with your Medical Student Affairs office or Financial Aid department. Conferences offer medical student travel awards, reduced registration for students, and early registration discounts! Check the conference website and email the coordinators to inquire. Make sure you have a credit card for airline miles & hotel points. Look for conferences that are happening near you to reduce cost. Dressing professionally on a budget is hard. Good quality business professional clothes can be found in thrift stores and online consignment boutiques. Good tailoring makes a difference too! **Use your network** It’s easy to feel alone at a conference. Identify other students and strike up a conversation. Offer to coordinate a group chat or ask them to show you their posters. If you already know students interested in the field, ask if they’re attending and plan to meet! You never know who might become a valued connection. Touch base with your primary investigator to see if they can see your poster or podium. For students closer to residency, let your mentors know which programs you are interested in. They may be able to facilitate introductions to faculty. If your mentor isn’t there, make sure to send photos! **Practice safety at all times** Be careful about leaving the conference with new connections and bring a notebook to take down contact info instead of handing your phone to a stranger. Have fun and meet new people, but maintain awareness and be safe. **Be judicious about conference swag – hold out for the good stuff!** I happily collected all the free stuff during my first few conferences and regretted it when I had to declutter. That being said, sometimes free samples or demonstrations give you a better understanding of patient experience and the business side of medicine. **All in all…** Conferences are a great way to present your research to a wide audience, meet new colleagues, and experience a new city. Always bring a USB with your slides, splurge on having the poster printed on site to avoid travel with a poster tube, and treat yourself to something special while you’re there. I hope these tips help you and if you ever see me at a conference, say hi! **About the Author** ![Rachel Akers headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/03/Screenshot-2025-03-04-093856.png) Rachel Akers is a third-year medical student at Rush Medical College in Chicago, IL. She will be applying for otolaryngology-head & neck surgery residency in the 2025-2026 NRMP Match. She loves classical music, piano, fishing, and all kinds of trivia. **Categories:** AWS conference, career development, education, medical students, networking, professionalism, URiM, women --- ### [Egg-specting the Unexpected: A Medical Student’s Experience on Premature Ovarian Insufficiency and Fertility](https://blog.womensurgeons.org/egg-specting-the-unexpected-a-medical-students-experience-on-premature-ovarian-insufficiency-and-fertility/) **Published:** February 20, 2025 **Author:** Blog Team **Content:** **by Meryem Guler BS** The first time I witnessed a birth was in my third year of medical school on my OBGYN rotation. I found myself in the delivery room assisting the team by holding up one of the patient’s legs during her contractions and counting to ten for each push – a popular role amongst medical students. The patient’s mother was pacing the room around the team, as if walking was the only outlet for her nerves. With one final push, a baby was born screaming and crying into this world. The new grandmother rushed up to greet them, sobbing tears of joy. She kept repeating “they’re so beautiful” and “you did amazing” to her daughter and grandchild. Observing this scene, I thought of my mom and how she would react similarly if this were me. Blinking back tears, I had one final thought before I had to step away from the room: I had deprived my own mother of this experience. I found out about my infertility in a rather unceremonious way during my gap years before medical school. As a research coordinator at a reproductive medicine office, I worked with many couples and individuals facing infertility prior to my knowledge of my own. One day, for reasons unrelated to this story, I had checked my serum hormone levels and noticed that my FSH levels were elevated given the timing of my cycle. Thoughts of worst-case scenarios were confirmed with an Anti-Mullerian Hormone (AMH) level of 0.75. My AMH levels were equivalent to that of the average woman approaching menopause, and I was only 24. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/02/Meryem-Guler-Graph.png) <https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.593216/full> I had never felt that my value as a person was tied to my ability to carry a child (as I’m sure many female-identifying individuals can agree), so I was surprised at how much I mourned the news. Growing up, we are ingrained with a natural fear of pregnancy and told to always be hypervigilant as if it could happen at any time without warning. Why are we not taught to fear the opposite? I pictured myself standing at the base of Sylvia Plath’s fig tree, watching the fruits, twigs, and branches of my future family tree quickly shrivel away until nothing but dust remained. In many ways, I was fortunate in my circumstances. Since my insurance refused to cover any fertility preservation treatments unless I was ready to get pregnant (surprise, I was not), my workplace offered to cover the cost of doing 3 egg retrieval cycles with them. I was given almost-expired sample medications while my incredible coworkers did my labs and scans. When it came time for my egg retrievals, the doctors let me watch through the ultrasound monitor during the procedure. After 4 months and 3 cycles, we managed to retrieve a whopping total of 5 eggs. For anyone who would like an interpretation: that’s pretty damn bad. Most IVF cycles in a healthy 20-something year old would yield at least 15 eggs per cycle. I was lucky if I got 2. On top of that, my IVF experience had aged me – the space for my ovaries had been replaced with dusty old figs from my decrepit tree. Hot flashes tormented me at night as a residual effect of the medications. My abdomen felt as if an amateur boxer had used it in practice. Needles had poked and prodded at me until I had nothing left to give. It took me months to feel normal again, if only physically. Even now, I find myself at times still grieving. I sit and imagine holding my biological child. I imagine their little fingers, the small wisps of hair, the smell of baby powder. I picture them growing up, their favorite foods, their hobbies. I wonder if there is another universe in which they could exist. Another reality in which I had the emotional and physical capacity to create this life. Fortunately, I’ve since had the time, space, and support from my loved ones to come to terms with my diagnosis and how it would shape my future. Looking back on the specific breakdown that led to this story, I know that my mom prioritizes my happiness over anything else. But such is grief: it’s not always rational. And who knows, maybe one of my 5 mediocre frozen eggs has an extraordinary attachment to life. I ended up finding comfort in a place I was not at all expecting. In my first year of medical school, I attended a Women Leaders in Surgery conference at my school. A surgeon spoke of her own experiences with infertility as she and her partner attempted to have a child after residency, ultimately going through IVF treatment. Her story reminded me that despite being an outlier, I am not alone. There was a whole community of female physicians and surgeons who have gone through and will go through similar experiences. Rather than wallowing in self-pity, I could share my experiences to provide comfort and information to those in similar situations. I’ll be the first to admit that my route to diagnosis and treatment was not the most conventional. I’m not sure what my future holds or what souls will take the shape of my future family, but in this moment I am incredibly privileged to be loved by my parents, my siblings, my partner, my friends, and sometimes by my pet lizard and 2 cats – I am more than satisfied with the family I’ve created. While difficult, this experience has given me the ability to explore my values and share my experiences with others. For that I am very grateful. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/02/Meryem-Guler.png) **Author Bio** Meryem Guler is a third-year medical student at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA. She is originally from the Bay Area of California and graduated with a BS in Neurobiology from UC San Diego in 2020. During the winter months on the east coast, she can be found hibernating in her walk-up apartment with her 2 rescue cats and leopard gecko. Her childhood was filled with arts & crafts with her artist mother, which ultimately drew her to the hands-on careers of General Surgery and Plastics and Reconstructive Surgery. During the 2025-2026 academic year she can be found thawing back on the west coast while pursuing a research year in pediatric craniofacial surgery. Twitter handle: @MeryemCGuler **Categories:** family life, health, medical students, parenting, reflection, self-care, women --- ### [The Shadow of Sacrifice](https://blog.womensurgeons.org/the-shadow-of-sacrifice/) **Published:** February 13, 2025 **Author:** Blog Team **Content:** **by Ashley Martinez** I stared back at her feet in four-inch heels as I lay under my mother’s desk, awakening from my nap. A single mother of three, my mother worked what seemed like all hours of the day to make ends meet. As a result, I quickly became accustomed to napping under her desk after school or sipping on a juice that her client offered me and my youngest brother while we sat in the living room of a home we could only dream would be ours. Was her work ethic passed down to me due to genetics, model behavior, or a mix of both? Now, as a third-year medical student, I like to think it’s an accumulation of these factors, once fueled by the need to prove myself, but now sustained by something far greater. There was no doubt that I was smart. I took after my mom in that way. The only difference between me and my mom was that she had her first child at 16 years old and, as a result, dropped out of high school with only a 9th-grade education. Despite that, she established a career for herself and was relentless in pursuing a better life for her children, even if it meant running herself into the ground to do so. Just like her, I imagine a better life for my children than the one I grew up in, one where they never have to face poverty, abuse, housing, or food insecurity as my brothers and I did. I quickly realized that the only way for me to achieve that was through climbing the ladder of higher education. It is no secret that the weight of medical education debt can feel enormous. However, no one talks about the hidden costs of achieving your dream, the sacrifices one makes as a first-generation college and medical student that are often overlooked by peers and preceptors in the clinical setting but weigh heaviest on your shoulders. My family lives on one side of the country, and I attend medical school on the opposite side, a distance of over 3,000 miles. The sacrifice I make every day to be here extends beyond missing birthdays, weddings, funerals, etc. No, this sacrifice extends to generations of women who came before me. My grandmother made the same sacrifice of leaving her mom to cross the US-Mexico border in search of a better life. My mom sacrificed meals to ensure we were fed, sleep to work two jobs, and her peace to face the threat of losing our home on more than one occasion. When I think of all the sacrifices that have been made for me to pursue my dream of becoming a surgeon, I can’t help but feel a sense of emptiness at the center of all my gratitude. Yes, I will achieve great things and my Spanish-speaking patients will look at me with appreciation, seeing someone who looks like them, who understands them – but at what cost? Pursuing a career in medicine has never been about me, not entirely. I’ve walked this arduous journey with my family and my community on my back. I am who I am because of where I come from. That, in itself, has fueled my motivation and has been the foundation of my grit and resilience for as long as I can remember. Underneath my short white coat, I yearn for the opportunity to watch my only parent age gracefully, to be within driving distance from her for our morning cafecito and evening walks. It is this yearning that engulfs every corner of my mind when I’m spoken through like air by an attending or when I’m reduced to “the medical student” by a resident. Regardless of whether the culture of medicine has stained their sense of humanity, I stand with my two feet planted firmly on the ground, knowing that this journey is not mine alone. Every step I take is a testament to the strength of the women who came before me, and the dreams they entrusted me to fulfill. I am driven not just by the desire to succeed, but by the unyielding belief that I must because my story, and theirs, demands it. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/02/Ashley-Martinez.jpeg) **About the Author** Ashley Martinez is a third-year medical student at Albany Medical College with an interest in General Surgery. Born and raised in California, Ashley earned a Bachelor of Science in Biochemistry from UC San Diego. Before medical school, she worked at the USC Keck School of Medicine, studying the association between high-density lipoprotein particles in cerebrospinal fluid and Alzheimer’s disease risk. As a first-generation student, Ashley is driven to support others from similar backgrounds. Through her leadership in the Latino Medical Student Association and her research, she is committed to identifying the needs of underserved populations and aspires to become a surgeon who can address these disparities by providing quality, equitable care. Outside of academics, she enjoys traveling, paddle boarding, and powerlifting. **Categories:** education, hispanic heritage, medical students, reflection, training, URiM, women **Tags:** AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Waltz of the OR – Finding the Music from Within](https://blog.womensurgeons.org/waltz-of-the-or-finding-the-music-from-within/) **Published:** February 7, 2025 **Author:** Blog Team **Content:** by Minjal Patel There is an air of musicality that has drawn me towards the OR, whether it is the organized chaos of the beeping monitors or the sounds of steel instruments hitting the table as the team prepares for the patient to arrive. It reminds me of a Chopin waltz – everyone carefully navigates the space as the pristine sheets of blue are draped over the patient. Having trained in classical piano performance since the age of nine, I often find parallels between music and surgery. Those similar bright lights that shine overhead illuminate the surgical field while blurring the rest. While it may seem like a dramatic romanticization of surgery, I reflect on my training as a pianist, which spanned over a decade and has now become a pivotal part of who I am today. It transports me to the time I performed a structured Bach prelude in front of an audience. I sat down at the piano, placing my hands on the keys. Looking into the crowd, I saw blurred faces and whispers as the conversations dwindled into inaudible sounds. If I had learned anything in my training it was to focus on the rhythm of the music from within, silencing the sounds outside. When standing over the surgical field, I find a serene beauty in the calm that penetrates the surrounding chaos. I believe that as third-year medical students first navigating the OR, we are often terrified of the space and its uncertainty. I highly suggest to my fellow colleagues to embrace the OR as a place where immense learning for medicine meets uncovering yourself. There are moments when you will discover your resiliency and perhaps even your “Why?”. Lean on the nurses, scrub technicians and rest of the staff to navigate this space. Continue to ask questions and have a fervor for learning. I have heard from many that the OR is a special place in the hospital – it truly is! I believe that you have to experience its musicality to appreciate it. As an aspiring surgeon, I hope to continue hearing the music this space has to offer amidst its challenges and its noises. ![](https://blog.womensurgeons.org/wp-content/uploads/2025/02/Patel-Minjal-Headshot-scaled.jpg) **About the Author Minjal Patel is a third-year medical student at Rowan-Virtua School of Osteopathic Medicine in New Jersey. She aspires to pursue a general surgery residency. She currently serves as an ACOS Social Media Ambassador. She also loves writing, gardening, and traveling the world with her family. **Categories:** education, medical students, reflection, women **Tags:** womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Maximizing Time Off: My Path to Surgical Residency Preparedness](https://blog.womensurgeons.org/maximizing-time-off-my-path-to-surgical-residency-preparedness/) **Published:** January 29, 2025 **Author:** Blog Team **Content:** By Dr. Niosha Price As an International Medical Graduate (IMG) with aspirations of joining a general surgery residency, I have structured my time off to maximize personal growth, professional development, and well-being. This period between completing medical school in November and starting residency in July is a unique opportunity to prepare myself for the demanding yet rewarding path ahead. One of the activities that has brought balance and joy to my life is swimming. To combine this passion with meaningful work, I became a certified lifeguard at an indoor pool near my home. This role keeps me physically fit, generates income, and allows me to contribute to my community by ensuring the safety of others. Staying in shape is especially important for a surgical residency, where long hours and physical stamina are often required. Additionally, working as a lifeguard has strengthened my ability to remain calm under pressure–a skill that is invaluable in the operating room. In line with my career goals, I also took on a part-time role as a medical scribe at the John Hopkins Orthopedic Surgery Center. This position has been instrumental in keeping me clinically engaged and sharpening my documentation skills. It provides first hand exposure to surgical workflows, patient interactions, and the intricacies of orthopedic procedures. As a medical graduate pursuing general surgery, this experience is enriching my understanding of surgical care and preparing me to excel in residency. While professional development is important, I am cherishing moments with family and friends as well. These relationships provide the emotional resilience needed to thrive in the high-pressure environment of a surgical residency. Celebrating my medical school completion with a trip to Dubai is another way I am recharging my mind before embarking on the next chapter of my career. This period also involves essential administrative tasks related to residency applications. I am actively participating in interviews, crafting thoughtful thank-you letters, and carefully creating my rank list. These steps are critical in securing a program that aligns with my professional aspirations and personal values. My dedication to thorough preparation reflects my commitment to excelling as a future surgical resident. Ultimately, these seven months are about maintaining a balance between preparation and rejuvenation. By engaging in activities I love, such as swimming and spending time with loved ones, while also gaining valuable clinical exposure as a medical scribe, I am equipping myself for the challenges ahead. This holistic approach ensures that I will enter residency not only well-prepared academically and professionally but also physically and emotionally resilient. These experiences reinforce my passion for surgery and my readiness to contribute meaningfully to a residency program. ![Dr. Niosha Price headshot](https://blog.womensurgeons.org/wp-content/uploads/2025/01/niosha-price-headshot-scaled.jpg) **About the Author: Dr. Niosha Price** Dr. Niosha Price, is a recent medical graduate of Ross University School of Medicine. She was born and raised in Plaquemine, LA, and earned her Bachelor’s of Science in Biology from Grambling State University. After joining the US Army, she worked for the Public Health Command of Europe as an Environmental Specialist. During her time in Germany, she completed a Master’s in Environmental Policy from Kaplan University. Her multifaceted background inspired her to pursue medicine, and she is now applying for the General Surgery Match 2025. Outside of medicine, Dr. Price enjoys spending time with family and friends, going to concerts, and traveling. **Categories:** career development, diversity and inclusion, family life, global surgery, health, medical students, professionalism, residency, self-care, training, women --- ### [Tools for Empowering Female Medical Students in Research](https://blog.womensurgeons.org/tools-for-empowering-female-medical-students-in-research/) **Published:** January 22, 2025 **Author:** Blog Team **Content:** By Xiomara Ortiz As a fourth-year medical student with aspirations of becoming a surgeon, engaging in research is an essential and fulfilling step in your career journey. Research allows you to deepen your understanding of surgical practices, hone your critical thinking skills, and build meaningful connections with mentors and colleagues who can guide your professional development. However, for female medical students, particularly those from smaller programs or non-traditional educational backgrounds, initiating or finding research opportunities can be challenging. This guide provides practical advice on how to get started and make the most of your research experience. **Attend events and join professional organizations** Networking is a cornerstone for finding research opportunities, especially if your medical school lacks integrated research programs. Begin by evaluating your current network and identifying your goals. Do you wish to gain insight into a particular surgical specialty? Are you aiming to publish papers or participate in clinical trials? Once you clarify your objectives, seek out mentors or faculty members whose research aligns with your interests. **Diversify with your mentors** Building relationships with mentors requires effort and persistence. A proactive approach involves contacting experienced surgeons and expressing genuine interest in their work. Participating in conferences, workshops, or surgical interest group meetings can provide opportunities to meet potential mentors. For female students, organizations like the Association of Women Surgeons (AWS) offer invaluable resources, including mentoring programs and events that connect you with professionals who can provide guidance. Even if your school lacks an AWS chapter, becoming a member can grant access to national resources and expand your network. Additionally, having multiple mentors can provide well-rounded support. For example, one mentor might focus on research, another on clinical skills, and another on emotional support or career strategy. This strategy allows you to benefit from diverse perspectives and expertise, enhancing your personal and professional development. **Reach out to mentors through cold-emailing** For students without immediate research opportunities, reaching out through “cold emails” can be an effective strategy. If your institution has a Level 1 trauma center or academic surgical department, identify faculty members, residents, or statisticians who may need assistance with ongoing projects. Craft a thoughtful and personalized email expressing your interest in their work and how you can contribute. While cold-emailing may lead to more non-responses than replies, persistence often pays off. **Learn basic research skills** Once you secure a research opportunity, focus on acquiring foundational research skills to ensure a strong start. Familiarize yourself with literature review techniques and tools like PubMed, Google Scholar, and ResearchGate. Don’t hesitate to ask your mentor for guidance or utilize your institution’s library resources to strengthen your knowledge base. **Show your gratitude and stay persistent** Always express appreciation for the time and guidance provided by your mentors and colleagues. Whether through thank-you notes or consistent follow-ups, showing gratitude strengthens professional relationships and fosters future collaboration. Additionally, it is important to complete tasks on schedule or communicate early if deadlines cannot be met. Keeping the team you’re working with informed of your progress and potential delays helps maintain trust and ensures everyone is aligned on expectations. By focusing on networking, cultivating mentorships, and remaining proactive, you can overcome challenges and find research opportunities that align with your goals. For female medical students, organizations like AWS can provide additional support to thrive in the surgical field. With patience, persistence, and dedication, you’ll lay the foundation for a successful career in surgery. **About the Author: Xiomara Ortiz** ![Headshot of Xiomara Ortiz](https://blog.womensurgeons.org/wp-content/uploads/2025/01/Xiomara.jpg) I am a fourth-year medical graduate candidate from Ross University School of Medicine with a strong passion for the surgical field, particularly colorectal surgery. Born in Puerto Rico, I am a native Spanish speaker, which has given me the privilege of serving underserved communities in Miami, where I currently reside. As I prepare to apply for the next Match cycle, I dedicate my time to organizing health fairs for these communities—a rewarding way to give back while further enhancing my clinical skills **Categories:** career development, education, medical students, mentorship, networking, professionalism, research, training, women --- ### [Empowering Women in Oral and Maxillofacial Surgery: Breaking Barriers and Shaping the Future](https://blog.womensurgeons.org/empowering-women-in-oral-and-maxillofacial-surgery-breaking-barriers-and-shaping-the-future/) **Published:** January 17, 2025 **Author:** Blog Team **Content:** By: Dr. Shohreh Ghasemi The field of oral and maxillofacial surgery (OMS) is dynamic and essential, focusing on surgical procedures involving the mouth, jaw, and face. As more women enter this specialty, it becomes increasingly important to recognize their contributions, the challenges they face, and the strides they have made toward greater representation. Over the past few decades, the landscape of OMS has changed considerably. Women now represent an increasing percentage of residents and practicing surgeons in this specialty. This shift signals a broader change in the medical profession, where women are stepping into roles once predominantly held by men. Notable female surgeons who have made significant contributions to oral and maxillofacial surgery and beyond include Dr. Lucy Hobbs Taylor, Dr. Gaziya Al-Habib, Dr. Nada Al-Badri, Dr. Valerie Murrah, Dr. Maria Troulis, Dr. Rania Habib, Dr. Patricia Numann, Dr. Salma Kefi, and Dr. Noma Heena. Adding to this inspiring list even me as a dedicated faculty member in the Middle East and the USA, breaking barriers and mentoring future generations in the field. Despite these advancements, women in OMS continue to encounter unique challenges. One major issue is work-life balance, particularly for those managing family responsibilities alongside their professional commitments. Many women report feeling the pressure to excel in their careers while also fulfilling familial obligations, which can lead to stress and burnout. Additionally, gender bias persists in the workplace, affecting opportunities for advancement and mentorship. Personal stories from women in the field reveal various range of experiences, from overcoming skepticism about their capabilities to navigating the complexities of surgical training in a male-dominated environment. For instance, Dr. Maria Troulis, chair of Oral and Maxillofacial Surgery at Harvard School of Dental Medicine, has shared her journey of overcoming skepticism about her abilities early in her career. As one of the few women in her residency program, she often had to prove herself in a male-dominated environment, facing doubts about whether she could handle the physical demands and technical precision of OMS. Through perseverance and excellence in patient care and research, she not only earned the respect of her peers but also became a trailblazer in the field, paving the way for more women to follow in her footsteps. Having access to mentors who understand the specific hurdles faced by women can provide invaluable support and guidance. Organizations like the Association of Women Surgeons (AWS), founded by Dr. Patricia Numann, have profoundly impacted many female surgeons by fostering mentorship, collaboration, and networking. For example, members have connected with mentors at AWS events, leading to career advancements such as fellowship opportunities, research collaborations, and lifelong professional relationships. Female surgeons are also making significant strides in research and clinical practice within OMS. Their innovative approaches and diverse perspectives lead to improved patient care and outcomes. Women are increasingly involved in groundbreaking research that addresses critical issues in the field, such as managing oral cancers and advancements in reconstructive techniques. For example, Dr. Maria Troulis has pioneered virtual surgical planning and 3D printing for craniofacial reconstructions, while Dr. Valerie Murrah has advanced research in the early detection and management of oral cancers, significantly improving patient outcomes. This diversity of thought is vital in shaping the future of oral and maxillofacial surgery, as it brings innovative ideas and solutions to longstanding challenges. As we celebrate the achievements of women in OMS, it is crucial to encourage future generations to pursue careers in surgery. Mentoring young women interested in this field can take many forms, from offering shadowing opportunities to speaking at schools and community events. By actively supporting initiatives that promote women in surgery, we can help break down barriers and create a more inclusive and fair environment. Empowering women in oral and maxillofacial surgery is not just about representation; it’s about enhancing the entire surgical community. The positive impacts of diversity lead to better patient care and innovative solutions to complex challenges. As we look to the future, let us continue to uplift and support women in this field, fostering a culture that values their contributions and inspires the next generation of female surgeons. Together, we can ensure that women’s voices in OMS are heard, respected, and celebrated, paving the way for a more inclusive and progressive future in oral and maxillofacial surgery. **Shohreh Ghasemi DDS, MD, PhD (fellow of EACMFS in head and neck oncology), advisory board of Oklahoma University in Women Leadership.** ![Headshot Photo of Dr. Shohreh Ghasemi](https://blog.womensurgeons.org/wp-content/uploads/2025/01/Ghasemi.jpg) Dr. Shohreh Ghasemi is an innovative force in the field of oral and maxillofacial surgery, widely known for her innovative techniques and profound humanitarian contributions. One of her most significant accomplishments came when she became the first-ever winner of the prestigious Baku Rhinoplasty Symposium in October 2024, a recognition that solidified her position as a leader in facial cosmetic surgery. Dr. Shohreh Ghasemi was an Adjunct Faculty of the OMFS Department of Augusta University and dental faculty of the Royal College of Surgeons and the University of South Wales in the United Kingdom & NASA Open Science Ambassador. Dr. Ghasemi’s career is not only marked by professional excellence but also by her deep commitment to giving back. As a dedicated volunteer with Mercy Ships, an organization that provides free medical services in developing nations, she actively contributes her expertise to communities in need. Her extensive studies have given her a strong foundation, enabling her to develop innovative techniques that push the boundaries of modern cosmetic surgery. She is also a prolific author and speaker, having been invited to address global forums like the AMWC meetings, and Vegas Aesthetic Shows. where she shared insights on the latest advancements in aesthetic surgery. Instagram: [dr.shohrehghasemi](https://www.instagram.com/dr.shohrehghasemi/profilecard/?igsh=MXNjeTd6c2ZydDJsaQ==) Email: [Shooshoo\_gh@yahoo.com](mailto:Shooshoo_gh@yahoo.com) Facebook: <https://www.facebook.com/share/15XMZsJ5f5/?mibextid=wwXIfr> **Categories:** career development, diversity and inclusion, education, global surgery, practice, URiM, women --- ### [Getting the Reps In: Lessons Learned on Building Mental and Physical Strength While in Medical School](https://blog.womensurgeons.org/getting-the-reps-in-lessons-learned-on-building-mental-and-physical-strength-while-in-medical-school/) **Published:** January 8, 2025 **Author:** Blog Team **Content:** By: Rica Generoso As a third-year medical student navigating the clinics and operating room, I’ve learned that resilience isn’t just a buzzword – it’s a lifeline. Many hospital experiences have left me in awe, bringing to life medical knowledge I’d only read about, but the emotional rollercoaster of patient care and the constant pressure to perform can be overwhelming. No matter how prepared I felt, you can’t truly understand until you’re in it. What tested my resilience wasn’t just academics but also my passion for physical fitness. Many who have blazed the trail before us say the most important thing you can do as a medical student is to keep doing what makes you happy outside the hospital. For me, that happiness comes from weightlifting. As a former collegiate swimmer and water polo player, I’ve always been at home in the weight room, and that love has only grown since college. When I felt the mental and physical demands of medical school, the gym became my place to challenge myself, socialize with peers, and reset from the day’s chaos. I’ve seen many friends struggle to maintain exercise routines in medical school. When the demands intensify, it’s tempting to cut back on fitness to make more time for studying. But without regular movement, school-related stress can boil over, anxiety can worsen, and focus may dwindle. Even 30 minutes of physical activity can pay off tremendously and help to distract your mind for a bit. Reflecting on my journey, I’ve found six lessons from strength training that parallel my path to becoming a woman surgeon – lessons I hope will resonate with anyone looking to lean on physical fitness as their outlet. 1. ***Consistency Brings Results*** Spoiler: In both medicine and fitness, results take time. Physically, progress comes from consistently showing up and having a plan, whether a structured protocol or knowing what makes your body feel good. Through progressive overload in the form of heavier weights, higher reps, or more controlled movements, muscles adapt to stress. Medicine mirrors this process. Each day brings new challenges, and leaning into them instead of shying away is key. Success comes from “getting the reps in,” as a surgeon mentor of mine once said – whether that’s suturing daily or pre-charting for weekly clinic. Small, steady efforts accumulate into meaningful growth. 2. ***Develop a Flexible Routine You Enjoy*** Routines are critical for managing medical school and fitness, but flexibility within them is equally important. Schedules can be unpredictable – a case that runs over, unexpected add-ons, or urgent study demands can derail the best plans. I learned to adapt; some days, I could manage a full lift, while on other days, I squeezed in a 30-minute walk and stretch. Friends of mine found joy in hot yoga or joining an intramural basketball team. In physical fitness and medicine, we thrive when we learn how to roll with the punches. Flexibility should make the process sustainable, enjoyable, and effective. 3. ***Make Self-Care a Priority*** In weightlifting and medicine, recovery is as important as the work itself. Pushing too hard without rest can lead to burnout and injury both physically and mentally, and I learned this the hard way at times. As a first-year, once I nailed down study strategies, I made an effort to take Sundays off from academics completely. I slept in, organized my apartment, meal-prepped for the week, and FaceTimed friends. On particularly busy days, I let the gym mark the end of my studying – a small but powerful boundary! We’re more than just medical students and residents – exercise, self-care, and other priorities should feel rewarding rather than taxing. 4. ***Embrace the Discomfort*** Medicine, particularly surgical fields, thrives on innovation – refining techniques, adopting new technologies, and pushing perceived limits. As providers, we thrive on “the grind” – putting in work day after day, even when it’s hard. Progress in fitness is similar. Whether pushing through a final set or grappling with a complex medical concept, discomfort is inevitable. But these moments – when the work feels hardest – are where real growth happens. Resilience is forged in embracing the discomfort and knowing it’s worth it. 5. ***Lean on Your Support System*** An unexpected joy of medical school has been finding accountability buddies for fitness, studying, and staying grounded. The intensity of moving far from home to start medical school built up rather quickly once I factored in managing a fast-paced curriculum, finances, housing, unexpected life events, and more – the “fire hydrant” felt like more of a hurricane at times –but I wasn’t alone. My peers faced the same hurdles, and opening up about our frustrations brought comfort and solidarity. Some days, the weights felt heavier or the material endless, but that’s when support systems mattered most. Friends who cheer you on, push you to finish those extra reps, or study just a little more before a break can make all the difference. You’re never too cool to have people in your corner. 6. ***Celebrate Small Wins*** Recognizing small wins are vital for cultivating a growth mindset – the belief that we can improve our skills through learning, discipline, and persistence. While motivation can be fleeting, breaking progress into smaller steps builds momentum. Some days, becoming a surgeon feels far away,but by celebrating the progress I make – whether it’s mastering a suturing technique or surviving a week of nights – I am refreshed with confidence and excitement for what comes ahead. Lifting has evolved into a hobby I look forward to most days simply for the sake of moving my body rather than seeking a particular end goal. It’s my time to block out distractions, get my headphones on, and catch up with like-minded friends. Translating that same enjoyment into medicine is still a work in progress; some days are just tougher than others, but the lessons I’ve learned keep me grounded. As I grow in both the gym and medicine, I’m confident these lessons will guide me through the toughest days. **Bio:** ![](https://blog.womensurgeons.org/wp-content/uploads/2025/01/Generoso.Rica_-150x150.jpg)Rica Generoso is a third-year MD candidate at Central Michigan University College of Medicine. She grew up in southern Connecticut and attended Tufts University for her undergraduate education, where she earned her bachelor’s degree in Neuroscience with a minor in Art History. At Tufts, she also competed in Division III swimming and women’s water polo. She is a proud member of the Association of Women Surgeons and serves on the AWS Outreach Committee as a medical student representative. In her free time, she enjoys traveling, skiing, spending time outdoors, cooking, and cheering on Boston sports teams. X/Twitter: @Rica\_Generoso2 **Categories:** education, medical students, practice, reflection, training, URiM, women --- ### [First-Generation Immigrants in Medicine: Overcoming the Challenges](https://blog.womensurgeons.org/first-generation-immigrants-in-medicine-overcoming-the-challenges/) **Published:** December 18, 2024 **Author:** Blog Team **Content:** ### #### **By Juliana Ampadu Otiwaah** #### **My Journey** As a first-generation immigrant, my path to becoming a doctor was far from straightforward. My family immigrated from Ghana to Canada nearly 30 years ago. My father arrived first, working tirelessly to create a foundation for us. Three years later, my mother, brother, and I joined him. My parents, both blue-collar workers, did their best to support me, but they weren’t familiar with the complexities of higher education. When making decisions about my future, I had to rely on teachers and school staff for guidance—many of whom underestimated my potential based on early academic performance. Growing up in a French-speaking region and learning English presented additional challenges, as did navigating schoolwork without my parents’ ability to assist. By high school, I had unlocked my potential and excelled academically, but understanding how to pursue a career in medicine remained a mystery. Nursing became a practical starting point, influenced by my mom’s experience as a hospital aide. It offered financial stability and exposure to healthcare, but deep down, I knew I wanted to become a doctor. The transition wasn’t easy, but I worked hard to carve a path forward. Now, as I prepare for the match process, I reflect on how far I’ve come—a journey defined by resilience and determination. #### **Challenges and Resilience Required as a First-Generation Immigrant** The challenges faced by first-generation immigrants in medicine are multifaceted, shaped by limited knowledge, financial barriers, and a lack of representation. Many immigrant families are unfamiliar with the education system, which makes navigating prerequisites and applications especially daunting. Without mentors in the family or professional connections, students like me often rely on trial and error, which can delay progress. Financial constraints further complicate the journey. Higher education is expensive, and for families already struggling to make ends meet, the additional costs can feel insurmountable. Perhaps the most significant challenge, however, is self-doubt. When you don’t see people who share your background in positions of success, it’s easy to question whether you belong. For me, the absence of role models in medicine sometimes made the dream feel out of reach. Yet, these challenges also fostered resilience. I learned to advocate for myself, seek guidance where I could find it, and push through the barriers in my way. #### **Finding Strength and Building Support** For first-generation immigrants, building a support network is essential. Mentorship programs, student organizations, and online communities can connect aspiring doctors with those who have navigated similar paths. For instance, I relied on the AMG Mentoring Program, the Student National Medical Association (SNMA), the Association of Women Surgeons (AWS), and a local African church support group during my time at SGU. These organizations provided guidance, encouragement, and a sense of belonging that helped me stay focused on my goals. Financial aid opportunities, including scholarships specifically for immigrants and first-generation students, can help alleviate the financial burden. Which can be very difficult—in my case, I worked to support myself but also tried to find a bank loan back in Canada to help me, which wasn’t easy. The process often required navigating complex systems and proving my commitment to education despite limited resources. Schools also offer valuable resources, from academic advisors to career counseling, which can provide guidance when family support isn’t an option. Above all, it’s important to believe in your potential. Your unique journey—shaped by resilience, determination, and a desire to succeed—adds value to the field of medicine. While the road may be long and filled with obstacles, each step forward is a testament to your strength and capability. #### **Conclusion** The path to medicine as a first-generation immigrant is undeniably challenging, but it’s also deeply fulfilling. Our diverse experiences, shaped by the sacrifices of our families and our determination to succeed, enrich the medical field. By sharing our stories and supporting one another, we can pave the way for others to follow and show that no dream is out of reach. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/12/Otiwaah.Juliana-Ampapadu-240x300.jpg)Juliana A. Otiwaah, is a 4th-year medical student at St. George’s University School of Medicine. Born in Ghana and raised in Canada, she earned a Bachelor’s of Science in Nursing at McGill University, which launched her career as an emergency department nurse. She later completed a Master’s in Nursing at the University of Toronto and practiced as a nurse practitioner. Her diverse experience has shaped her journey to medicine and she is now applying for the General Surgery Match 2025. Outside of her academic pursuits, Juliana enjoys spending time with family, friends, traveling and exploring her passion for music as an amateur DJ. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, medical students, professionalism, reflection, training, URiM, women **Tags:** AWS, AWSBlog, ILookLikeASurgeon, womeninsurgery, WomenSurgeons --- ### [Breaking the glass ceiling: Importance of representation in medicine](https://blog.womensurgeons.org/breaking-the-glass-ceiling-importance-of-representation-in-medicine/) **Published:** December 4, 2024 **Author:** Blog Team **Content:** By Camila Gonzalez,MD The [glass ceiling is a metaphorical concept ](https://builtin.com/diversity-inclusion/glass-ceiling#:~:text=The%20glass%20ceiling%20is%20a%20metaphor%20that%20refers%20to%20the,Getting%20rejected%20from%20a%20job)used to describe an intangible barrier that hinders the career advancement of certain individuals, particularly those seeking to attain managerial or executive positions within an organization or industry. Unfortunately, this term can be applied to the current environment in medicine, where underrepresented groups such as women and International Medical Doctors (IMGs) face significant obstacles in advancing their careers. This is a concept that I have been dealing with for a large portion of my young medical career. I come from a family of strong women who did the best they could with their circumstances, between migrating continents and countries, taking care of their families, and assuming jobs that could bring food to the table and give better opportunities for the generations to come by sacrificing their dreams. A good example of this is my grandmother, who had a great affinity for medicine but because of the restrictions on education for her gender, couldn’t pursue it at that time. Despite this, she gave everything she could to my mother so she could become the amazing architect she is to this day. My medical career path has rarely been straightforward, since all the socioeconomic barriers and stereotypes inherent to what seems to be a male-dominated field in a third-world country that is the Dominican Republic, I was constantly discouraged from following my passions. So instead of letting go of it, I decided to start taking down the barriers that were in my control, like applying for an academic scholarship to study medicine that allowed me to graduate with honors one pandemic and a couple of years later. Another similar action was interviewing for a highly competitive spot of a 1-year internship at one of the top surgical hospitals in the country, which I’m happy to say I got and helped me to both grow my surgical skills and to become a better caregiver by learning to listen and be comprehensive of my patients. Yet, as a foreign-trained woman in medicine, every door seemed harder to open, despite all these achievements and other outreach and leadership experiences, whenever I externalize my goals of pursuing surgery, I have been met with questions about my skills or if I could ‘’handle ‘’ the long hours as a woman. As an IMG, these doubts have multiplied since I’m proving my capabilities as a doctor andnot just proving my capabilities as a doctor, but also fighting for visibility in a competitive system. An example of this is finding mentorship: the mentors I reached out to often couldn’t relate to my unique challenges, leaving me without the critical guidance many colleagues relied on. As IMGs, we understand that the journey to enter and thrive in the U.S healthcare system can be daunting and require tremendous effort and adding the fact that Latina physicians remain significantly underrepresented in the U.S. medical field, c[omprising only about 2% of all doctors, with even fewer in specialties such as surgery.](https://latino.ucla.edu) However, we draw inspiration from countless individuals who have achieved success and surmounted various challenges along the way. Their experiences serve as a source of motivation and guidance for us. Moreover, they can advocate for diversity and challenge biases in medical education, helping to pave the way for future generations of doctors from diverse backgrounds. By learning from their stories and examples, we can better navigate the obstacles that lie ahead and work towards breaking down the invisible barriers that still exist. As the demographics of the United States population are changing at a rapid pace, the demand for promoting diversity in healthcare is crucial. Medical students who learn in a diverse environment might be better prepared to provide care to a diverse patient population. In addition, this will enable patients to receive care from professionals who understand their unique needs and can effectively communicate with them, ultimately leading to positive impacts on patient outcomes. Patients are more likely to feel understood and comfortable when seeking medical attention, and in the long run, they can create a bond as trust is built with their doctor, helping reduce health disparities among different communities. [Dr. Quinn Capers highlights the benefits of diversity in medical education, emphasizing that students exposed to diversity are more likely to be culturally competent and aware of social determinants of health that may affect their patients](https://www.ahajournals.org/doi/10.1161/JAHA.120.018893). Therefore, promoting diversity and representation among incoming doctors is crucial in providing equitable and effective healthcare to diverse patient populations. Every medical doctor has something important to bring to the table, regardless of their gender, background, or where they come from. It’s important to continue breaking the glass ceiling for our patients and for the incoming generation of physicians who share the same goals and dreams as we do in this community. Let us persevere and draw inspiration from those who have broken barriers before us, as we work towards a more diverse, equitable, and inclusive healthcare system. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/12/Gonzalez.Camila-1.jpg)A proud graduate of the Universidad Nacional Pedro Henríquez Ureña (UNPHU) in the Dominican Republic, Camila Gonzalez is a driven medical professional with a passion for surgery, currently working as a Research Coordinator. With a focused interest in Trauma and Colorectal Surgery, she is preparing to compete for a coveted residency position. Beyond the operating room and the laboratory, she is an advocate for diversity and inclusion in medicine, striving to create pathways for underrepresented communities. Known for her dedication and vibrant personality, she balances her medical aspirations with pursuits like writing, exploring new cuisines, and championing initiatives that inspire future generations of international medical graduates. IG @Lifeinwhitecoat ![](https://blog.womensurgeons.org/wp-content/uploads/2024/12/Gonzalez.Camila-3.jpg)![](https://blog.womensurgeons.org/wp-content/uploads/2024/12/Gonzalez.Camila-2.jpg) **Categories:** advocacy, awareness, career development, diversity and inclusion, education, medical students, practice, professionalism, reflection, resources, training, Underrepresented in medicine, URiM, women --- ### [Performance Punishment, Perfect Punishment?](https://blog.womensurgeons.org/performance-punishment-perfect-punishment/) **Published:** November 20, 2024 **Author:** Blog Team **Content:** By Jenna Kwon I heard about it for the first time during a recent meeting with my mentor from the AWS Mentoring Program. As I was telling her I wanted to dedicate more time to research, she advised me to ask my current research mentor if there were additional projects I could join, saying, “since good work gets rewarded with more work.” My immediate reaction during the meeting was, “I hope he thinks I did a good job so I can get more work.” After all, I both wanted and needed research opportunities. After the meeting, as I looked through my notes on a Post-it, I noticed that the phrase about good work being rewarded with more work was circled several times with a small, sloppy “??” scribbled next to it. How lucky would it be to get involved in a research project you are passionate about—and to keep getting more chances to contribute? I think this stood out because, on one hand, I was a little envious of people who don’t have to chase opportunities with endless “Sent x days ago. Follow up?” Gmail reminders. On the other hand, the idea of being given more work for doing well seemed both obvious and oddly counterintuitive. I started to wonder if this concept was actually a thing and if so, what we—who generally love giving names—decided to call it. Typing… I pressed Enter. “When good work is rewarded with more work, it’s often called performance punishment.” *Punishment*? How did words like “good” and “rewarded” come to mean “punishment”? This made me reflect on how we, as medical students, often find ourselves in situations where extra work is seen as a reward for our efforts or, simply, more learning opportunities. As medical students, the most common question we hear is, “Have you decided on a specialty?” This is often followed by, “Yes, but I’m keeping an open mind.” Perhaps this process—deciding, staying open-minded, accepting the hard path—becomes part of our journey in medicine, even though it often leads to more work. Perhaps it’s the nature of medicine: to excel requires continuous learning, adapting to evolving technology, and keeping up with new protocols. By doing a good job, we inevitably take on more responsibilities. Not to mention, for women, this often means taking on additional volunteer work rather than advancing their careers. While its prevalence does not make this phenomenon fair, it does explain why we’ve come to somehow accept it, which may contribute to high physician burnout rates. Of course, my thoughts may evolve in the future. But for now, as a medical trainee aspiring to be a surgeon with boxes to check off, performance punishment feels more like a reinforcement of others’ reliability in my responsibility. So, if it is a “punishment” by definition, I’d gladly take it as my “perfect punishment.” ![](https://blog.womensurgeons.org/wp-content/uploads/2024/11/Kwon.Jenna_.2.jpg)Jenna Kwon is a medical student at the Warren Alpert Medical School of Brown University. She grew up in Seoul, South Korea, and she plans to pursue an integrated vascular surgery residency. Outside of medicine, she enjoys taking hot yoga classes, writing reflective essays, and learning about animals. **Categories:** awareness, career development, current events, medical students, professionalism, reflection, self-care, training, URiM, women --- ### [Sci-Fi to Surgery: The life story of a Latin American surgeon](https://blog.womensurgeons.org/sci-fi-to-surgery-the-life-story-of-a-latin-american-surgeon/) **Published:** November 6, 2024 **Author:** Blog Team **Content:** By: Alix Yurany Baez Ramirez, MD In an operating room, under a mask, you don’t know the life story on the other side. What decision has made the person in front of him decide to enter the world of medicine? After all, we are all stories, the sum of our experiences, the sum of the dreams we had as children, the construction of longings or whims in adolescence, and the social and cultural realities that surround us to become and build those adults that we visualized as children. This is mine. To better understand the context of my story, it is important to consider higher education statistics in our region. [According to UNESCO-IESALC (2020)](https://www.iesalc.unesco.org/2021/10/18/educacion-superior-en-america-latina-y-caribe-presente-y-futuro/), higher education in Latin America and the Caribbean has experienced an acceleration in the enrollment process, going from 23% in 2000 to 52% in 2018. This expansion is attributed to three main factors: an increase in the number of students, a greater interest in access to knowledge, and a greater diversity of academic programs. In Colombia, the situation reflects the regional landscape. In 2000,[ the gross coverage rate was 24%, while for 2021, the outlook is much more encouraging, with a percentage of 53.94%.](https://doi.org/10.13043/dys.78.2) I was born in Colombia in the 90s in an interior region of the country called Boyacá, a place where peasant culture and agricultural work predominate; area of landscapes worthy of postcards, with infinite greens and endearing moors that reveal the purity and magic of nature, an area rich in history and cultural tradition. There, where economic, social, and cultural difficulties are also the order of the day, access to education became a privilege. In this context of educational challenges, my personal story takes on a special meaning. I am part of the first generation of my family to complete university education. Therefore, accessing medical school represented a great opportunity. I am the result of the tireless effort of a mother dedicated to her home, bold and intelligent; and of a loving father, a tireless worker, and an example of perseverance. However, both faced the gaps and difficulties imposed by an unequal society. My parents dedicated all their efforts so that I, their only daughter, had the opportunities that they could not have. [As in the life of Dr. Inés Ochoa Pérez, the first Colombian woman who graduated as a doctor in 1938 at the National University of Colombia ](https://www.uptc.edu.co/export/sites/default/vie/extension/unidades/museos_uptc/vo_muj/doc/mhms_mujhistmed.pdf)and also from my region, my story represents a milestone in my family and community. At that time, Inés was the only woman among 60 students and faced discrimination. Today, decades later, women in Latin American medicine continue to open paths and overcome obstacles. This tradition of overcoming obstacles has shaped my dreams and aspirations. While some dream of interstellar travel or floating on the moon, my movie scene was more earthly but just as shocking: studying to have a professional career. I longed to be a doctor who not only helped people in general but could also assist mine. In the course of my medical career, the desire to achieve a goal and a life project was getting closer and closer. However, on the way, getting to know the operating rooms and the skills with the scalpel on an operating table of so many admirable women and men who saved the lives of children and adults to return them to their families; made me fascinated by that scenario and dream of becoming a surgeon. Today, having graduated as a doctor, I work in operating rooms and many of those dreams are a reality. The next step is very close: faced with the process of entering a surgery residency, I have the dreams that I have built intact, in which becoming a great pediatric surgeon will go from being an illusion to a beautiful reality. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/11/Yurany-Baez-Ramirez.Alix_-150x150.png)Medical professional from the University of Boyacá, Colombia. She works as a doctor in operating rooms and is currently competing for a residency position in surgery, with a continued interest in pediatric surgery. In addition to her life in medicine, she has a great interest in biodiversity, the sustainable world, looking for alternatives to reduce the polluting footprint on our planet, she does ecotourism with the objective of learning about ecosystems and making them known. Instagram: @[naniibaez\_](https://www.instagram.com/naniibaez_/) **Categories:** advocacy, awareness, current events, diversity and inclusion, education, hispanic heritage, professionalism, reflection, training, URiM, women --- ### [Let it go!](https://blog.womensurgeons.org/let-it-go/) **Published:** October 30, 2024 **Author:** Blog Team **Content:** --- By: Dr. Shruti Venkitachalam, Head and Neck Surgeon, Chennai, India It was an early morning surgery. I was the second assistant, retracting for a neck dissection. After almost three hours of retracting, I asked if I could get a five-minute break. The prompt reply was, “Why? Are you pregnant?” I was appalled and embarrassed. The others in the OR giggled. It made me cringe. He didn’t pause to think before saying that, and I was embarrassed – not him! Since completing my fellowship training, I have worked with only male superiors in different hospitals. I saw them as ‘surgeons’ and not as ‘male surgeons’ – until certain situations forced me to look at them that way. Years passed and faces changed but the story remains about several ‘hims’ and me. One morning, ‘he’ gave me several tasks to do. I scrambled to finish them but was late for the clinic. When I reached, there was a nurse and two patient relatives in the room. Panting and sweating, I apologized for the delay and entered behind the curtain where he was examining the patient. He was quick to say, “I think you are hypothyroid”. The patient immediately replied with a “No, I am not, Doctor”. He clarified with a “Not you, Ma’am. I am talking to her, who seems too slow for anything.” One may think that could be reasonable! I could be slow, hypothyroid, or plain lazy or inefficient. Well, here’s the context to that. This is how my ‘work’ worked! He would see patients in the clinic and give orders. I counselled the patients and family members about the tests, financial aspects, surgery, post-op events, and everything else. I saw patients when they were admitted. He saw them after they were on the OR table and most often intubated. He’d do the main part and leave. I spoke to the patient’s family after surgery, coordinated with other teams of doctors, did post-op dressings, managed drains, discharged patients, and took patient calls on my phone 24/7. When he passed the “hypothyroid” comment, it never struck him that I was the one interacting with the patients constantly. Or even worse, maybe he didn’t care. I was working almost 6.5 days a week. And was “on call” (or as he liked to call it ‘available at all times’) 24/7. Often, I’d fall asleep at the steering wheel at a long traffic signal and wake up to honking on my way home at night. I was constantly exhausted, physically and emotionally. After slogging several months in this thankless role, I told him I’d like to have a few days off. He asked if I was going on vacation. I said, “No, I just need a little break. I am worried I am having burnout”. He said, “You don’t have burnout; you’re just incompetent!” The second time he called me “hypothyroid”, there was no one else in the clinic room but the two of us. I had a breakdown and started weeping. He immediately sat me down and started “consoling” me. Slowly he meandered to “Are you happy at home? Maybe you are frustrated because you don’t have a child?” I was so shocked that I couldn’t react. Over the years, I was so gaslit, that my fingers trembled to apply a single surgical knot. On tough days, I would slip away from his clinic and go into other doctors’ clinics- just to get away from him. They would smile and ask, “Need some breathing space?”. Everyone seemed to know! No one encouraged me to confront him. No one else confronted him on my behalf. All the witnesses, the nurses, other surgeons, and anaesthetists consoled me but did nothing. To me, they all participated! I would often vent my frustrations at home. I became a very bitter person. Most friends and family I discussed this with asked me to “let it go” and many even pointed out how I wasn’t ‘smart enough’! These instances and many more, made me question my role as a doctor, my personal growth as a surgeon, and how much I could tolerate before I was driven nuts. In my last role, when I couldn’t take it anymore, I simply quit. No one was surprised, except him. What I experienced, through several perpetrators, wasn’t misogyny. It was just disrespect for another human being! One needn’t be a “feminist” to be hurt (Although there is nothing wrong with being one!). One just needs to be human. I have re-run my story to myself a million times, telling myself the wrong narrative all along, one of a victim! After several years, I realized, I was not a victim. I was amongst the perpetrators! I am not ashamed anymore to say that I sought therapy for several months. Nevertheless, now I can talk about this without shedding a tear and without hating ‘him’ (them). I am still ‘unsettled’ in my career but I am a happier and nicer version of myself. People close to me see that too. Several things that I managed to achieve later were simply out of the grit to prove ‘him’ (them) wrong – I am grateful for that. It is important to speak up, stand up for oneself, to build a healthy team where communication isn’t restricted merely by hierarchy. \#ilooklikeasurgeon, an online campaign, was started to celebrate women in surgery. It sought to break the stereotype of the arrogant, white, male surgeon as a barrier to surgical professionals. It set out to emphasize that appearance, motivations, and behaviors of surgeons are as varied as humanity. Diversity, equality, and inclusion are fancy PowerPoint presentations prepared by HR teams. But in reality, each one of us needs to assert it. If these issues are addressed early, good professionals and good careers can be built, enabling sustained good patient care. Burnout is real! And it starts in the early years of training. If one has the avenue to clear one’s mind off other things and focus just on work, we could build a much stronger and more confident future generation of doctors. “Women shouldn’t have to carry the burden of proof at personal risk to self and career. But for those who have the bandwidth — your stories are the fuel needed to drive change.”- Erica C. Kaye (*Kaye EC. Misogyny in medicine. New England Journal of* *Medicine. 2021 Jun 17;384(24):2267-9.*) This is my story. What’s yours? ———- I am a head and neck consultant at a tertiary care corporate hospital in a metropolitan city in the South of India. Other than being a passionate surgeon, I am vocal about issues like parity in care for patients; emotional, financial, and social as much as physical rehabilitation of cancer patients; and equal cerebral opportunities for women at work workplaces, to name a few. I am also a founder and director of a young biopharmaceutical company, having some brilliant women scientists on our team. I feel fortunate to have their support to help me inch towards a dream I have had for a long time- the indigenisation of products/ drugs/ technology leading to sustainable, world-class quality and affordable health care for Indian cancer patients. **Categories:** awareness, diversity and inclusion, gender differences, guest blog, practice, professionalism, reflection, URiM, women --- ### [From Sci-Fi to Surgery: Exploring Neuro-Enhancement Technologies](https://blog.womensurgeons.org/from-sci-fi-to-surgery-exploring-neuro-enhancement-technologies/) **Published:** October 23, 2024 **Author:** Blog Team **Content:** By Larissa Werneck For centuries, the idea of enhancing human cognition has captivated scientists and thinkers alike. Early experiments in brain augmentation, such as Roberts Bartholow’s 1874 electrical brain stimulation, laid the foundation for further exploration (Patra et al., 2019). Today, rapid technological advancements and increasing scientific curiosity have led to a surge in neuro-enhancement research (Clark et al., 2014). These innovations are revolutionizing healthcare, particularly in surgery, where they are used therapeutically (Giordano, 2012) and to enhance surgical performance (Patel et al., 2020). As research in this area expands, neuro-enhancement technologies hold the potential to revolutionize surgical practice, pushing the limits of precision, stamina, and ethics. How will this rapidly evolving field reshape the future of surgery? Neuro-enhancement technologies are various tools aimed at optimizing cognitive and neurological functions, either by enhancing existing abilities or compensating for deficits (Giordano, 2012). Examples of these technologies include brain-computer interfaces (BCIs), neurofeedback devices, and neuroprosthetics (Brenninkmeijer et al., 2017). Deep brain stimulation (DBS), for instance, targets specific brain regions to alleviate symptoms of conditions like Parkinson’s tremors (Sironi, 2011). While initially developed for therapeutic use, these technologies are increasingly being applied in high-performance fields like surgery, where cognitive enhancement can be critical. Neurofeedback, a biofeedback technique that trains individuals to voluntarily regulate brain activity (Weiskopf et al., 2004b), has been investigated as a potential tool in reducing surgical burnout. In one study involving fifteen surgical residents, cognitive workload was measured using electroencephalography (EEG) and neurofeedback intervention was found to significantly improve cognitive workload (Kratzke et al., 2021). EEG patterns shifted from those indicative of post-traumatic stress disorder to a more efficient neural network (Kratzke et al., 2021). Similarly, transcranial direct-current stimulation (tDCS), a non-invasive technique that uses electrodes to modulate cortical activity, has been associated with enhanced attention and surgical skills, such as laparoscopic surgical skills (Ciechanski et al., 2018, Ciechanski et al., 2019). The future of neuro-enhancement technology in surgery is rapidly advancing as companies like Elon Musk’s Neuralink push the boundaries of brain-machine interfaces (Musk and Neuralink, 2019). Recent breakthroughs, such as noninvasive brain-computer interfaces controlling robotic devices (Durham, 2019), hint at a future where surgeons could operate using only their thoughts. Augmented reality (AR), already making strides in the operating room, allows surgeons to visualize complex anatomical structures and plan procedures with great precision (Connolly, 2024). The potential for integrating AR with neurofeedback systems could enhance decision-making and situational awareness, propelling surgical performance to new heights. However, despite these exciting advancements, ethical challenges must be addressed. Autonomy and equity are key concerns, as widespread adoption of neurotechnologies may pressure surgeons to incorporate them, potentially undermining their autonomy (Patel et al., 2020). The rising demand for advanced neurotechnology could also exacerbate socioeconomic disparities, as access to these tools may become limited to those who can afford them, thereby widening the gap in healthcare equality (Jangwan et al., 2022). Balancing the benefits of neuro-enhancement with ethical considerations will be crucial as the field advances. Ultimately, neuro-enhancement technologies could profoundly impact the future of surgery, offering improvements in precision and cognitive endurance. However, addressing the ethical implications of their use, such as accessibility and autonomy, will be as important as the technological advancements themselves. The future of surgery may well depend on the synergy between human skill and neuro-enhancement technology, but careful thought will be required to navigate this evolving landscape. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/10/Werneck.LArissa-138x300.png)Larissa Werneck is a third-year medical student at the University of Incarnate Word School of Osteopathic Medicine (UIWSOM) in San Antonio, TX. She earned a Bachelor of Arts in Neuroscience from Boston University (BU) and went on to complete a Master of Science in Biomedical Sciences, along with a Certificate in Genomics and Predictive Health, from Florida Atlantic University (FAU). Outside of medical school, Larissa enjoys fostering dogs from local rescues, gardening, and cooking! **Categories:** awareness, career development, current events, education, medical students, Neurosurgery, practice, professionalism, research, resources, training, URiM, women --- ### [Sustainability, and Beyond…Another Case for the Resurgence of Private Practices](https://blog.womensurgeons.org/sustainability-and-beyondanother-case-for-the-resurgence-of-private-practices/) **Published:** October 17, 2024 **Author:** Blog Team **Content:** By… Erin King-Mullins, MD Sustainability has become a critical concern across all sectors, and the healthcare industry is no exception. While large hospital systems often grab headlines for their sustainability initiatives, private medical practices are emerging as unsung heroes in the quest for a more environmentally friendly and sustainable healthcare system. Physicians and trainees are grappling with tough decisions regarding the type of employment. One of the many concerns pertains to sustainability (including self-preservation). Let’s explore how smaller, more agile entities are making a significant impact in this arena. 1. Reduced Energy Consumption Private practices typically operate in smaller spaces compared to sprawling hospital complexes. Whether by using smaller office spaces and on site staff, or performing operations in ambulatory surgical centers, this inherently leads to lower energy consumption for heating, cooling, and lighting. In my practice, I utilize a virtual medical assistant to help with patient callbacks, scheduling and many other administrative tasks that don’t require onsite physical presence. Many private practitioners are taking this a step further by implementing energy-efficient lighting systems, using smart thermostats to optimize temperature control, investing in energy-efficient medical equipment or using pre-owned equipment. These measures not only reduce the carbon footprint but also lead to cost savings that can be reinvested in patient care or staff. 2. Minimized Waste Generation Smaller practices often have more control over their supply chains and waste management processes. This allows them to implement stringent recycling programs, opt for reusable or biodegradable medical supplies where possible, and carefully manage inventory to reduce expired medication waste. By generating less waste, private practices contribute to reducing the healthcare industry’s environmental impact. 3. Telehealth and Reduced Transportation Emissions Many private practices have been quick to adopt telehealth solutions, especially in the wake of the COVID-19 pandemic. This shift has multiple sustainability benefits including: reduced patient travel, leading to lower transportation-related emissions; decreased need for physical office space and associated energy consumption; minimized use of disposable medical supplies, paper, energy, and water typically used in in-person visits. 4. Personalized Care and Preventive Medicine Private practices often excel at providing personalized care and focusing on preventive medicine. Numerous goals can be achieved with this approach. Fewer unnecessary tests and procedures reduce medical waste and cost. Earlier interventions can prevent more resource-intensive treatments later. This can all lead to better patient outcomes, which can mean fewer emergency department visits, hospital admissions, and their associated environmental costs. In addition, it can reduce after hours and weekend calls, leading to less healthcare worker burnout, less turnover, and longevity in practice. 5. Efficient Resource Utilization With tighter budgets and more direct oversight, private practices often achieve higher efficiency in resource utilization. Streamlined appointment scheduling maximizes practitioner time and reduces idle equipment usage. Careful selection of multi-purpose equipment to minimize redundancy. Optimizing use of space, reduces the need for expansive, energy-hungry facilities. Other ways to improve resource utilization and even generate additional revenue streams are sub-leasing or cohabitation of medical space. Unique situations can allow for practical use of physical space and resources. Early on after the birth of my son, and my practice, I took advantage of the low volumes and excess space to care for my child on site. Participation in research studies led to developing a research department. Some of the equipment funded by participation can be used in direct patient care, reducing cost for the practice. 6. Community Engagement and Education Private practices are often deeply embedded in their local communities. Their associated healthcare provided are trusted experts in the community and understanding the unique needs of the area. Practices can educate patients on the health benefits of sustainable living. Participation in and promotion of local environmental and targeted wellness initiatives sets an example for sustainable business practices in the community. This year I hosted my first community Colorectal Cancer Awareness Month event. It was family friendly and provided education about screening, and healthy eating. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/10/EKM-2-150x150.png) ![](https://blog.womensurgeons.org/wp-content/uploads/2024/10/EKM-1-150x150.png) While the contributions of individual private practices may seem small, their collective impact on healthcare sustainability is significant. By operating more efficiently, embracing technology, focusing on preventive care, and engaging with their communities, these practices are proving that sustainability in healthcare isn’t just the domain of large institutions. The ability to adopt swift change as necessary for the betterment of the environment, patients and staff allows for immediate change in outcomes. As we move towards a more environmentally conscious future, the role of private practices in fostering sustainability in healthcare and the environment will only continue to grow. Most importantly, the culture and care that can be created in the workplace can lead to sustainability of the most important resources of all…the human resources. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/10/King.Mullins.Erin_-300x230.jpg)Erin King-Mullins, MD, FACS, FASCRS Atlanta, GA Dr. Erin King-Mullins is a double board-certified general and colorectal surgeon. She transitioned to private practice in 2022 by founding Colorectal Wellness Center after serving as Faculty/Research Director for an Atlanta-based colorectal fellowship program. She has a husband with whom she shares an amazing, blended family. The kids keep them pretty busy, but their favorite times are spent on warm sunny beaches. **Categories:** advocacy, awareness, career development, current events, diversity and inclusion, family life, leadership, practice, professionalism, reflection, resources, URiM, women --- ### [Navigating Uncertainty on Medical Mission Trips: Lessons in Adaptability and Patient Care](https://blog.womensurgeons.org/navigating-uncertainty-on-medical-mission-trips-lessons-in-adaptability-and-patient-care/) **Published:** October 9, 2024 **Author:** Blog Team **Content:** **By Mindy Hong** Murphy’s Law—“Anything that can go wrong, will go wrong”—has often resonated with me during my medical mission trips. Despite thorough preparation, unforeseen challenges inevitably arise. I’ve realized that, as medical students, we must embrace adaptability and flexibility to overcome these challenges and grow as future physicians. My experiences on two medical mission trips, one as a rising third-year and the other as a fourth-year medical student, have shaped my approach to patient care and broadened my understanding of global health. **The Guatemala Mission: Building Clinical Confidence** My first mission trip as a third-year medical student took me to Guatemala, where I would work clinically for the first time. I was eager yet uncertain, as each day brought new patient populations in various locations. Roles were fluid, and I found myself working as a pharmacy technician—far from what I anticipated but essential for understanding healthcare systems and team-based care. On our first day in the clinic, we experienced a whirlwind of activity as we unloaded medications and equipment. The chaotic organizational process underscored the importance of collaboration and communication. Once settled, I began working with patients alongside my close friend and fellow medical student, performing full histories and physicals (H&Ps) and presenting our findings to attending physicians. One patient, a middle-aged woman with uncontrolled hypertension and poorly managed diabetes, had not seen a doctor in years due to limited access to care. With guidance from my attending, we formulated a treatment plan involving medications, lifestyle modifications, and follow-up care. This experience in Guatemala provided my first real taste of patient interaction. I learned the importance of humility in medicine—recognizing that it’s okay not to know everything, but crucial to ask questions and rely on your team to provide the best care possible. Reporting to an attending physician was intimidating, but an invaluable opportunity to strengthen my clinical reasoning and presentation skills ahead of my third-year rotations. **Oaxaca, Mexico: Interprofessional Collaboration and Specialized Care** Fast forward to my fourth year: I had the privilege of participating in a second medical mission trip to Oaxaca, Mexico, in collaboration with the University of the Incarnate Word and Quijotes of San Antonio. This trip brought together a diverse group of professionals and students, highlighting the importance of teamwork in delivering holistic patient care. As we set up the clinic, we faced familiar disarray, but this clinic had more robust resources, including specialty services like gynecology, emergency medicine, optometry, and physical therapy. On my first day in the gynecology clinic, I struggled to connect with patients due to my limited Spanish proficiency. Frustrated but determined, I decided to take a step back from gynecology for a day and followed an emergency medicine physician. During our time together, we saw a patient experiencing recurrent chest pain and palpitations. She had consulted several specialists, including a cardiologist, but no definitive cause had been found. Through careful questioning, we discovered that her symptoms were related to stress from financial struggles and caring for her teenage sons. The holistic approach of my attending, who sought to understand the patient’s life circumstances, reminded me that in medicine, we are treating whole people with emotions, families, and struggles. The next day, I returned to the gynecology clinic with renewed confidence. After practicing medical Spanish in the evenings, I was better equipped to communicate with patients, leading to more productive interactions. I performed several pelvic exams and participated in Nexplanon removals and insertions, reinforcing the technical skills I had developed in my clinical rotations. One patient, a young woman in her early twenties, came in to have her Nexplanon removed after five years. I assisted with the procedure under an OB/GYN attending. This encounter not only provided valuable procedural experience but also allowed me to build rapport with the patient despite language barriers. The gratitude of patients throughout the trip left a lasting impression on me. **Adaptability as a Core Skill** Both mission trips reinforced a key lesson: adaptability is critical, regardless of preparation. On the day we traveled to Oaxaca, our flight was delayed, leaving me without any extra clothes to change into. It wasn’t the ideal start to a mission trip, but it taught me the importance of staying calm and making the best of challenging situations. On our final day in Oaxaca, a humorous yet fitting example of Murphy’s Law unfolded. After a long day at the clinic, I sprained my ankle stepping into a pothole while enjoying a walk through the local market. Fortunately, it was a minor injury, but it served as a reminder that unexpected events can occur at any moment. For those considering medical mission trips, I offer this advice: Be open to the unpredictable. Each day presents new challenges, whether logistical, clinical, or personal, and these experiences will shape you as a future healthcare provider. Serving populations with limited access to care is an honor, and these trips have taught me invaluable lessons in flexibility, resourcefulness, and humility. **Practical Advice for Future Mission Participants:** - Pack extra scrubs and personal hygiene items in your carry-on, as laundry services may not be available. - Bring a personal towel and extra undergarments; simple comforts can make a big difference. - Carry a journal or use your phone to document your daily experiences. Reflection solidifies lessons learned. - If possible, bring extra supplies like gloves, masks, and exam tools—they can be invaluable in resource-limited settings. - Always bring a positive attitude and a willingness to adapt to any situation. In the end, it is the people you serve and the lessons you learn that leave the greatest impact. Whether assisting with procedures, learning new skills, or simply offering a kind word to a patient, each experience contributes to your growth as a physician and a person. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/10/Hong.Mindy_.jpg)Mindy Hong is a fourth-year medical student at the University of Incarnate Word School of Osteopathic Medicine (UIWSOM) in San Antonio, TX. She received her Bachelor of Science at the University of Houston where she double majored in Biology and Psychology. Before starting medical school, Mindy completed a Master of Science in Biomedical Sciences at the UIWSOM. She aspires to continue participating in medical mission trips every year and is considering pursuing a fellowship in Global Health. Outside of medical school, she enjoys spending time with her dogs, hosting movie nights, and trying new foods! She can be found on Instagram @hellomyndee **Categories:** Uncategorized --- ### [Becoming part of the pathway](https://blog.womensurgeons.org/becoming-part-of-the-pathway/) **Published:** October 7, 2024 **Author:** Blog Team **Content:** By Shaidy Moronta, DO I march along to different appointments with my elderly grandparents—a normal routine for first-generation non-English speaking immigrants. We prefer to serve as the primary interpreters for our family. In many cases, this is our first introduction to the medical field. In other cases, it is where we find our life’s calling. I recall a particular appointment with my Abuelita for a colonoscopy screening. The doctor, an African American man who led a very pleasant appointment, tried to explain the plan in Spanish as best he could. My Abuelita began to weep immediately. She was in this country for less than a year and was navigating the foreign world of medicine in a language she could not comprehend. This was the first physician who tried to speak to her in her language. At that moment I realized just how important it was to feel seen, to be heard, and to be able to communicate with your doctor. It was the impetus to fortify my Spanish skills and aid in increased patient satisfaction and outcomes. I started the arduous task of pursuing a career in surgery at a young age. I shadowed in different hospitals and joined a dedicated high school track for careers in healthcare. It granted me the opportunity to meet healthcare providers from several disciplines within the field. I quickly learned that none of them looked like me. They didn’t share my background, or my customs, and most of them had a relative already engendered in the field. People of Hispanic/Latinx descent are the fastest-growing population in the United States making up [18.7% of the U.S. population](https://data.census.gov/table?g=010XX00US&d=DEC%2BDemographic%2BProfile) according to the 2020 census. Unfortunately, that increase has not been paralleled within the physician workforce where [only 5.8% identified as Hispanic/Latinx](https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019). The further I ventured into the field, that diminutive figure was starkly sensed. I felt isolated. I knew this was the field for me but time and again, I questioned whether it would love me back, whether I was truly meant to break away from my town’s negative expectations, and whether I would even be given a chance to further my prospects. Those feelings changed when I got accepted for an internship at Columbia University College of Physicians and Surgeons under the SMDEP program. The program prepares students of underrepresented backgrounds for a career in medicine by providing shadowing opportunities, accelerated courses, and mentorship. I left that summer inspired and supported by a community I never knew existed. I realized I had many misconceptions, yet no one was close enough to correct them or inquire. Thankfully, SMDEP illustrated how important it is to reach out to underrepresented youths, to dispel the myths, and to connect them to mentors in the field. A qualitative study [detected these themes amongst African American and Latinx surgeons](https://doi.org/10.1097/ACM.0000000000002282) in creating a path to medicine. Even with our varied backgrounds, it is important for us to identify aspirational figures early in our careers. It would be years later that I would meet a Latinx surgeon. During my final year of medical school, I met two Latinx residents during an external sub-internship. That feeling of belonging was once again instituted and served as much-needed hope during the chaotic residency application cycle. In 2022, I matched into a general surgery residency in Danbury, CT. I connected immediately with Dr. Vargas-Pinto. She is a spectacular endocrine surgeon who shares an extraordinarily similar background as me. In moving to Connecticut, I found comfort in being closer to home and my heritage. There is a sizable Portuguese and Latino community in Connecticut, so I get to utilize my native tongue on an almost daily basis. I continually see myself shifting in my role as I progress further in the profession. I am no longer the child who was told I would never make it and to “find an easier job”. I am here now and have gathered the tools necessary to help those coming after me. It is a daunting responsibility but one I cherish. Going back to my community and hosting events at local high schools is my way of giving back further to the pipeline. I want to see more Latinas in medicine. I want more Abuelitas to have full conversations and disclosures with their doctors. I want my family to see *me* in the providers attending to their health. I want to see us as a community that continues to succeed, and I am elated to be part of the revolution. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/10/Moronta.Shaidy-141x150.jpg)Dr. Shaidy Moronta, DO is a general surgery resident completing her training at Danbury Hospital in Danbury, CT. She is originally from Hazleton, PA, and attended medical school at Edward Via College of Osteopathic Medicine in Blacksburg, VA. Her current interests include endocrine and head and neck surgery. When not in the hospital, she enjoys creative and thrilling ventures such as singing, art, skydiving, and rollercoasters. **Categories:** advocacy, awareness, current events, diversity and inclusion, education, family life, hispanic heritage, leadership, reflection, residency, self-care, training, URiM, women --- ### [The Evolution of Women in Surgery: Defying Barriers and Shaping Medical History](https://blog.womensurgeons.org/the-evolution-of-women-in-surgery-defying-barriers-and-shaping-medical-history/) **Published:** October 2, 2024 **Author:** Blog Team **Content:** By: Andrea Iturralde, MD Women in surgery have been in a constant state of evolution. In the early history of medicine, women played a fundamental role in surgery, but by the Middle Ages, they were forbidden from practicing. Despite these restrictions, women found ways to remain involved, demonstrating that when a woman has a dream and a strong desire, she doesn’t let go. In Greek mythology, Asclepius, the god of healing, married Epione. They had five immortal daughters and two mortal sons. Their daughters—Hygieia, Aceso, Iaso, Aegle, and Panacea—were all physicians who represented different stages of the healing process and pharmaceutical treatment (Filippou et al., 2020). In the 11th and 12th centuries, another remarkable woman, Trota of Salerno (also known as Trotula), contributed as a practitioner and writer to the medical field. She was part of the Medical School of Salerno and was responsible for important advances in education and knowledge about diseases and treatments for women (Bifulco et al., 2019). A 15th-century English proverb stated, “The ideal surgeon should have the eye of an eagle, the heart of a lion, and the hands of a woman.” This likely alludes to the healing touch of women, as our hands can treat illness and care for patients. Women persevered even during male-dominated eras when they were actively discouraged from practicing surgery. Despite the many closed doors, women persisted in pursuing medical and surgical residencies. With strength and sacrifice, they have broken down these barriers. For example, during the Napoleonic Wars, Margaret Anne Bulkley, known as Dr. James Barry, served as a surgeon in the army. She studied at Edinburgh Medical School, posing as a man, and became a highly skilled surgeon who performed the first successful cesarean section. She was believed to be a man until her death when her female anatomy and signs of a previous pregnancy were discovered (Wirtzfeld, 2009). She was willing to change everything about her life rather than give up on her dream. Another pioneer in medicine was Dr. Elizabeth Blackwell, who graduated from Geneva Medical College as the first female physician in the U.S. in 1849, nearly 80 years after the first medical school was established in the country. From Dr. Blackwell to Dr. Bertha Van Hoosen, the first female surgeon admitted to the American College of Surgeons in 1913, to Dr. Kathryn Steimson, the first woman certified by the American Board of Surgery in 1940, women have brilliantly overcome obstacles. Acts of bravery and tenacity, such as those of Dr. Mary Edwards Walker, the first female surgeon in the U.S. Army, and of determination, like Dr. Jennie Smillie Robertson, who established the Women’s College Hospital and served as its chair of gynecology for 30 years (Wirtzfeld, 2009), demonstrate the capacity of women to defy the status quo and overcome adversity. All these remarkable women exemplify our bravery, brilliance, and determination, proving that we are capable of achieving anything despite obstacles and challenges. We have always been—and continue to be—an integral force in the evolution of medicine and surgery. 1. Wirtzfeld D. A. (2009). The history of women in surgery. *Canadian journal of surgery. Journal canadien de chirurgie*, *52*(4), 317–320. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724816/> 2. Filippou, D., Tsoucalas, G., Panagouli, E., Thomaidis, V., & Fiska, A. (2020). Machaon, Son of Asclepius, the Father of Surgery. *Cureus*, *12*(2), e7038. <https://doi.org/10.7759/cureus.7038> 3. Bifulco, M., De Falco, D. D., Aquino, R. P., & Pisanti, S. (2019). Trotula de Ruggiero: The Magistra mulier sapiens and her medical dermatology treatises. *Journal of cosmetic dermatology*, *18*(6), 1613–1616. <https://doi.org/10.1111/jocd.12882> ![](https://blog.womensurgeons.org/wp-content/uploads/2024/10/Iturralde.Andre_-150x150.jpg)I am an International Medical Graduate (IMG) from Ecuador, currently working as a postdoctoral research fellow in the Neurosciences Department at the University of New Mexico. I am applying for General Surgery in the 2026 match. I am passionate about addressing surgical disparities and improving access to surgery in low-income countries. Outside of medicine, I enjoy photography, painting, and exploring the outdoors. **Categories:** advocacy, awareness, diversity and inclusion, gender differences, leadership, networking, practice, professionalism, training, URiM, women --- ### [All the things I do for free (Women do more “non-promotable work”)](https://blog.womensurgeons.org/all-the-things-i-do-for-free-women-do-more-non-promotable-work/) **Published:** September 25, 2024 **Author:** Blog Team **Content:** By Carmen Fong, MD, FACS I always said yes. That’s what you’re supposed to do, right? Always say yes because you don’t know which opportunity is going to be “the one” that launches your career into orbit. So I said yes to organizing the lunch orders when the drug reps came; I said yes to an extra teaching session about bowel obstructions for the PAs; I said yes to Saturday morning medical school interviews, and Friday afternoon laparoscopic workshops, and joining XYZ committees on which I was the token Asian lesbian. I thought, someday, all this hard work, all this extra time I’m putting in, will get recognized. Little did I know that none of these things counted toward the most important benchmarks of productivity and publication. At the end of the year, when the hospital administrators have you justify your bonus, they ask you what your relative value units and how many papers you wrote, not how many committees you were on. Not to say that I didn’t do a lot of surgery cases and also write a bunch of abstracts, and this isn’t to say that I don’t enjoy all of the other stuff that I do, because I love teaching and writing and being a voice for the people, but I had been thinking a lot about all the things I do for free, both at work and outside of it. We pay to go to medical school, and then we are paid when we become physicians. But then, we end up paying to be part of a society or association so that we can serve on their committees and do a bunch of work for free. Some of us also volunteer, work as ambassadors and mentors, do virtual shadowing, write recommendation letters, edit personal statements, write guest blog posts, edit and present abstracts, review journal articles, and more. What is it all for? Perhaps some of the extracurriculars count as stepping stones toward a bigger goal, say a promotion or a national committee chair. But does ordering lunch really make that much of an impact? Or is it that “getting the food” is considered womanly work, or is it that I’m too nice and people always think, “Carmen will do it!”? Studies have also shown that women tend to do more of this “free” work than their male colleagues. The authors of “The No-Club” wrote in this [Harvard Business Review article](https://hbr.org/2018/07/why-women-volunteer-for-tasks-that-dont-lead-to-promotions) that women were found to do 200 more hours of non-promotable work than their male counterparts. These hours include sitting on committees, planning birthday parties, ordering coffee, and working with trainees. At a recent Zoom meeting where a dozen or so early career surgeons were “chosen” to be part of a journal article reviewer academy, we were sold and told to apply because it gave us the “chance” to work with seasoned article reviewers and potentially join the group of reviewers one day, or even rise to be an editor. I jumped at the opportunity and was extremely honored that my application was accepted. I learned a lot at each session and valued the feedback I received for my article reviews. However, as I looked around the virtual room at my fellow reviewers, I saw a lot of women, and especially a lot of women of color. I couldn’t help but think, were we enticed into doing free, non-promotable work by showing us the carrot of a prestigious career path that only white, cis-men have taken? One of the examples given in this [article](https://www.pnc.com/insights/small-business/running-your-business/unpaid-work-holds-women-back-at-work-too.html) is “tending to high-touch clients.” I can’t help but think how women colorectal surgeons bear the brunt of pelvic floor dysfunction patients, which tend to be more time-consuming and require more extensive workup and psychosocial evaluation, generally without the “payoff” of a large operation. We do a lot for free. Should we stop doing the free stuff, or demand fair pay, or should we count it all as stepping stones toward higher-paying, more prestigious positions? Evidence suggests maybe all of the above, but most importantly, institutions need to make a conscious effort to evenly distribute these ‘housekeeping’ jobs, or ask the most qualified person, regardless of gender. Women find it hard to say no. “A big contributor to women doing this work is that we expect them to do it,” one of the authors of the Harvard Business Review article says. When considering my own culpability in this systemic injustice, I realize that sometimes I take on these roles because I feel that I could do a better job than anyone else, and sometimes if you want something done right, you have to do it yourself! I am sure that many of you who are reading this feel this way. Doing it yourself nurtures some sense of control. But sometimes it’s okay to delegate. For whatever reason, or no reason at all, consider this your permission to say no. The thing is … maybe I like doing all these other things? While a man only has to be good at one thing at a time, women have to be good at at least three things at once. But is there a better feeling than being able to say, “I swung by the bakery on the way to work and picked up this cake and had everyone sign this card before your surprise birthday party?” Or throwing a Secret Santa for all your colleagues as a minute speck of light in all the darkness that is residency training? One afternoon, my wife told me she had to make a list of all the things she’s done in the past year as a part of her annual performance evaluation, and she was surprised at how long her list was, even though she didn’t feel like she was doing much at the time. She said I should make a list of all the things I’ve done. Looking back,I realized I have done a lot in my short career, andwhile the majority of it did not count toward the productivity and publication standards that we’re often judged by, I feel like I can count my successes in the people I’ve helped along the way. And that counts for something. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/09/Fong-Square-150x150.jpeg)Dr. Carmen Fong is also the author of *Constipation Nation*, a non-fiction book about what to know when you can’t go, forthcoming from Rowman & Littlefield in November 2024. More information on Dr. Fong’s work can be found on[ www.carmenfong.com](https://linkprotect.cudasvc.com/url?a=http%3a%2f%2fwww.carmenfong.com&c=E,1,zeylPre2LsbZHoF514ZzwsEivq04ovv2A0pkk_NEmOTC4j4xKpQrtDvR8dKBnK-YhBUhjzhEpXY3rH3SvwjN7xnT11yGdT_qsxIMklfc_OqBrrtvKwzefWG-SSE,&typo=1),[ www.constipationnation.com](https://linkprotect.cudasvc.com/url?a=http%3a%2f%2fwww.constipationnation.com&c=E,1,qd2PKVWAM_bdB1kWXRWOWbBKG0PU0D6gZiWMy-RPeHPS7LHJwTzsF8-0Oopiu3HliojUYnbZoM7Z8hfOmqlbkeDyLNdbwDjv9DkFcwYKddyqmW1pSjvZhp3b&typo=1), Substack, KevinMD, Instagram (@drcarmenfong), and Tiktok (@dr.carmenfong219). She used to be on Twitter but now she is on Threads. By day, she is a colorectal surgeon and the Co-Medical Director of Hemorrhoid Centers of America. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/09/Fong.Carmen-Surgery-222x300.jpg) **Categories:** advocacy, awareness, career development, current events, gender differences, leadership, practice, professionalism, self-care, URiM, women --- ### [Food as fuel: optimizing health in med school, residency, and beyond](https://blog.womensurgeons.org/food-as-fuel-optimizing-health-in-med-school-residency-and-beyond/) **Published:** September 18, 2024 **Author:** Blog Team **Content:** By Maya Zhou The phrase “food as fuel” is not a novel concept, but I didn’t fully appreciate the truth in this phrase until I started my surgery rotations in medical school. Studying nutrition in college, I experimented in my own kitchen to come up with convenient and simple recipes that I could rely on when on a time crunch. I tried cooking with new vegetables (like collard greens and artichoke) and proteins (like tempeh) that I hadn’t tried before, and I found ways to incorporate them into recipes that I cooked regularly. In medical school, during my surgery rotations, time became a precious resource, and cooking everyday was no longer realistic. It became more challenging to consume a balanced diet every day. Through trial and error, I developed a reliable and realistic method to optimize nutritional intake every day, and wanted to share this in case it would be helpful for other surgical trainees or women in surgery: 1. Set aside just five minutes to pack some sort of lunch for the next day. This saved me more than just five minutes the next day and gave me peace of mind knowing that I had food ready whenever I had a quick break to eat. I found the most efficient way to pack lunch is to bring any kind of leftovers along with 1 fruit that stores well like an apple or banana. 2. Optimize protein intake, whatever type of protein you prefer. I found that I perform at my best when I eat enough protein daily; it sounds self-explanatory, but I think this is especially important for surgeons, as our physical endurance is essential and we spend long hours standing in the OR. It’s important to provide sufficient building blocks for muscles to repair and rebuild. 3. Try to ensure that 1 meal every day is well-balanced. Even if all other meals are unplanned, on-the-go, or only snacks and “random” foods, just making sure you have 1 complete meal a day can have a noticeable impact on strength, digestive function, and energy. I hope this blog can be a gentle reminder to take care of ourselves amidst our busy and hectic lives as surgical trainees and surgeons. Especially when sleep and exercise are limited, it is necessary to pause and remember that it is okay to fuel and take care of ourselves, in order to be the best surgeons that we can be, and to take the best care of our patients. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/09/Zhou.Maya_-150x150.jpg)Maya Zhou is a fourth year medical student at Boston University Chobanian & Avedisian School of Medicine, currently applying into urology. She is from Upstate NY and graduated from Cornell with a BS in Nutrition. In her free time, she enjoys playing tennis, skiing, cooking, and painting. She is grateful to be a part of the AWS community and the Blog Subcommittee! **Categories:** awareness, career development, diversity and inclusion, education, health, medical students, practice, resources, self-care, training, URiM, women --- ### [Bienvenidos, Hispanic Heritage Month is here!](https://blog.womensurgeons.org/bienvenidos-hispanic-heritage-month-is-here/) **Published:** September 17, 2024 **Author:** Blog Team **Content:** By Susana Vargas Pinto, MD September 15 to October 15 is a significant period dedicated to recognizing and honoring the contributions, history, and culture of Hispanic and Latino Americans. This observance was officially established in 1988 by President Ronald Reagan, though its roots stretch back to the 1960s. The celebration offers an opportunity to reflect on the diverse heritage of Spanish-speaking countries and the impact these communities have had on the fabric of American society. The timing of Hispanic Heritage Month is symbolic: September 15 marks the anniversary of independence for several Latin American countries, including Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua. The choice of this date as the beginning of Hispanic Heritage Month serves as a reminder of the historical and cultural significance of Latin American independence movements. Additionally, Mexico and Chile celebrate their independence days on September 16 and September 18, respectively, further anchoring this period in the history of the Hispanic world. One of the central themes of Hispanic Heritage Month is the acknowledgment of the significant contributions of Hispanic Americans to various fields, including science, politics, art, and literature. In surgery, our field has evolved over time to include and support underrepresented minorities. While it’s challenging to pinpoint a single “first” movement, there have been several notable early efforts aimed at addressing disparities and fostering inclusion in our field. As a recognition of the need for a collective voice and support system for Latino surgeons, the Latino Surgical Society (LSS) was founded in 2003. Its founding was driven by the realization that Latino surgeons faced unique challenges in their professional development, including issues related to mentorship, representation, and access to resources. The LSS was established with several key objectives: 1. To advocate for the interests of Latino surgeons within the broader surgical and medical communities. 2. To provide educational and professional development opportunities, including workshops, conferences, and networking events. Our biannual symposium was held at the University of Washington earlier this year. 3. To foster mentorship relationships between experienced surgeons and those in training, helping to guide the next generation of Latino surgical professionals. 4. To promote research in areas pertinent to Latino health and surgical practice, and to disseminate this knowledge through publications and conferences. The first issue highlighting the work of LSS researchers will be published in the American Journal of Surgery later this year. Today, our organization continues to focus on expanding its reach and impact. Building partnerships with other surgical and medical organizations such as AWS is key to promoting diversity and inclusion. In partnership with the AWS, opportunities were created for our medical students and residents to attend the annual AWS meeting and the first co-sponsored visiting professorship program was launched this year. We are excited to announce that Dr. Mecker Moller will be our inaugural speaker and the selected host institution will be announced later this month. I hope these upcoming weeks can serve as a time for education, reflection, and appreciation of our values, and foster a deeper understanding of the Hispanic communities that contribute to our cultural richness. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/09/Vargas-Pinto.Susana-2024-UPDATED-Blog.jpg)Susana Vargas Pinto, MD is a board-certified endocrine surgeon and current Latino Surgical Society (LSS) liaison to the AWS. She practices and lives with her husband and daughter in western Connecticut. **Categories:** advocacy, awareness, current events, diversity and inclusion, hispanic heritage, mentorship, practice, professionalism, resources, training, URiM, women --- ### [Trauma: The Hidden Dimensions of a Universal Struggle and Strategies for Overcoming It](https://blog.womensurgeons.org/trauma-the-hidden-dimensions-of-a-universal-struggle-and-strategies-for-overcoming-it/) **Published:** September 12, 2024 **Author:** Blog Team **Content:** **By Barbara Buccilli MD** Trauma is an omnipresent force in our lives, manifesting in various forms and degrees of severity. We encounter it in our patients, our neighbors, sometimes within our own families, and we can also experience it first hand. As a medical professional, I am acutely aware of the diverse nature of trauma, raging from physical injuries to the psychological wounds inflicted by life’s hardships. Neurosurgical trauma is a field characterized by its fast pace, high stakes, and the necessity for precise decision-making under pressure. When I’m working with one of the most delicate organs in the body, in which every nucleus and every fiber has its precise and often irreplaceable function, my actions can have an immediate and tangible impact on a patient’s survival and quality of life. Trauma to the brain and nervous system is multifaceted, and despite advances in medical science, we often lack definitive treatments. In addition, physical trauma is only the most evident kind of trauma our patients have to face, and no doctor can be entirely prepared to face every possible aspect of trauma, especially the ones that have no physical counterpart. However, what I can do is treat the trauma I can see and have the opportunity to address. My goal is to provide patients with the immediate care they need, stabilizing their conditions, and giving their bodies and minds the strength and resources to fight the battles I cannot directly intervene in. This might sound like science fiction, but I can’t help but wonder about the potential functional neurosurgery could have in these patients. Functional neurosurgery is a specialized field within neurosurgery that focuses on restoring or improving the function of the nervous system. This is achieved through surgical interventions that modulate, restore, or replace dysfunctional neural circuits, often using techniques like neurostimulation, lesioning, or the implantation of devices. Combining trauma neurosurgery and functional neurosurgery, could hold immense potential to address both the physical and mental aspects of trauma comprehensively. Trauma neurosurgery focuses on the immediate, life-saving interventions required to stabilize patients with critical injuries, while functional neurosurgery delves into advanced techniques such as Deep Brain Stimulation (DBS) to treat neurological disorders and alleviate chronic pain, depression, and other psychological conditions. DBS uses low-dose electrical impulses delivered through an implantable device to specific brain regions, modulating abnormal neural activity and leading to therapeutic changes. It allows for adjustable, reversible stimulation, meaning its parameters can be fine-tuned over time for the best therapeutic response. DBS targeting the central thalamus has been explored to improve arousal and consciousness in patients with severe TBI, particularly in those who are in a minimally conscious state. Stimulation of regions such as the fornix or hippocampus has been explored experimentally to improve memory functions in patients who experience cognitive impairments post-TBI, while targeting areas like the nucleus accumbens or ventral striatum has shown potential to modulate behavior and emotional regulation. Spinal cord stimulation, which involves implanting electrodes near the spinal cord to modulate pain signals, can provide relief for post-traumatic pain syndromes or aid in rehabilitation efforts for spinal cord injuries. Intrathecal baclofen pumps or selective dorsal rhizotomy can help manage spasticity and improve mobility. DBS targeting the globus pallidus interna or the subthalamic nucleus can also improve spasticity. Vagal nerve stimulation has been explored in the treatment of cognitive impairments and mood disorders. Additionally, functional neurosurgery plays a key role in the development of brain-computer interfaces, further expanding its potential to restore function in patients affected by trauma. By researching ways to integrate these two fields, we could not only repair the acute physical damage caused by trauma but also enhance the long-term recovery and quality of life for patients by both speeding up physical recovery and addressing the underlying neuropsychological effects. This holistic approach could lead to more effective and enduring outcomes, bridging the gap between immediate surgical care and long-term mental health support. One of the most profound aspects of trauma surgery is the ability to make a difference in moments of crisis. We all experience trauma in our lives, whether big or small, public or private. We understand the significance of a kind, extended hand during times of need. In my career, I aspire to be that hand for my patients. However, more than just offering compassion, I aim to provide them with the expertise and precision that neurosurgery demands. I want my patients to learn the value of a kind, precise blade the same way they learned to value a kind, extended hand. In conclusion, my interest in neurosurgery and trauma is fueled by a desire to make a meaningful difference in the lives of patients during their most vulnerable moments. As I said before, my idea could sound like science fiction, but science fiction is only such until it becomes reality; then it’s just science. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/08/Buccilli.Barbara.png)Dr. Buccilli is a Neurosurgical ICU pre-residency fellow at the Icahn School of Medicine at Mount Sinai and 2025 match applicant. With prior neurosurgical residency training at the University of Ferrara in Italy and 2 years of clinical and research work in the Neurosurgery department at Policlinico Umberto I, the academic hospital associated with Sapienza University of Rome, Dr. Buccilli brings a wealth of international experience to her practice. Currently, heavily involved in research, Dr. Buccilli’s is committed to advancing the field of neurosurgery through innovation and comprehensive patient care. **Categories:** advocacy, awareness, current events, Neurosurgery, practice, professionalism, URiM, women --- ### [Breaking Barriers: My Journey As A Female Img And How The Association Of Women Surgeons Fueled My Surgical Aspirations](https://blog.womensurgeons.org/breaking-barriers-my-journey-as-a-female-img-and-how-the-association-of-women-surgeons-fueled-my-surgical-aspirations/) **Published:** September 4, 2024 **Author:** Blog Team **Content:** By Yashjot Kaur From a small town in India to the vast medical community in the United States, my journey as an International Medical Graduate (IMG) has been one of resilience, discovery, and growth. When I decided to pursue a residency in the U.S., I had few opportunities available. As a first-generation medical student, the first in my family to ever take an international flight, and from a background where neither of my parents spoke English fluently, my journey has had many peaks and valleys. In my first year of medical school, I fell in love with anatomy. As an artist at heart, surgery combined my passion for art and anatomy. Crafting mandala art, with its intricate designs and attention to detail, mirrors the precision required in surgery, and, very much like art, surgery provides me with an opportunity to work with my hands. When I decided to pursue a career in surgery, I noticed the low representation of female surgeons in the department and wondered about the factors contributing to this disparity. Motivated to explore these issues, I designed a study to assess the influences and deterrents for medical students of all genders considering a surgical career. I was amazed by the study results, where both male and female students reported an equal interest in pursuing surgery, highlighting the need to encourage more women to enter the field. With a question in mind about how to bridge the gap to encourage more females to pursue surgery, I submitted the abstract “ Assessment of Factors and Deterrents Influencing Medical Students in Pursuing a Career in Surgical Disciplines: Gender-Based Perceptions From a Teaching Hospital in India” for poster presentation at the ACS Clinical Congress Medical Student Program. It was accepted to be presented in Boston that year! My first time presenting at an international conference was a rewarding experience. It was during my first few days in the US that I was introduced to the Association of Women Surgeons by an amazing mentor I connected with through art. As a student, I had limited access to female surgical role models, but AWS introduced me to an incredible community of women surgeons who have inspired and guided me. As an IMG, finding mentors can be challenging, but through AWS, I have built a network of supportive mentors who have been instrumental in my journey. From attending the wine and cheese event to having my art displayed at the annual conference, my involvement with AWS has been transformative. I have since participated in many virtual webinars and events conducted by AWS and have presented my research at the medical student poster competition held online. As I embark on the next chapter of my career, applying for the general surgery match in 2025, I am deeply grateful for the opportunities and support I’ve received. AWS has played a vital role in my professional growth, and I look forward to paying it forward by inspiring the next generation of surgeons. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/09/Kaur.Yashjot.jpg) ![](https://blog.womensurgeons.org/wp-content/uploads/2024/09/Kaur.Yashjot-2.jpg) I am an International Medical Graduate (IMG) from India, currently applying for the general surgery residency match in 2025. As a first-generation doctor and college graduate, I’ve pursued my medical education with passion and dedication, earning gold medals in anatomy, otorhinolaryngology, and head and neck surgery. My love for surgery is rooted in my passion for art, where precision and creativity come together. Outside of medicine, I express my artistic side as a mandala artist, creating intricate designs that reflect the same attention to detail required in surgery. And a fun fact: Since I was born on February 29th, I’m officially just 6 years old! Twitter Handle- @KaurYashjot5833 Instagram art page- \_the\_mandala\_doc **Categories:** awareness, AWS conference, diversity and inclusion, education, medical students, networking, professionalism, reflection, training, URiM, women --- ### [Need extra board exam preparation? Try Chat GPT…](https://blog.womensurgeons.org/need-extra-board-exam-preparation-try-chat-gpt/) **Published:** August 27, 2024 **Author:** Blog Team **Content:** By Alicia Podwojniak M4 Everyone has mixed opinions about Chat GPT and other forms of artificial intelligence. When the concept began to gain traction last year, I found myself viewing it in a negative light. I distinctly remember a friend teasing me about how Chat GPT would soon take away all our jobs. She even pointed out that it had passed the USMLE Step exams, which triggered a defensive response from me. The idea of a robot passing an exam that I, and many others, had stressed over for years made me quickly dismiss the notion. A few months later, I had a change of heart. I realized that AI was not just a passing trend but rather, becoming a substantial presence in our lives. I felt like I was being stubborn and resistant to change, much like my parents during the tech boom of the early 2000s. I understood that not embracing new technology could put me at a disadvantage, and I wanted to learn how to use AI tools to enhance my education and training. Today, I want to share how Chat GPT can be leveraged to generate high-quality practice questions to aid in studying for exams like USMLE/COMLEX. I didn’t set out my studying with the intention of using Chat GPT; in fact, I only used it in the last final days of my studying but wished I started earlier – and thus, I’m writing this post to share its potential benefits. As I was studying for my Step 2 exam several months ago, I had a few practice questions without answer keys. I posted them into Chat GPT to see if it could generate an answer key with quality explanations. To my surprise, it did, and I figured I could use it as a tool to create more questions. At this point, I was mainly reviewing the ethics and biostatistics just days before my exam. I had exhausted my resources (UWorld and Amboss), so I asked Chat GPT to generate some questions. Here is an example prompt: “You are a writer for the USMLE Step 2 CK exam. I am a medical student looking to enhance my learning, have exhausted my resources, and need more practice questions. Please generate five high-quality, difficult, Step 2 CK-level practice questions on ethics and quality improvement. Please include the answers and explanations for wrong answers.” Here is a real example question generated from the above prompt: ![](https://blog.womensurgeons.org/wp-content/uploads/2024/08/Blog-1.png) Unsatisfied with the answer explanations, I followed up with: “Please give more thorough answer explanations for question 1.” And it provided a more thorough series of answer explanations. The most important aspects of using these tools to augment studying is twofold: 1. Understand that it is not the gold standard and should not be used as a primary study source. 2. Prompting is the most critical aspect of generating a solid practice question. I’m not an expert in AI, but I found it helpful in generating a few extra practice questions. To reiterate, I’d personally recommend only using this to supplement your studying and exhaust the tried and trusted resources first. I shouldn note a word of caution with believing everything Chat GPT says as fully truthful, as it has been known to provide false, or made up, responses. With that being said, always fact check its outputs and be confident in your strong base of clinical knowledge. Happy studying! **![](https://blog.womensurgeons.org/wp-content/uploads/2024/08/VSLO-headshot-240x300.png)Alicia** is a fourth-year medical student at Rowan SOM in New Jersey, with an interest in applying to surgery, aspiring to become a plastic surgeon. She has a particular interest in working with pediatric populations and is deeply passionate about medical education. She received her Bachelor of Science at The College of New Jersey, where she majored in Biology and minored in both Public Health and Psychology. Outside of her academic pursuits, Alicia enjoys running, practicing yoga, and reading on the beach. She is an avid animal lover with a special place in her heart for her dog. **Categories:** awareness, career development, current events, education, medical students, resources, training, URiM, women --- ### [Crying Over Spilled Milk](https://blog.womensurgeons.org/crying-over-spilled-milk/) **Published:** August 25, 2024 **Author:** Blog Team **Content:** **Special Edition for National Breastfeeding Awareness Month** **Marjorie Liggett, MD** When my newborn wasn’t gaining weight in the first week of life, I became obsessed with my milk supply. I couldn’t stop the racing thought: *Am I failing as a mother because I can’t feed my own child?* I’ll admit, that was a little dramatic. Blame the hormones and the sleep deprivation, if you must, but I’m sure someone else reading this knows exactly what I’m talking about. Throughout my maternity leave, I diligently pumped and breastfed every 2-3 hours, day and night. Eventually, after a lot of hard work, I felt confident in my milk supply and my goal to breastfeed for 6 months or more. The baby was gaining weight, the anxieties I had around feeding my child began to subside, and I even had generated a moderate freezer stash for a rainy day. As I prepared to return to work, I thought I had a good plan in place for pumping. I had purchased my absurdly expensive wearable pumps, recommended by other working moms, my ice packs, my collection bottle, and my lunch box to keep it all in. I set my alarm to go off every 3 hours to remind me to pump. Mama was ready to bring home the bacon (so to say). Fast forward to my first day back in the operating room. The beginning of the case went off without a hitch. However, one hour into the case, I ran into some unexpected problems. As I am painstakingly troubleshooting, relying on my plan B and then plan C to salvage the case, I suddenly hear my “it’s time to pump” alarm go off. But it is not a safe time to stop. Time continued to tick on, and by the time the case was complete, I realized I hadn’t pumped in almost 5 hours. My breasts were sore, swollen, and leaking. When it was safe to do so, I ran to the locker room and got out my fancy wearable pumps. I was gratefully anticipating the relief and also feeling anxious regarding the long stretch of time and its impact on my supply. Then: *error flush falange*. Flush with what? It’s dry!? I had only used these pumps three times before. I replaced the falange, and tried again. *Error, flush falange*. This went on for another ten minutes. I only had 20 minutes before I needed to return to the OR. I tried to make do with one working pump. Only 2 ounces out, significantly less than my normal yield. Disappointed, still feeling full, and now feeling rushed to return to the OR, I went to dump my liquid gold into my collection bottle. And then, my worst fear: As I removed the collection canister of the pump, the entire 2 ounces spilled onto my scrubs. Covered in my own breast milk, I began to cry. Breastfeeding while training as a surgeon is no easy feat. Our lives and workplaces are just not designed to be breastfeeding-friendly. When I embarked on this journey, I knew staying committed to breastfeeding was going to be hard, demanding work that required a lot of careful planning to make it logistically feasible. But I was unprepared for how emotionally charged the experience could be. When my supply dwindled, I felt immense guilt and shame. When my child got so used to bottles, because of my long hours away, and no longer wanted to nurse at night, I felt lonely. When I was able to pump successfully and had a good yield, I felt proud and resilient. The rollercoaster of emotions around feeding your child (however you choose to do so) is something no one can prepare you for. So, if you haven’t heard it lately, but need a reminder: it is, indeed, okay to cry over spilled milk. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/08/Liggett.Marjorie-148x150.jpg)Dr. Marjorie Liggett, MD is a PGY-5 General Surgery Resident at Northwestern University Feinberg School of Medicine in Chicago, IL and an AWS member since 2020. She is a graduate of the College of the Holy Cross in Worcester, MA, where she studied Biology and Anthropology. Prior to medical school, she was a high school special education teacher, an experience that has shaped her practice and fostered her love for education. She received her medical degree from Michigan State University College of Human Medicine. Currently, she is pursuing a Master of Science in Clinical Investigation degree from Northwestern University. Her research interests are in traumatic brain injury, damage control resuscitation, and hemorrhagic shock. She plans to pursue a career in Trauma Surgery and Critical Care. She loves to teach and mentor other residents and medical students and is always looking for an opportunity to get a coffee and talk about surgery, resident wellness, medical education, parenthood, and dogs. Twitter: @liggett\_MD **Categories:** advocacy, awareness, current events, diversity and inclusion, family life, health, parenting, professionalism, resources, self-care, training, women --- ### [Cultivating Self-Compassion](https://blog.womensurgeons.org/cultivating-self-compassion/) **Published:** August 21, 2024 **Author:** Blog Team **Content:** By Laura Roe Stevens Brought to you by our partners at [Canyon Ranch](https://www.canyonranch.com/) Ever wonder how some people seem to sail through tough times, while others struggle for years? Experts say one key to a person’s strength and resilience is something rarely spoken of: a dose of self-compassion. “Self-compassion is a way of relating to ourselves in times of suffering that enables increased kindness and decreased self-judgment,” says Jaimie Mudd, MDiv, MC, PCC, spiritual wellness provider at Canyon Ranch. “When we’re able to be kind to ourselves and lighten up on self-criticism, it allows each of us to be honest without being harsh. We can have our unique experience, while also connecting to the larger human experience of loss, failure, pain, and healing,” she says. Jaimie’s advice is not solely based on her training and education. It’s deeply rooted in experience and recent losses. “This year I have experienced profound loss in a short period of time,” she begins. “Ten people dear to me, including my beloved brother, passed away. When needed, I asked for support from trusted friends. My healing journey includes acts of self-compassion: walking in nature, using creative expression through photography, and writing to share this journey with my community. I allow myself to open my heart and connect to both loving awareness as well as to the fullness of grief.” Self-compassion is not just needed during the loss of loved ones. For instance, allowing yourself to be kind and more accepting during any hardships – from job instability to illness or divorce – can help. If you’re hard on yourself and filled with perfectionist or unforgiving thoughts during stressful times, Jaimie suggests mindfulness techniques to foster healing and greater compassion for yourself. First and foremost, incorporate some self-care into your life. The term “self-care” is often championed in the media and people can say just about anything is a form of self-care, from splurging on a glass of champagne to getting a pedicure. But what Jaimie is referring to are mindful ways to get centered, lower stress, and foster joy in your daily life. These examples of mindful self-care practices can help you cultivate self-compassion: - Pause and take five slowing and calming breaths in the morning to start your day. Be sure to breathe deep from the belly. “Whenever you have your form of a mental block or losing your way, take breaths and pause,” advises Jaimie. - Slow down to enjoy a moment of awe and wonder. Need ideas? Take a nature walk, go stargazing, look into the eyes of a delighted child, notice butterflies, hummingbirds, and flowers in your neighborhood. As Jaimie says, “When the going gets tough, turn to wonder.” - Say no more, and take a nap. When you’re overwhelmed and out of balance, it’s critical to realign, prioritize, and recognize your own needs. - Maybe cleaning your house or car or garage makes you feel better or going through old photographs and writing about fun times in a journal might create a wellspring of gratitude. Practice whichever self-care acts speak most to you. And if you’re grieving and unable to pause to take care of yourself, acknowledge that and be gentle with yourself. Give yourself permission not to be perfect during this trying time. Ask for help or to talk with a friend, too. Self-compassion can make all the difference to you. References: Bluth, Karen, Neff, Kristen D,(2018) New Frontiers in Understanding the Benefits of Self Compassion, Self and Identity 17:6, 605-608 Neff, Kristen D., (2003) The Development and Validation of a Scale to Measure Self-Compassion, Self and Identity, 2:3, 223-250, DOI: 10.1080/15298860309027 Barnard, Laura K., Curry, John F., (2011) Self Compassion: Conceptualizations, Correlates and Interventions, Review of General Psychology, Vol 15, 4, 289-303 Terry, Meredith L., Leary, Mark R. (2011) Self-compassion, self-regulation, and health, Self and Identity, 10:3, 352-362, DOI: 10.1080/15298868.2011.558404 **About the Expert** Jaimie Mudd Jaimie is committed to creating a safe space for guests to explore their inner lives. Jaimie offers spiritual care, presentations and teaching, as well individual, couple, family, and group sessions on practices that sustain a generative life. [Read Full Bio](https://www.canyonranch.com/integrative-wellness-approach/experts/jaimie-mudd/) **Canyon Ranch:** These all-inclusive destination resorts offer everything from relaxing spa treatments and scenic hikes, to life-enhancing classes spanning stress management, culinary arts, and spirituality to name a few. **Categories:** awareness, guest blog, health, self-care, URiM, women --- ### [Fragile - Ah not any more!](https://blog.womensurgeons.org/fragile-ah-not-any-more/) **Published:** August 14, 2024 **Author:** Blog Team **Content:** By: Dr Swathy Elangovan It is really appreciable to realize how far we have come as women in this competitive world. Balancing professional and personal life for a woman surgeon is indeed challenging. There is a famous quote which says ‘“the profession chooses us.” Nothing matches the feeling of being in the OR performing surgeries. Despite the long work hours and time away from family, the adrenaline rush coupled with the sense of satisfaction of saving someone’s life is something only a surgeon can experience. Challenging aspects faced by women surgeons in their field include: opportunities for scrubbing in leadership roles, cumbersome learning curves etc. Unless you have a good teacher who identifies your full potential and trains you to the best of your ability, it’s difficult for you to come up. I would like to share one of my personal experience with a patient. It was a sunny day. The outpatient room was flooded with patients. I had to examine patient X. She had swelling in the anterior part of her neck. The swelling was about 4×3×2 cm. Upon investigating her, we found out it was Tirads 4 and got her admitted for further management. I was considerate enough while explaining the condition to her in a polite way making sure she didn’t emotionally break down. She understood her condition and agreed to go ahead with the surgery. After the surgery, her histopathological report suggested it to be hashimotos thyroiditis. We started her on medication and kept her on follow-up. On the day of getting discharged, she gave me a hug and a box of Cadbury chocolates, with tears in her eyes telling “doc, you were so kind. I don’t know how I would have pulled through this without your support. You were like a sister to me. For a moment I was on cloud nine.” Though there were male residents in my unit, but I was the one who was thanked for my patience and compassion towards her treatment . Though some days are literally tiring, it is all worth it in the end. I am proud of being a surgeon. On the road to becoming a surgeon, passion coupled with determination will enable you to become a good one! ![](https://blog.womensurgeons.org/wp-content/uploads/2024/08/Elangovan.Swathy-217x300.png)I am Dr Swathy Elangovan 2nd year General Surgery Postgraduate. I believe that hard work coupled with interest will fetch us laurels. I am a person who believes writing brings peace . I enjoy singing , sketching to escape the mundane routine of my life at times. **Categories:** awareness, career development, diversity and inclusion, medical students, practice, professionalism, training, URiM, women --- ### [From Scalpels to Swaddles: Unexpected Joys and Life Lessons Learned in Neonatology](https://blog.womensurgeons.org/from-scalpels-to-swaddles-unexpected-joys-and-life-lessons-learned-in-neonatology/) **Published:** August 7, 2024 **Author:** Blog Team **Content:** **By: Denise Nemeth** Pediatrics has never been my forte. As a former Physician Assistant accustomed to adult care, the prospect of caring for neonates filled me with apprehension. No one really tells you how difficult it can be to navigate rotations. It is like having a new job each month. Each rotation: an unknown. With each rotation comes a new attending, new residents, a new building, new rules, and new expectations. Only those in medicine know what third year of medical school is truly like. During clinical clerkships you are expected to switch specialties monthly while mastering the learning curve within the first day, lest you be deemed the “slow one”. I can hold my own. I am a fast learner and can find my way through unspoken rules and new environments. But this time it was different. I was about to go into the world of tiny humans. The day I stepped into the neonatal intensive care unit (NICU), I was acutely aware of my discomfort. Would I break one? Why did something so small make me so nervous?! The air was thick with urgency as nurses hurriedly attended to preterm infants, their tiny bodies fighting for every breath. “I am so out of place here,” I mumbled under my breath, feeling like an intruder in this world of delicate balances and tiny miracles. I have never felt out of place in a hospital setting. This was so unlike me. Then again, this was completely out of my wheelhouse despite having completed a whole month of pediatric surgery earlier in the year. The first encounters were daunting. Two preterm babies, fragile and in distress, had just arrived, demanding immediate attention from the entire team. I stood aside, unsure of where I fit in this chaotic scene and perfectly synchronized ballet of medical expertise. The nurses, however, were quick to notice my unease. With reassuring smiles hidden behind their masks, they took me under their wing. Patiently, they introduced me to the intricacies of neonatal care—the monitors, ventilators, and the gentle art of handling a newborn with care. As the day progressed, I met my attending and resident who would be my guide through this unfamiliar terrain. They welcomed my questions and encouraged me to take on tasks that stretched my abilities. Their warmth and patience were a stark contrast to my initial anxieties. Laughter filled our shifts, reminding me that even in the most stressful environments, humanity and humor thrive. I welcomed the banter and quirky questions such as: “If you were a vegetable, what would you be?” As the week unfolded, I found myself unexpectedly enchanted by the smallest of moments, such as learning how to swaddle a newborn. I found joy in choosing which of our newborns had the cutest outfit of the day during rounds, delighting in their miniature onesies and tiny dinosaur-printed socks. These daily rituals became the highlight of my day, second only to the attending’s generous gesture of a Twix ice cream bar after successfully completing rounds—a small reward that symbolized kindness and recognition in a demanding field. Beyond the medical lessons, this rotation taught me profound life lessons. It taught me never to dismiss any opportunity for growth, regardless of initial discomfort. It underscored the importance of learning from everyone around me—nurses, residents, nurse practitioners, and attending physicians alike—each offering unique insights and perspectives that enriched my understanding of patient care. It reminded me to trust that even when faced with uncomfortable and unfamiliar situations, I have the ability to develop new skills and thrive in new environments, as challenging as they might be. Above all, it emphasized the power of kindness and compassion in fostering a supportive learning environment. It comes as no surprise that surgery programs haven’t always been known to be the friendliest or warmest. As the surgical training culture continues to change and improve, I hope I can contribute to this change as a student, resident and hopefully one day, as a future Program Director. Now, as I stand on the precipice of licensing exams and residency applications, the weight of uncertainty presses upon me. The stress is palpable, and the future is daunting. Yet, despite all the chaos and challenges, one truth remains with me: joy and community can be found in unexpected places. In the NICU, amidst the beep of monitors and the tiny swaddled babies, I discovered a community bound by a shared dedication to healing and humanity. To my fellow future surgeons and surgeons in training embarking on their own journeys, I offer this reflection. Embrace every rotation, however daunting it may seem. Learn voraciously from every interaction. Be kind and compassionate, for the impact we have on others transcends the boundaries of medicine. In the hustle and bustle of our careers, let us remember that even through challenges lie moments of unexpected joy and profound growth waiting to be discovered. To the attending and resident that helped me come to these realizations: I am deeply grateful. Thank you for showing me the type of attending and resident that I would like to be and the kind of mentorship I aspire to provide. Thank you for showing me compassion when I needed it the most and expected it the least. Above all, thank you for showing me that kindness and constructive criticism are not mutually exclusive. You demonstrated that dedication and effective teaching need not come at the expense of empathy. At the risk of sounding cliche, it is certainly true what they say: “People may not always remember what you said, but they will always remember how you made them feel”. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/08/Nemeth.Denise-2024-300x300.jpg)Bio: @dv\_nemeth Denise Nemeth is a fourth-year medical student at the UIWSOM in San Antonio, TX and will be applying to General Surgery residency this upcoming September for Match 2025. Denise aspires to become a rural surgeon and is considering pursuing a fellowship in Surgical Oncology. She recently finished her term as the Association of Women Surgeons (AWS) National Medical Student Committee (NMSC) 2023-24 Social Media and Marketing Coordinator and has been an active member of the AWS Communications Committee for the last four years. She is passionate about providing healthcare to marginalized communities and is a strong advocate for Latinx health and increasing the number of Latinx physicians and surgeons. In her spare time, she loves traveling the world, reading, and writing. Recently, she graduated from the Universidad Autónoma de Guadalajara with a degree in Tequila Production and Marketing. She is very proud of this achievement as it deepens her connection to her heritage and allows her to share her culture with both old and new friends. **Categories:** career development, education, leadership, medical students, practice, reflection, training, URiM, women --- ### [Feeling Behind in Medical School and in Life](https://blog.womensurgeons.org/feeling-behind-in-medical-school-and-in-life/) **Published:** July 31, 2024 **Author:** Blog Team **Content:** By Jenna Dvorsky Medical school is a long, challenging path with delayed gratification. For the majority of those that choose to take this route, the four years of medical school occur during the prime years of early adulthood. This is true for myself, as a 26-year-old who has just completed my third year. When I first started medical school at 23, I knew I had a demanding road ahead. Despite knowing the grueling nature of medical school, I expected that I would go through my four years seamlessly with my head down, focused on becoming a doctor. I had goals to do well in my pre-clinical years, excel on my board exams, and honor every rotation. While I have had great successes the last few years that I am extremely proud of, medical school has proven to be a trying time with bumps in the road. I’ve had multiple personal struggles, which is likely true for everyone, but my hardships over the last 1-2 years seemed to come at the worst possible times, and definitely affected me as a medical student greater than I anticipated. Still even in the face of adversity, I managed to make it through STEP1, all my required rotations, and most recently STEP2. Throughout the last few months as a seasoned third year medical student, the time to start thinking about residency and life after medical school felt so close and tangible. I have known for a long time that I want to pursue a surgical specialty, specifically orthopaedic or trauma surgery. Over the past few months when it came time to look inward and assess myself as a surgical residency candidate, I was not sure how I would fare in a competitive residency match, especially for orthopaedic surgery. For as long as I can remember, throughout all stages of my education, I’ve been prepared and put together, but as I near the end of medical school, I do not feel that way at all. After multiple discussions with residents, attendings, and mentors at my home institution, in addition to many late nights weighing my options, I ultimately decided to take a research year between my third and fourth years of medical school. At the time, and even to some extent now, this felt like a failure in my mind. At the end of my third year, I felt competent as a medical student, confident in the hospital, and excited as I pictured myself as a doctor. Simply put, taking another year to do research was not on my original agenda, especially since I had already completed a one-year master’s before starting medical school. It is true that in recent years, many choose to take a research year(s) during medical school and the so-called “nontraditional path” is actually becoming the more traditional way to become a doctor. Yet all I could think initially was I should be on my fourth-year rotations, applying to residency, and preparing to graduate medical school. Enter the feeling of being behind in medical school. Perhaps the biggest struggle for me personally is feeling like I have set back my own timeline. I thought that I would be done with medical school by this time next year. I thought I would be a doctor at 27 not 28. I have to recognize that taking this extra year is another year of my life spent as a student. I can’t help but think about the things outside of medicine I have yet to do or even been close to doing in my life, such as traveling, getting married, having kids. I also believe that these worries are heightened as a woman pursuing surgery as all the “what if’s” pop into my mind: What if I never get married? What if my career in medicine hinders my fertility? At times, my personal reality and fears for the future make me sad, especially when I see so many of my classmates getting engaged and doing other ‘big life things’. I think now being in the latter half of my 20s, I have more of a sense of time passing by than ever before, hence my feelings of also being behind in life. While these feelings of being behind in medical school and in life can be quite heavy and isolating at times, I would bet that many other medical students, especially women, are feeling the same way. My new timeline has pushed the perfectionist inside of me to step aside and give myself grace, as I learn to accept that everyone’s path in medicine looks different, including my own. In the meantime, I continue to remind myself that I’m still taking small steps every day towards my dream of becoming a surgeon. My new goals are to use my research year not just to publish papers and network, but also to take time for myself mentally, think more about what I want in my life as a resident, and gain more confidence for residency applications. I used to think of myself in comparison to other medical students around me, but this year feels more like a competition with myself rather than with others. I will continue trying to find enjoyment in life through any and all struggles and be thankful for the process, trusting my hardships will only make me stronger as a surgeon in the future. *![](https://blog.womensurgeons.org/wp-content/uploads/2024/07/Dvorsky.Jenna_-232x300.png)Jenna is a medical student at the University of Pittsburgh School of Medicine and is originally from Pittsburgh, PA. She received her Bachelors of Science at John Carroll University where she majored in Biology and minored in Chemistry and Exercise Science. While there she also was a member of the women’s varsity volleyball team. Prior to starting medical school, Jenna completed a Masters of Science in Biomedical Sciences. Outside of medical school she enjoys playing volleyball when she can, spending time with family and friends, and taking trips to visit her sisters in North Carolina and Texas (fun fact: Jenna is a triplet!) She can be found on Instagram @jennadvorsky* **Categories:** advocacy, awareness, career development, education, medical students, professionalism, research, training, URiM, women --- ### [We Are Sorry, But You Did Not Match Any Position. What's Next? A Perspective From An IMG.](https://blog.womensurgeons.org/we-are-sorry-but-you-did-not-match-any-position-whats-next-a-perspective-from-an-img/) **Published:** July 24, 2024 **Author:** Blog Team **Content:** By Gabriela Alvarez Pérez, MD The words “ **We are sorry, but you did not match any position** ” were not what I anticipated reading in March. I had envisioned relocating and embarking on my residency journey in the United States. However, life has a way of redirecting our paths. Faced with the unexpected, I had to reassess my next steps. Thankfully, I have a network of supportive physicians who have consistently championed my professional growth. Sharing the disappointing news was difficult, but their unwavering encouragement provided solace during those challenging days. After taking time to reflect on my experience and set new goals, I resolved to start afresh. This time, I am better prepared and more determined than ever. Self-compassion has been essential throughout this process. I’ve learned to combat self-loathing and lean on the support of loved ones. I actively sought guidance from my mentors, seeking advice on strengthening my application. Hearing from those who have successfully navigated this path, especially in competitive specialties, has been invaluable. Remember, if you find yourself in a similar situation, be patient. Answers may not come immediately, but they will come. I’ve also discovered the significance of networking- ‘Your network is your net worth’-. After reaching out to a physician in my community, she generously offered me two invaluable opportunities. As an IMG, cultivating connections and finding mentors can be challenging, but I’ve made significant strides in recent months, learning from others and paying forward the support I’ve received. Above all, I’m prioritizing self-care. The residency application process is demanding, especially for international medical graduates. Remember, you are not alone. Seek out mentors, rely on your support system, embrace opportunities, and take care of your mental and physical well-being. If you share my experience, please don’t lose faith in yourself. Life’s journey isn’t always a straight line. It twists and turns. You are where you are supposed to be, and I wholeheartedly believe everything happens for a reason. As someone told me, ‘I know you are going to do amazing things, just not on the timeline you wanted.’ So, the words now are “**One more time”.** Big dreams need a balance of ambition and practicality. Embrace your setbacks as learning experiences on your path to success. Adapt and persevere through challenges, breaking down your goals into manageable steps. With determination and self-belief, you can turn aspirations into reality. If you’re reading this, and you’re an IMG, I want you to know that as I continue to pursue my own goals, I’ll be cheering you on every step of the way. Sincerely, Gabriela, your fellow Match 2025 applicant **![](https://blog.womensurgeons.org/wp-content/uploads/2024/07/Gabriela-Alvarez-Perez-150x150.jpg)Biography**: I am an International Medical Graduate from Ecuador. I got my Medical Degree from Universidad de Guayaquil. I’m interested in women’s health and reconstructive surgery. My research interests focus on women’s healthcare access and improving care for Spanish-speaking patients. Outside medicine, you can find me enjoying the outdoors or pushing my limits at F45 Training. Twitter: @galvarezprz **Categories:** advocacy, awareness, career development, current events, education, medical students, reflection, residency, training, URiM, women --- ### [Applying to Residency as a Caribbean IMG](https://blog.womensurgeons.org/applying-to-residency-as-a-caribbean-img/) **Published:** July 17, 2024 **Author:** Blog Team **Content:** By: Miranda Montion Medical school, regardless of where someone attends, will come with obstacles. Regardless of who you know, your previous experiences, or what school you go to, students will share similar experiences during didactics and clinical rotations and in a way it’s comforting. Each day we are surrounded by peers that understand what we are going through more than most. I have had some experiences as a Caribbean student that I wished I had been aware of sooner. As I have progressed through rotations and various experiences, I found some things helpful along my journey, which I have listed below. I hope these will give you some encouragement and guidance during this wonderful, hectic, exciting, and stressful time of your life. - **Be proactive about your goals** With my experience, most of my guidance and support has been from my colleagues and recent alumni. Reach out to these people when you can because they have been through similar experiences recently. For example, being interested in surgery comes with requirements on your involvement with research, volunteer experiences, etc. Find out from your surgical colleagues what they have done and resources they use, which could include what national organizations to join and become involved in, research groups to apply to be involved with, or places to volunteer at that compliment your interests. This will allow you to continue to work on your career goals and give you the opportunity to share these things with other students. - **Engagement on-island** When students are on island for their first 2 years of medical school, it can feel isolating, especially regarding research and mentorship. Instead of focusing on the things you can’t do during this time, shift your focus to what you can do. I knew early on my interest in the field of orthopedics. I applied and served on the orthopedics interest group e-board and as a team member in the surgery interest group. This shows your interests and can open connections to doctors in these specialties with alumni from your school. It can also provide opportunities to participate in specialty-related activities like suture labs and surgical knot tying in preparation for clinical rotations while developing a sense of community. - **Finding resources that work for you** Everyone has preferred learning styles and is what is so great about being in medical school now with all the different types of resources that exist. I am sure you have been told this too, but as early as you possibly can, identify the 2-3 resources that work for you. You will get recommendations from your colleagues being shared with good intent, but focus on what works for you, keeps you motivated to return to, and breaks down difficult concepts easily for your understanding. To this day, I use the 3 resources I found on-island to work and have continued to work for me through clinicals. - **Attend conferences** After you get to clinical rotations, I encourage you to engage in conferences of the related field you’re interested in. I have found the state chapter meetings with ACS for example to be an easy way to make connections, find out about residency programs and what they are looking for in applicants, and general motivation when I’m in a studying slump. These are great opportunities as well to showcase research and demonstrate your level of commitment to the field. They’re generally free to medical students or heavily discounted too, so take advantage of it! - **Seek out research** During rotations, verbalize your interest in research opportunities to residents and attendings in case they come across something they find interesting and would be helpful to conduct further research on or have something ongoing you can assist in. Various journals are now available at low cost to encourage publication as well. This shows your commitment to the field, interests, and helps you learn in depth physiology and pathology. - **Find a mentor** I personally have found this to be the most difficult as I don’t want to be a burden to anyone. But finding a mentor, especially in your field of interest can be so helpful on multiple levels. If they are willing to mentor you, it tells you they care and want to teach you. They want to see you grow and eventually become the physician they found potential in upon starting your relationship. Medical school is a journey meant to be shared, not isolated. The earlier you find your community and friends, the less difficult it will be. I also want to gently encourage you that your school does not define the type of physician you will be someday. Meditate on that, not letting people’s words or statistics dictate your future aspirations. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/07/Miranda-Montion.jpg) Miranda Montion is a third-year medical student at Ross University School of Medicine. She will be applying for orthopedic residency in future application cycles. Her surgical interests include caring for pediatric patients and working with congenital deformities. As a student mentor, community volunteer, and research leader, she continues to advocate for medical students pursuing what they are passionate for regardless of what obstacles or discouragement they may face. She was born and raised in Michigan/ Ohio and currently resides there. She enjoys hiking with her husband and dog, competing in triathlons, and baking with her grandmother and sisters. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, leadership, medical students, mentorship, professionalism, research, residency, resources, self-care, training, Underrepresented in medicine, women --- ### [Surgical Rotations as a International Medical Student](https://blog.womensurgeons.org/surgical-rotations-as-a-international-medical-student/) **Published:** July 11, 2024 **Author:** Blog Team **Content:** By: Sarah Bueno Motter As an international medical student, doing elective rotations in the US brings us many challenges, but this experience also can open unexpected doors. I would like to talk about the good people we meet on this path. Seeing how people can help without knowing you well is very inspirational; they give us their best, taking our word as proof of commitment. The beauty is recognizing those people in your path and allowing them to help you. First, you must put yourself in their view and try connecting. Set up meetings, ask for conversations, ask questions, share your goals, and ask advice from the people you work with. We often focus on meetings with the PDs, for example, but we must remember the ones we are with daily. Ask your residents for feedback, and connect with them and other medical students. The medical staff, nurses, and surgical technicians: You will be a better student if you understand everyone’s role in the US system. You can share your vulnerabilities, and you will find that everyone is struggling with similar challenges at the end of the day. And, with that, we discover the relief that we are not alone. As Brené Brown reminds us, vulnerability is not a sign of weakness but a display of courage. Regarding the challenges, you must know that not everyone will be available to listen to you when you open up. And the negatives that we hear in this path can never be seen as personal. Those are only “nos”, and to see the opened doors, we must pass the fear of rejection. There are days that we take this “no” to our home, and we have dinner with these thoughts and sleep on, but life’s generosity reveals the need to seek positive signs. Perhaps a patient will tell you that you are in the right way, just saying, “Keep up with that smile; that is what we need the most.” Rotations in another country are about living the bad and the good; the key is retaining the good. One morning might be difficult, but an unexpected gift from life can brighten the afternoon. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/07/bueno-motter-1.png) Sarah Bueno Motter is a Brazilian medical doctor who graduated in February 2024. In 2023, during medical school, she completed elective rotations at hospitals in the United States in breast surgery and acute care and trauma surgery. This experience profoundly marked her training. Sarah is one of the founders of the AWS Chapter at her university in Brazil (UFCSPA). She has an interest in research in the areas of surgical oncology, gender equality in surgery, and global surgery. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, Fellows, health, medical students, networking, practice, professionalism, reflection, resources, self-care, women --- ### [Breaking the Taboos Around Colo-Anal Diseases: A Female Surgeon’s Perspective](https://blog.womensurgeons.org/breaking-the-taboos-around-colo-anal-diseases-a-female-surgeons-perspective/) **Published:** July 3, 2024 **Author:** Blog Team **Content:** By: Dr. Zeel Sheth The healthcare industries of developing countries like India have seen an enormous gain in the past few decades. Developing countries have taken up multi-track strategies, including preventative measures propagated by educational campaigns, to further this medical advancements. But that blessing can sometimes act as a vice when there is a vast, unfiltered sea of information available on the internet with unrestricted access by the patients searching their symptoms and not being able to resist the non-regulated self treatments. Surgery has been my ultimate passion. From how to use my scalpel to when to not use it, to the glory of the theatre and its humility, my surgical residency taught me everything. While it did teach me how to help those who need it, what it failed to educate me on was how to be of assistance to those who would hesitate to ask for your help. While ignorance can be blissful, it seldom helps when it is related to your health issues. There are numerous diseases or problems that people are still embarrassed to talk about or share because of the social construct. We have reached the Moon quite literally, but our people on Earth are still suffering in silence because they are ashamed of admitting to what is bothering them. According to the literature, the incidence of anorectal diseases in the general population is around 5-15%, and can reach up to 44% during pregnancy. While hemorrhoids are not gender specific, women are more prone to develop hemorrhoids and are less likely to seek treatment for the same. Accepting the problem is the first step towards finding the solution. Since, certain colo-anal diseases like hemorrhoids or fistulas, are not the so-called glamorous health issues, patients tend to slip it under the rug and ignore it until it legitimately becomes a pain in the arse. They are considered taboos because there are numerous myths around them, such as hemorrhoids result from poor health hygiene or are, related to bad gut health, or are caused by unnatural activities and many other such misconceptions. Female patients are the most common victims to such myths. Factually, hemorrhoidal cushions are bound to enlarge during pregnancy and it’s an expected bodily response. But because of the hesitancy, females fail to express their issues and concerns to a specialist and end up suffering, in the hope that they will disappear on their own while their disease keeps worsening. My constant efforts are to provide medical reasons to explain the causes of these conditions to fight these myths and create an environment where healthy discussions can be partaken. It is said when you fail to listen to your body, it will force you to listen to it and it won’t be on your terms. Any health problem should not be ignored ,especially, just because it’s not fun to talk about it. We need to understand and accept as humans, that our colons and anus, are also a part of our bodies and they require equal care as the other organs. In this century, where we are so mentally evolved and technologically advanced, we need to be able to shatter these taboos and myths around these health conditions and just be able to discuss it with our doctors so they can provide an accurate diagnosis and a timely treatment. So let me ask you the important question: In your health journey, How Can I Help? ![](https://blog.womensurgeons.org/wp-content/uploads/2024/07/Sheth.Zeel_-200x300.jpg)Dr Zeel Sheth Agrawal, is a Minimal Access Surgeon with her primary focus on Colorectal Surgery and Proctology. Dr Sheth, is a dual degree holder in General Surgery along with a Fellowship in Minimal Access Surgery and Proctology. She has additional training in Advanced Colo-rectal Surgery at AMC, Seoul. An author to multiple publications along with a chapter in a Textbook of Surgery, she is practicing as a Consultant Surgeon in Bengaluru, India. She completed her medical school and her post graduation in General Surgery from Smt.NHL MMC, Ahmedabad. Her being a female health enthusiast, she strives to create a welcoming environment for all her patients, to discuss their health issues. Instagram page:- Thefemalesurgeon\_india **Categories:** advocacy, awareness, current events, education, practice, professionalism, resources, URiM, women --- ### [A Journey to Self-Acceptance and Surgical Residency](https://blog.womensurgeons.org/a-journey-to-self-acceptance-and-surgical-residency/) **Published:** June 30, 2024 **Author:** Blog Team **Content:** Alexis L. Woods, MD Being comfortable with my queerness is not something that always came easy to me. I grew up in a Southern household where homophobic comments were common. As a result, I had a lot of internalized homophobia as a teenager and I struggled to come to terms with being gay – leading down a winding road out of the South and to medicine. I was in denial for a few years, lacking positive queer role models. It was the 90s, and there were only a few queer women openly out and I didn’t identify with them. Emancipated at 16-years-old, I left my parents’ home, began working, and finished high school through a community college completion program. During this time, I could no longer deny I was queer, but I was closeted and spent a lot of time wishing I wasn’t gay. In my early 20s, I found seasonal adventure jobs that took me to Bavaria in Germany, Alaska, and Baja California Sur in Mexico. It was an incredible gift to get to travel and explore nature. I landed in the Pacific Northwest in my mid-20s, coming into my “gay awakening,” where I finally felt comfortable being out and was surrounded by other queer people, easing the transition. To witness queer joy in others, who were living full and happy lives was transformative. My journey of self-exploration and love for being gay evolved over time, and my desire to live out and proud in life and at work became non-negotiable. I pursued medicine later than some, and when I was applying to medical school at 33-years-old, it was the summer of 2014, and marriage equality was not yet legal in all states. The Defense of Marriage Act was still in effect and there was debate among people who I asked if I should be openly queer on my application. Being part of the LGBTQ+ community was such a huge part of my journey to that point, and I knew I didn’t want to be somewhere that didn’t celebrate that aspect of me. As a result, I only applied to schools in states with marriage equality and was openly gay on my personal statement. I also knew I deserved equal rights and wasn’t prepared to settle for less, even to pursue my dream of being a surgeon. Luckily, I ended up in Los Angeles for medical school and didn’t have to compromise those goals. DOMA was overturned just before I started medical school in 2015 and it seemed like LGBTQ+ issues weren’t such a hot button issue anymore. We were finally making progress nationwide, which was an especially good thing, because I met my wife at the end of my second year and we were married in my fourth year. We matched at our top choice for general surgery residency at University of California, Davis in Northern California, a place where I have been lucky to feel valued as an LGBTQ+ voice in the room and have not experienced homophobia. I know not all are lucky enough to have the same experience in training and I am forever grateful. My home state continues to have LGBTQ+ supportive laws, but I have watched in horror over the last few years as LGBTQ+ rights have been taken away across the country, particularly for the transgender/gender diverse (TGD) community. I’m a cisgendered queer woman, but I’ve seen that TGD people face multiple health disparities and barriers to healthcare access. Despite awareness of these disparities, education for surgeons is lacking and the training that is in practice is often focused on medical students, leaving a large portion of practicing surgeons without TGD-inclusive training. Our surgery department’s mission is creating an inclusive environment and culture in which everyone feels respected and valued. Equity and social justice are essential to the health of our patients. I felt it was important to ensure our mission aligned with the care we were providing to our TGD patients. To address that need in my health system, I created the TransCare Initiative: A Knowledge-to-Action Project. We first wanted to assess the department-wide understanding, awareness, and comfort in treating TGD patients with a survey covering 4 domains (personal perceptions, prior healthcare training/experience, comfort providing care, and barriers to access for TGD patients). This was sent to all faculty and residents in the surgery department. With a response rate of nearly 48%, split evenly among faculty and residents, most of our respondents were aware of the unique health needs and barriers to access, but lack of experience and training created gaps in their comfort and ability to provide ideal care, particularly when it came to obtaining comprehensive histories and physical exams. In fact, 38% had no prior training on the topic and another 10% weren’t sure if they had. To address those needs, we curated a grand rounds lectures on TGD healthcare, barriers to care, and clinical encounter training. We also wrote a practical guide to TGD healthcare, which included definitions, language for clinical encounters, tips for physical exams, gender affirming care, and healthcare disparities that TGD patients experience. This guide and pronoun pins were provided to the surgery department. To provide further training to our residents, we partnered with Rutgers Surgery to help pilot a general surgery resident curriculum on equitable and inclusive surgical care for TGD patients. The response was overwhelmingly positive from our trainees, and I hope to find additional opportunities to improve training on this important topic, especially when TGD people everywhere are under attack. I love my LGBTQ+ community, and I am grateful that I have had institutional support at UC Davis to carry out this project. This month I am celebrating my queerness in all its incarnations. As I go forward through training and begin my career, I hope to keep expanding better access and surgical care to all my LGBTQ+ community. Happy Pride! ![](https://blog.womensurgeons.org/wp-content/uploads/2024/06/Woods.Alexis-300x257.jpg)Alexis L. Woods, MD received her undergraduate degree from University of California, Berkeley, graduating with highest honors in molecular and cell biology with an emphasis in neurobiology and attended medical school at David Geffen School of Medicine at University of California, Los Angeles. She is a PGY-6 in general surgery at University of California, Davis, with research interests in clinical outcomes and health equity and plans to pursue a colorectal surgery fellowship. **Categories:** advocacy, awareness, current events, diversity and inclusion, leadership, practice, professionalism, reflection, resources, URiM, women --- ### [4 Part Blog Series: Considerations as Junior Faculty: What Should I Be Doing? - Part 1: You Are Done with Training, Now What?](https://blog.womensurgeons.org/4-part-blog-series-considerations-as-junior-faculty-what-should-i-be-doing/) **Published:** June 26, 2024 **Author:** Blog Team **Content:** **By: Christine Castater, MD, MBA** Congratulations! You’ve completed surgical training and are now a junior faculty member. This is the culmination of years of research and training, and this transition changes your career and lifestyle. When I finished training, I felt like I had been running a marathon and suddenly ran face first into a wall. The sudden cessation of everything that had been my reality left me feeling stunned and confused. I seriously wondered about my identity since for 15 years, my identity was “trainee.” It took me a year to breathe and acclimate into my new job. At that point, I was able to look around and figure out my next steps. **Setting Goals and Expectations**: The first thing I did was to set realistic goals for my next five years. These goals partially depended on the dynamics of my new setting. Goals in academia can look quite different from goals in private practice. I met with my chief and chair to clarify expectations and explore what opportunities already existed for me to become involved in ongoing projects and to talk about my interests for starting projects of my own. I also made sure to obtain a copy of promotion requirements so that as I set goals for myself, I could make sure they aligned with what I needed for promotion. **Building A Network:** Networking is crucial. I am painfully shy, but over the years I have learned how important it is to connect with others in surgery. These networking connections guided both my residency and fellowship match. As a junior faculty member, I sought to connect with other faculty members, join professional associations, and attend conferences. These connections have led to collaborations and mentorship opportunities that enrich my professional life. **Maintaining Work-Life Balance:** Work-life balance has always been important to me, and as a new faculty member it has become more important than ever. I had to adjust to my new workload while maintaining a healthy work-life balance. I made a concerted effort to prioritize tasks, delegate whenever I could, and make time for myself, my family, and my friends. A career in surgery can take over every minute, so I still struggle to make sure that I carve out the time I need for my life outside of the hospital. **Self-improvement:** I have made an evolving “to-do” list where I continue to critically evaluate my trajectory to make sure I am aligned with my values and goals. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/06/CCastater-1.jpg) Dr. Christine Castater is a “non-traditional” student who decided to pursue medicine after being a victim of violence. She lives in Atlanta Georgia and is an Assistant Professor of Surgery at Morehouse School of Medicine (MSM), Vice Chair of Operational Diversity, Inclusive Excellence, Equity, and Belonging for the MSM Department of Surgery, Assistant Clerkship Director for the MSM surgery clerkship, Site Director for the MSM trauma surgery clerkship, a trauma, critical care, and acute care surgeon at Grady Memorial Hospital, and the Medical Director for the Grady acute care surgery wards. She finished her BA, MD, and MBA all at the University of Connecticut before completing General Surgery Residency at UCSF East Bay followed by Acute Care Surgery and Surgical Critical Care Fellowship at Emory University. **Categories:** advocacy, awareness, career development, education, Fellows, leadership, medical students, mentorship, professionalism, women --- ### [Authenticity and Queer Joy in Surgery](https://blog.womensurgeons.org/authenticity-and-queer-in-surgery/) **Published:** June 23, 2024 **Author:** Blog Team **Content:** *By Aeryn Kangas-Dick, MD* The art of surgery is the art of connection. As surgeons, we have the unique privilege to meet our patients in times of need and offer them real, concrete, often rapid solutions to their diagnoses. As vital as the surgeon’s skills in the operating room are, the surgeon’s mandate is to create an immediate connection forged with trust and understanding with our patients. We ask them to be put under general anesthesia and to place their lives in our hands. In return, we become their fierce advocates. The sense of ownership in patient care is unmatched in any other specialty. We make ourselves available to tend to their needs after typical business hours and drop everything to care for their issues whether we are on call or not, often to the neglect of our personal lives. Creating a meaningful connection requires honesty, openness, skill, confidence, and experience. For many LGBTQ+ patients, finding a provider they feel comfortable with can be a daunting task. This leads to more than low patient satisfaction scores. LGBTQ+ patients follow less regularly with primary care providers, engage in preventative measures like cancer screening at lower rates, and consequently have poorer health outcomes. Particularly in a political climate where open celebration of queer identity has become controversial, creating an environment of allyship creates a comfortable experience for our patients, and makes it more likely that they will seek further care. Therefore, Pride Month is more than a celebration of who we are and our community, it is an opportunity to recognize the significant issues and barriers in access to care in the LGBTQ+ community. In my own experience as a queer transgender woman, I know how difficult it can be to see a new provider as a patient. Wondering how well or poorly you might be treated by various staff members is extremely anxiety provoking. In my experience, it’s the small touches that make me feel comfortable. At my most recent primary care visit upon moving to a new city for fellowship, I was excited and relieved to see that the iPads the medical assistants and nurses were carrying all had a rainbow and transgender pride flag! As a trainee in complex general surgical oncology, I have had the privilege to participate in gender-affirming mastectomies as part of my fellowship. It has been highly rewarding to see the joy and relief on my patients’ faces when they are seen pre-operatively, and even more so during that first “peek” when they wake up in the recovery room. Almost as rewarding is the connection we make when we first meet for consultation. Our shared experience makes it simple to put the patients at ease. Visibility and authenticity encourage connections between patients and providers. Celebrating my queerness has vastly improved my ability to access the joy that comes from learning to be a surgeon. Beyond patients, I am better able to connect with my peers, mentors, and co-workers. By connecting with those around me, I recognize that beyond the stress of a surgical career lies the opportunity to make a profound difference in the lives of those around us. We need more surgeons who represent the diversity of our patients. When we are showing the world our true selves, we have a greater opportunity to create connections with those around us. As a queer transgender woman in surgery, Pride Month represents an opportunity for me to reflect on the many pioneers and mentors who have made it possible for me to train and practice as my authentic self. Pride means more than acceptance. It means creating an environment where each of our identities is celebrated. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/06/Kangas-Dick.Aeryn_-150x150.jpg)Aeryn Kangas-Dick is a fellow in Complex General Surgical Oncology at Roswell Park Comprehensive Cancer Center in Buffalo, NY. Her clinical interests include hepatopancreatobiliary surgery, Upper gastrointestinal surgery, and HIPEC. She previously completed a residency in General Surgery at Maimonides Medical Center in Brooklyn, NY. In her spare time, she enjoys playing Rugby with her local club, and spending time with her partner, and their cat and dog. **Categories:** advocacy, awareness, current events, diversity and inclusion, Fellows, practice, professionalism, reflection, resources, URiM, women --- ### [Back to School Mom – A Decade Later: Trauma Surgery Fellowship with Teenagers](https://blog.womensurgeons.org/back-to-school-mom-a-decade-later-trauma-surgery-fellowship-with-teenagers/) **Published:** June 20, 2024 **Author:** Blog Team **Content:** By: Dr. Evelyn Coile The house is silent. The house is silent for the first time in the last 16 years of training. Both kids received the news this week that they landed their first summer jobs. My husband and I finally sit staring at each other—no one to cook for or entertain. My eldest son, now a licensed driver, is taking control of the drop-offs with me closely watching a Life360 app and praying for constant safety. Previously, drop-offs were mostly handled by my husband. From community college night classes while working, to attending medical school, followed by a vigorous surgical residency, I was not available for drop-offs. It is quite ironic that as I look back now (as most parents do at this phase), I wish I had made it to more drop-offs. To wish them a “Happy Day Ahead!” To ask them “How Was Your Day?” It just always seemed that drop-offs were where the caring mothers existed. They knew the teachers’ names, the next PTO date, and served food for the class party. I never knew any of these. But, that wasn’t my calling. My calling was to become a trauma surgeon. I like the movement and, most importantly, I’m an “I got you” kinda gal. On your worst day, I got you. While other surgeons are sleeping soundly, I like being the one awake waiting for the page, waiting to save the lives of those involved in something they would consider their worst day. I would be there. I would get them through it, because I’m an “I got you” kinda gal. I know about the worst days. Sixteen years ago, my now licensed son was then fresh out of his second neurosurgery. A Code Blue had been called this time. We had nearly lost him. A mother will never forget the sight of her newborn baby boy turning shades of gray. I was motivated to be a healer at that point. In our worst of days, I found motivation to become a back-to-school mom—quite literally, at the worst of times. I took one class, Political Science, over the summer. Sixteen years later, we are finally almost done with my training. Sixteen years. A lot happens in sixteen years. Most people completing surgical residency find that reflection on their journey is focused on learning surgery and completing the amazing accomplishment of becoming a surgeon. However, my journey truly is about becoming a surgeon and the amazing childhood of both of my sons. There is regret, there is longing for past times, and there is tremendous joy and pride. My last sixteen years are mostly about all of their accomplishments. I can say they truly learned by direct sight a reflection of perseverance and hard work, even when I didn’t make it to drop-offs. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/06/EvelynCoileProfessionalPIcture.jpg) Dr. Coile is an AAST Trauma / SCC Fellow at UT Southwestern / Parkland Trauma Center in Dallas, Texas. She received her MD and General Surgery Residency at Mercer University School of Medicine / Memorial Health University Medical Center in Savannah, Georgia. Dr. Coile has also been a Registered Sonographer since 2002. Twitter Handle: @evelyncoile **Categories:** awareness, career development, education, family life, leadership, medical students, mentorship, self-care, women --- ### [Pride in the Operating Room: How the Structure of Surgical Residency Can Keep Us in the Closet](https://blog.womensurgeons.org/pride-in-the-operating-room-how-the-structure-of-surgical-residency-can-keep-us-in-the-closet/) **Published:** June 16, 2024 **Author:** Blog Team **Content:** By: W. Tyler Crawley Pride in residency is difficult, especially in surgery. How you are evaluated and how you are able to participate within the operating room are directly decided by the attending surgeon. Meaning that how you are viewed by an attending can impact not only your clinical experience but also your advancement within the program. This creates a power dynamic in which residents are put in a position to “get along” in order to “go along.” This is problematic for two reasons; the first is that it discourages residents from speaking up, whether that be an inappropriate joke, an inaccurate statement, or even something as simple as misgendering a patient. Personally, when I was an auditioning medical student and starting my surgical training, I was very discreet when it came to my personal life, especially around attendings. I heard many jokes and false narratives about the LGBTQIA+ community, and while most of these comments came from a place of naiveté, they were/are nevertheless harmful. The second reason is that it can force residents into trying to fit a mold. LGBTQIA+ individuals are a unique population and what makes us diverse is not always externally visible. As a result, especially in medicine, we have to choose how much of ourselves to share, whether that be with attendings, colleagues, or patients. In the political environment of today, the queer community is constantly under attack and queer issues have become strongly contentious. You never know when someone might react negatively to what they perceive, inaccurately, as a “choice” or “lifestyle.” When it comes to residents, we depend on the team around us and are constantly trying to impress the surgeons we are working with since they are the ones who will evaluate us. While it is improving, much of the medical community continues to perpetuate the idea of a “model” trainee with underrepresented minorities more likely to receive narrative evaluations based on appearance rather than on clinical performance. When I made the decision to pierce one of my ears during residency, a part of me was worried that it would potentially be viewed as “gay” and unprofessional. Addressing these challenges is no small task. As I have grown more comfortable with my attendings and fellow colleagues, I find myself more likely to speak up and have found support in that. There is a time and a place though, and learning when it is appropriate to address things and have individual conversations is equally important. Personally, I like to pull people aside to discuss, whether that’s when debriefing a case or just grabbing something to eat. I believe this allows for a better discussion and comes from a place of education rather than judgment. When it comes to being “out” at work, I often hear people say that their identity as an LGBTQIA+ individual does not impact them as a surgeon. While I agree that it might not impact your clinical abilities, I do believe that who we are as individuals impacts how we interact as physicians. Everyone should be able to be comfortable in who they are, wherever they are, whether that be at work or anywhere else. I started small by being open with my fellow residents, and eventually found my support system. These changes have to start from the top in order to shift this power dynamic. As a rising PGY-4, I know the impact my voice can have on students, trainees, and the hospital. This visibility and representation are important because it shows that LGBTQIA+ individuals do exist within surgery and medicine as a whole. Being a role model can be as simple as “if you see something, say something,” and support those who do speak up. Remember that who you are does matter – for your colleagues, your patients, and for yourself. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/06/Crawley.-W-Tyler.jpg)William Tyler Crawley is a rising fourth-year surgical resident at HealthOne – Swedish Medical Center in Denver, CO. Originally from Albuquerque, NM, his interests are in medical education and LGBTQIA+ representation in the surgical community. Outside of work, he enjoys running, cycling, and spending time with his husband and two dogs. **Categories:** advocacy, awareness, current events, diversity and inclusion, education, professionalism, reflection, resources, self-care, training, URiM --- ### [Progress of LGBTQ+ Rights – A View from One of America’s Youth](https://blog.womensurgeons.org/progress-of-lgbtq-rights-a-view-from-one-of-americas-youth/) **Published:** June 10, 2024 **Author:** Blog Team **Content:** By: Alexis Moren The progress of LGBTQ+ rights has seen significant advancements globally, although challenges remain. Over the past few decades, there have been major milestones such as marriage equality, anti-discrimination laws, gender identity rights, parenting rights, and the LGBTQ+ community serving openly in the military. Despite these advances, challenges persist. I have been part of conversations discussing how lucky we are to live during this time. This sparked my curiosity – are we? Do LGBTQ+ kids and teens feel this way? I have the pleasure of being close to a pre-teen trans girl who dreams of becoming both a trauma surgeon and a published author. I asked her to tell us about her journey and her aspirations. “I am trans. This does not define me but it sure plays an important part in many aspects of my life; I have been bullied at school, had to keep my identity a secret while on sports teams, been shunned and not accepted by one of my parents who is part of the LGBTQ+ community, and constantly live in fear that I am going to be “found out” and denied access to things I love. On the flip side – I have another set of parents who love, accept, and advocate for me any chance they get. It is with their support that I hope to be both a trauma surgeon and an author. I do not feel that I am as carefree as my friends. I am constantly watching my surroundings, making sure I wear the appropriate clothing as to not give anything away. At the age of 7, I was diagnosed with body dysmorphia. Although I meet with endocrinologists and therapists often, I live in constant fear of puberty, and long for the day to start hormone therapy. I crave connection with other kids like me. These encounters are often created over Zoom with kids who are similarly looking for a connection. These connections are not natural, even though we are meeting like people we often don’t have the same interests, leaving most of us with continued feelings of isolation and loneliness. I am lucky. I am not blind to the fact that there are others who do not have an accepting family or live in an area where LGBTQ+ rights are not recognized. This can result in kids running away from home, being bullied, and ultimately becoming victims of violence. It is because I know that the LGBTQ+ community, especially trans individuals, are targets of violence and hate crimes that feeds my desire to become a trauma surgeon. Despite being bullied or feeling isolated, I have always tried to be nice to others. Growing up I have spent countless hours asking my mom, a trauma surgeon, to tell stories of saving lives. She shares stories but focuses more on the situations that cause people to end up in the trauma bay. She is largely involved in helping marginalized people, and I have come to realize that I am part of this minority group. For me, becoming a trauma surgeon makes sense. I know there is a group of people who could benefit from a doctor who can not only help them physically but can connect with them on an emotional level. I am often scared to go to the doctor, becoming shy and scared when asked my gender or asked to undress for a physical exam, even if the person knows me. I am uncomfortable in my body. I can feel the judgment of others and I’d rather leave the medical office than continue. I know I am not the only one – I think of all the transgender people who are unable to transition or do so in their older age and how they must fear the stares, comments, and judgment. I hope to be a writer and a trauma surgeon. Writing allows me to create a perfect world of equality where I escape all my anxiety and fears.” While significant strides have been made towards equality and acceptance, the youth of today live very much like how many of us did; ashamed, fearful, and anxious. Hopefully, the narrative is changing, but ultimately the global landscape of LGBTQ+ rights remains uneven, necessitating ongoing advocacy and legal efforts to protect and expand rights for all to feel safe and equal. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/moren.Alexis-blog.png)Dr. Moren is a Trauma, Critical Care & Acute Care Surgeon at Salem Health in Salem, Oregon, and an Assistant Professor of Surgery at Oregon Health & Science University. Dr. Moren received her fellowship training in Trauma & Critical Care at the University of Pennsylvania. She completed her General Surgery Residency at Oregon Health & Science University and received her MD/MPH from St. George’s University in Grenada, West Indies. **Categories:** advocacy, awareness, current events, diversity and inclusion, family life, gender differences, parenting, practice, reflection, resources, self-care, training, URiM, women **Tags:** AWS, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Being a First Generation Immigrant from India: Breaking Down Stereotypes about “Model Minorities”](https://blog.womensurgeons.org/being-a-first-generation-immigrant-from-india-breaking-down-stereotypes-about-model-minorities/) **Published:** June 2, 2024 **Author:** Blog Team **Content:** By Gopika SenthilKumar, PhD I still remember the news of the 2008 economic crash playing everywhere within a few weeks of us arriving in the US. As a first-generation immigrant family, this meant the highest level of uncertainty about our jobs, residence, and place of employment. Sure enough, in the years that followed, we ended up having to move six times over six years. I have a few distinct memories of these times. I still remember the first year that we were here – I was 11 years old, and I wanted a nightstand and wardrobe and a bookshelf in my room like all the other kids,… but it was too risky to spend our savings on furniture. Instead, I used to take cardboard boxes, build them into shelves, rearrange them if I was bored, and I was a very happy kid. We didn’t have a car for a while, so every morning my dad would walk with me to the bus stop, and if we happened to miss the bus (god forbid if it was in the winter!), he would walk a mile and a half to drop me off at school, walk the whole way back, and then start his workday. I also remember the many times that I had to sit alone at lunch because I was always the new kid, and being turned down for a band because it required us to buy our own expensive instrument with no guarantees of staying in the country. I nearly failed a class in middle school because I could not understand the accents in some classic American movies and the grades in that class were based on our answers to questions about these movies. Somehow, the teacher could not comprehend how I could not understand the accents. I usually joke that I was an indecisive kid, and so I applied to colleges for architecture, pre-law, and biomedical engineering. In reality, I didn’t know any better. And of course, there are the classic stories that you might’ve heard from most Asian immigrant kids – the bullying for smelling like our food, dressing differently from the other kids, etc. But, it was not all doom and gloom. In fact, most of my memories are not unhappy. I still remember the joy of playing soccer outside every day with a bunch of kids who were also from immigrant families. I remember how much fun it was to have my grandparents here over the summers, and the incredible quantities of chicken biriyani I have eaten (best food ever – must try). I will never forget the countless jokes and happy moments with my sister and family. I loved being a part of Indian Classical charity dance shows and being able to celebrate our culture to benefit important causes. Of course, I could not express more gratitude for the educational, career, and leadership opportunities that were available to me – especially as a woman – here in the US. I am also incredibly grateful for the mentors, sponsors, and close friends who have gone above and beyond to support my family and me. I could not imagine what my life would be like without them. I share my story to highlight that the stereotypes we build around Asians as a “model minority” – rich, affluent, all-successful – could not be further from the truth for many families. Immigrant Asian populations, especially, get the “double whammy” of not qualifying for financial aid or assistance for education because of visa status and also not receive support from DEI-focused efforts since we belong to an “overrepresented minority.” Beyond the finances and support, there are so many nuances that those of us on visas continue to navigate and I want to highlight a few that specifically apply to academic medicine. On a visa, we are incredibly limited in the work, research, and extracurricular opportunities that we are allowed to participate in – especially in premedical years. Importantly, these restrictions are not always obvious, and there is very limited cohesive information available about them. When we do apply for medical schools, our acceptance rates are over 2-fold lower than non-visa holders and only those with the highest GPA/MCAT scores are offered a spot (1). Whether applicants on a visa also need to be exceptional in other aspects of their application is still unknown quantitatively; however, from personal experience, I can attest that my friends on visas had to go above and beyond to secure a spot in medical school. For those of us in research-oriented careers, we qualify for very few grants/funding opportunities and have severe limitations with traveling for conferences – especially internationally (2). In medical school, we continue to face similar selective preferences for residency applications, although there is no qualified data available to truly know how residencies view US-MD students on a visa. This leaves those of us on visas with no choice but to try and be exceptional residency candidates. That is, of course, only possible for those who might not have financial limitations, family obligations, or other important factors in life that need their time, money, and attention. I also want to acknowledge that to try and be truly exceptional – and be recognized for our success – requires many constant battles with the norms of Asian culture. We are taught not to be out-spoken or carry ourselves “too confidently,” and to always be grateful for what we have and minimize concerns. It’s not surprising that you will find very few blog posts like these from Asian immigrants. We are also taught that if you work hard, you will automatically be noticed, and so self -advocacy and -promotion are discouraged, and even deemed as “being cocky/self-centered” or a “bad omen.” Within the Asian immigrant community, there is also the constant fear of failure, as well as speaking up about a controversial topic and being reprimanded. Even when writing this article, I can hear my family’s voice in my head saying, “How might this be seen by future employers? Could this affect your visa status? What if you say something that offends your colleagues? Wouldn’t it be easier to just stay grateful for what we have and not focus on the challenges?” There is another layer to being a woman in the Asian immigrant community. There is a certain stage in our life when the entire community sees our value based on familial success and not on career success. This is not only about perceptions, but also about expectations, the norm, and having a sense of belonging to your community. I acknowledge that there are a wide variety of experiences among those of us who identify as immigrants, Asians, and women. This blog is only a reflection of my story and is by no means meant to represent a broader voice. My hope is that this blog post empowers others to share their experiences as well so that we provide a more holistic voice to our experience and advocate for changes that help those who come after us. 1. Jaber Chehayeb R, SenthilKumar G, Saade Z, Gallo Marin B, Aghagoli G, Virji AZ. Examining the First Peer-to-Peer Mentorship Program (F1Doctors) for International Medical Students. *J Interdiscip Stud Educ*. 2022;11(1):102-125. 2. Chugh M, Joseph T. Citizenship privilege harms science. *Nature*. 2024;628(8008):499-501. doi:10.1038/d41586-024-01080-x ![](https://blog.womensurgeons.org/wp-content/uploads/2024/06/SenthilKumar.Gopika2-278x300.jpg)Dr. SenthilKumar was invited to contribute this article in celebration of AAPI heritage month. She is the current Chair of the Association of Women Surgeons National Medical Student Committee and is a MD-PhD student at the Medical College of Wisconsin. Dr. SenthilKumar is also a member of the Society of Asian Academic Surgeons Communications Committee and spearheads the society’s medical student SAAS Sips events (online panel discussions). Previously, Dr. SenthilKumar has served as the Executive Director and Research Coordinator for F1Doctors, a national student-led mentorship platform for international students interested in health-related careers. She is passionate about supporting and lifting-up trainees in our field, especially those who may have experienced similar challenges to her. **Categories:** advocacy, awareness, current events, diversity and inclusion, leadership, medical students, professionalism, reflection, training, Underrepresented in medicine, URiM, women **Tags:** AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Oral and Maxillofacial Surgery: The Best Specialty You Know Nothing About](https://blog.womensurgeons.org/oral-and-maxillofacial-surgery-the-best-specialty-you-know-nothing-about/) **Published:** May 29, 2024 **Author:** Blog Team **Content:** Oral and Maxillofacial Surgery: The Best Specialty You Know Nothing About By Jaclyn Tomsic The famous philosopher Confucius once said, “Choose a job you love, and you will never have to work a day in your life.” I can say that being an oral and maxillofacial surgeon has made this quote my reality. Oral and maxillofacial surgery, or OMFS, as we are most commonly referred to on hospital wards and in EDs, is an internationally recognized specialty. As defined by AAOMS, The [American Association of Oral and Maxillofacial Surgeons](https://www.aaoms.org/), oral and maxillofacial surgeons are the experts in face, mouth, and jaw surgery.1 Despite this, few people truly understand what we do. I am here to shed some light. Let’s break it down for a minute. Oral and maxillofacial surgery. What does that really mean? Oral means mouth. Maxillofacial means jaws and face. Therefore, putting that together, OMF surgeons treat disease, injuries, and defects in the head, neck, and face, including the hard and soft tissues of the oral and maxillofacial regions. The scope of OMFS is broad and includes: - Dentoalveolar surgery – surgery of the teeth-bearing portion of the maxilla and mandible - Pathology – both benign and malignant pathology of the oral cavity, head, face and neck - Facial trauma – we treat trauma of the entire facial skeleton including the mandible, maxilla, palate, zygoma, nasal bones, frontal bones as well as the facial soft tissue envelope and associated soft tissue structures - Orthognathic surgery – a multi-disciplinary surgery intricately planned to achieve facial and dental harmony by purposefully repositioning the maxilla, mandible, and chin as indicated - Treatment of significant facial infection requiring surgical intervention, - Temporomandibular joint or TMJ surgery - Facial cosmetic surgery – including cosmetic facial surgeries as well as non-surgical rejuvenation with Botox and fillers - Cleft and craniofacial surgery - Dental implant surgery to replace lost and missing teeth and restore function As you can see, OMFS covers a lot of ground, and this is one of the things I love most about my specialty: the diversity of procedures I can perform. Now you may also be wondering the steps it takes to become an oral and maxillofacial surgeon. Oral surgery requires completion of undergraduate school, then dental school, followed by a 4-6 year residency program. Many residency programs also include attendance and completion of medical school integrated into the tract. This was the path I chose. OMFS has historically been a male-dominated field. Statistics in 2016 revealed that although dental schools are comprised of 49% women and 51% men, women comprise only 15% of OMFS residents and 7% of active oral surgeons in practice. Some of the barriers identified include [the length of training, lack of mentorship, and lack of exposure and/or understanding of the specialty](https://www.joms.org/article/S0278-2391(19)30700-1/fulltext).2 The good news: statistics overwhelmingly show that [oral surgeons are satisfied with their career selection](https://www.sciencedirect.com/science/article/pii/S0278239196906977?via%3Dihub).3 As physicians, being lifelong learners is innate; we are often also hardwired to reinvent ourselves as individuals. I have found passion in increasing the visibility of my amazing specialty and joy in motivating other women to pursue a career in OMFS. Thank you for the opportunity to show you as well! ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/Tomsic.Jaclyn-240x300.png)Jaclyn Tomsic is a board-certified oral and maxillofacial surgeon. She attended Boston University for dental school and Wayne State University in Detroit for medical school and residency training. Her education journey took her to many new places: Boston, Charlotte, Detroit, DC, and St. Louis, before returning home to Cleveland, which she feels has have greatly contributed to her personal growth. Having trained and worked in places like Detroit and St. Louis, she gained a strong background in facial trauma, which is one of her favorite surgeries. She also enjoys all things dento-alveolar: third molars, extractions, dental implants, bone grafting, sinus lift surgery, and bone recontouring. Her other clinical interests include orthognathic surgery, benign pathology, TMJ surgery, facial cosmetics, and anesthesia. One aspect of OMFS she enjoys the most is the opportunity to collaborate with her medical and dental colleagues to help treat patients as a whole, as many oral surgeries involve a team approach. She has a passion for fitness, wellness, and daily activity, is an avid sports fan – especially Cleveland sports – and enjoys baking, traveling, and listening to country music. She is a huge advocate for women in surgery and has fun sharing her surgery and life experiences on social media and can be found on instagram at @doctorjacci. **Categories:** advocacy, awareness, practice, resources, URiM, women --- ### [Growing Up Iranian-American](https://blog.womensurgeons.org/growing-up-iranian-american/) **Published:** May 26, 2024 **Author:** Blog Team **Content:** Sophie Dream, MD, MPH My father moved to Chicago at a young age. He and his father had applied for him to get a visa to come to the United States to further his education. The day my father’s visa arrived, his father passed away in a sudden and tragic accident. A testament to my father’s strength and perseverance, he arranged for his father’s burial, set his mother up to have an independent life, in a very paternalistic society where she otherwise would be dependent on my father, and left for school in Chicago. He met my mother through an acquaintance before she had any thought of moving to the States. They fell in love the way people in the movies do and, after marrying, fled Iran at the very beginning of the Iranian Revolution, “as they were canceling flights and shutting the airports down for 30 years.” My parents tell the story of how they got here with a suitcase of Iranian currency that the currency exchange clerk threw in the trash and told them, “Don’t you know what’s happening in your country? This is garbage now.” They began life as full-time college students with full-time jobs, no money, and no family around. My parents were able to make something of nothing, and my siblings and I benefited from their fortitude. I was raised in a Persian household. We spoke Farsi at home and celebrated Persian holidays; I still consider the first day of spring, Nowruz- a holiday that originated from the Persian religion of Zoroastrianism, to be New Year. My experience with my culture throughout my childhood, adolescence, and early adulthood has been very private. This was not by my choice but out of my parents’ caution and engineering. My parents left Iran because the country they grew up in was changing, and they never went back because that change was permanent. The trouble for them was that their new home was not always welcoming. In 1979, the Iranian hostage crisis created a diplomatic standoff between Iran and the US that only furthered tensions between the two nations. This diplomatic standoff had nothing to do with my college-attending, young, and in-love parents. It did, however, affect the way they saw their new home, and it shaped how they perceived they fit in. Seeing their friends attacked and deported despite being legal immigrants and experiencing discrimination made them feel they needed to assimilate as much as possible. When they filed for their Green Cards, their names read “Heidi” and “Robert.” My parents always told me not to tell people where they were from or my ethnicity, not to say what religion I was, and would tell stories of what they experienced in the late 70s in Chicago. “You can’t truly trust anyone, and being born here doesn’t mean anything; they can kick you out if they want.” So, I did not talk about who I was when I left my home. On September 11, 2001, I was a freshman in high school. My father was about to board a 9 am flight leaving LaGuardia to come home from a work trip. I remember that tragic day very vividly; my father remembers it even more so, having witnessed the atrocity firsthand. Our family mourned the lost lives of innocent people that day, along with the rest of America. What our family experienced in the aftermath has stayed with me. The anti-Middle Eastern sentiment that pervaded the country seeped its way into our home. My younger brother was bullied at school; at a sleepover, his classmates called Immigration and Naturalization Service on our family as a prank. This experience made me believe in my parents’ caution, I was really happy that we were not very religious and that I did not wear a hijab. I was happy that I could blend in; being tan and born in New Jersey while living in the Midwest meant I was an ethnic chameleon. This is where I think this issue is and why I am starting to question the engineered assimilation I thought I was privileged to have. My heritage is rich, and the values my parents instilled in me are part of my Persian culture. We appreciate the arts and equity in education. I was raised on the principles that permeate my Persian culture of “Good Thoughts, Good Words, Good Deeds.” I am proud of the strength, perseverance, and fortitude that led to my parents’ fulfillment of their American Dream. This is the experience many children of Iranian Immigrants carry with them, but that all gets washed away when I leave my parents’ home. Our experience echoes the experience of many other Asian Americans, with a long history of hate and discrimination that has been tolerated because we are “allowed” to quietly succeed. My Persian experience is just the beginning of a generation of a newly minted and growing community. I worry as time goes on that I will lose my culture, that my children will not know its richness, and that no one will be better for what I have to offer. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/Dream.Sophie-225x300.jpg)Dr. Sophie Dream is an Endocrine Surgeon who joined the Department of Surgery at Froedtert and the Medical College of Wisconsin in September 2019 after completing her fellowship in endocrine surgery at the University of Alabama. She holds appointments as an Assistant Professor of Surgical Oncology at Froedtert and the Medical College of Wisconsin and the Zablocki Veterans’ Administration Medical Center in Milwaukee. She is also the Program Director for the Medical College of Wisconsin Comprehensive Endocrine Surgery Fellowship. Dr. Dream’s clinical practice focuses on the surgical treatment of benign and malignant disorders of the thyroid, parathyroid, and adrenal glands. She has brought thyroid radiofrequency ablation to MCW and has successfully grown the non-surgical thyroid intervention program at Froedtert. Her focus of investigation is on identifying and quantifying the more elusive impacts primary hyperparathyroidism has on quality of life to inform the operative indications for parathyroidectomy. Her clinical practice contributes to the Medical College of Wisconsin Endocrine Surgery research program through the growth of prospective databases that support this research. Dr. Dream is an Associate Editor for *Clinical Thyroidology* and serves on the Editorial Boards of *Surgery, American Journal of Surgery, and Surgical Oncology Insight.* **Categories:** advocacy, awareness, career development, current events, diversity and inclusion, leadership, resources, Underrepresented in medicine, URiM, women **Tags:** AWS, AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Navigating Professional Development Time: What Are My Priorities?](https://blog.womensurgeons.org/navigating-professional-development-time-what-are-my-priorities/) **Published:** May 22, 2024 **Author:** Blog Team **Content:** **By:** Ariana Naaseh, MD, MPHS Often the first thing I get asked by friends and family regarding residency is “So what year are you in now?” followed by “So what exactly are you doing?” These questions have heightened since entering professional development time in June 2023, as I’ve been much more present at gatherings. It’s challenging to explain exactly what goes on during these two years of professional and personal growth. One of my commitments to myself upon entering General Surgery residency was to not lose myself, and my core interests. Some days that proved to be easier than others. I had to be stringent in recognizing not only what truly mattered to me, but also what was feasible within the confines of clinical duties and rest. There were some major and minor sacrifices made while adjusting to a new life in a new city, learning how to live with my now husband, learning how to be a surgeon, and building my St. Louis community. I stuck to the essentials – my Orangetheory membership, cooking at home, my time outside in nature, travel, and filling my cup with family and friends. That looked different day to day, week to week, month to month. Then came June 2023. Professional development time was in front of me. The two-year block with endless time to mold to fit my interests and needs. It’s such a blank slate that I was overwhelmed to navigate it. I was lucky enough to have rigorous advising to come into the time with an established research plan and guaranteed funding, but what about all of the other hours? Going from working for a greater portion of the week to having much more free time made fitting in everything I wanted to do seem much more doable. Overall, fewer sacrifices needed to be made and I could go back to being the “yes” girl I once was. I was a bridesmaid in two of my best friends’ weddings. I got married and traveled for over 2 weeks in Italy with my husband. I was present at every important family birthday, graduation, and holiday. Early on though, I got caught up in the nuances of what I felt I should be doing and accomplishing. Academia undoubtedly has its pressures. I felt that while I was so proud of everything I was doing to enrich myself personally, it was not enough. I am completing a 10-month Masters of Population Health Sciences this month which helped alleviate some of those concerns as I spent the greater deal of this year learning and imagining and completing projects through my classes. I have worked on my major cancer genetic equity project throughout the degree program and done some surgical education research. I submitted to present at conferences and published manuscripts. The thought still lingered in the back of my mind – am I doing enough? Am I involved enough? Do I have enough on my plate? Is it ok to take these breaks? The answer to these questions differs based on who you talk to. One of our wonderful Graduate Medical Education psychologists at Washington University in St. Louis who I have seen monthly since starting residency asked me a very simple question – “Imagine you are yourself in June 2025. You’re about to go back to clinical residency. What will you be proud of that you accomplished?” I answered that I would be proud of working on and discovering myself, spending time outside and with family and friends, and enriching myself with professional activities that would help me in my future academic career. From there, I was able to build a list of goals and priorities for my time. Most importantly, not all of them were professional. She normalized for me that professional development is much more than academic productivity and enrichment. Now, I am spending my time conducting research, taking classes and attending national conferences, getting involved on a national level with organizations that align with my values and professional goals, and ensuring I am making time for the personal events and time that matters to me. I still don’t have a great answer of how to get rid of the nagging voice in the back of my head that I am not doing enough, but surrounding myself with a supportive community who shares similar values and goals has been so helpful in feeling secure in the decision to spend this time on me even if that path looks different from one of my co-residents. **BIOGRAPHY:** ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/Naaseh.Ariana-218x300.jpeg)Ariana Naaseh is a general surgery resident in her first year of two professional development years at Washington University in St. Louis. She grew up in Southern California and attended University of California, Berkeley where she earned her degree in Cognitive Science. She earned her M.D. at University of California, Irvine School of Medicine before relocating to St. Louis with her husband and fellow general surgery co-resident Steven Tohmasi. Ariana’s primary research focuses are in understanding breast cancer care disparities and improving genetic equity along with surgical education with an emphasis on medical student experiences on the surgery clerkship, residency recruitment, and wellness. As a general surgery resident, she serves on WashU’s Curriculum Committee and Wellness Committee. She is involved nationally in AWS on the Resident and Fellows Committee as well as through ASE as a Surgical Education Research Fellow, the 2024-2025 ASE/SIMPL Surgical Education Research Webinar Co-Lead, and a member of the Collaboration of Surgical Education Fellows (CoSEF). **TWITTER HANDLE**: @ariananaaseh **Categories:** Uncategorized **Tags:** AWS, AWSBlog, ILookLikeASurgeon, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Applying to Residency as an International Student at a US Medical School](https://blog.womensurgeons.org/applying-to-residency-as-an-international-student-at-a-us-medical-school/) **Published:** May 19, 2024 **Author:** Blog Team **Content:** By Yoshiko Iwai Part of being an international student in the US is navigating the complex process of visa sponsorship. I have been fortunate to have had tremendous support from my various international student offices, but even now I have trouble understanding the system. One of the reasons that obtaining a visa and maintaining status is so challenging is that there are so few international students to begin with—and therefore few mentors who can provide us with meaningful guidance. These are some things I wish I knew as an international student in the US applying for residency. I applied in general surgery, so the details may be different in other specialties. This is not legal advice and does not represent the official policies or views of the institutions I have been a part of. Rather, they are things I have learned through my research or from the generous advice I’ve received from mentors over the years. - Plan Early - Matching into residency is competitive, especially if you are limited to programs that accept international students and sponsor specific visas. I met with my international student advisor during my first semester of medical school. There is a decent amount of information online, but visas are often specific to your circumstances and country of origin. Ask your international advisor about Optional Practical Training (OPT, a practicum year that comes with most F1 student visas that you can use during your intern year) and transitioning to J1 vs H1b visas in residency. Get a sense of what barriers you might face and plan accordingly. - As early as possible, I created a list of all programs in the US that sponsored J1 and H1b visas for residency in general surgery. You can find this on places like Residency Explorer or the FREIDA AMA Residency and Fellowship Programs Database which make it easier to filter and search across the country. As you get closer to applying for residency, you should cross-check information from these aggregate sources with individual program websites because visa requirements change or have exceptions. I also took note of the applicant metrics of these programs (e.g., Step 2 score, publications, presentations) so I had a general sense of the bar I needed to reach to be considered a competitive applicant. - If you have specific visa preferences (e.g., H1b), several exceptions exist for US medical students. It can be challenging to figure out which rules do and don’t apply to you because international students at US medical schools do not go through the Educational Commission for Foreign Medical Graduates (ECFMG) but do require a visa to train in the US. I emailed program coordinators at places I was most interested in the summer before I applied to residency. I inquired about their visa rules and whether I would be eligible for a particular visa at their institution. Program coordinators are very knowledgeable and can be immensely helpful as they are often the ones putting together residents’ visa applications. If they cannot verify whether you would be a candidate for an H1b or J1 visa, I would request to be connected to the graduate medical education (GME) visa office. - Identify Mentors - This is more challenging because visa information is personal. In the process of connecting with research mentors and academic advisors at my home institution, I proactively sought out individuals who could give me meaningful visa advice. My mentors and letter writers made introductions to their friends from residency, fellowship, or the conference circuit who were previously in similar situations to mine. I found these connections were most helpful for figuring out which questions I should or shouldn’t ask during interviews, which institutions had the broadest visa support, how to curate the list of programs I would apply to, and how to ultimately create my rank list. - Joining organizations like F1 Doctors can also be helpful. I served as a mentor for this organization and, through this network, connected with other US medical students who were on a visa. Having peers who you can ask informal questions to can be reassuring and it is a bonus if you get to know them more closely on the interview trail. You may even become co-residents with some of them! - Touch base with your international student advisors. I cannot emphasize this enough. They are the most knowledgeable about the specific visa regulations and processes for ensuring you can get to the next step. Double-check what paperwork you need to prepare (e.g. H1b visas typically require that you have already completed Step 3 to be eligible), and then double-check again! - Visa Specifics - J1 visa - This visa is for “exchange visitors” who are approved to enter the US for purposes of training, teaching, studying, and obtaining other skills, which includes graduate medical education. - This is the most commonly sponsored visa for residency and fellowship. - The J1 visa is typically sponsored by ECFMG, even if you are not an international medical graduate who goes through ECFMG for the residency application process. - The J1 visa has a 2-year home-country physical presence requirement which mandates you to leave the US after your residency or fellowship for a minimum of 2 years. This is a US law. There is a waiver for this home-country requirement (e.g., facing persecution in your home country, working in a federally underserved area in the US); however, this typically requires working with a lawyer, and obtaining a waiver is not guaranteed. - Depending on your country of origin, you will have to return to your home country and renew your J1 visa periodically. This can be challenging with a resident’s schedule and requires coordination with the person managing trainee schedules. - H1b visa - This visa is for “specialty occupations” and can be used to support trainees during residency and fellowship. - The H1b visa is more costly for residency programs and is often processed by the hospital system. The applicant cannot pay for the cost of sponsoring an H1b visa and this typically comes from the Department of Surgery (or the specific department you are applying in). Some medical schools have specific rules against sponsoring H1b visas, though rarely, exceptions may be made at the leadership level. - H1b eligibility typically requires passing Step 3 for international medical graduates but may not be required for a transfer from OPT (i.e., prior F1 visa). - There is no 2-year home-country physical presence requirement for H1b visas; however, there is a maximum of 6 years for being sponsored on an H1b. If you are eligible for OPT, this means you can receive a maximum of 7 years. Be mindful of research requirements for your residency program to ensure you can complete all duties within the allotted time of your H1b visa. - Paths to permanent residency (i.e., green card) are typically easier from an H1b visa than a J1 visa. This still requires working closely with a lawyer and may take several years. The residency application process is challenging and thinking about visas on top of everything else is difficult. I have found immense comfort in speaking with current residents who successfully navigated the visa process and in connecting with mentors who have advocated for me and generously shared their experiences. Working through the visa process in college, medical school, and residency applications has also made me reflect on my goals and refine them regularly. Where do you see yourself in 10-20 years? What do you want your life to look like? Where do you want to be? If you can answer these questions, then you’re off to a good start. ———————- ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/Daniel-Turbert-Photography-146-300x300.jpg)Yoshiko Iwai, MS, MFA, is a fourth-year medical student at the University of North Carolina at Chapel Hill School of Medicine. She received her undergraduate degrees from the University Michigan in dance and neuroscience. She subsequently received a master’s in science in Narrative Medicine and a master’s in fine arts in Creative Nonfiction from Columbia University in New York. She will be starting her general surgery residency at Massachusetts General Hospital in the summer 2024. Her research interests include surgical oncology, health equity, and medical education. **Categories:** advocacy, awareness, career development, current events, diversity and inclusion, leadership, professionalism, reflection, residency, resources, training, URiM, women --- ### [WOMEN SURGEONS HAVE BETTER OUTCOMES THAN THEIR MALE COUNTERPARTS](https://blog.womensurgeons.org/women-surgeons-have-better-outcomes-than-their-male-counterparts/) **Published:** May 15, 2024 **Author:** Blog Team **Content:** By: Anna DeFreitas **“Women cannot seriously pursue medical careers (…) unless they stop being women: due to physiological laws, women doctors are ambiguous, hermaphrodite or sexless creatures, monsters at any rate. Let those who fancy such a distinction try to acquire it.”** This affirmation by the French physician Lucas-Championnaire shows the long and arduous path women had to take to become doctors and surgeons. The practice of Medicine required masculine qualities, according to the 19th-century view: “In order to be a physician, one needs a sharp and open mind, a solid and varied education, a serious and strong character, a great deal of self-control, a mix of benignity and stamina, a complete command over one’s feelings, moral vigor and, when necessary, muscular strength. (…) Isn’t feminine nature just the opposite?” The Journal of Medicine and Surgery Practice stated: “Let us add that it seems obvious that in France women would be exposed to utter failure concerning the final outcome.” After two centuries, it seems these predictions were wrong: women not only became physicians and surgeons without losing their femininity, but according to two recent studies, women surgeons achieve better results than their male colleagues. Patients cared for by female surgeons are less likely to experience complications and need follow-up care than when males brandish the scalpel, according to two major studies in Toronto and Sweden. **The Canadian Study** A Canadian research team analyzed data from about 1.2 million patients in Ontario spanning from 2007 to 2019, focusing on medical complications, hospital readmissions, and mortality rates following surgery. The study covered 25 diverse surgical procedures involving the heart, brain, bones, organs, and blood vessels. The analysis, published in the JAMA Surgery, revealed that 90 days after an operation 13.9% of patients treated by a male surgeon had “adverse post-operative events”, including death and medical complications such as major infections, heart attacks, and strokes, compared to 12.5% rate for patients seen by female surgeons. Long-term outcomes were also better with female surgeons: 20.7% of the patients had an adverse postoperative event, contrasted with 25% of those seen by males. Particularly striking is the finding regarding post-surgical mortality: patients under the care of male surgeons had a 25% higher likelihood of death within one year after surgery compared to those treated by their female colleagues. **The Sweden Research** A second study of 150,000 patients in Sweden, also published in JAMA Surgery, found that patients treated by female surgeons for elective and acute care cholecystectomies suffered fewer complications and had shorter hospital stays than those treated by men, suggesting that surgical technique and risk-taking might explain some of the differences observed. **Operate Like a Woman** As a result, some specialists now recommend that male surgeons learn from their female peers by adopting some practices that are more common among them to improve outcomes for the patients, like trying not to rush the surgery and taking fewer risks. Attention to detail and involvement in the post-op could make a difference, too. We have come a long way since the French doctor Richelot declared “The accoutrement (blood-stained overalls), the appalling rooms, the human body parts and remains, the hard work contrast most crudely with feminine curves. (…) These young women lose the graciousness, the gentleness, the charm of their sex. They are neither women nor men.” As female surgeons, we all have our experiences of patients thinking we are the nurses, or asking to talk to the doctor, but it happens in other specialties, too. I am glad I did not have any special challenge among my male colleagues for being a woman physician. We have walked a long path to arrive at the point where we are valued as doctors. Kudos to every woman physician and surgeon who made our work possible. REFERENCES 1. Lucas-Championnaire, Just, “article 9997” J. méd. chir. prat., June 1875 issue. p. 241-242. 2. Richelot, G. La Femme-Médecin (Women Doctors), Paris: E. Dentu, 1875, p.43. 3. “Feuilleton”, Gaz, hebd. med. chir., n°38, Sept 20, 1872, pp. 409-421. 4. Pigeard-Micaulta, Natalie. History of Women’s Entrance into Medicine, Paris X, EA 373 Histoire de la philosophie, Histoire des sciences. 5. Wallis CJD, Jerath A, Aminoltejari K, et al. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries, JAMA Surg. 2023;158(11):1185–1194. 6. Blohm M, Sandblom G, Enochsson L, Österberg J. Differences in Cholecystectomy Outcomes and Operating Time Between Male and Female Surgeons in Sweden, JAMA Surg. 2023;158(11):1168–1175. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/DeFreitas.Anna_-150x150.jpg)Ana De Freitas is a surgeon and a published writer and researcher, with works in Medicine, Neuroscience, and Bioethics. She has Medical Residencies in General and Pediatric Surgery and is a member of the American Health Lawyers Association and the American College of Healthcare Executives. Ana loves delving into medical research and health law. Outside of work, she enjoys reading, writing poetry, and playing volleyball. You can find her blog at <https://medium.com/@acdfreitas13>. **Categories:** advocacy, awareness, current events, gender differences, practice, women --- ### [Living at the Intersection of Person and Surgeon](https://blog.womensurgeons.org/living-at-the-intersection-of-person-and-surgeon/) **Published:** May 12, 2024 **Author:** Blog Team **Content:** By: Priyanka V. Chugh MD, MS When I started medical school, nearly ten years ago, I had an idea of what a surgeon looked like. Largely rooted in the perspective of the media, it was “supposed” to be a white, affluent, straight, cisgender man without any visible or invisible disability. As a South Asian woman, who is part of the LGBTQIA+ community, and lives with invisible disability, I never contemplated becoming a surgeon. In fact, I believed that my unique experiences and challenges would not be understood or accepted by surgeons. When I discovered that surgery felt like the right path for me professionally, a new anxiety clouded my excitement. I had never met a surgeon that lived at the same intersection of identities that I did. I met with women surgeons and South Asian surgeons; I spoke with disability advocates and followed queer surgeons on social media. I craved for that experience that echoed mine or at least for someone to acknowledge my background. I wanted reassurance that it would be okay to be me. Intersectionality, a term coined by civil rights advocate and scholar Kimberlé Williams Crenshaw in 1989, is defined in the Oxford English Dictionary as “the interconnected nature of social categorizations such as race, class, and gender, regarded as creating overlapping and interdependent systems of discrimination or disadvantage; a theoretical approach based on such a premise.” #1 We don’t live with each of our identities partitioned off. For example, I don’t experience the same challenges as all women or all South Asian people. We are instead, uniquely impacted by the amalgamation of these identities and the challenges presented by each. This plays out in the field of surgery in multiple ways. For example, the intersection of gender, race, and ethnicity in surgical leadership was recently explored by *Iwai et al*. #2 The authors found that the majority of surgical chairs were white males, followed by Asian males and then white females. In fact, there had not been any black female chairs of surgery at an academic center in the United States until 2021. #2 It has been demonstrated that a greater number of women trainees report experiencing mistreatment than men, but LGTBQ+ women report even higher rates of mistreatment. #3 This trend plays out over and over with different identity groups. So, while many have applauded the great strides achieved by certain groups in surgery, there are still gaps when we examine the intersections of identities. Those gaps in representation are palpable to those in minoritized groups. Even as surgery diversifies, there are still operating rooms around the country where no one looks like me or some of my peers. There are many places where talking about a same-gender partner would be met with uncomfortable silence, or a request to use appropriate pronouns would not be respected. Surgeons or trainees from the same racial or ethnic background might be confused for each other. A surgeon who discloses a disability might fear for their job. A trainee who has to financially support their family may not be able to attend the same conferences as their more affluent peers. The weight of these challenges compounds and the onus to educate or make change often falls to those who are the most impacted. This takes time and mental space that should be used for learning how to be a surgeon. This means working twice as hard to be given the same treatment as peers who come from the historical majority. While the obvious solution is to increase diversity and representation in surgery, that takes time and intention. Minoritized surgeons and trainees don’t have the time to just wait, action has to be taken now. Organizations such as the Association of Women Surgeons (AWS), Society of Asian Academic Surgeons (SAAS), Association of Out Surgeons and Allies (AOSA), and more have made progress in representation and education. Institutions across the country have invested in diversity and equity initiatives. This is just the start. Everyone deserves a safe and welcoming environment to learn and practice, regardless of their unique intersections of identity. It is an institution-level **and** a person-level problem and the solution all begins with creating a culture of respect and humility*.* Recognizing that none of us comes to the table with the same experience as another is the first step. Having the willingness to learn and help, regardless of background, is the second. My mentors have almost never shared my identities, but importantly, they all understand the value of cross-mentorship, or creating a mentorship relationship across differences. #4 They all see me for who I am as a person and who I am as a surgical trainee. They don’t make assumptions and they respectfully ask questions. They treat me like my peers and invest in me in the same way. We all owe it to each other to cultivate these types of relationships; to be better, more informed, be sponsors and allies, and to be humble. Help each other at the intersection of person and surgeon. We will all be better for it. References 1. Dictionary OE. Oxford English Dictionary: Oxford University Press; 2023. 2. Iwai Y, Yu AYL, Daniels NC, et al. Racial, ethnic, and gender diversity among academic surgical leaders in the US. *JAMA surgery*. 2023; 3. Heiderscheit EA, Schlick CJR, Ellis RJ, et al. Experiences of LGBTQ+ residents in US general surgery training programs. *JAMA surgery*. 2022;157(1):23-32. 4. Koprowski MA, Dickinson KJ, Johnson-Mann CN, et al. Cross-mentorship: a unique lens into the realities and challenges of diversity in surgery. *Annals of surgery*. 2022;275(1):e6-e7. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/Chugh.Priyanka-200x300.jpeg)Priyanka V. Chugh MD, MS is a general surgery resident at Boston Medical Center and currently a research fellow at Boston Children’s Hospital. Dr. Chugh received her undergraduate degree from New York University where she majored in Psychology with minors in Public Health and Policy, Child/Adolescent Mental Health Studies, and Chemistry. She then went on to continue her studies at Johns Hopkins University where she received her Masters in Biotechnology and then to Cooper Medical School of Rowan University for her medical degree. Dr. Chugh’s research focuses on understanding the experience of children and adolescents with chronic surgical conditions such as intestinal failure/short bowel syndrome. She also has a passion for improving equity in surgery, and founded Advancing Cultural Competency and Equity in Surgical Specialties (ACCESS) within the Boston Medical Center Department of Surgery. In her free time, Dr. Chugh can be found trying new gluten free spots, boxing (with appropriate hand wrapping for protection!) or napping on a beach. Her Twitter/X handle is @antiwheatgirl. **Categories:** advocacy, awareness, diversity and inclusion, URiM, women **Tags:** AWS, AWSBlog, ILookLikeASurgeon, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Being Vulnerable is Human; Even for Surgeons](https://blog.womensurgeons.org/being-vulnerable-is-human-even-for-surgeons/) **Published:** May 8, 2024 **Author:** Blog Team **Content:** By: Cathy Hung In the earlier years of my career, I always tried to accommodate patients’ needs anytime, all the time, whenever possible. I opened my office many times off-hours at the slightest concern of patients with complaints of bleeding or pain. One time, I rerouted my weekend day trip when my son was still a toddler. We planned to take him to a museum, but as soon as I got called, my family drove one hour back for me to see a consult while my family waited in the parking lot outside the emergency room, only to find out that it was a routine consult with no urgency what-so-ever. I jumped whenever someone called me off-hours. After all, I pride myself as a caring human and a good doctor. The fight-and-flight responses were by-products of being trained at a level-one trauma center during my residency. I would be frisked on the inside but put a smile on the outside to keep professional. In 2017, when my father was gasping agonal breaths at the hospice of Robert-Wood Johnson Hospital and finally passed away from long-standing prostate cancer, I was on-call with another hospital. Right at the moment when my father released his last breath, my phone went off for me to see a jaw fracture. I remember interrupting the nurse abruptly without her going into all the details, “My father just passed away, someone else will have to take this consult.” I hung up. It was the first time I didn’t feel anxious or guilty of not responding right away. Over the years, as life caught up with me and I dealt with many more professional and personal crises, I began to realize that I couldn’t save them all. Tending to others all the time left me depleted. I started to feel unwell physically and emotionally. I went into my office one morning in a crummy mood, and my first patient, who was an energetic gentleman in his sixties with a tan on his face, wearing a polo shirt and a cap, told me he played golf every day and gazed through me with concern: “How are YOU feeling?” He added, “You know, because if you are taking care of me, I want to make sure you are in top condition.” We briefly had some conversations about family, and I went a bit more personal than what I usually would allow myself as far as conversations with patients. It was surprisingly soothing and just what I needed at the time. My patient played therapist for me. He was compassionate, and I did not feel I had to have a stoic exterior. I let down my guard a bit, and it felt alright. That experience allowed me to start showing my human side to my patients. While still staying professional, I would let my patients know if I really wasn’t feeling well from time to time. I would allow myself to sometimes reschedule instead of toughing it out. To my surprise, most patients have been sympathetic, gracefully allowing their doctor to take a sick day. Here are a few things I’ve learned over the years: 1. Let go of perfectionism: we can’t be 100% of the time, and that is okay. 2. Being vulnerable is human, and most patients will respond to your human side as long as you behave professionally. 3. You can’t save every person, so relax and do the best you can. 4. Don’t feel bad asking for support. As surgeons, we are trained to act controlled, collected, and calm all the time. Having the courage to be vulnerable allows me to bond with my patients more. When I recuperate from whatever challenge I need to tackle, I return as a better human being. The act of vulnerability adds to resilience-building and better rapport with my patients. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/IMG_9626-1.jpg) Cathy Hung is an oral and maxillofacial surgeon in private practice in New Jersey. She is a twice-published book author, speaker, and coach in the areas of diversity, equity and inclusion, and wellness. She is one of the American Dental Association’s wellness ambassadors, a consultant for the Committee on Membership for the American Association of Oral and Maxillofacial Surgeons, and a member of the Outreach Committee for the Association of Women Surgeons. She enjoys traveling, reading, cooking, and collecting shells. **Categories:** career development, family life, health, practice, professionalism, reflection, resources, self-care, training, women **Tags:** AWS, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [What @womensurgeons Has Done For Me](https://blog.womensurgeons.org/what-womensurgeons-has-done-for-me/) **Published:** May 1, 2024 **Author:** Blog Team **Content:** By: Katerina Jou Setting the scene: My medical school didn’t have an AWS chapter. Surgery was just starting to become a growing presence on the school’s campus, with most students pursuing specialties like pediatrics, internal medicine, and emergency medicine, and few, in this new era, choosing surgery. For a little background, my medical school is now eight years old. I’m a student in the 7-year BS/MD Sophie Davis Program for Biomedical Education/City University of New York (CUNY) School of Medicine – we used to be a 5+2 program, where students would complete five years at Sophie Davis and “match” into affiliated medical schools to complete clerkship education. Our program historically has prioritized primary care, and despite expanding surgical presence with coordinators and advisors of practicing surgical background, a good part of my time there was spent wondering how I was going to get from point A to point B – from picking surgery as my chosen career path almost as I finished dissecting my cadaver’s hand in anatomy in my third year of undergrad and isolating the recurrent branch of the median nerve in such a satisfying way, to becoming a fully-fledged surgical resident. Fast forward a few years, and I was nearing the halfway point of my third year in medical school. I originally teetered between orthopedic surgery and general surgery, but I understood there were more people and experiences I could learn from. I had learned through organizing and moderating a “Women in Orthopedic Surgery” Panel at my medical school that there was the Perry Initiative, but didn’t learn about the Ruth Jackson Orthopedic Society until sometime later. Despite not being involved in these organizations, I am always in constant awe of how much the Perry Initiative and RJOS support young students, especially female-identifying students, pursuing orthopedic surgery with proper knowledge and support. As I spent one day following Instagram pages for various hospitals, I saw @womensurgeons. The page was so intellectually curated, teeming with information on networking, personal stories, and forming relationships with mentors, with WOMEN. Only one female medical student from my school had matched into general surgery so far in recent years, and despite having supportive male mentors, I wanted to find a community of women who were going through a similar journey. It was a sheer stroke of luck that I saw the e-board application post, and on a whim, I applied. And a few months later, I became co-coordinator for diversity and inclusion as I was about to enter my fourth year of medical school. I was in shock when I got the email letter saying that I was selected. I never thought that I was *that* candidate for these kinds of positions, let alone for something as important as DEI, and it was such a unique opportunity that I couldn’t pass up. After our initial transition meeting with the outgoing coordinators, Maria and I were scrambling the Asian American, Native Hawaiian, and Pacific Islander Heritage Month series, and were fortunate enough to have a speaker who was willing to engage with the AWS audience. Month after month with NMSC (national medical student committee) meetings, endless chats, more Heritage Month IG Lives, the possibility of organizing projects and seeking mentorship became more probable and believable. Truly the cherry on top was being able to meet several members at the national meeting in October – it solidified the community I had sought to find in the beginning of medical school. At the subsequent ACS meeting, I was even able to reconnect with an alumna from my medical school who had previously been involved with AWS. These strong, compassionate, incredible women have helped instill a new confidence to lead more projects, facilitate panels, and even be a panelist myself this past year for several AWS virtual and in-person events. Imposter syndrome still exists, but the support from mentorship and collaboration reigns superior. It’s already been almost a year and I’m still in disbelief. I just wish I learned about AWS sooner. Thanks to this opportunity, we’re now on the precipice of reviving our virtual National Day of Service event for high schoolers nationwide. This was only possible through a nationwide connection of committee members, chapter leaders, and willing medical students and surgeons. Being given the chance to be the DEI co-coordinator has taught me much more about what work remains to improve the state of diversity and inclusion in medical education and surgical training, and the need to expose the next generation to surgery. This continues to be an endeavor I hope to integrate into my career, and in working with my newfound mentors, friends, and colleagues. And as an update for my medical school – this year, we matched two female general surgery residents for the first time ever and two female MS1s are founding the AWS chapter at our medical school! ![](https://blog.womensurgeons.org/wp-content/uploads/2024/05/Katerina-Jou-1.jpg) Katerina Jou is a fourth-year medical student at the City University of New York (CUNY) School of Medicine, which is the medical school portion of the Sophie Davis BS/MD Program for Biomedical Education at CUNY City College in New York City. She is also one of the current diversity and inclusion coordinators on the 2023-2024 AWS National Medical Student Committee, and recently matched into general surgery at Zucker SOM-Northwell North Shore/LIJ in Manhasset, NY. Through her medical school career, she has developed great passions in artificial intelligence, mentorship, value-based healthcare, surgical outcomes research, health policy, and the intersection of public health and surgical practice in the care of vulnerable communities. As a medical student, Katerina also has worked with industry experts as a health policy intern for a California-based health policy institute and works as a health policy associate for a Florida-based laboratory benefits company, to whom she credits her desire to be deeply involved in the larger healthcare landscape. Her passion for surgery came from not only the novel robotic technology, but also the hands-on experiences she had in encouraging team environments and understanding the balance of both medical and surgical intervention. In her free time, she can be found watching her favorite syndicated sport, *Jeopardy!*, at 7PM Eastern, listening to music, singing, or working on her latest paint by number set. Her X/Twitter Handle is @katerina\_jou **Categories:** advocacy, awareness, career development, diversity and inclusion, education, Fellows, health, leadership, medical students, mentorship, networking, professionalism, reflection, resources, training, women --- ### [Exercise and Fitness During Medical School](https://blog.womensurgeons.org/exercise-and-fitness-during-medical-school/) **Published:** April 24, 2024 **Author:** Blog Team **Content:** By: Amber Park The way physicians provide care for their patients versus the way physicians care for themselves has been one of the most controversial and puzzling concepts I have yet to grasp. The undeniable hours and extent of effort we put into our studies and work can interfere with our ability to work out. However, I have realized that much of the disconnect truly comes from what we prioritize and how we schedule our days. As a former athlete, I have the advantage of knowing what kinds of exercises I like and can do in the gym. I know what has fueled my love for fitness. Given this background, I wanted to provide some tips for medical students, residents/fellows, and attendings who might not have had the same experience as myself in terms of learning about nutrition, scheduling, and the types of workouts that we can be doing. **Nutrition** Taking the time to cook and properly fuel ourselves can be time consuming and difficult. Medical students and physicians tend to stay up late, and stopping at the fast food drive through can be a welcome time saver. I also have to confess that I am a stress eater and love to snack on sweets or the closest free food available to me. We all have our struggles. To help myself eat better, I make a meal schedule each week with the same prepared lunch for all weekdays and a different dinner every night. I grocery shop the Friday/Saturday before so I have fresh ingredients for the weekend if I want to eat in (and believe me I love eating out and trying new food!), then I meal prep all my lunches on Sunday. At the same time, I prep all the ingredients for all of the dinners that I plan to make throughout the week. This makes it a lot easier and less time consuming to actually cook when getting home from classes/work. Here are a couple [ideas of what I like to eat](https://pin.it/2egOKczqW) (I also get a lot of recipes from tik tok): **Breakfast**: – Pancake bowl – Kodiak pancake mix with vanilla greek yogurt + berries/bananas – Yogurt bowl – greek yogurt mixed with protein powder + bananas or honey – Breakfast tacos – 2 eggs with turkey sausage and spinach in a low carb tortilla **Lunch**: – Steak and chicken fajitas with onions, bell peppers, and low carb tortillas – Alfredo pasta – chickpea pasta with homemade cheese sauce (cottage cheese, mozzarella, + seasonings) – Hamburger bowls **Dinner**: – Chimichurri steak with broccolini and mashed potato – Pineapple chicken with bell peppers over rice – Sushi bakes **Exercise** Scheduling time to workout as a medical student or physician can be extremely hard, especially as a resident. While I have no personal experience speaking for residents, I can share what I have learned as a medical student. As a medical student, I have realized that the more accessible you make working out, the easier it is to fit in. I also use it as my break in the day! Most of us turn to watching a show or being on our phones as a way to decompress. An easy change to make is to do those same things while on a walking pad or indoor bike. My current rotation is an hour to an hour and a half away, so I end up wasting about 3 hours of my day driving. In addition to that, I had a gym that was 15 minutes away, but I found that driving back and forth after getting home late made me eat much later and stay up later. So, I decided to use the money from what I would pay for a gym to buy a set of dumbbells. I already had bought a peloton bike off Facebook marketplace and am currently looking for other additions to my home gym. Access to workout equipment at home has been a life changer. As soon as I get home, I can just get on the bike and do a class for 30 minutes plus abs and I already feel that much better. More recently, I have also been working out in the morning. I just get up, brush my teeth, put some clothes on and go. Before, I had been working out about 2-3x a week; now I can workout 5-6x a week. For those who struggle to get motivated to work out or who don’t even know where to start, I think that the best thing to do is to start with simple activities like running or biking. Lifting weights can be technical but much like learning to ride a bike or to run is something that can always be learned. Knowing what motivates you and working toward a goal are a large part of what makes the difference for me. Personally, I have signed up for a marathon for the end of the year and look forward to training for it. For others, the goal may be losing weight or feeling better in general. By setting goals for ourselves, we create purpose which leads to the motivation to start and stick with an exercise routine. Here are some links to get get you started: - Running shoes: <https://www.reddit.com/r/RunningShoeGeeks/> - Youtube workouts: <https://www.youtube.com/@TIFFxDAN> <https://www.youtube.com/@pilatesbodyraven> <https://www.youtube.com/@sydneycummingshoudyshell> [Apple Fitness + ](https://www.apple.com/apple-fitness-plus/)is not bad either - Running workouts: [Nike Run Club App](https://www.nike.com/nrc-app) is a good place to start! I hope this was helpful, and like I said: I don’t know everything, and not everyone is the same. Working out and taking care of our nutrition can be challenging and difficult when working with limited time constraints, but, despite taking care of others, we need to take care of ourselves too. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/04/APark-Headshot-771x1024.jpg)Amber Park grew up in Houston, TX. She went to Davenport University where she earned a BS in biology and played collegiate lacrosse. Both of Amber’s parents are in the health field and were an inspiration for her initial interest in medicine. She currently attends Lincoln Memorial University – DeBusk College of Medicine Knoxville campus. Amber enjoys playing sports (basketball, volleyball, and lacrosse) and lifting weights/running along with running a small photography business – MAC CR3 studio (Ig: @mac.cr3.studio). **Categories:** career development, Fellows, health, medical students, mentorship, professionalism, reflection, self-care, women --- ### [Navigating Medicine: A Journey with Non-Physician Parents ](https://blog.womensurgeons.org/navigating-medicine-a-journey-with-non-physician-parents/) **Published:** April 17, 2024 **Author:** Blog Team **Content:** By: Emma Barham Growing up in a household where medical jargon sounded like a different language and stethoscopes were sparse, my journey into medicine was an uncharted territory. My parents always valued education, and I was taught from a young age that knowledge is power and can take you far in life. Although my parents were always supportive of me pursuing medicine, but they were unfamiliar with the intricacies of embarking on a career in the medical world. Their lack of firsthand experience in medicine meant that I had to chart my own course, relying on my own determination to navigate the challenges ahead. As I started my pre-medical journey, I quickly realized the importance of seeking guidance from mentors within the medical community. I gained invaluable insights into the realities of a career in medicine through my interactions with physicians and healthcare professionals. During sophomore year of my undergraduate education, I was able to shadow an orthopedic surgeon in my hometown, who has tremendously impacted the trajectory of my career. He had two sons, both interested in pursuing medicine, and I was constantly in awe at the magnitude of support and advice he was able to provide them in managing their own future careers. Although my parents were not in medicine, I want to emphasize how impactful they have been on my medical career. I have greatly appreciated their ability to help me disconnect from the world of medicine and enjoy the outside world. It sounds cliche, but they have kept me humble through this journey and are constant reminders of how important it is to maintain good relationships and a life outside of medicine. My parents served as pillars of strength throughout my journey, though the absence of medical expertise in my immediate family has presented unique challenges. As I have progressed through medical school, I have learned to overcome the challenges of navigating this journey as a first-generation medical student through following these three tips: **Seek Mentorship** Seeking mentorship during medical school is crucial for many reasons. Mentors are able to provide invaluable guidance and wisdom from their own experiences, helping students understand the complexities of medical education and clinical practice. Through mentorship, I have gained access to diverse perspectives, professional connections, research opportunities, and immense support. I cannot imagine coming as far as I have in my medical career without the advice I have received from mentorship. I sought out mentorship through the Medical Student Orthopedic Society MSOS and am currently a mentee with their program. Additionally, I have found mentorship at my school through forming relationships with professors and other faculty members. Ultimately, mentorship enriches medical education and empowers students to thrive academically and professionally as they embark on their own careers in healthcare. **Network** Networking in medicine is indispensable for professional growth and establishing connections within the medical community. Great opportunities to network can be found through attending conferences, joining professional organizations such as the Association of Women Surgeons AWS, and participating in extracurricular activities related to medicine like volunteering in the NICU at my local hospital. In an ever-evolving healthcare landscape, networking not only enhances individual careers but also contributes to the collective improvement of patient care. For example, I have had the privilege to attend a couple of conferences hosted by the American College of Osteopathic Surgeons and another conference hosted by the Student American Osteopathic Academy of Orthopedics. I understand not every medical student has the opportunity to attend conferences, but I think they are great opportunities to network with like-minded individuals in your field of interest. **Stay Informed** It is easy to get caught up in the hustle and bustle of studying for examinations, preparing for practical exams, and balancing life outside of medicine. It is crucial to keep up to date with developments in the field, journals, and continuing medical education. I believe being well-informed helps students make educated decisions about their career paths, learn about what specialties speak to them, and allows us to stay naturally curious. For example, I am an orthopedics subspecialty writer with The Keats Surgery Newsletter, which is a student-led newsletter dedicated to providing medical students with current surgical knowledge. This opportunity has allowed me to stay up to date with orthopedic knowledge and has also helped me collaborate with other students and residents interested in surgery. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/04/Emma-Barham-1.jpg)Emma Barham grew up in Monroe, Louisiana. She obtained her undergraduate degree in Biology and minor in Public Health from Oglethorpe University in Atlanta, GA. She is currently a second-year medical student at the Edward Via College of Osteopathic Medicine in Louisiana. She is passionate about pursuing a career in orthopedic surgery and is excited to get more involved with AWS. **Categories:** awareness, career development, education, leadership, medical students, parenting, professionalism, reflection, women --- ### [The Imprint of 3D-Printing in Health: A Students Perspective](https://blog.womensurgeons.org/the-imprint-of-3d-printing-in-health-a-students-perspective/) **Published:** March 27, 2024 **Author:** Blog Team **Content:** In a technology driven world, the abundance of information and ease of communication has influenced every aspect of our lives. Not only has it affected the way we interact as humans, but it provided new outlets for skill development and creativity. One of my favorite expressive outlets is 3D-printing. From designing flower vases to replicating anatomical models, my engagement with 3D-printing allowed me to bring theoretical ideas to life by combining the natural sciences, technology, and art. When I first observed my older brother use a 3D-printer, I was fascinated by the geometric lattice in which the machine ejected thermoplastic, as it closely resembled the molecular arrangement of atoms observed in structures like crystal and bone. My curiosity with both technology and human health, led me to learn more about 3D technology and its applications in research, specifically on improving and enhancing human health. Introduced in the 1980s as a tool for rapid prototyping, 3D-printing (or additive manufacturing) utilizes computer aided designs or a digital 3D file to construct a three-dimensional object. The object is built layer-by-layer using a wide array of materials including, but not limited to plastics, metals, or hydrogels. These printed layers are then fused to create a desired three-dimensional object. Decades later, this technology has gained more attention and morphed into a powerhouse tool. Advancing in design freedom, you can now print textiles, houses, and even engineer skin tissue. There is no doubt that this technology is rapidly growing, transforming, and advancing every field that it is engaged in. In medical research, 3D-printing is currently being used to improve and address an array of challenges. For example, the demand for tissue and organ transplants has paved the way for the emergence of 3D-bioengineering. Research experts from various disciplines collaborate to ensure that integral form, function, and biocompatibility are maintained when creating, repairing, and replacing these structures. The first time I 3D-printed a skin graft in the lab, I was astonished by the texture, mobility, and turgor properties that were present, mimicking human skin. To think that cells were encapsulated in the bioink and printed onto a tissue structure, it made me ponder about the future of regenerative medicine and implantation. Would there come a time in which we can take a patient’s own cells and print organs on demand? Can we use 3D-printing to assist in drug delivery? Afterall, nanoscale 3D-printing is a thing–creating structures that are smaller than the width of a human hair. As 3D-Printing is still a novel approach in medicine, there is much needed laboratory research and clinical translation to be done. However, with the current state of this technology, it’ll be interesting to observe its advancements and how it’ll evolve over time. Outside of the research, 3D-technology has been implemented in both surgical preparation and intervention. In dental school, I observed a mandibulectomy with fibula free flap reconstruction. I recall walking into the operating room and a large screen displayed an image of the patient’s fibula, cutting guides were highlighted to fit the custom titanium plates that would eventually replace the patient’s chin. Near the operating table, a 3D-printed mandible was constructed using the patient’s CT scan, displaying the exact size and location of the tumor. During the operation, the surgeon would refer to the 3D mandible and the X-Rays for precise tumor removal. I later learned that virtual surgical planning (VSP) is a common technology used in surgical procedures, with 3D printed models to assist surgeons in the OR. Studies have indicated that the precision offered by 3D-technology not only enhanced surgeon confidence by increasing surgical accuracy, but it also minimized inter-operator variability, protecting the patient from possible risks. To prepare future health professionals, academic institutions have started to incorporate 3D technology into their curriculum. Virtual reality (VR) simulators, adaptive learning environments, and haptic technologies; all offer new ways of learning that can supplement and improve student engagement. In return, students gain more hands-on experience, increase practice hours, and the concepts of structural anatomy are reinforced. As a first year dental student, I’ve utilized intraoral 3D-scanners to create dental impressions, learn cleft lip procedures with high fidelity 3D-printed surgical simulators, and engaged with 3D-imaging to visualize networks in oral and pharyngeal cancers. My personal experiences with 3D-technology have not only contributed to my education but have enhanced my motivation in learning new techniques and embracing challenges, while ultimately being able to improve patient care and their outcomes in the future. Ira Rutkow, a surgeon, medical historian, and author of Empire of the Scalpel: The History of Surgery, highlights in his book that the art of surgery is largely characterized by its tools and manual aspects of the craft. From the invention of the X-RAY to the Da Vinci surgical system, medicine will continually evolve with the growth and implementation of new technology. As it is important to be up to date and use technology to assist us, there is a need to acknowledge and appreciate the traditional and laboring aspects of the surgical craft. Whilst 3D-printing and its technologies can augment one’s experience in medicine, it cannot replace the knowledge, judgment, skill, and oversight that is unique to this profession. In this blog post, I’ve highlighted my personal experiences with 3D-printing, all of which have been positive thus far. However, crucial topics such as ethicality, provider liability, medical errors, barriers to access, and patient privacy will all need to be addressed when incorporating this technology. While 3D-printing has greatly benefited medical research, surgery, and education, we cannot solely rely on this technology to solve problems that we face in medicine, rather use it in conjunction with our current skill sets to improve the profession. Nonetheless, I am eager to learn about the progression of 3D-printing and implement them in my future. Whether it’s customizing care that attends to a patient’s needs or through research. As 3D-printing continues to grow, it’ll foster new opportunities of exploration, generating new ideas and concepts that’ll further define our 3D world. Lotz JM, Hoffmann F, Lotz J, Heldmann S, Trede D, Oetjen J, Becker M, Ernst G, Maas P, Alexandrov T, Guntinas-Lichius O, Thiele H, von Eggeling F. Integration of 3D multimodal imaging data of a head and neck cancer and advanced feature recognition. Biochim Biophys Acta Proteins Proteom. 2017 Jul;1865(7):946-956. doi: 10.1016/j.bbapap.2016.08.018. Epub 2016 Sep 1. PMID: 27594533. Meyer-Szary J, Luis MS, Mikulski S, Patel A, Schulz F, Tretiakow D, Fercho J, Jaguszewska K, Frankiewicz M, Pawłowska E, Targoński R, Szarpak Ł, Dądela K, Sabiniewicz R, Kwiatkowska J. The Role of 3D Printing in Planning Complex Medical Procedures and Training of Medical Professionals-Cross-Sectional Multispecialty Review. Int J Environ Res Public Health. 2022 Mar 11;19(6):3331. doi: 10.3390/ijerph19063331. PMID: 35329016; PMCID: PMC8953417. Tripathi S, Mandal SS, Bauri S, Maiti P. 3D bioprinting and its innovative approach for biomedical applications. MedComm (2020). 2022 Dec 24;4(1):e194. doi: 10.1002/mco2.194. PMID: 36582305; PMCID: PMC9790048. Weng T, Zhang W, Xia Y, Wu P, Yang M, Jin R, Xia S, Wang J, You C, Han C, Wang X. 3D bioprinting for skin tissue engineering: Current status and perspectives. J Tissue Eng. 2021 Jul 13;12:20417314211028574. doi: 10.1177/20417314211028574. PMID: 34345398; PMCID: PMC8283073 ![](https://blog.womensurgeons.org/wp-content/uploads/2024/03/Nivea-Vang-2.jpg) Nivea Vang is a first-year dental student attending the University of Minnesota School of Dentistry. Her personal experiences with head/neck trauma and hyperdontia, inspired her pursuit in Oral and Maxillofacial Surgery. She is an Association of Women Surgeons (AWS) member serving on both the Communications and the Outreach committees, as well as an active Community Health Worker at one of the largest multi-specialty Federally Qualified Health Centers (FQHC) in the state of Minnesota. As an advocate for public health and education, she helped initiate Gotcha Glasses! A community outreach program that provides vision screenings and free eyeglasses to school aged children in medically underserved areas. In 2020, she was awarded a NASA Space Grant which allowed her to partake in space aeronautics research. Her passion for research has allowed her to take roles in various projects ranging from cancer pathology to biotechnology, at facilities like Baylor College of Medicine and The University of Minnesota. During her free time she enjoys archery, playing tennis, and reading. **Categories:** awareness, career development, current events, diversity and inclusion, education, family life, Fellows, health, leadership, medical students, mentorship, practice, professionalism, resources, training, women **Tags:** AWSBlog, residency, womeninmedicine --- ### [Adding it to the List](https://blog.womensurgeons.org/adding-it-to-the-list/) **Published:** March 20, 2024 **Author:** Blog Team **Content:** By Alyssa Brown A few weeks ago, I apologized to my boyfriend for missing date night (again). I apologized that I feel like we are often just saying hi and bye and watching Bob’s Burgers in between. I apologized that even when I am physically present, I am not always emotionally present. I joked that I could add it to the list of things I can’t do right (things I can’t do right or don’t have the time and mental energy to do right). In truth, I barely feel like I can do anything right. As a PGY-2, often it feels like I am moving from crisis to crisis—like alarms in the SICU. Each small alarm or thing gets only a moment. Each upcoming deadline is finished just in time and often not the way I would like it exactly. It always feels more like a rough draft than a polished copy or effort. Residency often feels the same. I could always have prepared better, studied more, tied faster, stitched better, moved faster, or used my left hand more. I just add it to the list. I have had a hard time figuring out how to write this piece, and honestly, the piece is not the one I planned to write. Last year, I volunteered to the committee that I would like to do a piece on egg freezing because I was planning on going through it in the fall. I planned to write a piece about how supportive my program was of the process, and how even as a PGY-2 surgical resident, I managed to squeeze it in. I managed to do my future self a favor. I planned this well in advance. I started looking into it six months into my intern year. I had to have my Nexplanon removed and an IUD placed (because Nexplanon can suppress the egg-freezing cycle). This required extra visits, new doctors, and waiting 3 months for my IUD to regulate my cycle. I went to the appointments, took notes, and scheduled it. I put the payment for the freezing cycle on my credit card. I asked the chief residents ahead of time if it would be okay, and everyone was more than kind about saying okay. I traded call shifts to ensure my egg-freezing wouldn’t hit that day. The medications were shipped to my apartment, which no one tells you takes up a whole shelf in the fridge. I planned it out. Each night, I would mix the two injections and give them to myself in the subcutaneous fat around my stomach. In the mornings, I would sneak off during rounds to go to my ultrasound and lab appointments done at 6:30 am, and I would be back by 7:15 to pre-op patients. I would hear from the clinic via message in the afternoon about what doses of medications to continue on. It felt like hoops to jump through. I hoped that if I did all the right steps I would get the result I wanted. I was aiming for 12 eggs. The other women in my program talked about how they had done it and gotten 28, 27, 20, and 18 eggs. Some talked about how they expected to get less, but it just worked out. By my third appointment, I started to worry. The ultrasound tech at the end of the first week mentioned that I didn’t have many eggs compared to other patients. I felt a pit in my stomach for the rest of the day. I emailed the reproductive endocrinologist and infertility (REI) doctor to ask if my levels were progressing normally. I sure didn’t learn what my estradiol levels and ovaries were supposed to look like during this process in medical school. I felt blind. I didn’t even know what normal levels or imaging were supposed to be. I tried not to stress. I kept doing my two shots at night and then progressed to two at night and one during the day. I kept my hope close. At about 10 days, I got the call that it was my time to give the “trigger shot,” which matures the eggs. I took the call with the instructions standing in the hallway outside the ED before going to see a consult. I was supposed to give it at 11:30 pm. I had to set an alarm because 11:30 pm was well past my bedtime. I knew with the trigger that 36 hours later, I would have my retrieval, on a Saturday morning. Before the procedure, they told me to expect 12 eggs. I was a little surprised because I was hoping for more, but my co-resident reassured me that they told her 9 and she had 28. I kept my hope close that maybe I would get more than expected. I’ve seen versed given hundreds of times, but it was so funny to actually have it. When I was in the procedure room, I looked at the anesthesiologist and asked, did you just push the versed, then fell asleep. When I woke up, I was back in my pre-op room. The nurse gave me some Lorna Doone cookies and a Diet Coke. I figured I would see the REI on the way out, but I didn’t. They give you the number of eggs retrieved post-procedure, and after 24 hours, they will tell you how many were mature. As I got ready to leave, I asked the nurse, how many were retrieved. She shuffled some papers and told me 6. It was all I could do not to break down there. I looked up the calculations. Six eggs gave me a 30% chance at one live birth. I was expecting 12, which would have given me a 60% chance of one live birth. I had been disappointed enough by the possibility of 12, but I was floored that six were retrieved. I went home, tucked myself in under the blankets, and cried for a long time. I went to our Holiday Party that night. I put on a happy face and went to spend time with my co-residents. I kept the hope alive that maybe all six were mature. Six wasn’t great, but hopefully, they were all mature. I tried to push away worse thoughts for the night. I woke up to a notification from the REI office. I didn’t want to check, but I had to. 3 mature. 3 immature. 20%. I had a 20% chance of one live birth from these three eggs. Three eggs that would have to survive thawing, survive fertilization, implantation, and growth, not to mention hopefully having the correct number and arrangements of chromosomes. I was heartbroken again. It was a Sunday, so obviously, their office was closed andthe physicians were not available. I looked at the records and operative report. I tried to see what went wrong. Was I in the wrong position, maybe one of my ovaries was unreachable, maybe it was because I am obese, maybe there was an equipment malfunction. The operative report was bland, and it did not illuminate things further. The realization settled over me that after six months of planning, two weeks of shots, two weeks of appointments, and $4k debt accrued, I had failed. My body had failed me. It was another thing on the list of things I can’t do well. I talked to the REI later, and she recommended we try again. We try again without an IUD. We change the medications slightly, and we try to adjust. I appreciated her optimism and willingness to change what we were doing, but I told her this was all I could afford. I could afford one more try. (by afford I mean put it on my credit card) In a job that is often built on continually being hard on yourself and trying to improve each time, it is frustrating that my body and physiology failed me. It feels lonely when others in my program have had success. They have only had to do one cycle to reach their goal number of eggs. It feels unlucky and unfair, and it makes me ask why me? Don’t I already have enough on my plate? Why can’t something, anything go easily? The only reason I am doing it in the first place is that surgery residency isn’t the ideal time to have a child. I was being proactive in doing this, but now I feel like I could be too late. I jumped through the hoops, took notes, planned ahead, and wanted it to turn out okay. I want the chance to eventually be a parent. Data has shown egg-retrieval numbers and hormonal response are not indicative of overall fertility and chances of getting pregnant without the assistance of IVF, but it does still tickle at the back of my mind that maybe my body will fail me in that regard too. I wish I was writing this to say that it was a great experience, it was a hard two weeks, and I got all the eggs I need frozen away now. I was planning on writing that piece. It is hard to hold onto the hope that it will go better next time. It is hard to put belief there and still know it might break your heart. That’s the story of life and residency though, we keep putting one foot in front of the other, hoping that each day will be a little better. Maybe one day, my list of things I can’t do right will get shorter, but for now, the list will only continue to fill. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/03/Brown.Alyssa-2-284x300.png)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a Ph.D., before finishing her MD. In 2022, she graduated with an MD from the University of Louisville School of Medicine, and her Ph.D. in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is now a PGY-2 general surgery resident at Northwestern University in Chicago. She has been a part of the AWS Blog Subcommittee since 2018. You will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” embroidering, or off on a new adventure. You can find her on Instagram @Alyssa\_b\_futuremdphd and on Twitter @Alyssa\_B\_MDPhD. **Categories:** advocacy, awareness, current events, family life, health, parenting, reflection, residency, women --- ### [Basics of AI in Healthcare & Surgery](https://blog.womensurgeons.org/basics-of-ai-in-healthcare-surgery/) **Published:** March 14, 2024 **Author:** Blog Team **Content:** By: Brielle Ochoa On PubMed, the[ number of publications](https://pubmed.ncbi.nlm.nih.gov/?term=%22artificial+intelligence%22+surgery&filter=years.2014-2024&timeline=expanded&sort=pubdate&size=200) for “artificial intelligence” (AI) and “surgery” ten years ago was less than 100. In 2023, this number was up to nearly 3,500. But what basics should you know about AI in general in healthcare and surgery? 1. AI is an umbrella term for a wide range of technologies, which share the goal of mimicking human intelligence and cognitive function and processing. AI includes large language models, robots, machine learning, deep learning, neural networks, and artificial general intelligence; while beyond the scope of this post, these terms are interrelated but distinct from one another. 2. AI can be used in a variety of general healthcare and surgical applications, including algorithms for clinical decision making, as part of technology in medical devices, for pattern recognition in images and videos, and for preparation of written documents, such as research manuscripts and patient educational information. 3. AI must be trained on a dataset. Key phases of AI model creation are that it must be *developed* based on a nonbiased, heterogeneous, and relevant data set for a focused clinical problem and then must be *validated* on a separate data set. The model should then be evaluated, adjusted, and/or re-created as needed prior to clinical use. 4. AI is only as effective, safe, and relevant as it is to the dataset it was developed from. AI trained on data that is biased, false, or irrelevant for a task will yield inaccurate and potentially harmful outputs. This may sometimes lead to errors known as[ AI hallucinations](https://cloud.google.com/discover/what-are-ai-hallucinations). 5. Not all aspects of AI are currently regulated by the U.S. Food and Drug Administration (FDA). AI related to medical devices falls under FDA authorization, and[ currently approved devices utilize machine learning](https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-aiml-enabled-medical-devices), but none use generative AI or artificial general intelligence (as of October 2023). For clinical decision support tools,[ recent](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2810619)[ publications](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2810620) have emphasized the lack of transparency, standards, and evaluation of bias for these tools, which undermines their clinical utility. The output of AI should be critically questioned in a similar manner to research findings and use of devices. A few recent issues regarding AI illustrate the importance of the above points: 1. A risk-prediction algorithm used for patient care inappropriately[ underestimated risk](https://www.science.org/doi/10.1126/science.aax2342) for Black patients compared to White patients because the algorithm was developed based on health care costs instead of another measure of illness severity and health care needs. 2. Several reporting guidelines have been proposed to evaluate AI development, analyses, and associated processes. A[ recent JAMA publication](https://jamanetwork.com/journals/jama/fullarticle/2816213) focuses on AI-related reporting guidelines, including for manuscript preparation and for AI used in research. 3. A[ basic science publication](https://www.frontiersin.org/articles/10.3389/fcell.2024.1386861/full) included figures and labels that were AI-generated and nonsensical, likely due to poor training for the image generator driven by AI, and was retracted. This issue was not identified during the peer review or publication process. The use of AI poses additional questions regarding its use in research and patient care: Should patients be informed of clinical decisions driven by AI, and if so, to what extent?[ Who is liable](https://jamanetwork.com/journals/jama/fullarticle/2752750) when AI is wrong or fails to identify a problem?[ How should surgeons be approaching AI and robotics?](https://journalofethics.ama-assn.org/article/how-should-surgeons-consider-emerging-innovations-artificial-intelligence-and-robotics/2023-08) As AI technologies continue to develop, surgeons, as well as other healthcare providers, should be aware of how AI is being used in clinical care and research. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/03/Brielle-Ochoa-professional-photo-1-819x1024.jpeg)Brielle Ochoa attended the University of Delaware and the University of Virginia School of Medicine. She is a general surgery resident at the Medical University of South Carolina in Charleston, SC and a current pediatric surgery research fellow at Phoenix Children’s in Phoenix, AZ. Her interests are in research and clinical ethics. **Categories:** advocacy, awareness, diversity and inclusion, education, Fellows, health, hispanic heritage, leadership, medical students, mentorship, professionalism, women --- ### [Navigating Science Policy as a Medical Doctor: Strategies for Engaging Beyond the Clinic](https://blog.womensurgeons.org/navigating-science-policy-as-a-medical-doctor-strategies-for-engaging-beyond-the-clinic/) **Published:** February 28, 2024 **Author:** Blog Team **Content:** By Sewar Banimusa, MS3 In the realm of healthcare, the influence of medical doctors transcends the boundaries of clinical settings. Beyond diagnosing ailments and administering treatments, there lies a realm where medical professionals wield the power to shape policies that profoundly impact the health and well-being of entire populations. Engaging in science policy empowers medical doctors to harness their expertise and advocate for evidence-based solutions to pressing health challenges. Science policy encompasses the intersection of science, technology, and society – guiding decisions that affect research funding, healthcare delivery, public health initiatives, and regulatory frameworks. For physicians, involvement in science policy represents an opportunity to contribute to the greater good and drive positive change beyond individual patient interactions. Navigating the landscape of science policy can seem daunting at first, but there are numerous opportunities to start navigating your passion. Here are some ways to start your science policy career: Joining professional organizations dedicated to health policy and advocacy provides a platform for networking, learning, and collective action. Attending science policy related events and seeking mentorship from seasoned advocates can provide invaluable guidance and support. These organizations bring together enthusiasts, students, researchers, and early career professionals as well as senior experts in one setting to openly ask questions, learn, and share resources. Engaging with scientists from different fields and learning more about how they tackle problems in healthcare, climate change, ocean policy, and science diplomacy can link different fields together to start thinking of solutions and reporting research in these fields through science communication. This can be done by writing a blog post or an Op-Ed, starting a campaign, or handling your own project as a scientist! Some of these organizations are: - [*The National Science Policy Network (NSPN)*](https://www.scipolnetwork.org/) is an association of civically engaged individuals and local chapters committed to strengthening the role of science in society. It provides education and training in Science Policy, Communication, Advocacy, Diplomacy, Equity, and Inclusion. - [*AAAS*](https://www.aaas.org) is an inclusive, mobilized, and global scientific community that ignites, enables, and celebrates scientific excellence and science-informed decisions and actions. - [*National Academy of Medicine (NAM)*](https://nam.edu) is one of three academies that make up the [National Academies](https://www.nationalacademies.org). It works to advance science, inform policy, and catalyze action to achieve human health, equity, and well-being. **Policy for Science**: To effectively engage in science policy, medical doctors must build relationships with policymakers across all government levels. By establishing themselves as credible experts, doctors can shape policy decisions affecting healthcare systems, public health, and research priorities. Clear communication of key messages, along with emphasizing the real world impacts of policy choices, can drive significant change. **Research for Policy**: Medical scientists leverage research skills to inform evidence-based policy decisions, translating complex findings into actionable recommendations. Through conducting studies, analyzing data, and synthesizing research, physicians offer a unique perspective that shapes policy debates and legislative agendas, bridging the gap between research and practice. **Engaging in Advocacy and Outreach**: Whether writing op-eds, participating in advocacy campaigns, or meeting with elected officials, scientists in the medical field can lend their voices to advocacy efforts aimed at promoting health equity, expanding access to care, and addressing emerging health threats. **Staying Informed and Educated**: In a rapidly evolving landscape, staying informed is essential for effective science policy engagement. Medical doctors should actively seek out opportunities to stay abreast of current policy issues, trends, and developments. Subscribing to policy newsletters, following reputable organizations on social media, and attending policy-focused conferences and workshops can provide valuable insights and networking opportunities. One example is Commissions from The Lancet that collaborates with academic partners to pinpoint critical issues in science, medicine, and global health, aiming to offer recommendations that reshape health policies and enhance practices. As medical professionals, our unique blend of expertise, compassion, and dedication drives us to improve health outcomes for all. By broadening our engagement in science policy, we amplify our impact, advocating for policies that serve the common good and shape a healthier future. Despite the stress of medical school, I eagerly anticipate using my professional judgment to aid others, navigating a path filled with both anticipation and pressure. Throughout this journey, I remain committed to exploring new interests, cultivating passions, and expanding my scientific knowledge. I actively seek opportunities to collaborate with peers, whether to take breaks from studies, participate in community projects, or connect with like-minded individuals. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/02/Sewar-Banimusa-188x300.jpeg)**Sewar Banimusa** is an M.D. candidate at Yarmouk University, Jordan, with a keen interest in neurosurgery. Eager to specialize in this field, she aims to contribute significantly to patient care through her understanding of the intricate workings of the nervous system. Alongside her academic pursuits, Sewar is deeply involved in pioneering innovations in regenerative scientific research, synthetic biology, and robotics applications within medicine. Currently, she serves as the Professional Development Coordinator at the Science Diplomacy Committee at NSPN, where she advocates for open science and diplomacy to ensure accessibility and inclusivity in the field. Passionate about promoting youth engagement in healthcare innovation and policy, especially in low-resource settings, she actively contributes to student associations. Beyond her professional endeavors, Sewar finds joy in exploring nature, flâneuring, and sharing the delight of baking with friends. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, family life, Fellows, gender differences, health, leadership, medical students, mentorship, negotiating, networking, professionalism, reflection, research, residency, resources, women --- ### [Tackling Imposter Syndrome by Embracing Failure](https://blog.womensurgeons.org/tackling-imposter-syndrome-by-embracing-failure/) **Published:** February 21, 2024 **Author:** Blog Team **Content:** By: Rachel Akers Failure is something I’ve become intimately acquainted with throughout my career. I’m not alone in this. We can all recall instances in our professional lives where things haven’t gone our way, and we’ve failed to reach the expectations set by our educators, mentors, colleagues, families, or ourselves. Failure can be painful, embarrassing, and even harmful for those in the medical profession, and it’s not easy to talk about with others. As students transition to residents and eventually become attending physicians, our understanding of failure changes in tandem with our values. New responsibilities like parenthood, caring for your own aging parents, repaying gargantuan loans, and being directly in charge of patients’ well-being supersede the worries of passing exams or confidently blurting out a wrong answer. Regardless of the nature of a mistake or the level of training you’re at, failures shouldn’t be seen as something shameful to hide from others. By choosing to view past failures as catalysts for growth and opting to share our failures with others to prevent them from making the same mistakes, we start to tear down one of medicine’s biggest challenges: imposter syndrome. Many studies (see works cited) have described imposter syndrome (the persistent belief that one’s achievements are fraudulent, and someone will eventually find this out) and its prevalence in medicine. Of note, female physicians and female physicians of color are more likely to report feelings of imposter syndrome. Imposter syndrome erodes confidence and establishes toxic institutional culture that is often impossible to fully repair. To lessen the burden imposter syndrome puts on our physicians, we need to address it from the root. Medical school unfortunately creates an environment of neurotic students striving for perfection. Students fear sharing failure with their classmates and instead choose to broadcast their success. I understand – it’s much easier to share that you recently published or aced an exam instead of sharing that your physical exam skills aren’t where they need to be, or that you’re having trouble expressing empathy to patients. When we only hear our classmate’s successes and never their failures, students doubt themselves more and more. An unrealistic expectation is painted and becomes fact in the mind of the student, and no matter how hard they strive towards this expectation, it will never become their reality. The goal post will shift, the mirage will dissipate and reappear miles away, and the student will convince themselves further that their success is due to luck, or a mistake made by the admissions committee, and that their failures can only be attributed to themselves. One of the solutions to this problem is reflection and openly sharing stories of failure with your peers. This normalizes imperfection, emphasizes that everyone has their own unique paths, and helps others understand that failure is not catastrophic. For those severely affected by imposter syndrome, chronicling instances of positivity and accomplishments beyond what goes on the CV can be helpful. For me, this is a folder in my email inbox titled “nice things people say about me”. If I start feeling that I don’t belong, looking over the emails praising my work helps me navigate difficult feelings. It’s hard to give up some of our control and let others perceive us as someone who both succeeds and fails. I hope that sharing a more complete version of my experiences in medicine, with triumphs and failures, can help others feel that they belong, reduce the burden of imposter syndrome, and inspire others to share more complete versions of their stories. For me, it’s sharing that I had to retake some pre-med classes – physics and inorganic chemistry, to be specific. Sharing this has gotten significantly easier with time, but at one point, it was a source of major anxiety and imposter syndrome. When discussing research as a medical student with my peers, I make sure to convey that for every abstract, poster presentation, and publication listed on my CV, there are at least two or three unsuccessful projects. It’s similar to test-taking; for every one question that I get right during an exam, there’s a bunch of practice questions that I got wrong. This mindset of embracing failure also extends to my peers. I’ve had classmates tell me that they’ve failed a block, or need remedial education on clinical skills. I feel honored that they feel comfortable enough to share this with me and I do my best to maintain a non-judgmental space where they feel seen. Imposter syndrome can be overcome by sharing your own failure or actively listening to others, which helps our community understand that perfection is an unattainable goal. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/02/RMC-Headshot-1.png)**Rachel Akers** is a student at Rush Medical College, Class of 2026, and a proud member of the Association of Women Surgeons. **Works Cited:** Iwai, Yoshiko MS; Yu, Alice Yunzi L MD; Thomas, Samantha M MS; Fayanju, Oluseyi A MD; Sudan, Ranjan MD, FACS; Bynum, Debra L MD, MMEL; Fayanju, Oluwadamilola M MD, MA, MPHS, FACS. Leadership and Impostor Syndrome in Surgery. Journal of the American College of Surgeons 237(4):p 585-595, October 2023. \| DOI: 10.1097/XCS.0000000000000788 Gold KJ, Kuznia AL, Laurie AR, Williams CB. Gender Differences in Stress and Burnout: Department Survey of Academic Family Physicians. *J Gen Intern Med*. 2021;36(6):1811-1813. doi:10.1007/s11606-020-06287-y **Categories:** advocacy, awareness, career development, diversity and inclusion, education, Fellows, leadership, medical students, mentorship, networking, professionalism, reflection, women --- ### [Mindfulness as a Tool to Build Confidence](https://blog.womensurgeons.org/mindfulness-as-a-tool-to-build-confidence/) **Published:** February 7, 2024 **Author:** Blog Team **Content:** By: MaryAnn Ulasi I spotted a number 5 on the concrete street. By number 5, I mean the stage of a particular “bug” that was made famous by the swarm that landed in NYC last year. Its growth curve is visualized in order of the clockwise circuitous pathway of a quarter; it reminded everyone what they were looking at. As I continued to gaze at the nymph stage of the dead lanternfly with its mangled red body, crushed under spotted black and white wings, I was sucked into a moment of time that I rarely experienced – the present. It was gross and painful, and the exposure was a little too much for real life. After all, for most of us, real life is not the present but rather the past or the future and the irony is hardly ever obvious to us. I certainly have been guilty of living in the future rather than the present. After all, the mere *idea* of being a surgeon is far more enticing than the reality of sitting in a room studying as a stressed medical student. Why would one want to exist in the difficult space that is the present? Yet, it is the practice of being mindful in the present moment that yields the very result that we constantly strive for when we run to the future – joy. How can we cultivate this? How can we experience the joy we desire in the present moment? More importantly, how do we tap into the present moment when it seems bleak? 1. **Recognize that mindfulness is more than a practice. It is a habit.** Like all good habits, developing them takes time and discipline. Discipline implies that you do it regardless of motivational drive. If you studied every time you felt like it, how often would you study? The same rules apply here. You don’t practice mindfulness when you feel like it, you do it all the time. 2. **Don’t wait until the right moment.** It’s easy to be mindful when you are in a comfortable scenic environment. But what about in moments of pain? Hectic schedules? When you do not have the time? An act as simple as pausing to taste your coffee in the morning can go a long way to cultivating acceptance in the present. Use even the smallest of activities as an opportunity to practice this. 3. **Understand the concept of time. –** How long is a minute? How long is it when you are running to catch a train that arrives in a minute? How about when you are thinking of the answer to a question your Attending asked you? It seems like the minute is much longer in one scenario compared to another. However, it is the same 60 seconds. Making yourself aware of these time shifts in moments of present restlessness can assist greatly in times of stress when you would rather be anywhere else but the present. 4. **One bad apple spoils the bunch. –** How many times have you had a day where everything went right until it went wrong? You woke up and everything was going swimmingly until one minor distasteful event at 2 PM had you wishing you took the whole day off. Instead of considering all the positives, your brain focused on the one negative thing. The desire to practice mindfulness works the same way. If you focus on the failures from the past year, it can be very easy to write off the whole year. But what about all the positive achievements and challenges that you overcame? Practice cultivating a positive mindset by focusing on what you did accomplish rather than what went wrong. Over time this builds confidence because you are training your brain to shift focus away from what seems detrimental. It becomes easier to live in the moment because your focus will be on the positive events, achievements, and attributes that you created. If we make the effort, we can shift our pattern of thinking and our ability to live fully and deeply in the present moment. How would it be beneficial to us as aspiring physicians? Consider this: the goals that you strive for are in the moment. The reality of your patient’s diseases are in the moment. You would never ask a patient to focus on how life was before the disease. You walk and take the journey with them *now*. Every pound lost is a victory. Every cigarette they chose to avoid is a victory. These actions seem so small and insignificant in the grand scheme of things and yet they make all the difference to positive outcomes. It is much easier to dream of a future that may or may not make your life appear “better.” However, the struggle, frustrations, fears and tears you feel now are a part of the journey that you currently reside in. It is the reality of now. This is what builds confidence. **MaryAnn Ulasi** is a student of Ross University School of Medicine and a member of the Association of Women Surgeons. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, health, leadership, practice, professionalism, reflection, training, women --- ### [Impact of Narrative Medicine in Surgery](https://blog.womensurgeons.org/impact-of-narrative-medicine-in-surgery/) **Published:** January 31, 2024 **Author:** Blog Team **Content:** **By: Raslina Shrestha, MD** “*We can make the world a better place, one story at a time.*”- Lisa Gerber A revelation unfolded during my shifts in the burn ward in Nepal. As the patients grappled with excruciating pain, disfigurement, and an arduous path to recovery, I observed an extraordinary phenomenon*: patients from diverse backgrounds, occupying different beds, formed unexpected bonds of friendship and support*. They shared their personal stories, extended solace to one another, and, most significantly, provided invaluable insights into coping and healing. It became abundantly clear that shared experiences and a sense of community had a remarkable impact on the recovery process. To bolster the confidence of these patients, they needed to be reminded that they were not alone. Motivated by this insight, I stumbled upon the realm of “*Narrative Medicine*”, the intersection of the humanities, art and health care. This emerging discipline equips clinicians to better comprehend their patients’ experiences and perspectives to deliver effective health care.The concept seamlessly aligned with my objective of delving into patients’ narratives to provide more tailored and empathetic care and hence the vision was created for the story booklet to foster a sense of community amongst the patients, to elaborate on the personal experience of those who have survived major burns, and to educate current patients on the reality of their recovery. As a physician, I had always believed that our primary responsibility was only to educate patients about pain management, physical therapy, and post-operative care. While these elements are crucial for enhancing patients’ physical well-being, our traditional education can never fully encompass the lived experiences that only someone who had triumphed over the injury could truly grasp. Out of the ten individuals we interviewed, eight emphasized *their yearning to be understood.* They shared how even simple acts of kindness, such as doctors engaging in meaningful conversations, had a profound impact on their hospital journey. When presenting these findings to the department of surgery, there was unanimous consensus amongst the surgeons that there were time constraints which resulted in shorter patient rounds and less patient interaction, and the recognition that small acts of kindness could make a world of difference became apparent. The department director took this commitment further by appointing one of the survivors I had interviewed as a “patient counselor”. This remarkable individual had overcome a horrifying acid attack by her spouse, which had left her with facial disfigurement. Yet, she radiated resilience and kindness, brightening the lives of everyone she encountered in the ward. Witnessing this transformation from a small project to a profound impact underscored the incredible potential of our efforts. Though we may never fully grasp the depths of what our patients endure, our modest endeavors can yield tremendous results in their lives. Through the stories of burn survivors, I gained a profound understanding of effective communication, empathy, compassion, and a newfound appreciation for the patient experience, extending far beyond the walls of the operating room. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/01/Raslina-Shrestha-214x300.jpg) Raslina Shrestha is a physician at Department of Burns, Plastic and Reconstructive Surgery in Nepal Cleft and Burn Center in Nepal. She is also a NIH/Fogarty Global Health Fellow, nominated from University of Washington with her projects focused on improving access to burn care in LMICs. Her areas of interests are Burns, Trauma Surgery and Global Health. She loves cooking traditional Nepali dishes, exploring new cafes and soccer. To checkout more stories about the burn survivors: <https://nepalburnsurvivorstories.com/> Twitter: <https://twitter.com/raslinashrestha> **Categories:** advocacy, awareness, career development, diversity and inclusion, education, family life, gender differences, global surgery, health, leadership, medical students, mentorship, networking, practice, professionalism, research, Underrepresented in medicine, women --- ### [Brushstrokes and Incisions: Exploring the Artistic Aspect of Surgery and Drawing in Human Exploration](https://blog.womensurgeons.org/brushstrokes-and-incisions-exploring-the-artistic-aspect-of-surgery-and-drawing-in-human-exploration/) **Published:** January 24, 2024 **Author:** Blog Team **Content:** By Alessandra Yasumi Rodríguez Cárdenas In exploring the profound relationship between art and surgery, it becomes evident that their interconnected narratives extend far beyond the realms of canvas and operating theaters. To comprehend the significance of art, surgery, and their relationship, it is imperative to delve into their origins. First, most writers describe that the birth of art started in Europe with cave art, but most do not attribute these origins to one art genius. It is noteworthy that the development of art and drawings is often viewed as a result of cultural evolution and the dynamic interaction between artists and viewers. Indeed, Gombrich proposed that “art and drawings develop through artistic expression shaped by the continuous dialogue of various cultures”. On the other hand, the roots of surgery can be traced back to pioneering anatomists like Galen \[129 – 210 AD\], who dominated the first era of surgery in Rome and focused on anatomical structures rather than dissection techniques. Furthermore, Joseph Lister is credited as “the father of modern surgery” for his remarkable accomplishments, such as the preservation of limbs in case of compound fractures, using Pasteur’s fermentation theory to combat infections and gangrene, and opened the opportunity for the development of abdominal surgery. Subsequently, I introduce an interesting example of the intricate interplay between a society’s artistic expressions and the evolution of surgical practices. Illustrated by an innovation in Perú, the striking procedure of “pre-hispanic” medicine was trepanation. Within the Paracas culture, this practice, now recognized as craniotomy, demonstrated a significant intersection between art and surgery, with a high survival rate for that age, serving as a representation of art for this culture. In addition, drawing as a distinctive branch of art shares a profound relation with surgery across multiple facets that we will explain in the following paragraphs. Consequently, sketching a human body elicits a magnificent feeling of satisfaction because, with each meticulous brushstroke that contributes to the completion of a picture, there emerges an artistic journey toward achieving perfection by an understanding of optimal proportions to render a lifelike representation, captivating viewers and evoking a connection to the artwork. Nevertheless, according to Richard Selzer, a parallel exists with surgery, where surgeons use a scalpel, the incisions delve deeper into the human body, akin to creating a visual composition of the internal body, as if it were a brushstroke, creating a picture of the inside and affording viewers the opportunity to peer beneath each successive layer. In other words, an artist aligned with the realism movement conceives and constructs the human form, while a surgeon, armed with comparable knowledge of human proportions, undertakes a meticulous dissection through each layer. Notably, both endeavors evoke a sense of gratitude in their respective audiences. For instance, Leonardo Da Vinci was a supreme example of an artist who applied his skills in the study of human anatomy because he could create perfect proportions of the human body by understanding the layers under the skin. Numerous surgeons with a foundation in the arts affirm that the skills honed through drawing and painting enhance their precision, enabling them to discern intricate variations within the human body with meticulous detail. Besides, when surgeons refer to viewers, those observers are patients. Consequently, surgeons leverage their drawing skills to elucidate surgical procedures to individuals lacking expertise in human anatomy, fostering a sense of inclusion and understanding. That mentioned above is an advantage for most surgeons who want to enhance an empathetic connection with their patients; at the same time, it is a benefit for patients who comprehend better about the surgery. To sum up, the intertwining of art within various cultures and the field of surgery has been a longstanding association, involving notable historical figures in their development. Furthermore, the shared mission of comprehending the intricacies of the human body is the pursuit of both artists and surgeons throughout history. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/01/Alessandra-200x300.jpg) Alessandra Yasumi Rodriguez Cardenas is a seventh-year medical student at the Cayetano Heredia´s University in Lima, Perú, an actual member of the Association of Women Surgeons, who will apply to General Surgery, with an interest in surgical oncology. Currently, she is involved in investigations related to robotic surgery and surgical oncology. She loves playing basketball and painting. **Categories:** advocacy, awareness, diversity and inclusion, education, global surgery, health, medical students, reflection, Underrepresented in medicine, women --- ### [Optimizing Your 3rd and 4th Years of Medical School: Resources for Networking, Mentorships, and Continuing Research](https://blog.womensurgeons.org/optimizing-your-3rd-and-4th-years-of-medical-school-resources-for-networking-mentorships-and-continuing-research/) **Published:** January 18, 2024 **Author:** Blog Team **Content:** By Kayla Martinez, MS4 Approaching the final years of medical school is a paradox of fulfillment and stress. While students eagerly anticipate the conclusion of their academic journey, the looming task of applying for residency introduces a new layer of reality and pressure. Third and fourth years of medical school are opportunities to further your career by networking, finding mentors, and continuing research. Drawing from my experience as a current general surgery applicant, I have curated valuable resources that I believe can greatly assist prospective applicants navigating the uncertainties of what steps to take next. **Networking:** Networking provides access to various opportunities, such as research collaborations, clinical experiences, and mentorship. Building a network allows medical students to connect with professionals who can offer valuable insights and guidance. Attempt to make strong connections with residents and attendings in your specialty of choice. For example, if you connect or bond with a particular surgeon or general surgery resident, attempt to get as much exposure to them as possible – scrub their cases, take your opportunity to shine as much as possible, and leave a lasting positive impression. These fostered connections can lead to invitation to collaborate on research projects, community outreach initiatives, letters of recommendation, or other endeavors that can significantly contribute to your professional growth. Networking can lead to mentorships, establishing meaningful ties beyond the operating room. **Mentorship:** Establishing connections with experienced professionals provides medical students with mentorship opportunities. Mentors can offer advice, share their experiences, and provide valuable guidance for navigating the challenges of medical education and training. Several national clubs and organizations offer mentorship programs for medical students; look for national organizations that align with your specialty interests. For example, the Association of Women Surgeons (AWS) has a national journal club opportunity for medical students to virtually present interesting articles related to surgery. Such organizations often have mentor-mentee opportunities for medical students to be paired with residents. Lastly, these organizations usually have annual meetings, where medical students can present their research via poster or oral presentation. Medical students can be members of several organizations, including the American College of Physicians, American College of Surgeons, Association of Women Surgeons, Latino Surgical Society… the list goes on. Membership fees for medical students are very affordable, usually ranging from $0-50 USD. To remain actively engaged with these organizations, consider subscribing to their weekly newsletters and connecting with them on social media platforms. This way, you can stay well-informed about their latest developments at both the national and regional levels—especially if events are occurring near you or in the state you wish to go to residency in! **Continuing Research:** Acquiring research as a medical student involves exploring diverse channels. Despite the initial apprehension and uncertainty about where to start, multiple avenues exist to successfully pursue publication/research opportunities. If you are rotating at a large academic institution, touch base with a designated research department or International Review Board (IRB) advisor to see if current or future projects are seeking student involvement. If you are at a smaller community-based institution, finding research might require more skill. Here are some simpler ways to find research: *Stay Engaged*: Be present during your clinical rotations. Typically, residents are doing their own research, looking for help from medical students related to writing, editing, data collection, or basic statistics. If a resident or attending states a particular patient case is “interesting,” as a medical student, my next question would be “could I write a case report on this patient?” Usually, residents or attendings will encourage you to research the rarity or complexity of the case and will advocate for you to be a part of the case report. Additionally, for rotations that are heavily based on imaging such as radiology/interventional radiology, orthopedic surgery, pathology, or interventional cardiology, to name a few – interesting images can also be published as clinical images in certain online medical journals. Keep your eyes open for these opportunities. *The Cureus Journal of Medical Science, Part of Springer Nature Group*: Cureus is an open access medical journal for healthcare professionals. This online medical journal aims to generate and disseminate medical knowledge by providing fast publication rates and opportunities for waived publication fees. Upon completing a submission, ensure that you are the corresponding author, as other journals will contact you with future submission opportunities. Upon publication, your work will be indexed in PubMed. *StatPearls, Medical Student Contributors*: Medical students have the opportunity to write review articles and create practice questions related to basic medical sciences. Authors can receive academic credit for their work, which will be published in eBooks, Apps, and into an online learning CME/CE system. All articles are published and indexed in PubMed. This publication is completely free. *In-Training, The Agora of the Medical Student Community*: An online peer-reviewed publication for the medical student community, cultivating a collaborative center for discourse. In-Training allows medical students to submit reflection pieces, essays, poems, and art related to medicine. This publication is completely free. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/01/Kayla-Martinez.jpg) Kayla Martinez is a fourth year medical student at Ross University School of Medicine. She has applied for general surgery residency this current application cycle. Her surgical interests include surgical critical care/acute care surgery. Her passion for surgery comes from the intricate team based approach to care found within the operating room. As a student mentor, tutor, and orientation leader, she has consistently advocated for the success and well-being of fellow medical students. For the past 2 years she has been living in Detroit, Michigan. Born and raised in Buffalo, NY, Kayla enjoys watching and attending Buffalo Bills football games. Beyond her medical endeavors, she finds joy in indoor cycling, Orangetheory fitness, thrifting, and cultivating her gardening skills. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, medical students, mentorship, networking, practice, professionalism, reflection, residency, resources, training, women --- ### [Beating Burnout: Tips](https://blog.womensurgeons.org/beating-burnout-tips/) **Published:** January 15, 2024 **Author:** Blog Team **Content:** **By Dra. Elizabeth Perazza Valentin, FACS** Simplicity is the ultimate sophistication- Leonardo Da Vinci Greetings esteemed colleagues: Surgeons have long experienced a culture of silence when it comes to their personal pain. We have a reputation as stoic, determined, and driven. What can we do to prevent burnout and more importantly if we have suffered it what do we do to recover? How do we heal? In a field where we dedicate ourselves to caring for others, it’s easy to overlook our own needs. Over the next few moments, I invite you to explore a series of transformative tips designed not only to manage burnout but to invigorate our commitment to exceptional patient care and personal fulfillment. Let’s embark on this journey together, discovering how we can cultivate resilience, restore balance and ultimately enhance the quality of both our professional lives. Welcome to our discussion that I believe will resonate deeply with each one of us. Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, Maslach 20013.It’s not just a personal challenge but a systemic concern. Its relevance extends beyond individual lives, affecting patient care, healthcare systems, and overall quality. To understand burnout, we need to review the definition as established by psychologist Dr. Maslach in 2001.3 Burnout is characterized by 3 dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. 1.Exhaustion: this dimension involves feelings of extreme fatigue, both physically and emotionally. Individuals experiencing burnout may find themselves drained, lacking the energy to meet the demands of their work and daily life. 2.Depersonalization is marked by a sense of detachment and cynicism towards others, particularly towards those whom individuals are meant to serve, such as patients or clients. As example is when we name an “elevated PSA” instead of referring to “Mr. Rivera” who will be evaluated for an elevated PSA. 3.Reduced personal accomplishment in this dimension, individuals experiencing burnout perceive a decline in their sense of competence and achievement. They may struggle to see the positive impact of their work and feel a diminished sense of accomplishment. These alarming numbers were published in the magazine Galenus for the month of August.4 In Puerto Rico, 48% percent of active doctors are exhausted. We must remember the impact of Hurricane María in 2017, followed by earthquakes in the south of the island and three years of pandemic since 2020. Of this 48% of our colleagues reporting exhaustion : 1. 26% have clinical depression 2. 37% present clinical anxiety 3. 9.4% have considered suicide When asked about the primary workplace dissatisfier, 29% of urologists chose EHR- the extensive documentation required for each evaluation and management encounter, followed by 17% stating not having enough time for personal/family life, 14% experiencing decreasing reimbursements, and 12% identifying issues with office staffing and complicated requirements. In my experience, I would add receiving nonconstructive feedback from an anonymous source. In other words, workplace gossip could be a contributor to burnout. The American Urological Association workforce work group has analyzed the annual AUA census data over the past several years. Published1 results in March of this year shows that: Burnout in men decreased from 36.3% to 35.2%, but increased in women from 35.3% to 49.2%. Overall, urologists have higher burnout now when compared to 2016. The gender discrepancy has vastly widened with women experiencing burnout at an increased rate of 14% compared to 2016, while burnout in men decreased by 1%. Surpassing the Leviathan Stress is a perceived threat to the status quo. Ultimately, stress boils down to your perception of your degree of control. If you believe you have a high degree of control, your stress level will be low. Conversely, if you see life as happening to you without much control, your stress level will be high, as every little thing becomes a potential threat. It’s noteworthy that job stress alone doesn’t cause burnout, as concluded in the article “The relationship between job stress, burnout, and clinical depression”.2 Despite this conclusion in a peer reviewed journal, the dictionary definition of burnout still includes physical or mental collapse caused by overwork or stress. These are some of the strategies that we can adopt at an individual level. It’s important to recognize that organizational factors, including high workloads, extended working hours, and time-consuming administrative tasks, are frequently cited as significant contributors to burnout. Personally, I have been able to integrate the empathic listening skill into my work time. For example, I can understand as a mother of four now adults, how difficult it was to wait in the doctor’s waiting room when I had to take the children to a sport or ballet practice. Integrating empathic listening has allowed me to increase my social connection that prevents feelings of burnout. Recognizing the critical importance of maintaining our well-being, surgeons can proactively integrate preventive measures into their daily routines. One key aspect is maintaining a healthy work life balance, allowing time for personal pursuits and relaxation. Equally essential is setting clear boundaries between work and personal life, enabling us to recharge and rejuvenate. Furthermore, effective task prioritization helps us tackle demanding schedules with greater efficiency, minimizing unnecessary stress. As we navigate the challenges of our profession, embracing these preventive strategies empowers us to not only to enhance our own resilience but also elevate the quality of care we provide our patients. Fostering a positive and supportive work environment it’s not just a feel-good sentiment but a strategic imperative. When colleagues and leaders collaborate to create an atmosphere of respect, open communication, and empathy, the benefits are manifold. Team members thrive in such an environment, experiencing job satisfaction, improved mental well-being, and a greater sense of belonging. This in turn contributes to higher levels of productivity, enhance patient care and lower turnover rates. By prioritizing the cultivation of a supportive workplace, we invest in the overall health of our team, allowing us to collectively tackle challenges and seize opportunities with greater resilience and enthusiasm. By concentrating on preventing and recovering from burnout across all these areas, organizations and individuals can create a more supportive environment that positively impacts productivity and overall satisfaction. As surgeons we get to be the leader of our teams most of the time and I encourage you to lead by example. LatinaPRUroSurgeon Dra. Elizabeth Perazza Assistant Chief of Surgery VACHS Urologic Surgeon References 1. Burnout: A Call to Action From the AUA Workforce Workgroup. Letter. J Urol. 2023;209(3):573-579 2. Maslach, Christina, Wilmar B. Schaufeli, Michael P. Leiter(2001). Job Burnout. Annu. Rev. Psychol. 52:397–422 , 2001 by Annual Reviews. 3. Maslach, C.; Jackson, S.; Leiter, M. Maslach Burnout Inventory, 4th ed.; Mind Garden: Menlo Park, CA, USA, 2018; pp. 10–74 4. Ortiz Rodríguez , J. A. (n.d.). SÍNDROME de desgaste profesional. *Galenus* , *REVISTA PARA LOS MÉDICOS DE PUERTO RICO*. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/01/Perazza.Elizabeth-e1705336078682.jpg)I have been the Assistant Chief of Surgery @ the Veterans Administration Caribbean Healthcare System since 2018. Staff Urologist with a practice in general urology since 2001. Have led the implementation of prostate laser, and minimally invasive techniques to manage patients with enlarged prostate since 2010 until present. Assistant Professor of Urology Ad Honorem of the Puerto Rico School of Medicines, Universidad Central del Caribe, San Juan Bautista and Ponce Health Science. Principal Investigator in Prostate cancer Prostatak protocol @ our Facility. Presented this conference Beating Burnout : Tips at the PR Urological Association last October 2023. Currently I also lead the initiative Mentoring the Future Puertorrican Surgeon, an initiative promoted by the PR Chapter of the American College of Surgeons designed to mentor our medical students interested in surgical careers. I have been married to Dr. De Leon ( ENT Surgeon), mother of four children that are preparing one to become Ob -GYn, another in Masters of Health Administration and twins , one pursuing Psychology and the other general science. Hope this material is of benefit to everyone who has been “burned out “ , as I was from 2008-2016. **Categories:** advocacy, awareness, career development, health, practice, professionalism, reflection, resources, self-care, URiM, women --- ### [Fear of Applying or Fear of Rejection: Finding The Courage to Apply to New Opportunities: Part 2](https://blog.womensurgeons.org/fear-of-applying-or-fear-of-rejection-finding-the-courage-to-apply-to-new-opportunities-part-2/) **Published:** January 10, 2024 **Author:** Blog Team **Content:** By Denise Nemeth Rejection, once an unwelcome guest, has transformed into a catalyst for growth and redirection in my career. While my initial reaction to rejection was reluctance, I now am incredibly grateful for the role rejection has played in shaping my professional journey. I have evolved to not only make peace with it but actively seek and advocate for it among others. Growing up under the influence of my brilliant mother, who consistently expected nothing but the best from me, I naturally became an overachiever, albeit sometimes to my own detriment. As a child, I constantly strove to be at the top of my class and even school, including upperclassmen. Truthfully, I never struggled with academics, but I was not one to not put in the work. As my mother would say, it was my “only job”. And so, when the time to perform well in college came, I assumed I would naturally continue to do well. At first, this was true, thriving at my local community college. However, as I found myself needing to transfer to a four year university. Transitioning from a small community college to a large university was a pivotal moment. The shift from a cozy 30-person class to a daunting 400-person lecture hall caught me off guard, impacting my performance and, consequently, though I hate to admit it, my self-esteem. As my calculus professor astutely pointed out, I was accustomed to being a big fish in a small pond and found the prospect of becoming a small fish in a big sea intimidating—an observation I only truly grasped in hindsight. That first “C” was not only a shock, but also a harsh realization of the level of difficulty I was about to face, but in academics and in life. (More on this in a future blog). I now firmly believe that rejection should be normalized, expected, and openly discussed. The realization that rejection presents an opportunity for profound personal growth transformed my perspective. Reading Jia Jang’s book, “[Rejection Proof](https://www.rejectiontherapy.com/book),” and absorbing his TED Talk on “[100 Days of Rejection](https://www.ted.com/talks/jia_jiang_what_i_learned_from_100_days_of_rejection)” was a key moment in making amends with rejection. Jang, initially fearing rejection, intentionally sought it out, putting himself in amusing yet challenging situations, like requesting a “burger refill” at a restaurant. Inspired by his journey, I incorporated rejection-seeking into my life—asking for a high starting salary at the beginning of my career, applying to medical school, seeking research opportunities, vying for leadership roles, and pursuing scholarships and awards. Surprisingly, I’ve encountered much less rejection than I anticipated, and each instance has imparted invaluable life lessons. To my surprise, I was rewarded with some incredible opportunities and roles I never imagined I would have the chance to experience. Additionally, every rejection has served as a stepping stone to improvement, making me more resilient and resourceful. Consequently, I encourage those I mentor to fearlessly pursue their dreams, welcoming rejection as a companion on their journey. I often ask them, “What is the worst that can happen?” and guide them through verbalizing the worst-case scenario. Once articulated, the perceived challenges often appear more manageable, especially when we have a strong support system in place. To anyone perusing this reflection: Seek the discomfort of rejection. That is the only way you will ever get comfortable with it. Make it your goal to extract lessons from it and find ways to become a better person based on them. Challenge yourself to look for opportunities that seem too good to be true or too “out of your league”. You might just surprise yourself. ![](https://blog.womensurgeons.org/wp-content/uploads/2024/01/Denise-Nemeth-1.jpg) Denise Nemeth is a third-year medical student at the University of the Incarnate Word School of Medicine in San Antonio, TX. She is originally from Piedras Negras, Coahuila, Mexico via Eagle Pass, TX. She currently serves as the Association of Women Surgeons (AWS) National Medical Student Committee Social Media and Marketing Coordinator. Denise is an active member of multiple organizations including the Latino Surgical Society (LSS), the Latino Medical Student Association (LMSA), and the American College of Osteopathic Surgeons. She is passionate about providing healthcare to medically underserved and marginalized communities and she currently serves on the Community Practice and DLPD committees of SAGES. Her research and subspecialty interests are varied and include minimally invasive surgery, wound healing, and gender equity within surgical specialties. She is an advocate for Latinx health and hopes to see increased representation via increased numbers of Latinx/Hispanic physicians and surgeons. In her spare time, she enjoys traveling the world, reading, and writing. Denise aspires to become a rural surgeon. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, medical students, mentorship, networking, practice, professionalism, reflection, residency, resources, training, URiM, women --- ### [Fear of Applying or Fear of Rejection: Finding The Courage to Apply to New Opportunities: Part 1](https://blog.womensurgeons.org/fear-of-applying-or-fear-of-rejection-finding-the-courage-to-apply-to-new-opportunities-parts-1-and-2/) **Published:** January 3, 2024 **Author:** Blog Team **Content:** By Morgan Hopp Applications for on-campus opportunities, national opportunities, tuition scholarships, travel stipends, research, the list of applications goes on and on. As a medical student, the opportunities sound wonderful and important for matching into the right residency program, but there is limited time to take advantage of all the opportunities, even if you are selected for them. After a few rejections, it becomes overwhelming just to figure out if you are a reasonable candidate and should put the effort in to apply. It is overwhelming to ask your mentor to submit another letter for an opportunity you are applying for…especially when the last few were straight rejections. Then, you might hit a spiral – one I wish I was not as familiar with – if none of these applications turn into opportunities. Without any of these amazing opportunities, will I have a chance in the match, let alone match in a program that is “the right fit”? This process is not new to me, I did it in college about medical school, and in high school about college. To my chagrin, I suspect the same will happen at each stage of my career. In the last year or so the spiral has lessened, the fear of rejection has decreased, and as a result, so has the fear of applying. I did not have an epiphany,(my mom is probably right, but do not tell her I said that), nor did I earn the perfect opportunity to melt away my fears. Instead, I found people who, despite their similarities in interest and career trajectory, helped me celebrate the opportunity to apply rather than view me as a competitor in the application selection. I trust their insights because they know what I’m doing, why the opportunities are important, and where I’m hoping my career will go. As a result of this comradery and support, the fear of applying has reduced. Instead, I look at applications and rejections as two different processes. Applying: I will learn about myself in some way and as a result, and grow professionally in some capacity. Writing all the application essays, identifying “my most….” anecdotes, describing my tentative plans for “in your future career” and all the other prompts applicants must address gives me time to reflect on my experiences, aptitudes, and goals. We all have heard the statistics that men often apply to jobs they are underqualified for while women apply to jobs they are overqualified for. Now in my application process, I usually rely on these friends to help me brainstorm or refine my ideas, and they remind me of my competitiveness as an applicant for the opportunity. As a result of the genuine support, I am applying for more competitive opportunities, and I am no longer intimidated by the likelihood of acceptance (still have not earned one but I continue to try). I no longer fear applying. I know the application process is an opportunity worth taking on. I still struggle to tell my mentors about rejections. Every time I do tell them, I conquer a little fear in myself, but more importantly, she has started sending me additional opportunities. I think the process has made her understand my interests and end goals better, and gives her a more specific way to mentor me. My growth, which was catalyzed by applying, strengthens my bond with my mentor. It took way too much time to come to this mindset, but I am grateful for the friends who have allowed me to finally conclude (what my mom probably already told me years ago): try your best, you will grow in the process, and keep applying because you do not decide the perfect opportunity or best fit – you make it when the opportunity presents itself. I am so grateful to AWS for facilitating an environment to find these amazing people. But do not think this mindset shift has reduced all my application fears…just some of them. I encourage everyone, if you have not found the friend(s) and mentor(s) needed to shift your mindset, then at least be that friend or mentor for someone else. I think being that friend has been more empowering than finally having that friend. Check out part 2 next week to read about how Denise Nemeth came to terms with rejection and has become “that friend,” whose genuine support of others through the application process helps shift mindsets (mine included!). Happy applying! ![](https://blog.womensurgeons.org/wp-content/uploads/2024/01/Hopp.Morgan2-1-1.jpg)Morgan J. Hopp is a third-year medical student at Creighton University School of Medicine in Phoenix, Arizona and has earned bachelor’s in biochemistry and master’s in biochemistry, molecular and structural biology from the University of California, Los Angeles. During her time at UCLA, Hopp worked as a research chemist looking into the utilization of boron clusters in medicinal chemistry and Pd-catalyst systems. In her three years at Creighton School of Medicine, Hopp has participated in multiple research projects in surgery, with a focus in trauma surgery. Her current field of most interest is geriatric trauma surgery. She contributes to the body of work needed for geriatric surgery verification at Valleywise Health Hospital. Beyond research, Hopp is an active member of the Association of Women Surgeons serving on multiple committees, and an active student member of the Arizona Medical Association and American Medical Association. Recently, in partnership with the Arizona Alliance for Community Health Centers, Hopp developed a pilot high school research skills workshop series. She continues to value and actively facilitate mentorship, both as a mentor and a mentee. Hopp constantly looks for collaborations aimed at advancing her research and outreach programs. Outside of medicine, Hopp crochets, is in book clubs and loves being an aunt and big cousin. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, medical students, mentorship, networking, practice, professionalism, reflection, residency, resources, training, URiM, women --- ### [Applying to Surgery as an International Medical Student or Graduate: Tips and  Advice](https://blog.womensurgeons.org/applying-to-surgery-as-an-international-medical-student-or-graduate-tips-and-advice/) **Published:** December 30, 2023 **Author:** Blog Team **Content:** *By Maria Vashchenko* Navigating the competitive nature of applying to a specialty like Surgery as an International Medical Student or Graduate (IMG) is undoubtedly challenging. With obstacles such as the absence of a home-based institution in the United States and limited access to faculty, the journey requires meticulous planning and dedication. Drawing from personal experience, here are some valuable tips for IMGs aspiring to apply for Surgery Residency: 1. **Early Preparation is Key:** Initiating your preparation as early as pre-med or the initial years of medical school is instrumental. Identifying Surgery as your passion early on allows sufficient time for preparation for the application process. 1. **Mentorship Matters:** Forming a relationship with a practicing attending Surgeon can provide invaluable guidance. If you don’t already have someone in mind, seek a mentor during surgical clerkships, as their advice and expertise can deepen your understanding of the field and pave the way for your journey to becoming a surgeon. 1. **Prioritize Academic Success:** Achieving excellent academic scores is paramount. Strong board scores and grades throughout medical school are crucial factors that programs consider during the application review, making academic success a top priority. 1. **Gain US Clinical Experience (USCE) and Strong Letters of Recommendation:** Actively engage in clerkships to gain USCE and secure impactful letters of recommendation. The more personalized the letter is, the more weight it carries in portraying you as a strong Surgery applicant. Generally, having 3-4 letters from Surgeons is advised. Keep in mind that some programs require a letter from the Department Chair at your institution, and if you are able to get one reflecting personal insights, it’s a huge boost for your application. 1. **Be Well-Rounded:** Showcase your versatility by participating in extracurricular activities beyond academics. In addition to excelling academically, demonstrate interest in research, volunteer work, leadership, and hobbies to present a well-rounded profile. Regarding publications, stick to the “quality over quantity” principle. Research projects that reflect your genuine commitment to a specific topic will always be valued more highly than a publication in which you participated solely to fulfill a requirement. 1. **Network Effectively:** Leverage networking opportunities through organizations like the American College of Surgeons (ACS) and the Association of Women Surgeons (AWS). Participate in webinars, conferences, and social events to expand your professional connections within the academic Surgery community. Bonus points if you present an abstract or a poster at a conference! 1. **Craft a Compelling Story:** Many applicants express generic reasons for pursuing Surgery, such as the desire to work with their hands. I suggest developing a narrative that reflects your genuine passion and skills. Your Personal Statement, experiences, letters of recommendation, and overall application should collectively convey a compelling story that highlights your unique journey to Surgery as well as your strengths. 1. **Ensure Timely Application Process**: Have all necessary components ready well in advance of the application deadline. ECFMG typically takes a week or more to process most of your documents, so timely submission is critical, and even a slight delay can impact your chances. Board scores, letters of recommendation, a persuasive personal statement, and other materials should be in order. Embarking on the journey to Surgery as an IMG requires careful planning, dedication, and a distinctive narrative. Nevertheless, with a constructive plan in hand, it is entirely possible to achieve your dream of becoming a Surgeon in the United States. Best of luck, Your fellow IMG Surgery Applicant, Maria Vashchenko ![](https://blog.womensurgeons.org/wp-content/uploads/2023/12/MV-IMG.jpeg) Maria Vashchenko is a 4th year medical student at St. George’s University, Grenada. She is a member of the Association of Women Surgeons Outreach Committee and is currently applying to General Surgery, with an interest in Surgical Oncology. She found her passion for Surgery while working on Stroke research at Stanford University performing middle cerebral artery occlusion surgeries on rodents. When not in school, her favorite way to spend her free time is being outdoors, hiking or skiing, and going to the beach. Instagram: @imgclinical **Categories:** medical students, mentorship **Tags:** #IMG, surgical residency, womeninsurgery --- ### [Navigating Medical School, Residency and the Wild World of Medical Networking.](https://blog.womensurgeons.org/navigating-medical-school-residency-and-the-wild-world-of-medical-networking/) **Published:** December 6, 2023 **Author:** Blog Team **Content:** **By Charoo Piplani** Remember the days when the medical journey seemed like a straightforward path of applications and interviews? Ha! In retrospect, however, it was never nearly as straightforward as it appeared. We have always needed our networks or people with whom we built connections on our journey. Remember the high school teacher who wrote you that letter of recommendation, or the attending who made that phone call, or even your peers who were kind enough to introduce you to another superior at a new institution? They were all very much a part of networking. Networking in healthcare has traditionally revolved around in-person collaborations, mentorship, and shared research interests—amidst those awkward elevator rides with experts in the field. However, in the era of virtual connections, platforms like LinkedIn and Twitter have emerged as powerful gateways. Who knew that these platforms weren’t just for memes and job postings? And thankfully so, especially during the pandemic. It made the world seem smaller and helped create collaborations spanning across continents. I read a funny analogy, imagining them as tickets to virtual ballrooms, waltzing through profiles and forging connections, and rightfully so. For me, graduating and stepping into the pandemic felt like receiving a medical degree with a side of uncertainty. As an international graduate without personal or professional connections in the United States, the path often seemed perplexing. However, I soon realized that navigating through the unknown was an integral part of the game, and so, my quest amid a global crisis began. During the pandemic while working in India, these social networks were my constant source to reach out to attending consultants and superiors in the field for collaborations and research opportunities. Along the way, I established beautiful connections with like-minded individuals in the field. Emailing them directly has been an integral part of this process and allowing for a more personalized approach. Imagine a kind third-year surgical resident taking the time to sit down and rearrange my CV or explaining the nuances of the system I wasn’t familiar with. Picture collaborating with researchers from two reputable medical institutions in the US to collaborate on research. The virtual gateways have not only helped nurture these relationships, but enabled me to continually be in touch with one another about our career progression, professional work, research to name a few. Similar to in-person collaborations, the virtual realm became our reality and proved quite helpful in the process. It not only allowed us to discuss their work but also share personal interests and articulate the future we envision in the medical field. It has opened doors for all of us, creating opportunities that we might not have stumbled upon otherwise. The new age handshake is just a click away, and frankly faster than a stat order. So don’t hold back, be respectful, and good luck! Cheers to forging connections that go beyond borders and reshape the way we approach our medical careers. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/12/Piplani.Charoo.jpg)Charoo Piplani is an international medical graduate from India, currently working as a research fellow in Acute Care Surgery at Rutgers Robert Wood Johnson Medical School. She is passionate about pursuing academic surgery as a career and is committed to promoting equity, diversity in healthcare, and sustainable living. In her free time, she finds joy in painting, hiking, and the companionship of dogs. You can find her on Twitter @charoo\_piplani **Categories:** advocacy, awareness, career development, diversity and inclusion, education, leadership, medical students, networking, practice, resources, training, URiM, women --- ### [Cultivating Hobbies Throughout Training: How our Passions Keep us Human](https://blog.womensurgeons.org/cultivating-hobbies-throughout-training-how-our-passions-keep-us-human/) **Published:** December 4, 2023 **Author:** Blog Team **Content:** By Hannah Soltani Throughout training as a medical student, resident, fellow, or attending, we are all faced with increasing responsibilities that make us feel as though there just aren’t enough hours in a day. The demanding journey often leads us to neglect our passions and interests outside of the medical field. In reality, our hobbies not only serve us as a means to manage stress but also help us build better relationships and connect with patients and colleagues. After speaking with others on this journey, here are a few tips that stuck with me: 1\) Free time is your most valuable possession. Therefore, you must be stubborn with it. Just as you prioritize studying, rotations, and clinical practice, it is helpful to allocate dedicated time toward your hobbies. Whether it is writing an extra page in your journal, playing an instrument you love, or playing sports with some friends, you can indulge in your favorite activities by being disciplined with your time and organized in your daily schedule. This means asking yourself how you really want to spend the extra time and being able to say “no” to things that you don’t find valuable or truly enjoy. 2\) Join organizations, clubs, and societies related to your interests. You’d be surprised to find out that your niche hobby of crocheting may actually be shared amongst your peers. From professional organizations to student groups like my institution’s comedy group, there is an abundance of opportunities to share your hobby with others in a setting that is practical to your lifestyle. It helps that they are going through the same experience as you. 3\) Incorporate your hobbies into your study schedule. Research has shown that adding purposeful breaks in your studying can actually boost productivity. Whether it’s a 5-minute or 60-minute break, use this time to draw a quick sketch or bake your favorite dessert. It’ll refresh your mind, recharge your energy, and help you focus! As a medical student, it is especially important to get into the habit of cultivating hobbies now, as your life and schedule will only become busier. That way, when you are well into your career as an attending, you will be reminded of what makes up your humanity beyond your profession. On a bit of a more existential note, I am often reminded how precious our ability to connect with one another is. When I can strike up a conversation with a stranger about the team his sweatshirt is representing, or simultaneously admire the same work of art that a passerby is taking in, I am reminded of how our shared interests make us human. Rather than getting lost in the role of our identities, we can reconnect with one another, making us better students, physicians, and above all, humans. Hannah Soltani is a second-year medical student at Northwestern University Feinberg School of Medicine. **Categories:** Uncategorized **Tags:** AWS, AWSBlog, residency, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Trauma-Informed Care Deserves a Stronger Spotlight in Surgery](https://blog.womensurgeons.org/trauma-informed-care-deserves-a-stronger-spotlight-in-surgery/) **Published:** November 22, 2023 **Author:** Blog Team **Content:** **By Sara Campbell, OMS-IV** Trigger Warning: The following blog post contains mentions of sexual assault. A few months ago, I was catching up with one of my close friends when she told me about a recent experience at an oral surgeon’s office for an urgent root canal revision. “On the day of the surgery, I waited a long time in the operating room by myself. When the staff finally came in, they did not introduce themselves and basically moved in silence. I tried to explain that I have jaw pain to the doctor and staff, so I was concerned about it getting worse from the surgery, but they shrugged it off. Then, the doctor gave me the sleeping medicine without any warning, I passed out, then woke up by myself in a room with bloody gauze hanging out my mouth, where I was alone next to an exit for close to an hour while I was still really, really out of it.” Eventually, her boyfriend found her in the room and took her home after they got confirmation that they could leave. Perhaps you think this sounds like a standard trip to a high-volume outpatient surgery clinic – that is what it initially sounded like to me. I thought this clinic might need a refresher in patient care and maybe a negative review on Yelp. However, no matter what our assessments of her experience may be, when we put our own judgements aside, one thing about her story remains indisputable: my friend felt alone, scared for her safety, and extremely uncomfortable as she faced multiple unknowns throughout the day of her surgery. Recalling her history of sexual assault and subsequent PTSD, I realized how distressing the entire experience must have been for her. Over the next few days, I found myself ruminating on her words, and thought about how a “routine” trip to the operating room could potentially be a triggering and even re-traumatizing environment for a sexual assault survivor. I started to critically examine some of our current practices in surgery and think about how they could be improved by implementing trauma-informed care practices. Trauma-informed care (TIC) is an approach to delivering healthcare that assumes most people have experienced trauma at some point in their lives and recognizes the need to acknowledge all of a patient’s life experiences to provide quality care. According to the Substance Abuse and Mental Health Services Administration (SAMSAH), there are six basic principles that guide TIC and can be applied to surgical situations, which I have listed below. - **Safety** – The patient’s actual and perceived physical, psychological, and emotional safety. - **Trustworthiness and Transparency** – Includes obtaining consent, explaining risks, describing all possible procedures and outcomes, knowing who will be present, and what to expect on the day of surgery and throughout recovery. - **Peer Support** – Connecting the patient with support groups where the patient can discuss their surgery, experience, and concerns with people who have experienced it before or are in a similar stage of treatment. - **Collaboration and Mutuality** – Addresses power dynamics between the patient, doctor, and staff; treating the patient as an equal and allowing opportunities to collaborate with the patient. - **Empowerment, Voice, and Choice** – Making sure the patient knows that they always have a choice, their decisions are respected, and can be changed at any time; promoting patient autonomy. - **Cultural, Historical, and Gender Issues** – Respecting intersectionality. After doing an exhaustive search, I was surprised to find out that we do not have clear guidance on how to incorporate trauma-informed care in our surgical practices. That includes whether it is the day of the procedure in the operating room, preoperatively in the surgical clinic, or post-operatively in recovery. It is important to acknowledge that while TIC at its core is not meant to be a concrete set of instructions, specialties like obstetrics and gynecology have developed specific TIC considerations for routine encounters that necessitate pelvic exams or other gynecologic procedures. I wondered why, at minimum, general surgery didn’t have similar considerations for our analogous sensitive exams, including breast, rectal, and hernia exams, let alone for major operations requiring general anesthesia. My friend who shared her story with me was scheduled for another surgery within six months of the initial procedure, but never returned out of fear that she would have a similar experience. Now, after two years since the first surgery, she is facing even worse dental problems requiring a more lengthy, complicated surgery. Similarly, after a quick Google search, it was easy to find numerous posts on forum websites from sexual assault survivors who were avoiding or delaying necessary surgical care because they were worried about re-traumatization or being assaulted by the surgeon or staff members while under sedation. I am left wondering if we should take action to create concrete suggestions or guidelines for trauma-informed care in the OR. I hope that anybody who reads this post feels challenged to evaluate their own personal practices and contemplate how they could be improved to provide even better care to our surgical patients. **Bio** ![](https://blog.womensurgeons.org/wp-content/uploads/2023/11/Professional-photo-2-248x300.jpg)Sara Campbell is a fourth-year medical student at Michigan State University College of Osteopathic Medicine (MSUCOM) who applied to general surgery this match cycle. She serves on the AWS Instagram Subcommittee and helps host live interviews to promote the voices of women surgeons of all specialties. When she’s not at the hospital working a shift or flipping through Schwartz’s Principles of Surgery, she is probably at home with her fiancé cooking up a storm, cuddling with her two cats, or attempting to jog. **Categories:** Uncategorized **Tags:** AWS, AWS Blog, AWSBlog, womeninmedicine --- ### [Love yourself, be kind to yourself, and focus on yourself.](https://blog.womensurgeons.org/love-yourself-be-kind-to-yourself-and-focus-on-yourself/) **Published:** November 15, 2023 **Author:** Blog Team **Content:** By Yi Hsuan Chen, MD As healthcare professionals, we dedicate years to learning how to care for our patients, continually honing our skills to provide the best possible care. However, in our demanding schedules, we often forget to care for ourselves. To be effective caregivers, we must be in peak physical and mental condition – this starts with self-love and self-care. *Identify the source of stress and find an outlet.* There are many options for relieving stress, but you must find those that work for you. For me, yoga is my way to relieve stress; here are some components I think make yoga helpful: - **Breathing**: Besides training the body, we practice breathing exercises: inhale and exhale through the nose, ensure that exhale time is double the inhale time, and as your body adapts, prolong the time; for example, if you inhale in three counts, exhale in six counts, and increase to four and eight and so on. - **Positive Self-talking**: Another component is self-talking, telling ourselves positive phrases, phrases that reinforce our self-esteem, or phrases we need to reach the end of the day; it is a mix of motivational and self-affirmation self-talk; it helps to maintain a positive attitude, as well as boost confidence. - **“Me” time**: This is when you focus on yourself and pay attention to your mind, body, and emotions. Do not compare yourself to others, do not be frustrated if you cannot yet do some poses, and do not worry about what is on your to-do list or what you will do after yoga. It may be hard to clear your mind at first, so you can implement techniques like counting backward from 50 and starting over if you lost; this is when listening to your body’s needs, where you are tense, where you ache. Centering your attention on you and only you. *Automate to the maximum.* Time is precious, every minute counts. Optimize your time by delegating or automating tasks or chores. If you do not have time or do not like cleaning and it is stressful, pay someone to come once a week to do it for you or get an autonomous vacuum. The same goes for food. If you do not have time to think about what to eat, go to the grocery store and cook every meal; one way is to pay for a subscription-based healthy food delivered every day or every week to your house; you also can buy trustworthy frozen food or pre-cooked food to save time. These methods could cost some extra bucks, but it can optimize a lot of time and save a lot of arguing. *It is okay to need help.* The first and most crucial step is recognizing when you need help and seeking it. There is some stigma in certain cultures, where asking for help is seen as a sign of incompetence. However, it’s important to remember that everyone faces challenges; we cannot know everything or have everything figured out. It is paramount to prioritize getting the support you require. Friends can offer valuable support, but it’s essential to recognize that therapists are highly valuable resources for consistent, ongoing assistance. Seek professional assistance before a situation reaches a crisis point, and do not wait until you’ve reached your limit to ask for help. Life is like going on a journey. It is an endless journey with the process of finding what is important to you and what is precious. Through that journey, you will gain experience and build up various opinions and judgments. But be sure to keep this in mind. If you pay too much attention to the useless things, you will miss the things that truly matter –you. Biography: ![](https://blog.womensurgeons.org/wp-content/uploads/2023/11/Chen.Yi-Hsuan-225x300.jpg)My name is Yi Hsuan Chen, MD. I was born in Taiwan but raised in Argentina, where I earned my medical degree at the University of Buenos Aires. I serve as a Clinical Research Coordinator Intern at the Hospital Italiano of Buenos Aires, and I am finishing my Master’s in Clinical Research at the end of this year. I have been actively involved in volunteer work in the Taiwanese community in Argentina since a young age, and nowadays, at Red Cross Argentina. I am interested in breast reconstruction, cleft palate, tissue engineering, wound healing, microsurgery, and global surgery. I hope to advocate for patients of color’s well-being and health equity in the surgical area in the future. IG Handle: @dryihsuanchen **Categories:** Uncategorized **Tags:** AWS, AWSBlog, self-care, womeinmedicine, women, womeninsurgery --- ### [Gender Inequalities in Surgery in Low-Middle Income Countries](https://blog.womensurgeons.org/gender-inequalities-in-surgery-in-low-middle-income-countries/) **Published:** November 8, 2023 **Author:** Blog Team **Content:** **By Maymona J. Choudry** Gender inequality is a pervasive issue in many fields, including the surgical field, particularly in low-middle-income countries. Surgery has long been regarded as a man’s field, with only a few women physicians proceeding to surgical residency. This has resulted in a significant disparity in the number of male and female surgeons, which has implications for healthcare and surgical education. Firstly, cultural and societal norms play a significant role in this issue. Women are still viewed as caregivers and homemakers, with little emphasis placed on their professional pursuits. This has led to a lack of support and encouragement for women to enter into fields such as surgery, which are traditionally male-dominated. I remember at the beginning of my journey as a surgical resident, every time I would make rounds in a non-surgical ward, I was usually asked by the nurses or staff, whether I am a pediatrician or an internist. I always end up introducing myself as a surgical resident, and it made me wonder whether there was a certain stereotype in which I did not fit in that made me appear less of a surgical resident. Women may face discrimination and harassment in the workplace, which can deter them from pursuing their careers as surgeons. From my experience as being the team leader, there are certain times during rounds when patients direct their questions and concerns to my male juniors instead of me. This kind of discrimination happens everyday in the life of women surgeons-in-training. It’s like we have to prove ourselves everyday, even though we become senior residents and excel in certain aspects of surgical residency training. Women may also face challenges in balancing professional and personal lives, which can limit the ability to advance in their careers. Whenever I am asked about my future plans in my surgical career, some will voice out their concerns of me getting married, and having a family before pursuing further fellowship training. Secondly, there are significant systemic barriers that limit women’s access to surgical education and training. These barriers include limited resources, a lack of female mentors and role models, and biases in the selection process for surgical training programs. Furthermore, women may face unique challenges in surgical training, such as lack of diversity in surgical education and training, which can have negative effects on the quality of healthcare. Thirdly, the lack of female representation in leadership positions in the surgical field. Women have often been excluded from opportunities in the field of surgery, despite their qualifications and expertise. Limited representation of women can limit the perspectives and experiences brought to decision-making processes, resulting in a lack of diversity in approaches to healthcare delivery and policy-making. In my 5-year journey in surgery, I am the only Muslim woman in our department, and amongst my colleagues. Fortunately, my training officer is also a woman, and there are a few women surgeons in our department that have helped me throughout my training. Their dedication and hardwork has served as my inspiration in this field. Having a female representation in the training committee has provided various perspectives in the improvement of training for surgical residents. In conclusion, gender inequalities in the surgical field in low-middle-income countries can have significant consequences for healthcare access and outcomes. The various factors contributing to these inequalities must be addressed through systemic changes, including increased support and encouragement for women to enter the surgical field, the removal of systemic barriers to education and training, and the promotion of diversity in leadership positions. By doing so, we can work towards a more equitable and inclusive healthcare system that benefits all members of society. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/11/Choudry.Maymona-170x300.jpg)Maymona Choudry, MD, MPH, completed her graduate studies with a dual degree in Doctor of Medicine and Masters in Public Health from Ateneo de Zamboanga University. She is currently a PGY-5 in General Surgery from Vicente Sotto Memorial Medical Center, Cebu City, Philippines. Her interests include Thoraco-Cardiovascular Surgery, Global Surgery, Surgical Critical Care and Public Health. She is a member of Association of Women Surgeons, American College of Surgeons, Philippine College of Surgeons, and many more. Her hobbies include writing articles, reading journals, and participating in various medical and surgical webinars. **Categories:** advocacy, awareness, diversity and inclusion, practice, professionalism, Underrepresented in medicine, URiM, women --- ### [Art and Humanities in Surgical Education: A Necessity or a Luxury in the Age of AI?](https://blog.womensurgeons.org/art-and-humanities-in-surgical-education-a-necessity-or-a-luxury-in-the-age-of-ai/) **Published:** October 26, 2023 **Author:** Blog Team **Content:** By Razan M. Baabdullah, BDS, MS, FRCDC They say empathy is the cornerstone of a compassionate healthcare provider. They say that you must approach your patients as sentient beings. They say that you have to foster the patient-doctor relationship. But they time you, they love efficiency, and they like to see numbers and figures, big ones. Quality? Well, not so much. They like ubiquitous monitors, electronic medical records, and certainly a screen in the room where it soon becomes the focal point and more valued than the patient in the room, stealing attention from the very humans we swore to prioritize, and now we are turning our backs to them to face the screen. Now, we are spending more time, not with human beings, but with insurance papers, to face once again screens, forms, and emails. Let me be clear: I’m no Luddite. I’m not averse to technology or contend against its utilization or laudable advantages. I also champion efficiency when properly employed and when it does not reduce patients to mere digits or allow profit to sabotage care provision. But, we must not lose sight of our roots. We must hold onto the humanistic core of this profession with our teeth. We must keep the human touch untouched. And one salient way to help us stay connected in an AI epoch is through art and humanities. These are our allies. The divergence between STEM and art and humanities is significant because somehow, we have decided that one doesn’t complement the other, or there’s not enough time in the STEM curricula to inject any kind of art and humanities. I don’t propose a marriage between the two, but it is high time we ring this divide. Art becomes something we realize we can’t do without once we witness the consequences of its absence. And it has been absent from the painting of the STEM field for a very long time. Just like C.S Lewis put it: “Friendship is unnecessary, like philosophy, like art …. It has no survival value; rather it is one of those things which give value to survival.” We may not fully grasp the importance of art in medicine until we read something like this: [A cross-sectional study](https://pubmed.ncbi.nlm.nih.gov/31977341/) included 10,751 students in medical schools found a statistically significant diminution in empathy levels among clinical-year students (years three and four) compared to their preclinical counterparts (years one and two), despite the former’s superior scientific and clinical knowledge. So, we are doing very well on the STEM part but faltering on the humanistic part. Once we veer away from art and humanities, we risk losing sight of the very essence that drew us into this field in the first place: to provide care with utter care. That is because the humanistic edifice is inextricable from care provision. It is not an ancillary component, but rather, it is sine qua non. If we do not hold onto the humanistic aspect and continue forsaking the exploration of art and humanities, we may find ourselves entrapped in an occupation identity crisis, questioning why we are doing what we are doing. Call it [alienation](https://plato.stanford.edu/entries/alienation/) in Marxian terms or [cognitive dissonance](https://onlinelibrary.wiley.com/doi/abs/10.1002/9781405186407.wbiecf025) in Festinger’s parlance; the core issue remains the same. We lose connection with our patients. I can lecture my students all I want about the vital importance of compassion and empathy in our field. Still, it won’t matter if I don’t equip them with the means to forge genuine personal connections and put empathy into practice. Fortunately, art and humanities have the capacity not only to teach these indispensable qualities but also to nurture and foster them. They can inculcate the ethos of empathy and cultural humanities. Art has proven instrumental in enhancing [surgical residents’ skills](https://pubmed.ncbi.nlm.nih.gov/36347792/)**,** [improving cognitive abilities](https://jamanetwork.com/journals/jama/article-abstract/2678593)**,** [honing observation acumen](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517949/)**,** [refining patient communication and social competencies, and bolstering patient-physician relationships](https://pubmed.ncbi.nlm.nih.gov/33816794/)**.** It also plays a pivotal role in addressing [healthcare disparities](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464433/) and cultivating healthcare practitioners imbued with [empathy and compassion](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112699/)**.** As Richard Bach stated, “You teach best what you most need to learn.” Well, in this day and age, we all stand in need of relearning the art of empathy with our patients, and one potent way to achieve this is by introducing art into our teaching. [Several initiatives ](https://pubmed.ncbi.nlm.nih.gov/33830951/)have incorporated art into their medical pedagogy, but many still face bureaucratic impediments that question the relevance of art and humanities in a STEM-oriented field. “No prior knowledge is required. No art, art history, surgical, or medical knowledge is needed. There are no right or wrong answers here. This is a safe space. All you need for this is yourself, your brain, and your inner child to surface. Now, look at this painting and tell me, “What’s going on in this painting?” This is how I have been opening my lectures, sessions, workshops, and pretty much any chance of learning activity. I have been practicing [visual thinking strategies](https://link.springer.com/chapter/10.1007/978-3-319-05837-5_3) (VTS) with my students across all years, from preclinical to clinical, residents, and post-graduates. The amount of discussion it sparks and the level of enthusiasm and engagement it ignites are remarkable. All I allot is five to ten minutes for this exercise. At times, I conclude the VTS with a philosophical question, watching their eyes light up with curiosity. Or I delve into the social medicine dimensions, exploring how they might apply these insights in a clinical setting. It is not a lot, but it’s a start. If we can infuse more art and humanities into our curricula and plan visits to local museums, maybe we can commence to bridge the gap between STEM and the arts and humanities. Maybe we can preserve the level of empathy, not only for 3rd and 4th-year students but also for practicing physicians. Maybe we can nurture individuals who are less biased, less prejudiced, and more compassionate, individuals better equipped to navigate the rigor of this demanding profession. In these tumultuous times, our need for art and humanities is more pressing than ever before. We can dedicate entire courses to teaching them or simply set aside a few minutes. The choice is ours. But it is a choice we can make. We will use all kinds of technology because we can’t, shouldn’t, and don’t want to go backward. But we can also find ways, cogent stratagem, to reconnect with our humanistic sides in the multifaceted interactions we have with patients. Will this help remedy all the malignancies of contemporary medicine, the decline in empathy, and the surge of burnout? Well, no. But it’s certainly a tool, a starting point from which we may begin to address one aspect of this complex problem. **![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Baabdullah.Razan_-211x300.png)Biography:** Dr. Baabdullah is an assistant professor, clinical researcher, and oral and maxillofacial surgeon with a passion for education and healthcare innovation. She earned her dental degree from King AbdulAziz University in Saudi Arabia and completed her surgical internship and residency in oral and maxillofacial surgery at McGill University. There, she founded InnoVSP.com, a virtual platform dedicated to teaching innovation in the field, particularly in the realm of virtual surgical planning. Pursuing her academic journey, she obtained a Master’s degree from Harvard Medical School, concentrating on oral cancer screening and the role of policy making and social medicine in shaping healthcare agendas. Dr. Baabdullah’s research aimed to expand access to surgical care and reshape the practices of general dentists and primary healthcare providers regarding oral cancer screening. To this end, Dr. Baabdullah developed a program that integrates art and humanities into teaching oral cancer screening, leveraging VR and state-of-the-art museum technologies at Harvard University and MIT. Her overarching mission revolves around empowering students, fellow surgeons, and healthcare providers by reigniting the artistic and philosophical dimensions of their field. Consequently, she established an empathy program at the Harvard Art Museums where the worlds of art and humanities converge to revive a renaissance of thought and practice within the healthcare community. You can find more of her writing [here](https://razanbaabdullah.substack.com). **Categories:** advocacy, awareness, current events, education, professionalism, training, URiM, women --- ### [On Being Latina Enough ](https://blog.womensurgeons.org/on-being-latina-enough/) **Published:** October 18, 2023 **Author:** Blog Team **Content:** By Sarah Suhood ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Picture1-150x150.jpg)I was born on the island of Sri Lanka in the middle of the Indian Ocean, but I was also born Latina, thanks to my Guatemalan mom. Growing up bi-racial, I experienced the casual identity crisis many immigrants feel. I’ve lived in the states since I was five, so am I American? We make tamales for Christmas, so am I Latina? I don’t eat pork since my dad is Muslim, does that make me more South Asian? It was only in the last couple of years that I began to understand and embrace that I am all of the above. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Picture2-e1697638616954.jpg)With the rise of the “no sabo” kids in social media, we are seeing a beautiful move to embrace the second and third generation Latin-Americans. Both earlier and current generations faced much discrimination for having accents or not speaking English “well enough.” I remember my ESL (English as a Second language) teacher telling my mother in the 1st grade not to speak Spanish to me or I’d jeopardize my English skills. Then later in high school, I was told it was “such a waste” that I couldn’t speak Spanish and that my parents should have taught me. I couldn’t quite understand what exactly was expected of me. I found there tends to be an image of the “right” kind of immigrant. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Picture5-300x226.jpg)I endeavored to learn Spanish and took AP Spanish in high school. I minored in Spanish Language & Culture during my undergraduate degree and even studied abroad in Spain. I participated in service trips to Puerto Rico and the Dominican Republic. All of this in an effort to feel more connected to my Latina culture. I’m embarrassed to admit I found myself judging others for not learning Spanish themselves and thought them to be less Latino since they didn’t put in the effort to learn Spanish. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Picture6-150x150.jpg)I still found myself self-conscious about my accent, but I realized in my time working as a Nurse Tech prior to medical school that most Latino patients didn’t care. Instead, they seemed grateful and relieved to see someone that looked like them, someone that sounded like them. A patient told me, “Mija, no te preocupes por tu acento. Todavía serías Latina aunque no pudieras hablar español. Solo estoy feliz que alguien me entiende.” (Translation: my daughter, don’t worry about your accent. You would still be Latina even if you didn’t speak Spanish. I’m just happy somebody understands me.) ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Picture3-150x150.jpg)It was this conversation that was a catalyst for a lot of self-growth. I realized I was very privileged to have the opportunity to learn Spanish in university and study abroad to further my command of the language. I was privileged enough to be able to talk on the phone with my grandparents and mother and practice my Spanish. I was privileged enough to have access to fun apps and websites to further perfect my vocabulary. I was already enough. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Picture4-300x225.jpg)I didn’t need to prove to anyone that I was “Latina enough.” Aside from being a part of my identity, it was also a tool for me to better serve my patients – to help someone else feel heard. This connection matters more than if you can conjugate a verb in “preterito”. So, whether you are born and raised in Latin America, immigrated to the states yourself, a fourth generation Chicano, or whether you speak ‘Spanglish’ or know how to use “vosotros”: Be brave and be that advocate for your Latino patients. You are Latino enough. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Picture7-150x150.jpg)Sarah Suhood is an OMS-III at the University of the Incarnate Word School of Osteopathic Medicine. After living in Sri Lanka, she lived in Houston, Texas, then moved to Fort Lauderdale, Florida for most of her adolescence. While attending USF in Tampa, FL for her undergraduate and master’s degrees she worked as Nurse Tech at the Advent Health Tampa Mother & Baby/Gynecology Unit on night shifts. An Health Professional Scholarship Program recipient, she was commissioned as a 2LT in the U.S. Air Force when starting medical school. She hopes to advocate for patients of color both within the military and civilian sectors in the future. **Categories:** advocacy, awareness, diversity and inclusion, family life, hispanic heritage, professionalism, reflection, Underrepresented in medicine, URiM, women --- ### [Heels of Steel, Hands of a Healer, Heart of a Mother](https://blog.womensurgeons.org/heels-of-steel-hands-of-a-healer-heart-of-a-mother/) **Published:** October 10, 2023 **Author:** Blog Team **Content:** *By Dr. Smruti K Patel* 7:30 am. 15 blade. Incision. Bovie. Bipolar. Number one Penfield. Drill. Irrigation. Suction. Bipolar. 11 blade. 7 suction. Bipolar. The words, the commands, they are automatic. The muscle memory of opening, turning a craniotomy, hemostasis, irrigation, closing – it is all automatic. From start to finish, before every surgery, I am prepared. I have played this out in my mind. What I need, what I want, what the anatomy is supposed to look like, what I’m supposed to do if something untoward happens, what all the possibilities are. These are what neurosurgeons’ dreams are made of. These are what our nightmares are made of. Some may say it is unhealthy. I say – for some of us, the night before surgery is the when I can close my eyes and see what I need my hands to do tomorrow. 3:30 am – I hear the not so faint cry of my 5-month-old. Get up, warm a bottle, feed the bottle, pump, change the diaper, give the pacifier, put him down. The motions are automatic. The muscle memory of doing this the second time around – automatic. Children need to be kept on their schedule, feedings, nap times, bedtimes. When disarray occurs, when a nap is skipped, when a feeding is missed – these are what mom nightmares are made of. Sleep is a foreign concept when you’re a surgeon mom, as if it already wasn’t before becoming a mother. 5:30 am – Get up, shower, look alive, put on some makeup, pick out an outfit, not a ragged pair of scrubs, a classic blouse, with pleated dress pants, a subtle but luxe belt and the most comfortable pair of Jimmy Choos. I stand tall, I stand confident, and I stand up to whoever may think I’m not deserving of every little thing that I’ve accomplished. And just before I leave the house, I peek at those amazing human beings I have created. Sometimes I have flashbacks of my pregnancies – nearly passing out and the feeling of my body being on fire in the OR that I experienced for nearly 3 months because pregnancy hormones and hot operating rooms are not a great combination. I distinctly remember the discomfort of leaning against an OR table that was never quite right when I was doing the most technically challenging procedures, and the race between needing to close a wound and breaking scrub to run to the bathroom. Every minute, every ache and pain, everything about it was worth it. I have had many young women reach out to me about my neurosurgical journey and how I got here without “sacrificing” in other parts of my life. Make no mistake, compromises must be made, but the choices are entirely yours. I am a daughter, a sister, a wife, mother of 2, AND a pediatric neurosurgeon. However, I don’t define any of these parts of my life as “perfect” because they are 100% not. I strive to always be my best, but there have been and will continue to be difficult days, where nothing seems to go the right way. On these days, I lean on my partners for advice, my family for support, and sometimes, all I need is a few minutes to myself to breathe, to reset, and to remember that tomorrow is another day. There is power in recognizing when to take a step back and revising your strategy to attack the next day. Every day, I wear my heels of steel with pride. I take my mind and hands of a healer to work. Whether it is a gentle touch over a child’s head, the motion of when the scalpel meets the skin, or the stroke of the cutting bur as it meets the skull, the responsibility of this life just became mine.I remind myself that I earned this privilege, and that there is a way to do it all. When asked would I do it all over again? The answer is 100%. This piece is for all the young women who have been told they can’t do or be more; the medical students and residents who are told they would be “crazy” to want children during training or in their career; the women who feel judged for leaving their personal life behind for their career or vice versa; the doctor moms who struggle with the work-life balance every day and are fighting to stay sane. There are so many of us that are right there with you. There is no “perfect” journey to and through motherhood in our profession, there is only your journey, and that’s the one that is most important. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Patel.Smruti-198x300.jpg)Smruti K Patel, MD is a pediatric neurosurgeon and Assistant Professor at the Cincinnati Children’s Hospital Medical Center / University of Cincinnati College of Medicine. Dr. Patel earned her medical degree at Rutgers University, New Jersey Medical School in Newark. She completed neurosurgery residency at the University of Cincinnati Medical Center, followed by a fellowship in pediatric neurosurgery at Cincinnati Children’s. Dr. Patel serves as the Director of the Pituitary and Skull Base Surgery Program at Cincinnati Children’s and as the Director of the Adult Neurosurgery Transitional Clinic at the University of Cincinnati Gardner Neuroscience Institute. In addition to her clinical practice in Cincinnati, she is an active participant in the community outreach specialty clinics located in Indiana and Kentucky. Dr. Patel is an active member of the AANS/CNS Joint section on Pediatric Neurological Surgery and serves as co- chair of the Timothy George Committee on Diversity and Inclusion in Pediatric Neurosurgery. She is also actively involved with the AWS as part of the Coaching Project and blog subcommittee. In 2022, she was named one of the Future Women Leaders in Neurosurgery by the CNS Foundation and highlighted as an AWS top 40 under 40. She is also one of the recipients of the 2023 AWS Breaking the Glass Ceiling Leadership Education Program Award. She serves as a mentor and sponsor to undergraduate and medical students interested in neurosurgery, as well as to both surgical and neurosurgical trainees. She is a loving wife and mother to two children, ages 5 and 2. Twitter Handle: @SmrutiPatelMD IG Handle: @thefiercefemaleneurosurgeon **Categories:** advocacy, awareness, career development, family life, leadership, mentorship, Neurosurgery, parenting, practice, professionalism, reflection, self-care, URiM, women --- ### [From Barbies to Blades: Reflections on a Barbie Society](https://blog.womensurgeons.org/from-barbies-to-blades-reflections-on-a-barbie-society/) **Published:** October 5, 2023 **Author:** Blog Team **Content:** By: Shannon Small “Mommy, so does Barbie have a vagina now?” My 3.5-year-old daughter has been excited to see the Barbie movie since we saw the first preview last summer. So when it came out, we both dressed in our Barbie best and went to see what I can only describe as a tragically accurate depiction of the life of women in this country both as my inner child dreamt of, and as my 42 year old grown self now inhabits. My daughter saw everything I could have wished for- Barbies as scientists, doctors, writers, Supreme Court Justices, and her personal favorite, (especially as a little brown skinned girl), President. She gasped in righteous indignation as Ken took over Barbie’s dream house “that is BARBIE’S house- he needs to LEAVE Mommy!”, and applauded when Barbie rebuked an advance from Ken “no one should touch you without permission!”. Her excitement at the end, as I told her that yes, Barbie was choosing to become human, and yes, she now had a vagina “Barbie is like ME Mommy!” brought tears to my eyes, if only because just like Barbie, her child-like innocence as to who she can be and what she can do is still limitless. And yet, just as America Ferrera’s character Gloria, I fear for the world in which my beautiful baby girl is growing up. She lives in a society where the patriarchy isn’t as easily overthrown as in the Barbie movie, where intelligent, competent women wake up to the fact that while they have earned their careers and their rightful places as leaders in their society, in reality they may not even have control over their own bodies. As a trauma/critical care surgeon in my first few years of practice, I have been the only female surgeon, then the only pregnant surgeon, and subsequently the only breastfeeding surgeon. I have been told to smile more, and not to stand with my hands on my hips in the trauma bay so as not to appear too “aggressive”. I have had to apologize for the perception that I was too slow in running to a code when I was 7 months pregnant and having premature labor contractions. I have been reported to HR for having to utilize a breast pump in a mandatory staff meeting, when there were no accommodations made as I was the first surgeon to require breastfeeding accommodations. I have watched my peers get passed over for promotions, receive less pay than their male counterparts, and have no support for academic advancement. As Barbie says: “The real world is forever and irrevocably messed up.” Being a mentor now to multiple female residents and medical students, I am often asked how to navigate a career in academic surgery with starting a family. I am open and honest that I still haven’t figured that out. There are days when I feel like a total failure as a mother, when my two young children sob because they only see me on a computer screen and they don’t want Mommy to “help the sick people” because it takes me away from them. There are days when I feel like I have sacrificed my opportunity to improve my surgical skills and experience to make it home in time to get my kids to bed and kiss them good night. That still, six years into practice, rare are the days that I feel like I am succeeding at all my roles as a wife, mother, surgeon, mentor, researcher, leader. There are an increasing number of days when I feel like I have succeeded at at least one. For now, that is enough. Being a woman in a male dominated field is described in the movie perfectly: “It is literally impossible to be a woman. . . Like we always have to be extraordinary, but somehow we’re always doing it wrong. . . You have to be a boss, but you can’t be mean. . . You have to answer for men’s bad behavior, which is insane, but if you point that out, you’re accused of complaining. . . But never forget that the system is rigged. You have to never get old, never be rude, never show off, never be selfish, never fall down, never fail, never show fear, never get out of line.” Navigating this tightrope of expectations has been fraught with challenges in my initial years as a surgeon, and I have fallen more times than I care to count. Most importantly, I have also had help to stand back up. It is critical that we women, mothers, and surgeons are there to mentor and to help future generations, both women and men, to create the type of society where we support each other. A society where we both appreciate the work our men colleagues perform, while also lauding the work done by women, which is just as worthy of recognition. We must celebrate each other as women, and help ourselves and others obtain their version of work/life balance. We must recognize that our roles outside of the hospital are just as important as our roles inside, and that our life experiences only make us stronger. Being a mother doesn’t detract from being a great surgeon- I would argue it makes me a better one. “Us mothers stand still so our daughters can look back to see how far they’ve come”. This was my favorite line from the movie. I can only hope that my smart, beautiful baby girl grows up in a world where she is valued, respected, and capable of achieving anything and I will work to create that world for her and for others. So my takeaway from Barbie? Proudly strike a Superwoman pose, and continue on doing the best I can to show my daughter that just as in the movie, having a vagina is something to be celebrated. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/10/Small.Shannon-300x300.jpg)Grew up in Tallahassee, Florida, attended college at Duke University, majoring in English with a double minor in chemistry and classical studies. Attended medical school at Wake Forest University School of Medicine. Completed general surgery residency at Virginia Commonwealth University, and fellowships in critical care at Wayne State University and in immunotherapy at the National Cancer Institute’ Surgery Branch under Dr. Steven A. Rosenberg. Recipient of multiple teaching and research awards, member of numerous surgical societies and committees, author on twenty peer viewed publications and one book chapter. Numerous oral and poster presentations at regional, national, and international meetings. Proud wife and mother to two young children, Jonah and Jocelyn. **Categories:** advocacy, awareness, career development, current events, diversity and inclusion, family life, gender differences, leadership, mentorship, parenting, practice, reflection, resources, self-care, training, URiM, women --- ### [How to make the best of your surgery rotation during your 3rd year of medical school](https://blog.womensurgeons.org/how-to-make-the-best-of-your-surgery-rotation-during-your-3rd-year-of-medical-school/) **Published:** September 20, 2023 **Author:** Blog Team **Content:** *By Anna Sabu Kurian* Third year of medical school is one of the most important and interesting times because it helps you find your specialty of choice in medicine. The world of surgery might seem intimidating as a medical student, but there is enough room for everyone to learn and make the most out of the clinical rotation. The clerkship duties include daily rounds, operating room experience and clinics. Here are a few suggestions for the optimal third year experience in the **operating room** - Read about the specific surgical procedures the night before they are scheduled. Make sure to review the anatomy; and vasculature of different structures involved. The surgery textbook by Dr. Virgilio is a good resource. - Practice suturing, one hand ties (make sure that you know how to do them with either of your hands), two hand ties and instrument ties. Reference below for a video tutorial <https://www.youtube.com/@dr.omedary8170> - Once you get to the hospital, introduce yourself to the patient in the pre operative area. - Introduce yourself to the nurse, scrub techs and anesthesia team in the operating room. - Grab your gloves and gowns and hand them to the team in the OR. - Help the OR team to transport and prep the patient for the case (Always abide by the instructions of the residents and attendings). It is important as a future surgeon to know how to prep and correctly positioning the patient for a variety of procedures. - Text/ communicate with the resident/attending once the patient is in the OR and is getting prepped and inducted. - Be a team player and see where your help is needed before, during, and after the case and communicate clearly with your seniors and residents. - Once the case is done in the OR, help get the patient to the PACU and stay with the patients until you get the first set of vitals. It’s always good to inform the resident on the case when the patient is in PACU, if they have been extubated and if their vitals are stable post-op. A few tips to keep in mind when **rounding on surgical patients**. - Round on your patients before you round with the residents and attending as a team (Pre-round). - Always make it a point to talk to the nurse for your patient as they might have valuable information that you might miss out on. - Have appropriate supplies (wound dressings, suture removal kit etc) ready in the room before you round with the attending and residents (Saves a ton of time during official rounding, especially when you have a busy service). - If there are tasks to follow up on after rounds, make sure they get done. For instance, if a CT is ordered for increasing abdominal pain make sure to keep an eye on it and update the team in case they are busy with other patients. - Please see the link below for a concise guide for your daily round presentation on surgical patients. <https://docs.google.com/document/d/1YDyC8YzY6P3B7LEScVeBFv5jKFyUtFsfTLbbMdqWiCg/edit?usp=sharing> Keep these in mind for **surgery clinic days** - If time allows, chart review a few patients the night before the clinic and have an assessment and plan in mind if possible. When you are in the clinic, you can learn as to how your initial plan aligns with the final plan for the patient. - When in the clinic get a complete H&P, do an appropriate focused physical exam and report back to the supervising physician. Always attempt to present your assessment and plan as well. It may not be completely correct, but we all need to practice critical thinking to improve on our skills - Be ready in the patient room with supplies you would think might be necessary for the specific clinic visit (Ex: Staple remover, Dressing changes, Iodoform packings) One last thing to keep in mind is that, you learn from everyone on the team, which includes the nurses, scrub techs and the anesthesia team. Be humble and be ready to learn a lot of material in a short amount of time. Keeping an open mind, helping your team within your capabilities and being respectful of everyone on the team will get you to success! ![](https://blog.womensurgeons.org/wp-content/uploads/2023/09/Kurian.Anna_-300x254.jpg) **Categories:** advocacy, awareness, career development, education, medical students, training, URiM, women --- ### [New technologies in neurosurgery](https://blog.womensurgeons.org/new-technologies-in-neurosurgery/) **Published:** September 13, 2023 **Author:** Blog Team **Content:** By: Barbara Buccilli, MD Of all the things I learned in medical school, the one lesson that will always stay with me throughout my career is that medicine is continually evolving, and as doctors, we must evolve with it. While we receive our medical school degrees, we should never leave medical school completely behind, as medicine will outpace us if we do. This profession is for individuals who have an insatiable hunger for learning, much like a shark’s constant need to swim. We should continuously pursue new technologies until they become the standard of care, and even then, we should remain open to newer technologies replacing them. Over the past year, I have developed a fascination with magnetic brain stimulation, the integration of virtual reality and robotics in stroke recovery, and brain-computer interface (BCI) technologies. How far can we push these new techniques, and how far can they push us? What if we combine them with stem cell infusions or medications that enhance plasticity? I have witnessed firsthand how patients can greatly benefit from some of these innovations. Virtual reality and robotics significantly enhance motivation, as patients feel more empowered and in control of their progress. It transforms potentially tedious and painful experiences into adventures and challenges. Thanks to virtual reality, patients can turn their daily exercise into a walk on the beach or through a museum. Robots can support them, adding their strength to the patients’ to allow them to stand, walk, grab objects. Just imagine the potential impact even simpler devices can have on pediatric neurorehabilitation, when once a middle-aged man proudly announced to me that he achieved a perfect 5-star rating for the first time in one of our therapeutic minigames. This is the power of rewards. Virtual reality and augmented reality also hold promise in improving neurosurgeons’ performances. They enable us to visualize and simulate complex procedures, enhancing preoperative planning and surgical precision. In the operating room, robotics plays a crucial role by providing enhanced precision, stability, and dexterity, enabling neurosurgeons to perform intricate procedures with greater accuracy, especially in delicate surgeries like deep brain stimulation (DBS). BCIs have shown remarkable potential in restoring movement and function in patients with paralysis or neurological disorders. They offer individuals the ability to control prosthetic limbs or communicate using their thoughts. When a patient doesn’t have sufficient strength to perform the desired movement, an exoskeleton can provide it. This will allow the patient to regain theirs, limiting the frustration of failure and improving recovery and quality of life.. 3D printing is another technology which has found applications in neurosurgery, allowing for the creation of patient-specific models, implants, and surgical guides. These custom-made devices enhance surgical planning, improve accuracy, and optimize outcomes. They can be useful, for example, in dealing with AVMs, since the blood vessels in the human brain can present great variability. 3D printing is also precious in spine surgery, offering a more personalized and efficient tool to treat many degenerative conditions. For the general public nanotechnology belongs in comics and sci-fi movies, but in neurosurgery, nanoparticles can be used for targeted drug delivery to the brain. Nanotechnology is also a promising field for imaging, diagnostics, and neuroregenerative medicine. It’s the case of the nanosensors that can be implanted to monitor ICP in real time. This is only a short list, and I’m offering but a glimpse of the potential these technologies have to offer. I’m not trying to teach you something; I’m in a phase of my career in which I have far more to learn than I have to teach. I also won’t deny that new technologies can have their downsides: they can be harder to use for older patients, they are often pricy and delicate, and they need complex engineering, but I think this side of medicine is still a baby moving its first steps, and that we can still barely imagine how far it could bring us. What I want to share with you through this post are my hope and my curiosity – the marvel I feel looking at how far we already went, how far we carried medicine together, my desire to push the limits further, deepen my roots in the knowledge of today and reach out to new questions, new marvels, new magic. **BIOGRAPHY** **![](https://blog.womensurgeons.org/wp-content/uploads/2023/08/Buccilli.Barbara.png)Barbara Buccilli, MD,** is an Italian medical doctor and an applicant for US medical residency. She has always had a deep passion for the nervous system and has dedicated her career to this field. Dr. Buccilli obtained her medical degree from Sapienza University of Rome, where she graduated in the top 5% of her class, and she is a cerebrovascular and neurocritical care fellow at Icahn School of Medicine at Mount Sinai. Throughout her academic journey, she consistently achieved scores higher than the national average on the annual progress test, which earned her the corresponding awards. In 2021, Dr. Buccilli obtained her medical license from the Italian medical board. Since then, she has been actively involved in medical practice while concurrently preparing for and successfully completing all three steps of the United States Medical Licensing Examination (USMLE). Dr. Buccilli is currently engaged in research activities and actively participating in the writing of a comprehensive neuroanatomy book. She is also the CSO of the Global Neurosurgical Alliance. **Categories:** awareness, current events, education, Neurosurgery, practice, residency, resources, training, URiM, women --- ### [Medical Student Mental Health and Wellbeing ](https://blog.womensurgeons.org/medical-student-mental-health-and-wellbeing/) **Published:** September 6, 2023 **Author:** Blog Team **Content:** By Karla Arana As a fourth year medical student going through the residency application process, I have been told that residency only gets harder, with increased responsibility and longer hours. Especially as a student applying to general surgery, many have warned me that the idea of work-life balance is not applicable to the field. Through conversations with residents and fellow medical students, I have noted that many find the clinical years to be the most mentally taxing. Between studying for step exams, studying for shelf exams, and constantly being evaluated by different teams on rotations, the stress can be difficult to manage. A study out of Harvard Medical School demonstrated the prevalence of depression in students at 27.2% and in residents at 28.8% ([Study](https://jamanetwork.com/journals/jama/fullarticle/2589340)). In comparison, the prevalence of a major depressive episode among 18-25 year-olds in the general public is 9.3% ([Study](https://jamanetwork.com/journals/jama/fullarticle/2589340)). Researchers have hypothesized different reasons for the increased prevalence of depression in medical students, including the competitive nature of the medical school curriculum ([Study](https://jamanetwork.com/journals/jama/fullarticle/2589340)). Many medical schools across the country have implemented pass/fail curriculums in order to help address medical student well being. It has been demonstrated that when compared to students with graded curriculums, students with pass/fail curriculums have less burnout, lower stress levels, lower rates of depersonalization and emotional exhaustion ([Study](https://pubmed.ncbi.nlm.nih.gov/21952063/)). These findings have aligned with my own personal experiences as a student. At my institution, the preclinical years were a pass/fail curriculum, while the clinical years were a graded curriculum. The stress during the clinical years was much higher due to constantly being worried about how my performance affects my grade. In certain cases, a graded curriculum also encouraged students on the same team to become competitive towards each other. My graduating class was also the first class to take Step 1 pass/fail. Many of my classmates still found the exam difficult, and many felt the pressure to learn the material well in order to apply it to the clinical setting and future shelf exams. While this change was implemented in order to alleviate pressure on medical students, it has transferred the stress to performing well on Step 2. Additionally, the shift towards a pass/fail curriculum and licensing exams has placed more importance on extracurricular activities and research. While steps have been made to address medical student burnout and stress levels, the pressures students face continue to persist. While addressing how the medical school curriculum and institution affect student mental health and wellbeing, mental health stigma and access to care are also important factors to consider. A study published in Academic Psychiatry showed that out of students identified as needing services, the only group that was more likely to access care were those that were told to do so by others ([Study](https://doi.org/10.1007/s40596-021-01584-y)). The study also found that students endorsed fear of academic/professional repercussions and stigma as reasons to not access care ([Study](https://doi.org/10.1007/s40596-021-01584-y)). This demonstrates the need for discussions surrounding mental health to continue in medical schools and amongst medical students. As the medical profession continues to evolve, new stressors and demands will be placed upon students. In order to train the next generation of physicians, it is important to continue to find ways of improving access to mental health services and destigmatizing conversations regarding mental health. Citations: Phillips, M.S., Steelesmith, D.L., Brock, G. *et al.* Mental Health Service Utilization Among Medical Students with a Perceived Need for Care. *Acad Psychiatry* 46, 223–227 (2022). <https://doi.org/10.1007/s40596-021-01584-y> Reed D, Shanafelt T, Satele D, et al.. Relationship of Pass/Fail Grading and Curriculum Structure With Well-Being Among Preclinical Medical Students: A Multi-Institutional Study. *Academic Medicine.* 2011; 86 (11): 1367-1373. [doi: 10.1097/ACM.0b013e3182305d81.](https://pubmed.ncbi.nlm.nih.gov/21952063/) Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. *JAMA.* 2016;316(21):2214–2236. [doi:10.1001/jama.2016.17324](https://jamanetwork.com/journals/jama/fullarticle/2589340) ![](https://blog.womensurgeons.org/wp-content/uploads/2023/09/Arana.Karla_-150x150.png)Karla Arana is a fourth year medical student at George Washington University in Washington, DC. She currently serves as the medical student chair for the AWS blog subcommittee. She is currently applying to General Surgery, with an interest in transplant surgery. Her other interests include Global Surgery and community outreach. **Categories:** advocacy, awareness, career development, diversity and inclusion, education, residency, training, URiM, women --- ### [Balancing a Career as a Surgeon-Scientist](https://blog.womensurgeons.org/balancing-a-career-as-a-surgeon-scientist/) **Published:** September 5, 2023 **Author:** Blog Team **Content:** By: Kavitha Ranganathan, MD Satisfaction in one’s career can come from a variety of places. In fact, most of the time, it *has* to come from a variety of places. Don’t place all your eggs in one basket, they say. While a surgical career is unparalleled in the achievement of instant gratification, the daily reminder that healthcare isn’t perfect can also be a source of mental exhaustion. Being a surgeon-scientist is one way to address this. The scientist part of this career choice allows you to balance your short- and long-term visions, and amplify your contributions to the next generation. Importantly, however, it can be challenging to balance a clinical career alongside research acumen and productivity. Protecting your time for research and clinical care, securing grant funding, and staying resilient amidst unique challenges in two different worlds is tough. Below are some tips I believe to be helpful for those embarking on a career as a surgeon-scientist. 1. Study big problems - It can be challenging to figure out what you want to study as you embark on your career after surgical training. It is easy to avoid big problems. For the struggle of balancing a career as a surgeon and scientist to be worth it, study problems that are meaningful to you and humanity. By the end of your career, the satisfaction of working on a problem that is important to you will be worth it. My lab focuses on food insecurity in surgical patients. This is a problem that has been important to me since my childhood. While I tried to convince myself to pursue more traditional pathways including basic science and clinical research, global health work is what has always been my passion, and ultimately what brings me the most joy. 2. Focus on building your clinical and research acumen during residency - Becoming a safe surgeon is the obvious top priority during residency. Importantly, however, it is also your time to access rich mentorship from funded investigators, develop skill sets required for research, and build your CV. This allows you to be a top candidate for grants open to early career investigators during the first five years after residency graduation. Use this time wisely, and it will pay off. A focus on establishing expertise has been particularly important for me. It has always been easy for people to dismiss me as too young, too quiet, too un-surgeon-like. But, when people see what you really bring to the table from a more objective standpoint, they are less likely to turn you away. You will get more and more opportunities once you get a chance to prove yourself. 3. Recognize that research and surgery are team sports - Silos inherently limit progress. To be an effective surgeon and scientist, work on your collaborative spirit, and approach both fields with humility. Give credit to those around you that contribute to your success, and identify generous mentors and mentees who support your multifaceted career. As an early career faculty, my mentees have been especially critical to my success. They provide me with the drive and passion to serve them well as they work hard towards the goals of mitigating food insecurity and alleviating poverty in surgical patients within the context of our lab. The sense of community within the lab brings all of us joy in a way that is hard to replicate in virtual forums or through social media. 4. Don’t give up - Staying in the game is the best way to achieve success in academic surgery. To do this, you must be resilient. Grit is the most important unifying quality required for a surgical career and scientific advancement. Shifting my mindset from rejection=failure to rejection=opportunity for growth has been one of the most critical changes I’ve made since becoming faculty. It has freed me from the pursuit of perfection, and allowed me to learn from my mistakes instead of wallow in them. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/09/Ranganathan.Kavitha-300x300.jpg)Dr. Ranganathan is currently an Assistant Professor within the Division of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital. She serves as the Director of Craniofacial Reconstruction. To that end, her clinical practice focuses on trauma reconstruction, facial forms of gender affirming surgery at the Brigham, and cleft lip and palate reconstruction at Shriners Hospital for Children. From a research standpoint, Dr. Ranganathan’s lab known as Surgeons Against Poverty works at the intersection between national and international health equity work science with a specific focus on identifying solutions to financial toxicity and food insecurity for surgical patient populations as part of the Center for Surgery and Public Health. She has over 90 publications including in the Lancet, JAMA Open, and Plastic and Reconstructive Surgery, was awarded the National Endowment for Plastic Surgery Grant this past year, and has secured numerous grants in this space. She is Vice President of the Young Plastic Surgeons group within the American Society of Plastic Surgeons. **Categories:** advocacy, awareness, career development, diversity and inclusion, leadership, practice, professionalism, reflection, self-care, URiM, women --- ### [Difficult Conversations: a Resident’s Perspective](https://blog.womensurgeons.org/difficult-conversations-a-residents-perspective/) **Published:** August 23, 2023 **Author:** Blog Team **Content:** By Dr. Kathryn McElhinney One of the most challenging aspects of our careers as surgeons is delivering bad news to patients, but it is also one of our most important jobs. No matter the subspecialty, every surgeon has to have frank conversations about unexpected outcomes or diagnoses with their patients. There are a number of different formal and informal curriculums that have been proposed on how to teach residents how to navigate difficult conversations with patients and their families but no singular method prevails. As a resident, it is the ultimate opportunity to learn how to master these communication, empathy, and leadership skills. 1\. Embrace the opportunity to learn and be uncomfortable No one enjoys telling a family that the diagnosis is likely terminal or that the next best step in care may not be the surgery that they have been told would solve all their problems. It is okay to feel like this is not the kind of conversation you want to have. However, surgeons are afforded a unique relationship with their patients. Surgeons take ownership over the care of patients that they have operated on. This often leads to the surgeon being the de facto communicator in situations where there has been an unexpected outcome. Additionally, the resident is often the face that the patient and their family associate with the surgery team. They are the person they see rounding everyday despite revolving attendings. Embrace the opportunity to have these challenging conversations when they come up. Set up a specific time with the family and your team to sit down and fully explain the situation. If feasible, set up to have the conversation in a quiet and comfortable space away from distractions. If this discussion is going to be in the outpatient setting, make sure the patient will not be alone. Utilize known constructs for having these challenging conversations, and be prepared to revisit the topic more than once. We know that many times during these meetings, the shock of a new diagnosis or a change in treatment plan limits how much information is actually absorbed by our patients. Leave the door open to revisit this conversation again, once they have processed the new information. 2\. Ask for help As trainees, we have access to attendings who have been where we are. We have mentors around us who have had profound experiences in having difficult conversations with patients. Ask for their support. Ask for an attending to be present for the conversation if you need help. Before you walk into the patient’s room, ask for their advice on how to best approach the subject, especially if it’s a topic you haven’t discussed before. There are many resources available to help support conducting difficult conversations. Many like to use previously described protocols such as SPIKE to organize their conversation.¹ The American College of Surgeons also provides a resident’s guide for surgical palliative care that has sections on delivering bad news and discussing resuscitation status.² 3\. Recognize when the conversation is above your pay grade There are going to be some conversations that are not appropriate for a trainee to lead. In those instances, I would still advocate for being present if it’s a patient you have rapport with and if your presence would not be distressing. Don’t be surprised if you are asked to leave the room or to not join the meeting. In these scenarios, it is okay to take “No” for an answer. 4\. Process your experience and ask for feedback After the conversation, expect that you may have an emotional response to the difficult conversation and recognize that is normal. Take a minute to step away and collect yourself if needed. Take the time when it is appropriate to process what happened and what was said in the way that is most appropriate for you. Decompressing with co-trainees, writing it down, or discussing the encounter with a professional counselor are all options to explore. Ask for feedback from your attending if they were present. Discuss what you think went well and what you think could have been communicated better. Ask if your attending saw areas that could have been worded better or explained more fully. Debrief with your team members if they were present or not: update the team on how the conversation went and what next steps are. Get feedback from other residents or fellows about anything they have experienced themselves. Delivering bad news is an inevitable part of our careers as surgeons. Residency is the perfect time to learn and master the skills needed to manage these complex interactions. We all have the opportunity to take advantage and practice these skills and hone them under the guidance of mentors and colleagues. 1\. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist. 2000;5(4):302-311. doi:10.1634/theoncologist.5-4-302 2\. Dunn GP, Martensen R, Weissman D. Surgical Palliative Care: A Resident’s Guide. American College of Surgeons; 2009. https://www.facs.org/media/kcfn4mux/surgicalpalliativecareresidents.pdf ![](https://blog.womensurgeons.org/wp-content/uploads/2023/08/McElhinney.Kathryn-150x150.png)Kathryn McElhinney, MD is a general surgery resident from the University of Texas at Austin currently in her research years at Ann & Robert Lurie Children’s Hospital of Chicago. She is originally from Austin, TX and completed medical school at the McGovern Medical School at the University of Texas at Houston. When not in the lab, she is out running on the lakeshore with her dog, Snickers. **Categories:** advocacy, awareness, career development, medical students, practice, professionalism, residency, resources, training, URiM, women --- ### [No Longer Radical Contralateral Prophylactic Mastectomies: An Informed and Personal Choice](https://blog.womensurgeons.org/no-longer-radical-contralateral-prophylactic-mastectomies-an-informed-and-personal-choice/) **Published:** August 16, 2023 **Author:** Blog Team **Content:** ***By Dr. Victoria Haney and Dr. Christy Teal*** As of 2020, breast cancer has become the most common cancer in the world ([study)](https://www.birpublications.org/doi/full/10.1259/bjr.20211033). Overall survival has significantly increased in the past 20 years due to improvements in chemotherapy, endocrine therapy, genetic testing, and imaging studies used for screening ([ACS statistics](https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html)). Still, 1 in 8 women will be diagnosed with breast cancer during their lifetime. As women surgeons, the likelihood that our friends, family members, patients, or even ourselves will be affected by breast cancer is almost guaranteed. For most women, breast cancer is diagnosed in its early stages due to widespread screening initiatives for annual mammograms ([ASBS screenings](https://www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf)). Many patients with invasive cancers undergo breast-conserving therapy, or lumpectomy, along with adjuvant radiation. This treatment is well-established to have similar survival outcomes when compared to mastectomy ([study](https://www.nejm.org/doi/full/10.1056/NEJMoa022152)). During treatment, patients will often ask the question, “What if it happens again on the other side?” As surgeons, it is our role to educate women that the chances of this happening are very low, with more recent studies citing a less than 2% risk of cancer on the contralateral side ([study](https://www.nejm.org/doi/full/10.1056/nejmoa1804710)). Yet despite this information, more and more women ([study](https://www.tandfonline.com/doi/full/10.1586/14737140.2014.883284)) are opting to prophylactically remove their unaffected breast at the same time as their initial surgery. There has been a steady rise in contralateral prophylactic mastectomies (CPM) in recent years ([study](https://www.ingentaconnect.com/content/wk/sla/2017/00000265/00000003/art00026)). CPM is a procedure where the healthy breast is removed to almost completely negate the risk of developing future cancer on that side. The primary reason for this trend is the fear of developing future cancer on the unaffected side. Some [studies](https://link.springer.com/article/10.1245/s10434-011-1914-x) report that this is due to an overestimation of risk by patients. Other [studies](https://jamanetwork.com/journals/jamasurgery/article-abstract/1873911?casa_token=mdoV_es7owsAAAAA:b_9Er-pmM1z2SmviTVABijtzyyK1OnrZZWizqWb3r_ucO649jdi5pO8FsoMAwuP9luxt2r2Bu4k) attribute it to the increased utilization of MRI for dense breast tissue. Although CPM is not itself without risk, most patients who have undergone the procedure reported that they would do it again, even after experiencing complications. Long term, the majority of patients are satisfied with their decision to undergo CPM ([study](https://link.springer.com/article/10.1245/s10434-016-5753-7)). The topic of CPM is a controversial one in the world of breast surgery. Some surgeons are opposed to the idea and discourage their patients from undergoing CPM, due to no increased survival benefit. While it is true that there is no survival benefit to undergoing CPM when compared to recommended annual screenings, there is something to be said about how we are defining survival. Yes, more women are living full, healthy lives past their breast cancer diagnosis. But anyone who has been through the process will tell you, most come out with scars, both figuratively and literally. One patient we recently saw in clinic comes to mind; a young career woman in her early 40s without family history or genetic abnormalities, presented with a contralateral breast cancer. She had to undergo chemo the first time she was diagnosed in her 30s and was distraught when she found out that she would likely require another round. She expressed to us that she wished she had undergone bilateral mastectomies when she was initially diagnosed. For many women, the thought of undergoing repeat surgery, chemotherapy, or endocrine therapy is enough to consider CPM. Additionally, there may be daily insidious thoughts about if the cancer will come back or not. For some women, choosing to undergo CPM gives them back their peace. As surgeons, it is our responsibility to provide our patients with the risks and benefits of their treatment plan. In a world where medicine is becoming more personalized and where more women are surviving breast cancer, it’s time to start treating each patient individually. This may mean that CPM is the best treatment for some patients, while for others it’s continued surveillance. Every woman has different values and goals for herself, and as surgeons, it is our job to provide patients with all of the information, so that they can make an informed decision. Ultimately, it is time that we listen. To learn more about this topic and to read personal stories from patients and physicians alike, check out the book, *No Longer Radical*, authored by Dr. Rachel Brem and Dr. Christy Teal. <https://www.simonandschuster.com/books/No-Longer-Radical/Rachel-Brem/9781668001134> References: 1. Wilkinson, L., & Gathani, T. (2022). Understanding breast cancer as a global health concern. *The British Journal of Radiology*, *95*(1130), 20211033. 2. <https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html> 3. <https://www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf> 4. Fisher, B., Anderson, S., Bryant, J., Margolese, R. G., Deutsch, M., Fisher, E. R., … & Wolmark, N. (2002). Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. *New England Journal of Medicine*, *347*(16), 1233-1241. 5. Sparano, J. A., Gray, R. J., Makower, D. F., Pritchard, K. I., Albain, K. S., Hayes, D. F., … & Sledge Jr, G. W. (2018). Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. *New England Journal of Medicine*, *379*(2), 111-121. 6. Burke, E. E., Portschy, P. R., & Tuttle, T. M. (2014). Contralateral prophylactic mastectomy: are we overtreating patients?. *Expert review of anticancer therapy*, *14*(5), 491-494. 7. Wong, S. M., Freedman, R. A., Sagara, Y., Aydogan, F., Barry, W. T., & Golshan, M. (2017). Growing use of contralateral prophylactic mastectomy despite no improvement in long-term survival for invasive breast cancer. *Annals of surgery*, *265*(3), 581-589. 8. Abbott, A., Rueth, N., Pappas-Varco, S., Kuntz, K., Kerr, E., & Tuttle, T. (2011). Perceptions of contralateral breast cancer: an overestimation of risk. *Annals of surgical oncology*, *18*, 3129-3136. 9. Hawley, S. T., Jagsi, R., Morrow, M., Janz, N. K., Hamilton, A., Graff, J. J., & Katz, S. J. (2014). Social and clinical determinants of contralateral prophylactic mastectomy. *JAMA surgery*, *149*(6), 582-589. 10. Anderson, C., Islam, J. Y., Elizabeth Hodgson, M., Sabatino, S. A., Rodriguez, J. L., Lee, C. N., … & Nichols, H. B. (2017). Long-term satisfaction and body image after contralateral prophylactic mastectomy. *Annals of surgical oncology*, *24*, 1499-1506. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/08/Haney.Victoria.png)Victoria Haney, MD is a general surgery resident at The George Washington University Hospital in Washington, DC. She is currently in her dedicated research year with the Department of Breast Surgery at the GW Medical Faculty Associates. She is originally from Roswell, NM, and completed medical school at The Pennsylvania State College of Medicine. She is passionate about women’s health, women’s advocacy in surgery, and she is an aspiring breast surgeon. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/08/Teal.Christy-150x150.png)Christy Teal, MD is the Director of the Breast Care Center and Chief of Breast Surgery for The George Washington University Medical Faculty Associates, as well as an Associate Professor of Surgery. Since joining the faculty at GW in 2001, Dr. Teal and her colleagues have developed a cutting-edge, holistic, patient-focused Breast Care Center that integrates complementary medicine with the latest technology and surgical innovations. She is dedicated to performing clinical and translational research with the goal of improving patient outcomes. She has a special interest in taking care of breast cancer patients and those at increased risk for it. Dr. Teal is a *Washingtonian* Top Doctor, a *US News & World Report* Top Doctor, a Castle Top Doctor, and is a Fellow of the American College of Surgeons. **Categories:** advocacy, awareness, current events, practice, research, URiM, women --- ### [Awake Surgery](https://blog.womensurgeons.org/awake-surgery/) **Published:** August 2, 2023 **Author:** Blog Team **Content:** By Dr. Barbara Buccilli My initial exposure to neurosurgery was through awake surgery. I began my internship in the department, and I immediately joined an ongoing research project on awake surgeries for arteriovenous malformations (AVMs). This may seem unusual, but when considering my fascination with this type of surgery and my overall obsession with the nervous system, it becomes less surprising. These factors drew me closer to the field and motivated me to pursue that internship. The significance of awake procedures in neurosurgery extends beyond the remarkable experience of having our hands on a patient’s brain while they engage in activities like reciting Shakespeare, answering questions, or singing a tune. Brain tumors, AVMs, and other lesions can often be located within or near eloquent areas of the brain, necessitating a delicate balance between efficient removal of affected tissue and preservation of function. Asleep-awake-asleep procedures have transformed these operations from a blind pursuit, relying solely on anatomical knowledge and assistance with navigational technology, into ambitious strategic maneuvers aiming for a level of precision comparable to gamma knife procedures. We can now adapt the familiar anatomical map to each individual patient, accounting for the inherent variability we encounter in every surgical setting. This approach allows us to map brain activity in real-time, reducing the risk of damaging critical areas and connections, while maximizing lesion resection. Achieving such remarkable results requires thorough study and preparation. Advanced imaging is necessary before bringing the patient into the operating room. Following the initial craniotomy, the neurosurgeon employs electrical probes to stimulate the brain, aiding in the identification of critical functions. The patient is then instructed to perform specific tasks based on the targeted area of interest. This meticulous mapping of functional boundaries enables precise monitoring throughout the entire removal process, empowering the neurosurgeon to adapt their approach as needed. Awake neurosurgery also presents an incredible opportunity to study neuroplasticity and observe how the brain reorganizes and adjusts its functions in response to surgical intervention. Functional MRI (fMRI) can be utilized during surgery to obtain real-time images of brain activity, bringing us a step beyond the sole implementation of direct electrical stimulation to visualize functional areas. It is crucial not to overlook the potential stress faced by patients undergoing awake neurosurgery. Providing psychological support, step-by-step explanations of the procedure, and relaxation techniques are essential components of their care. While we cannot predict its ultimate development, I firmly believe that awake neurosurgery represents the future of the field, particularly when combined with other emerging technological approaches to medicine. Advancements in brain-computer interface technology, for example, hold the potential for direct communication between the surgical team and the patient’s brain during the procedure, facilitating even more precise mapping and monitoring. I consider today’s neurosurgeons, neurologists, and neuroscientists to be exceptionally fortunate as we are witnessing and actively participating in one of the most revolutionary eras in our collective field. **![](https://blog.womensurgeons.org/wp-content/uploads/2023/08/Buccilli.Barbara-150x150.png)Barbara Buccilli, MD,** is an Italian medical doctor, an incoming Cerebrovascular and Neurologic Critical Care Pre-residency Fellow at The Mount Sinai Hospital, and an applicant for US medical residency. She has always had a deep passion for the nervous system and has dedicated her career to this field. Dr. Buccilli obtained her medical degree from Sapienza University of Rome, where she graduated in the top 5% of her class. Throughout her academic journey, she consistently achieved scores higher than the national average on the annual progress test, which earned her the corresponding awards. In 2021, Dr. Buccilli obtained her medical license from the OMCEO. Since then, she has been actively involved in medical practice while concurrently preparing for and successfully completing all three steps of the United States Medical Licensing Examination (USMLE). Dr. Buccilli is currently engaged in research activities and actively participating in the writing of a comprehensive neuroanatomy book. **Categories:** awareness, career development, current events, education, Neurosurgery, practice, research, training, women --- ### [Empowering Success: Initiatives to Support International Medical Graduates in U.S. Surgical Training](https://blog.womensurgeons.org/empowering-success-initiatives-to-support-international-medical-graduates-in-u-s-surgical-training/) **Published:** July 26, 2023 **Author:** Blog Team **Content:** By Carolina Torres Perez-Iglesias International Medical Graduates (IMGs) currently make up 25% of all licensed physicians in the United States and a fifth of all first-year residency positions annually.1-3 In general surgery, IMGs commonly start training as non-designated preliminary residents (NDPR). Unfortunately, less than 50% of these residents will complete surgical training.4-6 **What makes IMGs different?** A potential contributor to the low success rate in surgery could be that IMGs are often perceived as less desirable than US medical graduates (UMG) . A study that polled members of the Association of Program Directors of Surgery found that 87% preferred offering positions to USMG over IMGs despite having equal qualifications.7 More than half also reported purposefully avoiding IMGs, in part because of the perceived potential for language barriers, the concern for substandard quality and abilities compared to USMG, and the lack of familiarity with educational standards at non-US medical schools. A successful preliminary year in general surgery can help reassure programs against these unfounded concerns. A survey conducted at my institutions, Beth Israel Deaconess Medical Center, identified that preliminary general surgery residents, most of whom are IMGs, face unique challenges and stressors in addition to those faced by categorical residents. Over 90% of faculty and residents in the program believe that NDPR experience added stressors that may adversely affect their clinical performance during the academic year. Respondents also believed NDPR are at a higher risk of being perceived negatively if they express dealing with stressors and 75% of NDPR admitted to fear of discussing stressors with faculty or senior residents for this reason \[unpublished work\]. **How can we support IMGs in surgery?** Our survey also demonstrated that faculty and peer trainees are invested in the well-being and success of the NDPR and that they represent an important part of their support system. For this reason, our program designed a novel structured mentorship program for NDPR that launched in 2021. In the two years of implementation, 94% of our NDPR that were part of the program were offered a categorical surgical residency position. Faculty and categorical residents serve as mentors, and they have also benefited from this initiative by participating in workshops on effective mentoring and in community-building activities. Despite some mentors not having a background being a preliminary resident or an IMG, we have noticed incredible value in cross-mentorship. This also reduces the diversity tax put on this population. We hope that this initiative will foster an improved sense of belonging and support within our institution and improve outcomes for our surgical trainees. In addition to mentorship, the program includes ABSITE study support, community-building activities, and informative sessions on immigration, legal and financial topics. **How else can YOU help?** - In addition to specialized mentorship, IMGs need targeted interventions for professional and personal development, such as pre-residency workshops that teach essential competencies for IMGs to excel during residency. For this reason, we are conducting a survey aimed to identify the objective and subjective measures of performance that IMGs, faculty and residents in general surgery programs can use to evaluate NDPR. If you are interested in providing your valuable input, you can find the survey in the following link: <https://redcap.bidmc.harvard.edu/redcap/surveys/?s=9HJFW9J9CK4EHXLY> References: 1. American Medical Association. How IMGs have changed the face of American medicine. Accessed May 1, 2022, <https://www.ama-assn.org/education/international-medical-education/how-imgs-have-changed-face-american-medicine> 2. Educational Commission for Foreign Medical Graduates. Match Day adds 7500 IMGs to US GME programs. Accessed May 12, 2022, <https://www.ecfmg.org/news/2021/03/19/match-day-adds-7500-international-medical-graduates-to-u-s-gme-programs/> 3. National Resident Matching Program. Charting Outcomes in the Match: International Medical Graduates. July 2020. Accessed May 12, 2022, [https://www.nrmp.org/wp-content/uploads/2021/08/Charting-Outcomes-in-the-Match-2020\_IMG\_final.pdf](https://www.nrmp.org/wp-content/uploads/2021/08/Charting-Outcomes-in-the-Match-2020_IMG_final.pdf) 4. Rajesh A, Asaad M, Chandra A, McKenzie TJ, Farley DR. Outcomes of non-designated preliminary general surgery interns: A 25-year Mayo Clinic experience. *Surgery*. 02 2020;167(2):314-320. doi:10.1016/j.surg.2019.09.013 5. Ritter KA, Anand RJ, Beard K, et al. Impact of Surgery Program Characteristics on Fate of Non-designated Preliminary Surgery Interns. *J Surg Educ*. 2020 Nov – Dec 2020;77(6):e11-e19. doi:10.1016/j.jsurg.2020.06.001 6. Sarosi GA, Silver MA, Ben-David K, Behrns KE. Training outcomes of preliminary surgical residents in a university and Veterans Affairs surgical residency. *JAMA Surg*. Nov 2014;149(11):1127-32. doi:10.1001/jamasurg.2014.2054 7. Moore RA, Rhodenbaugh EJ. The unkindest cut of all: are international medical school graduates subjected to discrimination by general surgery residency programs? Curr Surg. 2002 Mar-Apr 2002;59(2):228-36. doi:10.1016/s0149-7944(01)00644-4 ![](https://blog.womensurgeons.org/wp-content/uploads/2023/07/Torres.Carolina-233x300.jpg)Carolina was born and raised in Lima, Peru, where she completed her medical school training. She is currently a PGY-4 general surgery resident at Beth Israel Deaconess Medical Center in Boston, MA. Recently, she completed a two-year research fellowship at the Program in Global Surgery and Social Change at Harvard Medical School. She is a member of the GME council for Diversity, Inclusion and Advocacy at BIDMC, the DEI committee in surgery and the DEI Task Force at the Association for Surgical Education. At BIDMC, she leads a mentorship program for preliminary residents at BIDMC to help them secure categorical positions. Her interests include abdominal wall reconstruction, surgical education, health systems evaluation and advocacy for diversity and equity in medicine. She enjoys reading, interior design and hanging out with her dog Lucy. **Categories:** advocacy, career development, diversity and inclusion, medical students, research, Underrepresented in medicine, URiM, women --- ### [Representation in social media matters: interview with Dr. Betsy Grunch, MD, FAANS, FACS](https://blog.womensurgeons.org/representation-in-social-media-matters-interview-with-dr-betsy-grunch-md-faans-facs/) **Published:** July 19, 2023 **Author:** Blog Team **Content:** Interview by Agata A. Szulia, MD This series of interviews seeks to amplify the voices of female surgeons who are actively engaged on social media. Through sharing their perspectives, expertise, glimpses into their professional and private lives – including both challenges and moments of levity – these remarkable women contribute to creating an accurate and authentic portrayal of women in surgery. By engaging with millions of people on social media, they help to dismantle barriers for women in surgery and serve as a profound source of inspiration for aspiring and current surgeons alike. **![](https://blog.womensurgeons.org/wp-content/uploads/2023/07/Grunch.Betsy_-300x300.jpg)** Dr. Betsy Grunch is a board-certified neurosurgeon at Longstreet Clinic in Gainesville, Georgia. She received her degree in Biology from the University of Georgia and graduated from the Medical College of Georgia in Augusta. Dr. Grunch completed her residency at Duke University Medical Center in Durham, North Carolina, where she also completed her fellowship training in spine surgery. She is a fellow of the American College of Surgeons and the American Academy of Neurological Surgeons. Her main professional interests involve minimally invasive spine techniques, cervical and lumbar disc replacement, SI joint fusion, deformity correction, and advancing the field of neurotrauma. Additionally, Dr. Grunch runs successful social media accounts (Instagram, TikTok, Twitter, YouTube: @ladyspinedoc, Facebook: @drgrunch), where she has garnered over 2M followers by presenting engaging neurosurgical cases and medical educational content, promoting female medical practitioners, sharing her unique sense of humor, and showing snippets of her practice and private life with her husband, Ray, two children, Riley and Beatrice, and two dogs, Pancake and Butters. **The interview** - **Why did you choose the field of surgery, and neurosurgery in particular? Do you have a particular life or work experience that has shaped you as a surgeon?** Growing up, I wanted to be just like my mother. She was a force to be reckoned with and a true trailblazer, working as a police officer in the 90s – a male dominated field. When I was about to start high school, she was in a horrible car accident while on-duty. She suffered from a cervical spinal fracture that left her quadriplegic. In an instant, my mom went from being a very fit and active young woman to not being able to move her arms or legs at all. Following the accident, I became a certified nursing assistant so that I could help care for her. She had to go through rehabilitation and there, we were surrounded by other families in similar situations. Because of this experience, **I decided to pursue a career in neurosurgery, so that I could help people like my mother.** - **Did you encounter any misconceptions around women surgeons in your training and practice? If so, how did you overcome them?** Yes, being a woman in a male-dominated field has had its challenges because people often have implicit bias. You’re not strong enough, not knowledgeable enough, and just generally not enough. That’s not true, and **I wanted to break down those barriers**. Women absolutely can be strong enough and can certainly be just as knowledgeable, if not more. We deserve a seat at the table. In fact, a [recent study](https://pubmed.ncbi.nlm.nih.gov/29018008/) has shown that women have seen better outcomes when they are treated by a female surgeon. To overcome these challenges, I have had to always strive to be the best at what I do. That’s okay because **I want to be the best for my patients**. I’ve also had to learn how to rise above those who try to underestimate me. It’s easy to be brought down by those who are narrow-minded, but you have to **believe in yourself and trust your training**. - Is there anything that you would like to change in the field of surgery? **The stigma that you cannot have a successful career and be present for your family and friends**. I have had so many people ask me about whether it’s possible, and I always tell them yes! **It involves a lot of communication and planning, but absolutely, it is possible.** I am fortunate enough to have a partner who is a great communicator and supporter; I also rely on many others to ensure things can run smoothly both at home and at work. Additionally, I make it a priority to be home for family dinner and for my kids’ bedtime. - You spend a significant amount of time providing educational content and sharing your professional and private life on social media. What motivates you to create content for social media? I really like to use social media as a creative outlet, so it has been a lot of fun seeing what resonates with others as I play with ways to present cases, medical education, office shenanigans, home life, and more. **Many of the responses I receive are from young women aspiring to be in healthcare.** When I was going through school, it was before social media was so prevalent. I only saw what was in front of me which was a very male-dominated field. It would have been more encouraging if I had seen more people that looked like myself; representation matters. **My aim is to provide a little bit of inspiration and hope for future healthcare providers.** - What are your goals for the future? My goal is to **continue to provide patient focused and compassionate care**. I love my patients and always want the best outcomes for them. I also love educating, so I hope that there continue to be opportunities for me to impart some knowledge, whether that be through teaching new techniques to other surgeons, sharing knowledge on social media, or presenting at various association meetings. I hope to also push the envelope in advancing the positivity and inspiration on social media. - What advice would you give to aspiring female surgeons? **Know that you are worthy.** You have worked very hard to be where you are and it’s easy to give into imposter syndrome. Everyone does, but you must silence those doubts. **I want you to know that you are capable and you are incredible.** - What do you enjoy doing in your spare time? My family and I love spending time on the water. Our favorite pastimes include wakeboarding and surfing, jet skiing, and swimming. I also love watching football (Go Dawgs & Falcons), attending concerts with friends, and working out daily. **The interviewee** ![](https://blog.womensurgeons.org/wp-content/uploads/2023/07/Szulia.Agata_-201x300.jpg)Agata A. Szulia graduated with honors from the Medical University of Lodz, Poland in 2022, and is currently undergoing a post graduate internship in her home country. Since medical school, Agata has been involved in plastic and reconstructive surgery (PRS), participating in clinical and research work within her home institution as well as in Germany, Italy and the US. Her professional interests center around the breast – she is set to begin her PhD this fall at her home institution with a focus on genetic factors influencing sensation of the breast and female quality of life, and plans to apply to a research fellowship in PRS in the United States next year. She also plans to research and advance patient-centered and compassionate care for women. In her free time, you can find her out in nature hiking, running, swimming or traveling. Through her involvement with AWS, she aims to promote the importance of female representation in surgery and amplify the voices of women surgeons who are actively engaging with social media platforms. You can find her on LinkedIn (Agata Szulia), and, less formally, on Instagram (@awczapce). **Categories:** awareness, career development, current events, guest blog, leadership, mentorship, networking, resources, training, URiM, women --- ### [Power of Affirmation](https://blog.womensurgeons.org/power-of-affirmation/) **Published:** July 12, 2023 **Author:** Blog Team **Content:** By Hemu Yeluru *“You have a future in surgery…”* Six words that I never thought I would hear, and I never knew how badly I needed to hear before that night. It was 7:30 PM on a hot summer Tuesday evening on my first day of my first third year rotation: general surgery. By the luck of the draw, I got randomly assigned to cover the first 28-hour trauma call shift. I was trailing a resident on rounds when alarms blared throughout the hospital: ALPHA ALERT, ETA 5 MINUTES. The resident did a 180 and charged down the nearest stairwell; he hoisted himself up by the railings, skipping 4 stairs at a time down 6 flights. I sprinted to keep up, staying close to avoid being stranded in an unknown hallway. When we reached the ED, I stood back and studied as the trauma team danced through their well-rehearsed survey. Within minutes, we moved swiftly from the trauma bay straight to the OR. Little did I know, I would experience that tension another 4 times that night. We operated on patient after patient for the next 12 hours, each one seemingly sicker than the last. Despite the chaos, my attending carved out time to highlight key anatomy and explain his movements every step of the way. He tested my knowledge to the point where I was grasping for straws trying to imagine my cadaver from first-year anatomy lab. That night pushed me mentally, physically, and emotionally to a level I had never imagined. 7:15 AM, at the end of the last case, the attending shook my hand, looked me in the eye, and plainly stated: “you have a future in surgery” before turning around promptly to leave the OR. My heart raced one last time that night, as I swallowed his words, questioning if I had heard him correctly, but I knew he wasn’t one to mumble. That night began filled with uncertainty and dread, but I came out of it with a sense of belonging – a feeling that was unfortunately unfamiliar to me. As a first generation American, and soon-to-be first doctor amongst my extended family, my path to medicine was foreign terrain. It was not until discovering my passion for surgery did I feel at-home and supported. While self affirmation and self-confidence carried me to the doorstep of medicine, that one line of affirmation was what I needed to soar and to dedicate myself wholeheartedly to surgery. Medical students are often big dreamers, but it’s equally important to know that our goals are attainable, and to know that success will follow our efforts. Over the past year of medical school, I have been lucky to build a close-knit network of mentors who have encouraged me towards surgery, and I can only hope that all medical students have a similar support system in place. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/07/Yeluru.Hema_-270x300.jpg)Hemu is a fourth year medical student from Fairfax, Virginia. She currently attends Eastern Virginia Medical School and is applying to general surgery residency this fall. Her clinical interests include surgical critical care, pediatric surgery, and burn surgery. In addition, Hemu is passionate about medical education, education reform, physician leadership, and tackling physician burnout. She intends to pursue a career in academic medicine where she can be closely involved with resident and medical student education, as well as further her research interests in both physician burnout and quality improvement. Outside of medicine, Hemu loves to cook, read, write, sing, and kickbox. **Categories:** career development, diversity and inclusion, medical students, training, URiM, women --- ### [Making the Most of Your Research Year](https://blog.womensurgeons.org/making-the-most-of-your-research-year/) **Published:** July 6, 2023 **Author:** Blog Team **Content:** By: Charlotte Berry Research years during medical school are becoming increasingly popular, particularly among students interested in surgical subspecialties. Data support the notion that medical students who take research years are more likely to remain academically productive throughout their careers. As a student between MS3 and MS4, currently wrapping up the first year of a two-year research fellowship, I have been reflecting on what has worked well for me, the best advice I have received, and what I wish I had known when I first started. *Balance productivity and personal well-being* Compared to the structured environments of lecture halls or hospital wards, research time offers more flexibility and allows you to take leadership over your schedule. While it’s important to be dedicated to your research, do not neglect your personal well-being. Taking care of yourself will contribute to your overall productivity and happiness during your research year. When you are working, work hard. When you are not, take the opportunity to plan trips, attend special events like weddings, or visit your family. *Set clear goals and develop a plan* Define what you want to achieve during your research year. Whether it’s publishing a certain number of papers, developing specific skills, or making significant progress in your project, having clear goals will keep you focused and motivated. Collaborate with your mentor or PI to create a structured plan for your research year, outlining milestones, experiments, and deadlines. Having a roadmap will keep you organized and ensure steady progress. *Read, read, and read some more* Regardless of the lab or group you join, whether in basic or clinical science, your work will push the boundaries of current knowledge and go beyond what is covered in medical school curricula. Familiarizing yourself with seminal papers in your field will not only inform your project but also help you become acquainted with the writing process for papers related to your own research. *Plan for the podium* As a medical student, your research year will likely introduce you to academic conferences. Familiarize yourself with conferences in your field of interest and inquire about those your lab and PI would support you in submitting research to and attending. Seek advice from peers or residents on conferences known for quality research, networking opportunities, or both. Early on in your research year, take note of conference dates and abstract submission deadlines to ensure you don’t miss any important opportunities. Additionally, consider presenting your research at local or regional meetings, departmental seminars, or poster sessions. This will enhance your presentation skills, allow for feedback, and foster scientific discussions. *“The best way to publish is to write it yourself”* I received this advice early on in my research year, and I have found it to be valuable. While collaboration is crucial in the research world, it can be tempting to jump onto multiple projects and spend most of your time assisting others. However, the best way to control the pace of a project, ensure progress, and learn the intricacies of the peer-review process is to write and submit manuscripts yourself. Finding a healthy balance between first-author projects and collaborative experiences has been rewarding and fruitful for me. Remember, it is essential to be a good teammate while also protecting your limited time. *Experiments fail, you do not* Experiments may fail, but you should not be discouraged. Embrace setbacks and failed experiments as learning experiences. Seek feedback from your mentor, lab colleagues, and peers to refine your research approach and problem-solving skills. Remember, a research year is an opportunity for growth, learning, and exploration. Embrace the experience, be proactive, and make the most of this valuable time in your medical education. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/07/Berry.Charlotte-200x300.jpg)Charlotte is a fourth-year medical student from Rochester, Minnesota. She attends Geisel School of Medicine at Dartmouth and is currently taking time off between her third and fourth years to complete a research fellowship position with the Stanford Plastic and Reconstructive Surgery Department. Charlotte has an academic interest in regenerative medicine, wound healing, microsurgery, gender-affirmation surgery, and global surgery. Outside of work, she enjoys hiking, skiing, watercolor, ceramics, and medical illustration. **Categories:** advocacy, awareness, career development, education, Fellows, medical students, reflection, resources, self-care, women --- ### [Active Allyship – Beyond Rainbows and Parades](https://blog.womensurgeons.org/active-allyship-beyond-rainbows-and-parades/) **Published:** June 30, 2023 **Author:** Blog Team **Content:** By Lauren B. Nosanov, MD A few months ago, I was out to dinner with my family at a local restaurant when my 11 year-old son sighted a classmate sitting nearby. His excited wave was met with a somewhat urgent beckoning from his friend, so he ran over to chat. After a few minutes of intense, furtive discussion, he returned to the table. Unprompted, he explained that his friend was non-binary but was struggling with open communication in their home environment and was concerned about what pronouns my son might use in front of their parent. As he rambled on, I took a moment to reflect on his unwitting soapbox, notable for its simultaneous casualness and passion. His intense need to protect his friend’s right to self-identification, as well as his insistence on educating us, projected a profound respect for otherness and a deep kindness. The quest to find your sense of self, develop it, and embrace it is challenging no matter who you are. That said, it is crucial to acknowledge that a cis-heteronormative individual inevitably has a less rocky path ahead of them; to ignore this is to fail to recognize the privilege of majority. Allyship is founded in acknowledging this and seeking to support the LGBTQ+ community by embracing the value of difference. I’d like to believe I’ve always been an engaged ally, but I’ll admit that my son’s recent actions have inspired me to dig deeper into the intentionality of my approach, both in the world of medicine and in a broader community. As with any other endeavor, I believe that proactivity is at the heart of efficacy. To truly see, hear, and support our LGBTQ+ friends and colleagues requires us to: - **Learn** – It’s never too late to fill in knowledge gaps, and there’s always more to know. Ask questions. - **Be present and visible** – By all means, we can all use more parades and rainbows in our lives. But since allyship isn’t just for special occasions or the month of June, it is crucial to find ways to be engaged 24/7/365. Consider joining AOSA for a start! - **Speak up** – Don’t be a silent onlooker. Call out microaggressions, correct pronoun usage, and be a champion for diversity, equity, and inclusion. - **Teach** – We were all raised up in a “see one, do one, teach one” culture. To be a truly effective ally means educating those around us (including our children) as to how they too can rise up and be a part of the solution. Allyship must be active. It cannot simply consist of being a cheerleader at the sidelines. In Surgery, this means starting with an acknowledgement of the inequities in representation in our field. It demands sharpening our cross-mentoring skills, initiating challenging discussions, and digging into DEI initiatives locally and nationally. As a woman in Surgery it means appreciating that the lessons we have learned and the advances we have made in efforts toward gender equity have value and applicability to the LGBTQ+ community. My sentiment is best captured by the famous E.E. Cummings line: *“To be nobody but yourself in a world which is doing its best day and night to make you like everybody else means to fight the hardest battle which any human being can fight and never stop fighting”* As allies, the goal must be to see and hear others for who they are, and to join in the fight to defend each individual’s right to be themselves – not from the sidelines of a parade, but together on the battlefield. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/06/Nosanov-150x150.png)Lauren B. Nosanov, MD is an Assistant Professor of Surgery at the University of Wisconsin, specializing in the surgical and critical care management of burn and traumatic injuries. After graduating from the Keck School of Medicine of the University of Southern California she completed General Surgery residency at MedStar Health – Georgetown / Washington Hospital Center, and fellowships in Burn Surgery and Surgical Critical Care at NewYork-Presbyterian/Weill Cornell Medical Center. She is a proud ally and advocate. **Categories:** advocacy, awareness, current events, diversity and inclusion, family life, reflection, URiM, women --- ### [Paternity Leave's Incision on Gender Disparities in Academic Surgery](https://blog.womensurgeons.org/paternity-leaves-incision-on-gender-disparities-in-academic-surgery/) **Published:** June 20, 2023 **Author:** Blog Team **Content:** **Title:** Paternity Leave’s Incision on Gender Disparities in Academic Surgery **Authors:** Mayte Bryce-Alberti1,2, Rohini Dutta1,3 **Author’s Affiliations:** 1. Program in Global Surgery and Social Change, Harvard Medical School; Boston, MA, USA 2. Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru 3. Mary Horigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA, USA **Keywords:** Gender Equity, Work-Life Balance, Surgery **Corresponding Author Contact Information:** Mayte Bryce-Alberti. Program of Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115. Email: mayte.bryce.a@upch.pe. --- Academic surgery demands a significant amount of training and time commitment, with many surgeons pursuing postgraduate degrees and protected research time, in addition to completing medical school and surgical residency. The gender pay gap and disparities in surgery training can be attributed in part to the disproportionate burden of childcare responsibilities placed on women, which coincides with their fertile years and presents significant challenges for them in meeting the extensive training requirements. (1,2) *The “Mommy Tax” and the “Daddy Bonus”* Studies from other professions have consistently demonstrated that women and men are equally competitive in salary and working hours until the first child’s birth. Henceforth, women are the ones who bear the brunt of the “**mommy tax**” – the impact on income that results from leaving a job to take care of family responsibilities. In contrast, fathers benefit from the “**daddy bonus**” effect – the significant increase in income due to a perceived greater work commitment, stability, and deservingness without the actual burden of active childcare, compared to women and childless men. (3) Consequently, negotiations for more flexible hours, part-time jobs, and reduced workloads are disproportionately undertaken by women, putting them at a significant disadvantage when competing for promotions and higher pay. (4) In the academic surgical field, better-paid maternity leave policies, flexible work arrangements, and supportive workplace cultures are increasingly being implemented. (2,5) *Initiatives in Academic Surgery* While such initiatives are well-intentioned and necessary, they continue to place the burden of childcare on women by perpetuating the age-old notion that they should be the primary caregivers at home. To keep pace with successful initiatives from businesses and governments, a cross-continentally proven solution is the introduction of paid paternity leave. This policy has produced positive socioeconomic outcomes for men and women alike (6,7) by reducing the “mommy tax” through promoting and compensating shared parental responsibilities. *The Benefits of Paid Paternity Leave* Examples where this policy was implemented include the governmental laws of Japan (52 weeks), South Korea (52 weeks), and Iceland (20 weeks), as well as in private companies such as Netflix (52 weeks), Gates Foundation (52 weeks), and Morgan Stanley (16 weeks). When enacted in conjunction with fair and adequate maternity leave policies, paid paternity leave when mandated by academic healthcare institutions allows women surgeons to remain in the workforce after childbirth, increasing their active participation and retention. This ultimately leads to reduced recruitment costs, a boost in staff loyalty and morale, and increased competitiveness. These policies benefit the profession by ensuring that we retain our best surgeons, regardless of their gender. **References:** 1. Rangel EL, Castillo-Angeles M, Easter SR, Atkinson RB, Gosain A, Hu YY, Cooper Z, Dey T, Kim E. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021 Oct 1;156(10):905-915. doi: 10.1001/jamasurg.2021.3301. Erratum in: JAMA Surg. 2021 Oct 1;156(10):991. 2. McKinsey Global Institute. How advancing women’s equality can add $12 trillion to global growth \[Internet\]. McKinsey & Company; September 2015 \[cited 2023 May 17\]. Available from:[ https://www.mckinsey.com/~/media/mckinsey/industries/public%20and%20social%20sector/our%20insights/how%20advancing%20womens%20equality%20can%20add%2012%20trillion%20to%20global%20growth/mgi%20power%20of%20parity\_executive%20summary\_september%202015.pdf](https://www.mckinsey.com/~/media/mckinsey/industries/public%20and%20social%20sector/our%20insights/how%20advancing%20womens%20equality%20can%20add%2012%20trillion%20to%20global%20growth/mgi%20power%20of%20parity_executive%20summary_september%202015.pdf) 3. CUNY Academic Works. The Condition of Latinos in Education: A Factbook \[Internet\]. City University of New York; \[cited 2023 May 17\]. Available from:[ https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1034&context=clacls\_pubs](https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1034&context=clacls_pubs) 4. Acai A, Steyn C, Reid SE, Sonnadara RR. A solution to gender inequity in surgery? Better caregiving policies. Can J Surg. 2018 Feb;61(1):6-7. 5. Morrison LJ, Abbott AG, Mack Z, Schneider P, Hiemstra LA. What Are the Challenges Related to Family Planning, Pregnancy, and Parenthood Faced by Women in Orthopaedic Surgery? A Systematic Review. Clin Orthop Relat Res. 2023 Feb 27. 6. OECD. Parental Leave Systems in OECD Countries: Current Reforms and Challenges \[Internet\]. Organisation for Economic Co-operation and Development; \[cited 2023 May 17\]. Available from:[ https://www.oecd.org/els/soc/PF2\_1\_Parental\_leave\_systems.pdf](https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf) 7. The New York Times. Parental Leave Policies Around the World \[Internet\]. The New York Times; \[cited 2023 May 17\]. Available from:[ https://www.nytimes.com/interactive/2015/your-money/parental-leave-policies.html](https://www.nytimes.com/interactive/2015/your-money/parental-leave-policies.html) ![](https://blog.womensurgeons.org/wp-content/uploads/2023/06/Bryce.Mayte_-300x279.jpg)Dr. Mayte Bryce-Alberti earned her MD from Universidad Peruana Cayetano Heredia, Lima, Peru. As a Research Collaborator at the Program in Global Surgery and Social Change, she has dedicated her time to projects focused on Rwanda and the Pan American region. Her work involves strengthening health systems, surgical education, and improving access to minimally invasive surgery in low resource settings. She is an active member of the program’s Anti-Racism Curriculum team, organizing discussions, webinars, and capacity-building sessions for program members. She will be applying for the NRMP Match 2024 to train as a general surgeon. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/06/Dutta.Rohini.jpg)Dr. Rohini Dutta earned her MBBS from Christian Medical College and Hospital, Ludhiana, India. A recipient of the Women of the Future Award India in 2021, she is committed to a lifetime of empowering women through the provision of high-quality healthcare and strengthening its provision through socially conscious frugal solutions and policies. As a Global Women’s Health Fellow at the Brigham and Women’s Hospital where she is developing an educational mHealth tool for high-risk pregnant women undergoing cesarean delivery in Uganda to enhance their birth preparedness. She is currently an MPH Candidate in Global Health at the Harvard T.H. Chan School of Public Health and is applying for the NRMP Match 2024 to train as an obstetrician-gynecologist. **Categories:** advocacy, awareness, current events, family life, gender differences, parenting, professionalism, women --- ### [Even Shame Has Its Limits](https://blog.womensurgeons.org/even-shame-has-its-limits/) **Published:** June 18, 2023 **Author:** Blog Team **Content:** **Christina Georgeades, MD** “You mean every day should be shame day.” I was walking behind two of my co-residents the last month of my intern year when I heard the hurtful comment. It was Pride month, and in the professional world, I was a closeted gay resident. One of them had seen a Pride poster on the wall of the hospital hallway, and it had been heartwarming to hear her genuinely say, “Every day should be Pride Day.” But then my other co-resident responded to her with their derisive remark, the words quickly overriding her uplifting one. My heart sunk upon hearing it. Shame is something that those in the LGBTQIA+ community are uniquely familiar with, and it’s something most of us spend our lives overcoming to some degree. The words, therefore, cut deeply, especially considering I still battled with my own feelings of shame at that time. It hurt, and it was one of the first times where I feared for what the future would hold throughout the rest of my general surgery residency. There were other moments that contributed to my growing hesitance; words spoken in my presence without knowledge of my queerness – making fun of a transgender individual, scoffing at the prospect of going to the annual Pride festival, sarcastic comments about same-sex partners, and more. Would I be able to be “out” in the way that I wanted? *“Death by a thousand paper cuts”* aptly described it, and I was certainly feeling the effects. Everything started to shift, thankfully, in my third year of residency. The catalyst was a conversation with a co-resident friend over coffee. I felt comfortable sharing my fears and we discussed ways in which I could embrace being myself while avoiding potential professional repercussions. However, when the idea came up that I should perhaps consider remaining closeted throughout residency, my aversion to that notion was swift and strong, and I knew that would never be an option. Fortunately, my shame had its limits. The next impetus occurred when the Department of Surgery at my residency program started an initiative called “Cultural Complications” in 2020 that has since been routinely incorporated into Grand Rounds time. The initiative involves conversations surrounding diversity, equity, and inclusion topics, and although the sessions are data-driven, they are ultimately meant to be interactive, non-judgmental, and personal. At the end of my third year, a serendipitous email arrived in my inbox – an opportunity for a resident to help with presenting one of the Cultural Complications sessions. The topic? Being LGBTQIA+ in surgery. By that time, I had worked through a lot of my own internalized feelings of shame. However, after watching nearly a year’s worth of Cultural Complications sessions be handled with care and empathy by the department, and also having unwavering encouragement from some of my co-residents, it was ultimately that overarching support that motivated me to click “Reply” and volunteer for the session. That Cultural Complications presentation was the first time I publicly talked about being LGBTQIA+ in a professional forum. I felt empowered. Now, nearly two years later, I still feel empowered. To that point, proactive and deliberate departmental and individual faculty support for LGBTQIA+ residents and medical students is critical; I cannot emphasize that enough. Even the strongest individual can be overwhelmed by the power differential that inherently exists by being a trainee or medical student. Providing support and fostering empowerment can occur in a multitude of ways. Speak up when distasteful comments are being made. Focus on creating an inclusive culture not only among residents, but also in the department itself. Create forums for education and open, non-judgmental conversation, such as Cultural Complications. Talk to us like you would any other human being: ask us about our weekends or partners the same way you would a non-LGBTQIA+ individual. Each of these actions, among others, can help us feel less alone. Importantly, they can help us not only be the best versions of ourselves as individuals, but also the best physicians we can be for our patients. I struggle with shame far less these days, including in the professional sphere. My supportive co-residents, faculty, and program have played a critical role in that. It’s nice to feel like I can simply be *myself* in all aspects of my life, and to also know that one is never truly alone. Now when I look back on that conversation I overheard my intern year, I focus on the only remark that matters: every day should be Pride Day. Happy Pride, everyone. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/06/Christina-Georgeades_Academic-Profile-267x300.jpg)Christina Georgeades, MD, is a PGY-4 general surgery resident at the Medical College of Wisconsin in Milwaukee, WI. She is originally from Tampa, FL and graduated from the USF Morsani College of Medicine SELECT program. She is a proud member of the Association of Out Surgeons and Allies. New coffee, food, and city adventures make her happy, and she also enjoys socializing with friends, reading, and running. **Categories:** advocacy, awareness, current events, diversity and inclusion, resources, self-care, Underrepresented in medicine, URiM, women --- ### [“With Liberty and Justice for All”](https://blog.womensurgeons.org/with-liberty-and-justice-for-all/) **Published:** June 8, 2023 **Author:** Blog Team **Content:** By Alexis Moren MD,MPH,FACS The irony isn’t lost on any minority group as many of us recited the Pledge of Allegiance in elementary school: **“I pledge allegiance to the flag of the United States of America, and to the republic for which it stands, one nation under God, indivisible, with liberty and justice for all.”** Originally written in 1892 by socialist Francis Bellamey, additions such as “the United States of America”, and “one nation under God ” were added throughout the years. Written to unite the nation during the unrest of the Civil War, it’s almost comical to think that citizens of the United States felt the country, once the war was over, could truly be equal and undivided. Thousands, if not millions recite this Pledge without giving it an ounce of consideration – to this day America remains divided, subjugated, and full of inequity. Each June, we celebrate a small victory. June, otherwise known to most as “Pride” month, is a month-long recognition of the history of LGBTQ+ activism and triumphs. Although we acknowledge our successes during this time, we never forget that our community fights against discrimination, transgressions, aggression, and continued political targeting and bigotry year-round. For over 50 years cities across the world hold Pride Parades – we must not forget the foundation on which they began. The 1960’s, known as the counterculture decade, was a revolution of the American norm. Tom Wolfes’ *The Electric Kool-Aid Acid Test* although a work of fiction depicts what the era represented. Drugs were rampant, clothes were scant, music pushed suitable limits, and sexual liberation flooded the nation. The political scene was turbulent, the war in Vietnam raged, while on home soil the fight for equality heightened. Martin Luther King Jr. led the civil rights movement as freedom of expression and equality for all became prevalent. Police brutality was common, often depicted in regards to racial uprisings, but these aggressions were also common among other minority groups. In 1966, the first LGBTQ+ riots were recorded. The [Compton’s Cafeteria Riot](https://www.google.com/url?q=https://en.wikipedia.org/wiki/Compton%2527s_Cafeteria_riot&sa=D&source=docs&ust=1686579689432920&usg=AOvVaw0bsChwhCsaB8G_5YpPszSL) occurred in the Tenderloin district of San Francisco, was a riot response to police harassment of drag queens and trans-women. Thus began the transgender activism movement in San Francisco. The more well-known [Stonewall Riot](https://www.google.com/url?q=https://en.wikipedia.org/wiki/Stonewall_Inn&sa=D&source=docs&ust=1686579689436996&usg=AOvVaw0kMzPvFjB9Gw9Jg1ltWIYt) occurred 3 years later on June 28, 1969 and is often regarded as the beginning of the LGBTQ+ rights movement. When police raided the Inn, club-goers revolted bringing the violence to the streets where cis-gender and gay alike fought back. Protests grew as did support of the LGBTQ community. In remembrance of Stonewall, and to continue the fight for liberation and equality, the Eastern Regional Conference of Homophile Organizations expanded their annual picket to a “Christopher Street Liberation Day” (Stonewall Inn being located on Christopher Street). On June 28, 1970, the first gay pride marches took place in Chicago, Los Angeles, New York, and San Francisco. Celebrated in over 102 countries worldwide, awareness and advocacy of the LGBTQ+ community continues to grow. Despite often hostile environments, new Pride events continue to emerge. In the past 3 years 8 countries including Eswatini, Guyana, Micronesia, Macedonia, Angola, Botswana, St. Lucia, and Bosnia and Herzegovina have held their first Pride event. Even though the LGBTQ+ community continues to face criticism and hostility, Pride month is successful in continuing the mission it was created for; increasing awareness and advocacy, and building a community while increasing resistance. In recent years, more surgeons have felt comfortable being “out” in their respective programs and the surgical community is becoming more inclusive. [AOSA – the Association of Out Surgeons and Allies](https://www.google.com/url?q=https://www.outsurgeons.org/&sa=D&source=docs&ust=1686579689450399&usg=AOvVaw0fVkp1OoYLivq7KjFnsIs6), has played an integral part in spreading awareness and knowledge. Approaching 300 members nationally, AOSA’s education and outreach programs aim to accomplish throughout the surgical world what “Pride” has achieved universally. References 1. <https://www.loc.gov/ghe/cascade/index.html?appid=90dcc35abb714a24914c68c9654adb67> 2. https://en.wikipedia.org/wiki/Compton%27s\_Cafeteria\_riot 3. [https://en.wikipedia.org/wiki/Stonewall\_Inn](https://en.wikipedia.org/wiki/Stonewall_Inn) 4. [https://en.wikipedia.org/wiki/Pledge\_of\_Allegiance](https://en.wikipedia.org/wiki/Pledge_of_Allegiance) 5. https://outrightinternational.org/our-work/human-rights-research/pride-around-world-2022-report ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/moren.Alexis-blog.png)Dr. Moren is a Trauma, Critical Care & Acute Care Surgeon at Salem Health in Salem, Oregon and an Assistant Professor of Surgery at Oregon Health & Science University. Dr. Moren received her fellowship training in Trauma & Critical Care at the University of Pennsylvania. She completed her General Surgery Residency at Oregon Health & Science University and received her MD/MPH from St. George’s University in Grenada, West Indies. **Categories:** advocacy, awareness, current events, diversity and inclusion, URiM, women --- ### [From Sewing Circles to Mentorship Triangles](https://blog.womensurgeons.org/from-sewing-circles-to-mentorship-triangles/) **Published:** June 7, 2023 **Author:** Blog Team **Content:** By: Morgan Hopp, Anjna Kalya and Lily Foster During the summer between my sophomore and junior years of college, I completed an internship with a private practice plastic surgeon. I learned about surgery, operating rooms, staff interactions, and the inner workings of a private practice. More importantly, I solidified my understanding of mentorship. The experienced and compassionate office manager’s circuitous life provided many memorable conversations about relationships, especially with a mentor. She believed that a woman’s strength and ensuing success was instilled from the support of other women in their lives. As she pointed out, prior generations had sewing circles that provided three types of women to support the next generation’s values and future: an older woman to give her wisdom and perspective, a woman her own age to give her belonging in the current stage of life, and a younger woman to observe her own growth and contributions to the present world. I realized I had inadvertently stumbled upon my circle in college, but in medical school, I had to actively build it. In my first semester of medical school, I felt lost – just like everyone else. By the end of the semester, however, I found a mentor who went out of her way to support me: Dr. Alexzandra Hollingworth. She is an amazing trauma surgeon, a force for positive change in surgical culture and an involved AWS member. She helped me feel more grounded in this journey with our regular check-ins, guaranteed attendance to campus AWS events I co-hosted and research guidance. Second semester I was still struggling and unsure. I leaned on Dr. Hollingworth for support to become my best as a person and medical student. By the summertime, I had engaged a group of high school students and undergraduates who wanted my input about medical school and their future endeavors. As I built my “sewing circle,” my confidence in all aspects of my life grew. I attribute this professional growth to the personal support which I have renamed: the mentoring triangle. Each of us is equally proud and filled with joy to hear of our mentee’s or mentor’s success while our struggles are reduced because we are not alone. The unique distribution of life stages also limits unintended competitiveness and comparisons. More significantly, the different life stages give a sense of belonging and lineage – looking forward or backwards. I actively participate on multiple AWS committees nationally because AWS facilitates these mentorship opportunities and thus exponentially grows the success of all involved. With time, my success and confidence have grown exponentially, and my challenges are shared with my triangle. I am proud to contribute to the strength and success of the multi generations of women in my life. The significance of these relationships cannot be expressed by just me, and so these are some thoughts from my mentees: *“Medical school mentors are able to relay their recent experiences… while conveying applicable advice in a way that feels like guidance rather than instructions. I have received invaluable support from my medical school mentor as I navigate my future in healthcare” – Anjna Kalya, University of Arizona Undergraduate 2024* *“Morgan \[med student\] helped me learn to communicate with doctors formally and in a professional capacity through email and in person…The relationships between Dr. Rubin, my mentor for hospital volunteer program, and Morgan contrast through our conversations. While Dr. Rubin teaches me about his practice and his journey, Morgan and I talk about new things I will learn in college and how to navigate it. As a mentor, Morgan helps me not only with medical things but with becoming a more well-rounded and independent individual.” – Lily Foster, Xavier High School 2023* The learning curves of medical school often left me feeling lost and overwhelmed, but mentoring helped remind me how far I have grown and my current capabilities. I strongly encourage other medical students to remember you can mentor and be mentored at the same time. You do not have to be an expert to be helpful as a mentor. Overall, I am a more receptive learner because I am simultaneously a mentee and mentor. My hope for anyone reading this is you find a mentoring triangle and harness its strength as you build your own confidence and success. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/06/Hopp.Morgan.jpeg)Morgan Hopp is a MS-3 at Creighton School of Medicine Phoenix Regional Campus, class of 2025. Hopp is an active AWS member serving on both the communications and publications committee. Additionally, she loves research and is involved in multiple surgical outcomes projects at Valleywise Hospital in Phoenix, AZ. Anjna Kalya grew up in Phoenix and is a rising senior at University of Arizona in Tuscon. She is an amazing pre-med trying to learn about the realities of medical school, not just the admission requirements. Kayla has contributed to some of Hopp’s research at Valleywise Hospital. Lily Foster graduated high school this year and is looking forward to college in Chicago in the fall. Foster has actively sought out extra-cirrucular activities to explore medicine. In doing so, she has refined her professionalism skills and fortified her academic confidence. **Categories:** advocacy, awareness, career development, education, medical students, mentorship, women --- ### [Straight People Problems](https://blog.womensurgeons.org/straight-people-problems/) **Published:** June 5, 2023 **Author:** Blog Team **Content:** By Dr. Elinore Kaufman “Don’t worry, I still wear make-up every day.” A surgical resident was assigned to talk to our group of medical students about being a woman in surgery—the first of many such talks and events I have attended, and this was her opening line. I think I know what she was trying to get at. I think she was trying to say—you can be a surgeon, and still be yourself. You can be a surgeon, and still be a woman. To me, it sounded like something else. It sounded a bit more like—makeup is what makes someone a woman– like not having any on would be a sacrifice or a failure. Like you can be a woman and a surgeon, just so long as you are able to uphold the expectations of conventional femininity. When I started medical school in 2007, I had been out as queer for a decade. Not all LGBTQ+ people share this experience or the desire or privilege to be able to say the same, but I never considered not being out on any application or at any stage. I do my best to make sure that I am providing visible and vocal representation wherever I am. My personal experiences of discrimination from doctors were minor, but I was well aware of how medicine had pathologized and excluded many in my community. Entering medical school, whatl I encountered was less open hostility toward LGBTQ people, and more pernicious ignorance and invisibility. Many of my classmates, it seemed to me, and many more of the faculty, had no idea that gay people existed. They did not expect colleagues, patients, or families to be anything other than straight. Even fewer were aware that transgender people existed, or might be amongst their patients or colleagues, much less about their particular medical needs. I was shocked to find that of my class of approximately 250, only one other student was out when we started. There were vanishingly few out faculty, and so our campus LGBTQ group focused on forming connections and offering basic education. When I became a surgical resident, I did not get involved with the LGBTQ group in surgery, because there wasn’t one, and AOSA–the Association of Out Surgeons and Allies–did not exist yet. I did treasure the experiences I had with queer surgeons—my chief resident, for example, and the surgeon who I barely knew, but who was playing an all-Ani DiFranco soundtrack in the OR. In residency, I was fortunate to be at a program that had several queer residents, and we organized a series of informal get-togethers without any particular faculty or program support. I did attend any number of women in surgery events and gatherings, but I never felt quite at home. Not only because I wasn’t wearing makeup, but because so many of the concerns focused on what I often call SPP—Straight People Problems. SPP are often problems that have to do directly with heterosexuality, and heteronormative assumptions. Many are challenges related to husbands: husbands whose explicit or implicit expectations of their wives or of their lives are incompatible with being married to a surgeon. Husbands who may share tasks but do not share the mental load of home life or childcare. SPP also often focus on childcare. I do have children, and I share many of the challenges of being a “surgeon mom” with my straight colleagues. But because I am queer, I have always envisioned a wide range in how families come to be. I did not expect that because I was a woman, I would be the only or primary caregiver. My partner, endlessly patient and supremely loving, does much of the primary parenting. And I do everything I can: neither of us is surprised by needing to take responsibility at home. SPP also have to do with wearing makeup, with finding comfortable high heels, and with planning a wedding. I really, truly, understand that wearing makeup and high heels is perfectly fine. The problem comes when these are expected or required by our peers, colleagues, society, or in our own minds, and when these are assumed to be what we have in common, as women, and when focusing on these topics is seen as an automatic lever to build community among women. Queer people of course can and do wear makeup, but for me, it is my queer identity and analysis that changes and challenges these expectations, and often enough, alienates me in these spaces. AWS exists at least in part because being a woman in surgery is still not the norm. The default expectation for many is that the surgeon will be a man. The consequences are pernicious, from patients who don’t believe that we can be their doctor to gloves and instruments that don’t fit and attendings that distribute autonomy unevenly. But the converse is also true. Being a woman who is a surgeon transgresses our societal expectations of what a woman is and what she can and should do. There’s that famous trap: you can’t do the job if you don’t take charge, but if you’re assertive, you’re pushy. No one likes you, you can’t get cooperation, and then, once again, you can’t do the job. We cope with these parallel challenges with creativity, humor, grace, and frustration. But too often I find that women in surgery, and women-in-surgery-focused events and organizations also react to this marginalization by aggressively reasserting conventional femininity, and with it, heteronormativity. Women in surgery have so many shared experiences, and so many differences of identity, opportunity, and perspective, as well. When we find community and solidarity as women in what remains a male-dominated field, I hope it can be less about reasserting our ability to conform to expectations and more about creating new ones, for ourselves, our trainees, our patients, and surgery as a whole. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/06/Kaufman.Elinore.jpeg)Elinore Kaufman, MD, MSHP is an Assistant Professor of Surgery in the Division of Trauma, Surgical Critical Care, and Emergency Surgery at the University of Pennsylvania, where she does her best to bring a full and authentic self to all of her work. She is currently serving as Secretary of the Association of Out Surgeons and Allies. She lives in a house painted rainbow in Philadelphia’s Gayborhood with her partner and their 41/2 and 81/2 year old kids. **Categories:** advocacy, awareness, diversity and inclusion, reflection, Underrepresented in medicine, URiM, women --- ### [The Association of Women Surgeons National Medical Student Committee](https://blog.womensurgeons.org/the-association-of-women-surgeons-national-medical-student-committee/) **Published:** May 24, 2023 **Author:** Blog Team **Content:** By Charlotte Smith, Gopika SenthilKumar, Paulina Gutkin Fostering a community intended to elevate women medical students is vital not only for increasing representation within surgery, but also building and strengthening professional and interpersonal connections among the future generation of surgeons. The AWS National Medical Student Committee (NMSC) is a collaborative of 27 medical students from across the United States and five international regions. We are incredibly excited to introduce the [23’-24’ NMSC members](https://womensurg.memberclicks.net/assets/Resources/2023-24%20Roster%20Bios_Photos.pdf). ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Medical-Student-2023-2023-3-300x300.png) ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Medical-Student-2023-2023-4-300x300.png) The committee plans and coordinates national and local initiatives designed to engage medical students with the parent AWS organization and its values: engage, empower, and excel. Our main projects can be divided into the following categories: ***Research and Resource Development*** We use our strength as a diverse committee to brainstorm and execute research projects related to the [main mission](https://www.womensurgeons.org) of AWS. In 2022, we published our paper “[Comparison of Male and Female Surgeons’ Experiences With Gender Across 5 Qualitative/Quantitative Domains](https://jamanetwork.com/journals/jamasurgery/fullarticle/2799390)” in JAMA Surgery, generating exciting discussion on contemporary issues faced by AWS members. Several committee members also presented projects at ACS, including “[The impact of the COVID-19 pandemic on the Experiences of Female, Underrepresented-in-Medicine Surgical Applicants during the 2020-2021 Residency Match](https://journals.lww.com/journalacs/Fulltext/2022/11001/The_Impact_of_the_COVID_19_Pandemic_on_the.460.aspx).” Our committee is also responsible for organizing the Starr Research Forum at the AWS Annual Conference. We typically review over 200 abstracts to select ten medical students and ten residents/fellows to present their novel research at the conference, and provide scholarships for several under-represented in medicine (UIM) finalists. Outside of our research work, we produce a multitude of online resources for pre-medical and medical students, covering areas including getting involved with research and finding mentors. Please stay tuned for the publication of our newest resource, “Knots for thoughts”, a podcast run by our committee dedicated to helping students succeed on their surgery clerkships. ***Mentorship and Diversity & Inclusion*** One of the key goals of the NMSC is to create opportunities for medical students to find mentors that resonate with them. As such, the Mentorship Coordinators on the NMSC run a 6-month long mentorship program that pairs medical students one-on-one with a surgeon mentor. This past year, we piloted the incorporation of large group panel sessions on key topics of interest to medical students; these sessions provided an opportunity for students to meet each other, as well as a variety of other female surgeons. In addition, initiatives at the K-12 level are key for creating pipelines for students from disadvantaged/underrepresented backgrounds to not only gain exposure to the field of surgery, but also find mentors and opportunities to succeed. The NMSC helps organize day-long events for local K-12 students at the location of the annual AWS conference, and also coordinates a virtual day-of-service for students around the country to gain exposure to surgery. This upcoming year, the committee is looking forward to expanding these programs and also developing mentorship resources/opportunities for international students who have unique considerations within surgery. Our long term goal is to establish collaborations with other national surgical societies to create robust and scalable mentorship initiatives for students interested in surgery. We also are dedicated to promoting discussion related to Diversity and Inclusion, while providing space for our medical students to feel welcome and included within AWS. Our most popular project is our recurring Instagram Live series “Diverse Perspectives”, highlighting unique obstacles and triumphs of surgeons of various ethnicities at all stages of their careers. Keep an eye out for information regarding our Annual International Day of Service, partnering with URM high school students. ***Fostering Local and Regional Communities*** One of our primary goals is to expand the reach of AWS globally, as well as, strengthen the chapters that already exist. Local chapters at medical schools are a great resource for students to gather in person and form relationships with others within the institution that embody the mission of AWS. [All chapters](https://womensurg.memberclicks.net/assets/Resources/Medical%20Student%20Chapters.pdf) are in communication with regional representatives, who organize regional conferences that bring together many of these chapters and create local but accessible cohorts of AWS members. With this structure, the committee is able to strengthen relationships at the local and regional levels. This year, our goal is to improve the resources available for new and existing chapters, and create opportunities for implementing some of our more successful national events/initiatives at the local level. In addition, we hope to foster innovative spaces to share ideas between chapters/regions and build upon each others’ experiences. ***How to Support/Get Involved with The Committee*** Looking for ways to get involved or support the committee? As a medical student, we encourage you to participate in the numerous events that we organize, become involved with local chapters/regional events, and please introduce yourself to committee members at conferences! We have a webpage dedicated to medical student resources – <https://www.womensurgeons.org/medical-student-resources>. We also encourage you to apply for committee positions if you are interested in our work. As for residents/ fellows/ attendings, we are always looking for valuable speakers, panelists, and mentors! If you are interested in receiving emails about opportunities to help out the NMSC, please reach out to <awsmedstudentcommittee@gmail.com>. **Our pictures and Bios:** ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Smith.Charlotte-222x300.png)Charlotte Smith is a fourth-year medical student at UNC School of Medicine, interested in Trauma and Critical Care Surgery. Active within AWS since 2020, she is serving as chair for this year’s National Medical Student Committee. Her prior roles on the committee include Southeast Regional Representative and Research Coordinator. She is most proud of her effort coordinating the Starr Research Forum for the 2022 AWS Annual Meeting. She grew up in France before attending UNC-Chapel Hill for undergrad as a member of the D1 Fencing Team. Outside work, Charlotte enjoys medical illustrations, watching Formula 1, and supporting the Tar Heels! ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/SenthilKumar.Gopika-150x150.png)Gopika SenthilKumar is a G3 (5th year) in the MD-PhD program at the Medical College of Wisconsin in Milwaukee, and is the incoming Vice Chair for the AWS National Medical Student Committee 23’-24’. In this role, she is looking forward to supporting and encouraging the incredible initiatives organized by the committee members! For the past two years, she served as a Mentorship Coordinator within the NMSC, where she helped implement and expand an annual 6-month long mentorship program for medical students with limited access to mentors. She also helped coordinate the high school outreach event at the annual AWS conference. In her free time, Gopika enjoys trying local restaurants, painting, and working out with friends! ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Gutkin.Paulina-150x150.png)Paulina Gutkin is a fourth-year medical student at the Medical College of Wisconsin, interested in surgical oncology. She is serving as Chief of Chapter Development for this year’s committee and looks forward to working with our 13 Regional Representatives to strengthen and expand AWS chapters globally. Paulina previously served as the Midwest Great Plains Regional Representative on the committee. Raised in New York, she obtained her Bachelor of Science in Biology at Bucknell University, where she was also a Division I softball scholarship athlete. In her free time, she loves to hike, travel, and spoil her cat. **Categories:** awareness, career development, education, leadership, medical students, URiM, women --- ### [Forget About Perfectionism; Instead, Strive for Excellence](https://blog.womensurgeons.org/forget-about-perfectionism-instead-strive-for-excellence/) **Published:** May 17, 2023 **Author:** Blog Team **Content:** By Fara Bellows, MD As surgeons, we are high-level performers who expect specific results from precise planning and execution. Throughout our education, we developed a keen awareness of the requirements for a particular outcome. Some of us may have even over-prepared during our academic years in order to ensure success. The stakes are much higher when practicing medicine, and we may now strive for perfection, as we know that a single misstep can result in a devastating patient outcome. Fortunately, we remain inherently detail oriented, thorough, and conscientious when providing patient care. Sometimes, despite our best efforts, we have bad outcomes. Even a patient who undergoes a technically flawless operation can have complications. So how do we reconcile our desire for perfection in an uncontrollable world? Essentially, we must learn to comfortably co-exist with our negative outcomes and accept the fact that bad things *will* happen. The only way to avoid complications is to not operate at all, and as surgeons, this is impossible. How we handle our complications can affect our ability to care for our patients, and we owe it to them to continue to provide exceptional care. Here are some coping mechanisms we can utilize when things go wrong: - **Practice self-compassion.** Use self-talk that you would use for a friend or colleague who were in your situation. **Dr. Kristin Neff1** has wonderful resources available on this topic. - **Be present in the moment.** Try not to ruminate on possible past or future events or interactions. If you need to re-center, take a few deep breaths and notice your surroundings. Take it one step further and ask yourself whether going back or looking forward is effective or useful at that particular time. It’s unlikely that the answer will be yes. You can break the cycle of rumination by playing a favorite song, podcast or audiobook, or performing a well-loved task or hobby. - **Practice mindfulness. Use a meditation app** such as [**headspace**](http://headspace.com) to reflect on how you feel about the situation at hand and work towards having a sense of comfort with it. - **Question whether what happened was within your control or not**. If it was within your control, **what can you learn** from the experience that could improve your practice in the future? - **Look at the big picture.** Think about how many people you have already helped and will continue to help in the future. The number of negative situations you will encounter is likely a small fraction of the entirety of your career. - **Remind yourself of** **your power and capabilities**, especially if this feedback is not regularly provided by others. According to Vince Lombardi, “Perfection is not attainable, but if we chase perfection we can catch excellence.” I implore all of us to internalize this concept and to always give ourselves some grace when things don’t go exactly as planned. Fill your own cup, and it will overflow to fill others. 1. Dr. Kristin Neff. “Self-Compassion: The Proven Power of Being Kind to Yourself. Published 2015 by William Morrow. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Bellows.Fara_-200x300.jpg)Fara Bellows, MD was born and raised in New York. She obtained her BS in biology from Cornell University, where she graduated magna cum laude. Dr. Bellows then went on to obtain her medical degree and undergo her urology residency at SUNY Downstate College of Medicine in Brooklyn, New York. Dr. Bellows is currently affiliated with OhioHealth Physician Group Urology, where she practices general urology at Berger Hospital in Circleville, Ohio. Special interests include kidney stones, primary urologic cancer management and lower urinary tract dysfunction. She lives in Columbus, Ohio with her family. You can find her on Twitter @FaraBellowsMD. **Categories:** advocacy, career development, education, leadership, professionalism, self-care, women --- ### [The Identities We Choose](https://blog.womensurgeons.org/the-identities-we-choose/) **Published:** May 15, 2023 **Author:** Blog Team **Content:** By: Heather Wachtel, MD Growing up in Vermont, I had one person who looked like me – my sister. The children of a first generation Cantonese immigrant and a second generation Russian Jew, we loved the freedom of the rural countryside which our artist parents had embraced. However, when we returned to New York to visit our extended family, we alternated between eating dim sum with chopsticks in crowded restaurants on Mott Street, and celebrating the Passover Sedar on Long Island. As a result, we could protest that we were too full to eat any more in English, Yiddish, and Cantonese! Although I treasure my diverse heritage and the warm, loving acceptance of both sides of my family, to be mixed race is also to feel as though you never fully belong. As with many mixed race children raised between cultures, I learned instinctive code-switching from an early age. Code-switching involves adjusting behaviors including speech, appearance, expressions and even thought patterns, to fit in. Code-switching can be conscious or unconscious. I was one self with my Chinese family, another with my Jewish family, and a third with my peers. Yet my claim to each identity felt tenuous, dilute. College was the first community where I could define myself outside my heritage. In my diverse college class, I did not stand out. I fit in. I was just another student, with no particular effort. This was incredibly liberating. Paradoxically, this freedom led me to further explore both of my family’s cultures. I took Chinese language courses, and in-depth studies of Jewish history. I immersed myself in my life-long practice of martial arts, and I was welcomed at Shabbat at the campus Hillel house. As I learned more, I felt both deeper ownership and a developing understanding that I was not defined solely by my parents’ races. Then came medical school. Medical school is the ultimate code-switching experience. As medical students, we rotate through clinical specialties. We speak like internists when we are on medicine, we carry reflex hammers on neurology, and we wear scrubs on surgery. We emulate the people around us, trying on their identities and checking them for fit. We peer at ourselves tentatively in the mirror – is this right? Is this me? I embraced my chosen career as an infectious disease doctor, getting up early to join ID rounds, memorizing esoteric bacteria, and making flashcards of viruses, so I could recognize them instantly. I left surgery until the last clinical rotation, knowing that I had no interest, and assuming that by the end of the year I would at least have the skills to survive the grueling surgical schedule. nexpectedly, I found my people. Surgical residency is so difficult to describe to people who have not gone through it. The complete immersion, the feeling that nothing exists outside the hospital walls for days or weeks at a time. We bond with our co-residents, the people who know to groan about the blown IV, who laugh at the same jokes, who mourn with us over our patients. Ironically, residency was also the first time that I was aware of being treated differently based on my gender, where “woman” was appended as a modifier of “surgical resident”. I fell back on old instincts to blend in. Talk the same as the men. Walk the same. Dressing the same is easy when we all wear a literal uniform! Yet these comfortable old code switching habits fail to capture the essence of surgery. To be a surgeon is to always strive to excel, to push for technical excellence, to take the best care of our patients, to teach our trainees, to advance the field. Not to blend in, but to blaze the next trail. In a way, being different is actually the quintessential essence of surgery. As surgeons, we share an identity and purpose which supersedes race and sex and all the other categories by which people are classified. Each of us has had experiences in life where we don’t fit in, or feel that we lack ownership in an identity. Each of us has multiple selves and multiple communities. Yet on Match Day, we each chose to be surgeons, to define ourselves by what we do rather, than how we were born. Every day that we come to work, we renew that same choice. **![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Wachtel.Heahter.jpg)Heather Wachtel, MD, FACS** is an Assistant Professor of Surgery and Associate Program Director of General Surgery at the University of Pennsylvania. Dr. Wachtel completed her undergraduate work at Harvard University and received her MD from the Yale School of Medicine. She completed residency training in general surgery at the University of Pennsylvania prior to fellowship at the Massachusetts General Hospital. An endocrine surgeon, Dr. Wachtel’s translational research program focuses on the genomics of adrenal tumors and the development of novel targeted therapies for pheochromocytoma and paraganglioma. **Categories:** awareness, diversity and inclusion, reflection, URiM, women --- ### [THE MATCH EQUATION: AN IMG'S PERSPECTIVE](https://blog.womensurgeons.org/the-match-equation-an-imgs-perspective/) **Published:** May 11, 2023 **Author:** Blog Team **Content:** by: Anjani H Turaga, IMG The day starts at 5 am on an unusually cold morning in Los Angeles, where we see our protagonist, an IMG (International medical graduate) brushing her teeth furiously, trying her hardest to pay attention to the video lectures playing in the background, all while checking her clock to make sure she has enough time to reach the hospital before her preceptor. The physical exhaustion that comes with having only a few hours of sleep is overwhelming, yet she remains focused on her goal: matching into a residency program in the United States. While at first glance, the scene above seems overwhelming, it is a reality that every medical student, irrespective of their location, experiences in the year leading up to the Match. Our protagonist’s journey is made more complicated, however, with her decision to to pursue a surgical residency program as an IMG. The uphill battle that IMGs face in securing a residency position in the United States has been well documented (1), but what hasn’t been written about in such detail is that the path to matching into residency is very mathematical. For IMGs especially, understanding this “Match Equation” is essential. This equation isn’t our typical quadratic formula, nor is it a logarithmic one. It is a process, simplified into a formula, that involves a plethora of factors – some in the student’s control, others not so much. The higher you score on this formula and the more factors you possess, the more achievable the dream of being a surgeon becomes. Our protagonist aims to break down each of these factors, and provide some much-needed insight on what an IMG should focus on to succeed in the Match process. Let’s start with the first factor- academic performance. The United States invites medical students from all over the world to participate in their residency programs and to practice as a doctor in their country. While each country has its own medical curriculum, the education process is unique to the region, hence it’s understandable why the common benchmark of the USMLE is considered to be an important academic gauge. Scoring well on the USMLE not only shows that an IMG has the knowledge necessary to practice medicine in the United States, but it also demonstrates their dedication to their craft. Despite this, there might be several reasons why a student might not fare well on their examinations, and that makes the process more daunting. But, all is not lost. Other factors exist to help balance out any shortcomings in academic performance. One common misconception that a lot of IMGs face is that it is entirely possible to match into the United States for a residency without ever stepping foot in the country. However, when program directors were asked what they considered the most important factor in ranking residency applicants, clinical experience was voted the highest.(2) By way of common sense, it would only be fair that program directors would want to see that an applicant has some exposure to the healthcare system in the United States, and understands its nuances. For IMGs, this is a great way to be acquainted with the system and its intricacies, and to maximize their chances of success once residency begins. These clinical experiences often translate into letters of recommendation being given at the end, which makes the person reading them aware of how the student behaves in a clinical setting and what skills they bring to the table. When IMGs focus on the above two factors and combine them with the extra edge that a research experience or an additional degree such as a MPH brings, it can significantly boost their chances of matching into a residency program. A research experience does not mean that an IMG must have a breakthrough or a discovery published in a prestigious journal, rather it is important to show how their experience has made them adept at critical thinking and to demonstrate that they have the ability to contribute to a larger scientific community. Most university programs value the ability of an applicant to bring a research perspective and the skills required for it are easily transferable to a clinical setting. If an IMG goes the extra mile and is able to have a few papers published by the end of his research position tenure, those stand out as extremely positive points when an application is being reviewed by the Program directors. A doctor used to be called the greatest benefactor of mankind- and that still holds true today. Residency programs look for candidates who are in this profession for the right reasons and who are passionate about making a positive impact on the health and well-being of their patients. It is because of this reason that volunteering experiences are held in high regard on an application. Volunteering experiences show program directors that the applicant values service over personal gain and that the applicant has a larger goal of improving the lives of others. This entire process translates to a commitment stretching over a year, which most IMGs begin during their final year of medical school. Programs look for applicants they believe have additional work experience in their resumes. These experiences translate into showing how a student’s interests and passions extend beyond their academic work, which is crucial in the medical field where patients are not just numbers to be checked off on a chart but real people with real needs. Even when all of the above criteria have been met, additional elements that are often out of the control of IMGs can be a factor. A strong, professional personal statement, which is carefully worded to showcase the student’s strengths and skills, might look desirable to a few program directors, while an emotional, personalized, and heartfelt one might appeal to others. In addition, having an outgoing personality and excellent communication skills can be an asset during the interview process, especially during interviews which are conducted online as seen post-pandemic. It is often recommended to have mock interview sessions with family or seniors to help overcome the initial nerves associated with the process. A sad but often present factor, especially in surgery residencies is the student’s gender, which can sometimes be a limiting factor due to old-fashioned biases and stereotypes perpetuated in certain programs. When you succeed at all the above factors and work hard to excel in each of them, the likelihood of matching into a program increases significantly. For IMGs, this can mean: **Strong Academic Performance + Clinical Experience + Research Experience + Volunteering Experience + Add. Work Experience + Well-Written Personal Statement + Exuberant Personality/Communication Skills** **=** **Increased Chance of Matching into Residency** Even though it may seem daunting, and the road very uncertain at times, with perseverance, dedication, and a focus on the factors mentioned above, IMGs like our protagonist can have a successful, fulfilling career in medicine and make a positive impact on patient care in the United States. References: 1. <https://www.nrmp.org/wp-content/uploads/2023/03/Match-Rates-by-State-Specialty-and-Applicant-Type-2023.pdf> 2. <https://www.aamc.org/media/58896/download> ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Turaga.Anjani.png)Anjani Turaga is a humble medical student pursuing a career in general surgery, aiming to specialize in trauma surgery. As valedictorian of her class, she exemplifies a dedication to academic excellence. Additionally, Anjani Turaga founded The Health Herald, an independent medical magazine, showcasing her entrepreneurial spirit and commitment to sharing healthcare information. Her passion for research is evident through her published work in esteemed medical journals and presentations at national conferences. Her achievements contribute to her pursuit of knowledge and desire to improve patient outcomes as she enters her general surgery residency. **Categories:** advocacy, awareness, career development, diversity and inclusion, global surgery, medical students, residency, URiM, women --- ### [Finding Myself: A Korean-American Adoptee’s Reflections on Identity, Loss, and Purpose](https://blog.womensurgeons.org/finding-myself-a-korean-american-adoptees-reflections-on-identity-loss-and-purpose/) **Published:** May 8, 2023 **Author:** Blog Team **Content:** By: Elizabeth Lilley, MD, MPH Many people are surprised to learn that I am both a surgeon and a palliative care doctor. Although the number of surgeons pursuing fellowship training in palliative care continues to grow, it remains a rare combination, with fewer than 100 American physicians carrying dual board certification in surgery and palliative medicine. For me, this dual professional identity is rooted in my heritage as a Korean-American adoptee. I left a foster home in Korea – the country of my birth – when I was three months old to join my new family in America. Growing up, my dual identity as a Korean daughter to white American parents felt natural and right, and also led to some confusion. As a young girl, I once used modeling clay to sculpt myself a Caucasian nose so I could look more like my mother. On the other hand, when I was with my Asian friends my outward appearance blended in, but I could not fully relate to their experiences growing up in Asian American homes. Despite belonging to two worlds, I sometimes felt like an outsider in each. Over the years, I have met many other Korean-American adoptees. We shared a common background, so there was never a need to explain. Through these friendships, I found myself. When a dear friend was diagnosed with advanced cancer and died far too young, it sent a shockwave through our small community. I was 18 at the time, and will never forget when he called and told me that the chemotherapy had not worked and he was starting hospice. Weeks later, he died at home surrounded by family. Through this devastating loss, I began a path that led me to my career in surgical oncology and palliative care. During medical school and residency, I kept this memory in my heart as I cared for patients with cancer. My goal has always been to provide care to patients and their families, regardless of whether a cure is possible. And so, after finishing my surgical residency, I was excited to complete a fellowship in hospice and palliative medicine. Although I knew that not all surgeons were comfortable and familiar with palliative care, it had never occurred to me that not all palliative care physicians would feel comfortable and familiar with surgeons. Before long, it was clear to me and everyone else that my identity – my tribe – was firmly rooted in surgical culture. Although I was welcomed and wanted in the palliative care community that had adopted me, I was also representing foreign people. An early lesson in communication from my palliative care faculty involved switching from using “but” to “and also.” For example: - “Mrs. Smith has been adamant about getting more treatment, *but* she has had multiple hospitalizations with infectious complications.” - “Mrs. Smith has been adamant about getting more treatment, *and also* she has had multiple hospitalizations with infectious complications.” It is a small change that allows space for seemingly conflicting ideas to be equally valid and important. A patient can simultaneously want more treatment and be greatly suffering from it. In surgery, we so often deal in absolutes. We strive for precision and perfection. The cancer is resectable or unresectable. The margin is positive or negative. But in palliative care, we need to make space for uncertainty and complexity and contradiction. The lessons of my childhood, embracing and integrating the many aspects of my identity, are echoed now. I am an orphan from Korea. I am a daughter to loving American parents who do not look like me, but share my heart. I sit in quiet sadness with those who are facing their own mortality. I use my hands to cure cancer. Rather than let these many sides of myself come into conflict, I draw insights and inspiration from all of them to become the doctor and person I am today. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/05/Lilley.Elizabeth.png)Elizabeth Lilley, MD, MPH is a surgical oncology fellow at The University of Texas MD Anderson Cancer Center. She received her undergraduate degree from Lafayette College, her master’s degree in public health at the Mailman School of Public Health at Columbia University, and her medical degree from Rutgers Robert Wood Johnson Medical School. She began her General Surgery residency at Rutgers, then transferred to Brigham and Women’s Hospital to complete training. She did fellowship training in Hospice and Palliative Medicine at Massachusetts General Hospital and Dana Farber Cancer Institute. Following this, she began a surgical oncology fellowship at the University of Texas M.D. Anderson Cancer Center where she is currently in her final year of training. Next year, Dr. Lilley will join the staff at Brigham and Women’s Hospital and Dana Farber Cancer Institute, where she will specialize in sarcoma and melanoma. Her research focuses on the palliative care needs of surgical patients. **Categories:** awareness, diversity and inclusion, Underrepresented in medicine, URiM, women --- ### [A Weightlifters Guide to Fitness during Medical Education](https://blog.womensurgeons.org/a-weightlifters-guide-to-fitness-during-medical-education/) **Published:** April 26, 2023 **Author:** Blog Team **Content:** **By Sophie Hockran** Two years into medical school, and I have learned a lot, as expected. Many who have come before me know the feeling of learning so much information that your brain may explode. Being the first physician in my family, I was truly not prepared for this amount of information. I thought I was prepared, but it is hard to know before doing it. I think I need to make it clear that I am not just talking about the information from lectures, labs, and clinics. It is the hidden curriculum. Moving away from home, handling interpersonal relationships, finances, research, leadership, volunteering–the many arms of being a medical student and surgical hopeful, all create a unique set of challenges. The most important thing that I have learned is to hold onto the things that bring me joy. Coming from a collegiate track and field career, I have leaned heavily into health and fitness. I started a journey in Olympic Weightlifting the exact week I start medical school. I didn’t have an exact reason why, there was just something about it that felt right in the moment. Many called me crazy and questioned if I would be able to keep up with the rigors of medical school while continuing to train my body at a high level. Two years later, it is one of the best decisions that I have ever made. Throughout the countless hours of studying, training, researching, and more, I have grounded myself in my physical fitness. In doing so, I want to give advice to any incoming or current surgical hopeful who is looking to do the same. I have made a list of the five keys things I wish I knew before starting a new fitness journey while in medical school: 1\. Trust your body Medicine is a demanding field. We learn meticulously about the human body. Every inch of anatomy is studied in order to broaden our understanding of its function and purpose. Much of the time, this can come at the expense of our own mental and physical health. This can be a challenging thing to tackle when starting a new fitness journey. As we pursue this career, there is an unwritten expectation to push hard, study longer, and to just keep going. This can do one of two things: either transfer onto every other aspect of our lives or the complete opposite. When looking to start a fitness journey, it is important to recognize where you fall on that spectrum. If you are someone who likes to live all aspects in the push-harder mentality, a vital consideration to make in your fitness journey is to listen to your body. Take a moment to pause and listen to cues on when you need rest. It is an important piece that can be hard to swallow, and sometimes it is important to stray away from the plan to allow yourself time to recover. For those that may lean further away from that push-harder mentality in your life outside of medicine, it’s just as important to take this in as a factor. If you are considering a fitness journey, there is likely a reason. Medicine consumes a great deal of time and energy, so the thought of an additional outlet is not something to take lightly. Pursue that feeling, and don’t be afraid to add this to your commitments. Health and fitness can be as much of an outlet as you let it be, and it’s a different journey for each and every one of us! 2\. Be flexible Medicine can be unpredictable no matter the specialty, but that unpredictability heightens in surgical fields. Many people look at fitness as a large time-consuming entity that lies in front of them. Those thoughts are completely understandable. The way many dive into health and fitness, and how it is portrayed on social media it can be made out to seem like an entire additional career. When it comes to a personal plan for health and fitness, it doesn’t need to be made to fit the mold. In medical education, your weeks are constantly changing and every day can look a little different. Make sure to find a healthy relationship with a changing schedule and a changing program. Some weeks, it can look like four perfectly scheduled workouts and others can be two ten-minute walks after work while still wearing your scrubs. The most important aspect is you did what you needed and sometimes what you needed is not the plan you had written at the beginning of the week. 3\. Fuel your mind and your body Up until this point in this list, it has all been about scheduling. Figuring out when to work out, when to rest, etc. Along with a fitness journey comes a new relationship with food and fitness. As students, you learn about the demands your body has when it comes to energy. As you begin to transform the way you spend that energy, those demands increase. Medical education is fast-moving and can cause lapses in time to properly fuel yourself. When starting this journey, make sure you come up with a plan not only to continue to fuel your mind with all the information, but also to fuel your body as that is an important piece to your educational and physical journey. 4\. Get creative There will be days, that we know all too well, you’re stuck in a lab, class, or a rotation every day, all day for the whole week or weeks, and there is simply no time to stick to your fitness plan. Some weeks, it can be just a rest day and that may be what your body is asking for but in others, your body just wants to move. This is when creativity shines. Find times in your day to do something active. Find new and low-commitment ways to continue to move your body even outside of the gym. Whether it’s a ten-minute yoga flow on youtube or a walk around your town listening to a systems lecture, all exercise is good exercise. 5\. Give yourself grace The single most important thing I have learned from being on this journey is to give myself grace. Medical education is difficult, time-consuming, and draining. For me committing to a sport like weightlifting also came with long training sessions, aches, pains, and post-meet expectations. It is beyond important that I remind myself that what I am doing is difficult. I simply can’t be at my best every time I walk into the gym. If you are looking to start a journey into fitness while in medical school or residency, remember to give yourself grace. What you are doing is a difficult thing and adding a fitness journey is supposed to be fun, stress relieving, and a chance to better yourself even further. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/04/Hockran.Sophie.png)Sophie Hockran grew up in the small town of Andover, Ohio. She completed her Bachelors in Neuroscience at the University of the Sciences in Philadelphia. During that time she competed as a track and field thrower. She is a currently a second year medical student at Campbell University School of Osteopathic Medicine in North Carolina. She competes with the national weightlifting team 1Kilo and is capitilizing on that stress relief during her board prep. She has served as a member of the AWS IG Subcommittee for the last year. She is passionate about pursuing a career in general surgery with specific interests in global surgery. She also has interests in health policy and advocacy. You can find her on IG and twitter: @shockran99 **Categories:** awareness, health, medical students, residency, self-care, women --- ### [How an Arab American Made It to a Surgical Residency](https://blog.womensurgeons.org/how-an-arab-american-made-it-to-a-surgical-residency/) **Published:** April 19, 2023 **Author:** Blog Team **Content:** By Shadin Ghabra, MD As an Arab-American female of Syrian descent, who lived in the Middle East, applying to medical school was a no brainer. I grew up in a household that believed knowledge is the essence of female empowerment and strength. I had the full support of my family when I decided to go into general surgery. After applying to different programs, I was thrilled to find out I was accepted into the top residency of my choice. I believed that I would finish my surgical training in the Middle East, obtain my boards, and practice within the area. It wasn’t until the end of my PGY-4 that surgical oncology turned into this unmaintainable passion. It felt like the right fit, but no decision goes without consequences. Surgical oncology with all its complexity obviously required a fellowship. The fellowship that I was looking for was nowhere in the vicinity of the region I lived in. Although I am proud to say that I am the first female surgeon in my family, I felt as if my once ‘shiny and bright’ dream now looked very mediocre. Yes, I wanted more! **Sometimes, dreams evolve, and that’s okay.** I was now at a crossroad to make *the hardest* decision that I have had to make in my adult life. Do I stay in my comfort zone, and finish my current residency, not pursuing a surgical oncology fellowship? Or do I move back to the US, knowing that this dream probably came at the price of repeating a general surgery residency? Were the decisions made to evolve my path too late in the game? I completed my chief year and took my board exam. I resigned from my junior attending job that I had accepted and packed three large suitcases with all my possessions. Within six months of being a chief resident, I found myself in Houston, TX. I just started a new research job, had many unanswered questions, and with no idea how the future was going to unfold. What have I done? I had completely and utterly thrown myself into the unknown. **It’s a marathon, not a sprint.** I knew that applying to a general surgery residency in the US was not going to be an easy task! Well, there had to have been something in my favor. I was, after all, an applicant who was fully trained. That had to be a good thing, right? But wait! I *am a fully trained surgeon*. From my experience during interview season, that fact was a double-edged sword. I was an older applicant and an international medical graduate (IMG), nonetheless. It was constantly the elephant in the room during interviews, addressed over and over. Some interviewers were curious to understand my reason; others, doubtful of my ability to do it all over again. I stayed true to myself and soared across hardships, maintained honesty, and told the truth when aske*d. I did not and would not back down.* Fast forward to the present after many sleepless nights, today I sit here writing this as an upcoming PGY-4 general surgery resident in the US who matched into her top choice. I am currently in a surgical oncology research fellowship, on my way to becoming the surgeon I envisioned myself to be. I am proud to be the first Hijab-wearing research fellow at my program. I never thought that life would take me on this journey, and I never knew that I would have been lucky enough to have my dream come true, not only once, but twice. This experience showed me that being brave comes in many shapes, and has without a doubt humbled me in many ways. **Yes, the journey matters, but so does the destination!** Courage is in all of us and will emerge when we need it to. To anyone reading this, continue to believe in yourself. It doesn’t matter where you start from. Dream big, and once you start believing in yourself, others will too. Have the courage to start from scratch, and from there, the possibilities are endless! ![](https://blog.womensurgeons.org/wp-content/uploads/2023/04/Ghabra.Shadin.png)Shadin Ghabra is currently a Surgical Oncology research fellow at the National Cancer Institute (NCI), National Institutes of Health (NIH) in Bethesda, MD. Her research focuses on liver immunology and immunotherapy in hepatocellular carcinoma. She is a general surgery resident at MedStar Georgetown University Hospital/Washington Hospital Center in Washington, DC. Shadin received her M.D degree from the University of Sharjah, United Arab Emirates. After graduation, she then completed an ACGME accredited 5-year general surgery training program obtaining the Arab Board of Health Specializations for General Surgery (ABHS-GS) from Tawam Hospital in affiliation with Johns Hopkins Medicine, Abu Dhabi, UAE. Shadin worked as a research fellow at Houston Methodist Hospital, division of Minimally Invasive Colon and Rectal Surgery in Houston, TX. She also completed a post graduate High-Impact Cancer Research program at Harvard Medical School, Boston, MA. - Email: <shadin.ghabra@nih.gov> - Twitter: @ShadinGhabra\_MD **Categories:** diversity and inclusion, medical students, residency, URiM, women --- ### [To Do’s Before Starting Residency](https://blog.womensurgeons.org/to-dos-before-starting-residency/) **Published:** April 10, 2023 **Author:** Blog Team **Content:** By Alyssa Brown Congratulations are in order for the many new women surgeons that will be joining our ranks as interns next year! Last year, I felt like time flew by between opening that envelope and starting intern orientation. The finish line of my intern year is in sight, and looking back now, there were so many things I wished I had or hadn’t done. Here is my unofficial guide to getting ready for residency. - Do not study! This is one of the last times you will have time that is completely yours. You should not worry yet about how to study for next year or try to review for residency. The time will come for in-service exams, but that time is not now. - Update your CV This is very lame to do, but it is important. It is helpful to start residency with an up-to-date CV. It takes time, but it is better to spend the time now getting organized than to wait until residency when you have less time overall. It should be fairly straightforward to translate some of the ERAS data from residency applications. - Find a primary care physician and/or therapist From personal experience, it can take a while to get into a new doctor’s office. This can be made even more tricky if you have daily medications that you need. Ask some of the residents in the program if they recommend anyone, and once you have your new insurance information, you can start to establish care. Often, with insurance and location changes, it can mean changing therapists/mental healthcare providers. You can talk to your therapist to see if they can continue to see you virtually, if not, it is good to look up options in your area or through the GME office. - Say goodbye to mentors Your mentors want to know where you matched, so make sure you update them! It is a great time to see them before leaving for residency and to pick their brains on if they know any people in your new department. They can also give tips and tricks for residency. - Finish off projects If you have any papers or research to finish, it is a good time to complete these and get them submitted. These things can take time, but they can easily be lost and forgotten if you leave it until residency to pick up again. - Complete all the paperwork! I know this is the most annoying part. Our program coordinator called me on Match Day to ask for my social security number, and I was so worried that I gave her the wrong one! The paperwork, emails, and training sessions can seem boring and exhaustive, but the faster you get them done, the better. It can sometimes take a long time to complete and work through the bureaucratic system, so being on top of things really will pay off. - Enjoy your time! I know I just listed a bunch of mundane tasks, but this is the most important one. Read all the books you have been meaning to read, go sit in the sun, go on hikes, see your friends and classmates, spend time with your family, go on vacation—do whatever will make you happy. This is one of the last times you will have complete and total free time, so use it. I remember how stressed I was to start intern year. I wanted to fast-forward from March to July, but I am glad I didn’t and couldn’t. I read around ten books I had been putting off, played golf with my dad, spent a few weeks in California with my partner, cried saying goodbye to many people and the town I loved, but it was worth it. Medical school is a time that you will not forget. You will see many of your friends and classmates again, but with residency, it gets harder. You will find them in Facetime chats from call rooms and group chats attempting to find a weekend that everyone was free.. Also, it is okay to be scared. I was terrified last year. I was worried that it may not be the right program, that everyone would hate me, that I wouldn’t make friends, and the list goes on. It is okay. It is okay to be nervous and to feel the full range of emotions about this experience. No matter what I tell you, you will still be nervous, but it won’t be long until you will be an intern. Until then, enjoy the time while you have it. Go make some memories. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/Alyssa_Brown_HeadShot.jpg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She just started her fourth year back at Louisville (clearly). Her thesis research is on diaphragm muscle mitochondrial function and morphology. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past two years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram @Alyssa\_b\_futuremdphd and on Twitter @Alyssa\_B\_MDPhD. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, awareness, career development, education, medical students, residency, self-care, women --- ### [Diversify Ourselves](https://blog.womensurgeons.org/diversify-ourselves/) **Published:** March 29, 2023 **Author:** Blog Team **Content:** By Dr. Chantal Reyna How well would you handle not being able to perform surgery anymore? The real question is “How much of your identity is based on being a surgeon?” We tend to define ourselves by our professions. Our profession has been a large part of our identity. We have dedicated our formative years to this profession. When we lose our profession, we lose a part of ourselves. It is a void; it is a hollowing. How can we put ourselves in a position where we still recognize ourselves if we lose a piece of our identity? Resilience is the answer. Resilience is flexibility. Resilience is adapting to unexpected changes, stressors, or adversity. Resilience is strengthened by diversifying ourselves and can be learned. We are the sum of many parts. Think about jigsaw puzzles or impressionist artwork. Each individual piece combines and interacts to build a structure that is more than the sum of its parts. These pieces can be combined in different ways to create infinite unique configurations. These designs can be so solid that the structure will still stand strong even when removing one piece of it. This is what it means to diversify yourself to build resilience. As Linville described, identity (your personal puzzle or painting) is compiled from many self-aspects (work-self, community-self, relationships, home-self, etc.) or pieces that come together to make the whole. We even describe ourselves differently depending on which self we are at the time. Work-self may be reliable. Community-self may be giving. Family-self may be compassionate. This goes beyond work-life integration. The more numerous the pieces, the more self-complexity is present and the more resilience we will have. Take away one part of a jigsaw puzzle or one dot from the impressionist painting, and we will still see the overall picture: ourselves. How do we begin to diversify? It is an active choice. It is choosing to increase the number of self-aspects. Decide on a new self-aspect and repeatedly do an activity to reinforce it. Are there any old hobbies to rediscover? Are there new ones that have yet to be tried? Create a meaning, purpose, or goal for each newly chosen aspect to provide guidance, courage, and motivation to grow and maintain it. For example, if you add a marathon runner to your self-aspects to improve physical fitness, you might train by repeatedly running longer distances to build endurance. If you want to become an avid reader to understand literary references, it might be reading one chapter a night. Diversifying yourself is purposefully increasing the number of self-aspects and creating them through repeated action to lay the foundation for the new identity. It can be challenging to identify entirely new aspects, so we can also start with diversifying broader categories: self, relationships, and career. Self: Improving self-awareness and recognizing core values can guide which self-aspects would provide internal validation and fulfillment. Self-aspects such as being a volunteer, musician, or anything that aligns with your core values will provide fulfillment. Relationships: These are the support networks from family, friends, and co-workers. These can be separate networks. Just as you have a community self, a work self, etc., there can be friends from work, yoga, or college friends. Just as more than one mentor cannot fulfill all needs, the same is true for relationships. Rarely is one relationship sufficient to fulfill all different areas of support. These can be expanded through new activities. Career: Besides surgery, we can expand these roles by taking leadership positions or obtaining second degrees. When performing surgery, we have back up plans. Smae operation but different approaches when challenges arise. The same should be with careers. We can investigate related but similar fields, such as coaching. We can add research to our repertoire. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/AWS-blog-pic-3-2023-298x300.jpg)We are more than our profession. I am a world traveler, an avid book reader, a musical fan, a wife, an aunt, a friend, a mentor, and a surgeon. We are ingrained from our first interactions that our profession is our sole identity. How often have you asked someone or been asked, “What do you do?” This typical icebreaker question instills that our sole identity is our profession since the responses are “I am a thoracic surgeon” or “I am a vascular surgeon.” But that is not all we are. I’ve started asking people on new encounters a different variety of questions. “What activities do you enjoy doing?” “What type of activities do you enjoy outside of your work?” If asking about their work, I try to use “What is your occupation?” I have tried to rephrase the questions to avoid the implication that our sole identity is our profession. I have also tried to change my own response. “I work at X as a breast surgical oncologist.” It takes effort on both sides. I only recently started my journey to increase my self-aspects further to diversify and build resilience. I look at literature outside medicine, where resilience and diversification have been discussed in other fields for decades. I am a surgeon and grateful to be able to care for others. That is one piece of the whole. Who am I? “I am Chantal: world traveler, musical aficionado, wife, Hispanic, daughter, surgeon.” References: Linville PW. Self-complexity as a cognitive buffer against stress-related illness and depression. J Pers Soc Psychol. 1987 Apr;52(4):663-76. doi: 10.1037//0022-3514.52.4.663. PMID: 3572732. <https://betterhumans.pub/if-you-want-to-be-more-resilient-diversify-your-identity-1ad2211983ec> <https://medium.com/the-ascent/how-to-build-resilience-with-diversification-94c3cc7ee151> ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/reyna-213x300.png)Dr. Chantal Reyna is a fellowship trained, board certified surgeon, specializing in diseases of the breast. She currently serves as the Medical Director of the Breast Program and Chief of Breast Surgery at Crozer Health and will become the Section Head of Breast Surgical Oncology at Loyola University in Chicago. Her research interests include minimizing axillary surgery and male breast cancer. She is an active member and holds several committee positions in the Society of Surgical Oncology, the American Society of Breast Surgeons and the Association of Women Surgeons. She is an avid soccer fan and enjoys reading and traveling internationally. **Categories:** advocacy, awareness, career development, diversity and inclusion, family life, health, leadership, reflection, self-care, Underrepresented in medicine, URiM, women --- ### [Closing the Gap: An Interview with Dr. Adela Casas-Melley](https://blog.womensurgeons.org/closing-the-gap-an-interview-with-dr-adela-casas-melley/) **Published:** March 22, 2023 **Author:** Blog Team **Content:** By Ellen Basile, DO; Adrianna Gatt, MD; Laura Merlano, MS-III Leadership and pay gender gaps are current and necessary topics for women in medicine. Recent studies have shown a pay difference of up to $2.5 million between male and female physicians over a career amongst surgical specialists, and only 7% of U.S. surgical department chairs are occupied by women based on a 2020 study. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461563/> <https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2021.00461> Why women may lag professionally is the focus of many studies; reasons cited include gender bias, family obligations, and lack of support. In January 2023, we interviewed Dr. Adela Casas, Chair of the Surgery Department and Surgeon-in-Chief at Nemours Children’s Hospital in Orlando, to discuss her journey in medicine, her rise in pediatric surgery, and academic leadership. <https://jamanetwork.com/journals/jamasurgery/fullarticle/2769902> <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461563/> Dr. Casas immigrated to the United States with her parents from Cuba at four years of age. By the time she was eight years old, she knew she wanted to be a physician. She became the first in her family to graduate college and credits her parents with the ambition. Her father told her, “the only thing people cannot take from you, is your education.” She told us getting accepted to medical school was a challenge. Though *“*everything seemed to fall into place,” she expressed thoughts of unworthiness and being “out of place”. She felt she had to work harder to ensure her grades matched or exceeded her peers. The literature suggests that women struggle with imposter syndrome and self-doubt throughout their careers. <https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749264> Many successful leaders, however, can persevere through adversity, as Dr. Casas so clearly did. She told us, *“*I don’t think I would change anything. The things that have been bumps along the road have gotten me to where I am right now.*”* After graduating from The Medical College of Georgia medical with distinction, she completed her general surgery residency at The Medical College of Georgia, and a pediatric surgery fellowship at St. Christopher’s Hospital for Children. She highlights the importance of her mentors and sponsors during her journey. The literature suggests that mentor and sponsorship may be critical to career advancement, particularly for female physicians. Gender Gap: A Qualitative Study of Women and Leadership Acqu… : Anesthesia & Analgesia (lww.com) <https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789909> One of her early mentors, Dr Robyn Hatley, told us “as a fourth-year medical student, she was better than my residents,” and she had a “heck of a good work ethic*.*” A notable aspect of her story includes being gainfully employed during medical school and moonlighting as a resident. One attending during residency took notice of her extra hard work, and provided support by loaning her a large sum of money. This sponsorship provided her the opportunity to focus solely on her fellowship, without additional duties. Sponsors do not typically put their own money on the line, but they do actively support recipients in moving them forward in their careers and making opportunities happen. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541787/> Dr. Casas began her career as a pediatric surgeon at St. Christopher’s Hospital for Children and joined the transplant team. When the transplant program went to Nemours Children’s Health in Delaware, she went with it. After six years at Nemours , she “wanted to progress” towards leadership. She was recruited for the Chief of Pediatric Surgery position at Sanford Children’s Hospital in South Dakota. While there, she was selected to attend the Executive Leadership in Academic Medicine (ELAM) fellowship program at Drexel University. ELAM is dedicated to women in medicine with leadership aspirations. [Executive Leadership in Academic Medicine – Drexel University College of Medicine](https://drexel.edu/medicine/Academics/Womens-Health-and-Leadership/ELAM/) When the Department of Surgery chair position opened at Sanford’s, Dr. Casas applied. Although the position was given to another candidate within her department, he promoted her to the Vice Chair. Ten years into her career, her former boss and mentor, Dr. Stephen Dunn, from Nemours reached out. They were recruiting a Chair of Surgery for the Nemours Children’s Hospital in Orlando. Dr. Dunn said, “*I knew Adela was the real deal,*” and “*she could do anything.*” Dr. Casas acknowledged that Dr. Dunn had opened the door with hospital leadership and advocated for her to obtain the position. Today, she runs a surgical department that has six division lines, 19 surgeons, and 17 advanced practitioners. Dr. Casas is more than a surgeon and a leader, she is also a **wife and the mother of four sons.** This story would only be complete if we mention her family. When it came to childcare responsibilities throughout her career, she notes, “my husband really took the brunt of it.*”* At one point, her husband took an eight-year leave of absence to care for their children. She emphasized that without his support, it would have been challenging to practice surgery and achieve her career advancements and accomplishments. When asked what her proudest legacy will be, Dr. Casas, without hesitation, said “*the high points of my career are the kids I have taken care of for the last 24 years.*” The authors thank Dr. Casas for her time and the example she sets for us all. Ellen Basile, DO Associate Professor University of Central Florida Department of Pediatric Anesthesiology Nemours Hospital for Children Orlando, FL ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/Basile.Ellen_-138x300.png)Ellen Basile is a pediatric anesthesiologist. She graduated from the Philadelphia College of Osteopathic Medicine, completed her anesthesiology residency at Drexel University, Hahnemann Hospital in Philadelphia and her pediatric anesthesiology fellowship at St. Christopher’s Hospital for children. During her career she devoted her time to clinical patient care and service. She has served in many leadership roles including OR director, Associate Chief, Program Director for two university fellowship programs, and most recently was the Chief of pediatric anesthesia division at Augusta University. She currently works at Nemours Hospital for Children in Orlando, and plans to spend the remainder of her career pursuing research, and moving the effort to close the gender gaps for women in medicine. Ellenbasile4@gmail.com Ellen.basile@nemours.org Ellenroarkbasile, instagram **Categories:** advocacy, women --- ### [5 reasons I pursued an executive MBA and how it has helped me so far.](https://blog.womensurgeons.org/5-reasons-i-pursued-an-executive-mba-and-how-it-has-helped-me-so-far/) **Published:** March 13, 2023 **Author:** Blog Team **Content:** Heather Yeo, MD, MHS, MBA, MS Having recently (2019) completed an executive masters in business administration (MBA) program, I often get asked about why I pursued one in the first place, if I would recommend doing one, and how it has helped me so far. While there are many reasons for doing an MBA as a health professional, for me the decision was primarily focused on where I wanted my career to go and what I thought would be important to me, as I matured as a surgical attending. The top 5 reasons I pursued an executive MBA are: 1. **I wanted to set myself up for success.** As a woman in academic medicine, I know that a future in leadership is challenging as most recent data show that Full Professors of Surgery who are women make up only 5 % of the workforce. I felt that by getting and MBA I could help direct my skills towards leadership. Knowing that someday I hope to be a chair/chief, I felt like pursuing an MBA would help me for that and would show that I had the training I need to do the job well. 2. **I wanted to learn new financial skills.** A career in academic medicine is full of education and learning, however, it is short on the basics of financial management and accounting. In fact “money” is something that we shy away from talking about. However, in the higher levels of surgical leadership knowledge in finance is essential, and often only learned on the job. Understanding hospital financial structure and management of accounts is not something we typically learn. 3. **I wanted to learn proven techniques in negotiation, leadership and teamwork.** As surgeons we are all leaders and have experiences working in teams, however, there are proven strategies that are used in many other professions and could be translated to medicine. 4. **I wanted to branch outside of my comfort zone.** One of the best things in medicine is that it is a career of constant learning, however, it is all within our comfort zone. Several areas where I did not feel strong were in management, finance (already discussed), negotiations, marketing, strategy, and leadership. 5. **I wanted to build a network of colleagues with different experiences.** I am a strong believer that we can learn from other specialties and professions how to make ours better. Being part of an MBA cohort was important to me. I now have close colleagues across the country, in different specialties that have helped me to move my career forward. **What does it entail?** An MBA program can be done in many different formats, weekends, evening, online and in person. For my life weekend scheduling was the best as I could plan calls around it. Usually they can last anywhere from 1-3 years depending on how much time is spent weekly in the program. **So should you do an MBA?** An MBA won’t be right for everyone. The time commitment was hard on my family and hard on me. My work colleagues had to schedule my calls around my classes and picked up some of the load on my ‘intensive” weeks. In addition, MBAs are expensive, and many of us already have debt. While an MBA teaches technique, best methods, and skills, still much leadership must be learned on the job and from experience. Despite all of these challenges, an MBA has been valuable for me. It has taught me a number of financial skills that I hope to continue to develop. I have gained an amazing group of colleagues and friends from my MBA cohort. I have learned successful negotiation techniques. And I have a learned key strategies to help run successful teams. Choosing a program: I attended the Cornell Johnson Dual MBA/MS in Healthcare Leadership.[ https://www.johnson.cornell.edu/programs/emba/healthcare-leadership/](https://www.johnson.cornell.edu/programs/emba/healthcare-leadership/) This program was right for me for several reasons. 1. It was focused on physician and healthcare leadership with over half of my class being physicians (this was essential for me because I wanted to build my network). Other members in my class were healthcare focused, but all different areas, so I learned about a lot of other health focused professions. 2. It was mostly on weekends, with two children at home, I didn’t want to loose every night with them and so an evening schedule worked best for me. 3. It was in person, essential I think for networking and learning for me. 4. It was taught by both business and healthcare faculty. That diversity helped in terms of mentorship and experience. Learning from both was important to me. Look around and find a program that fits you. Other well-known executive MBA programs include: Northwestern Kellogg School of Management – https://www.kellogg.northwestern.edu/programs/executive-mba.aspx Harvard School of Business – https://www.hbs.edu/mba/Pages/default.aspx University of Pennsylvania – Wharton School of Managment- https://www.kellogg.northwestern.edu/programs/executive-mba.aspx Duke Fuqua School of Business – https://www.fuqua.duke.edu/ Columbia University School of Business –[ https://execed.business.columbia.edu](https://execed.business.columbia.edu/) Overall, executive MBA programs can be instrumental in setting you up for success and moving your career forward, but it they are hard work in an already busy profession, so make sure you have the buy in of your family, colleagues, and yourself. And good luck! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/05/Yeo.png)Heather Yeo, MD, MHS, MBA, MS is Associate Professor of Surgery and Associate Professor of Health Care Policy and Research at Weill Cornell Medical College and Associate Attending Surgeon at NewYork-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research, and Healthcare Leadership and an MBA and is focused on surgical outcomes, workforce diversity, tech advances in medicine, and quality improvement in Gastrointestinal Cancer Surgery. Dr. Yeo is interested in the psychosocial factors that go into surgical decision making and how they influence outcomes in patients. She is currently funded as a Damon Runyon Clinical Investigator for a randomized trial of an app that Dr. Yeo developed compared to the standard of care. Dr. Yeo believes that new technologies and apps are going to change the future of medicine. Dr. Yeo has studied disparities in surgical training and the impact of race and gender on attrition and training. Dr. Yeo has worked extensively with trainees and medical students. She works with residents and medical students to teach them study design, implementation, and career development. **Categories:** advocacy, awareness, career development, education, leadership, professionalism, training, women --- ### [What does being a surgical patient with limited English proficiency in the U.S. look like?](https://blog.womensurgeons.org/what-does-being-a-surgical-patient-with-limited-english-proficiency-in-the-u-s-look-like/) **Published:** March 4, 2023 **Author:** Blog Team **Content:** By Gabriela Brandão, MD Have you imagined yourself under the surgeon’s knife? It might be a terrifying circumstance even for us, right? Now, can you imagine yourself under the surgeon’s knife but in a place where nobody speaks your language? You would have no idea what’s happening with your health in that room… It would probably be an intense fear of death. That scenario is not just a fictional horror movie story, unfortunately. According to the [U.S. Census Bureau](https://www.census.gov/library/visualizations/interactive/people-that-speak-english-less-than-very-well.html), over 25 million people in the United States speak English “less than very well.” Many of them have very limited or no understanding of English. We have already faced or will definitely meet those patients throughout our surgical careers. We seek to provide the highest quality of care possible for all of our patients. Addressing language barriers in health, medicine, and surgery is urgently needed. Let’s think together about their main barriers and how to address them: In the outpatient scenario: – The very first difficulty might be reaching the first surgeon appointment. There are many barriers here, including scheduling, transportation, entering the hospital or clinic, finding the right place, and more. – With a lot of help or a lot of struggles, the patient is face-to-face with the surgeon. What now? The patient might already be stressed and anxious and have to explain their symptoms. Many other factors might play a role here, including the level of literacy and cultural background. Let’s consider that the patient was able to explain clearly and in detail enough for the surgeon to make the proper diagnosis. – Now, it is the surgeon’s responsibility to ensure the patient completely understands the explanation of the diagnosis, the surgical procedure, and all the risks involved in both decisions to be operated on or not and to give all the necessary preoperative instructions, medications, labs, imaging, etc. Now, what are the chances, under so many barriers, the patient has had a complete understanding to make an individual choice reasonably? It’s not for nothing that patients with limited English proficiency (LEP) have shown to have more LOS, chances of complication, late presentation of disease, and many other disparate outcomes. In the inpatient scenario: – During hospitalization, the challenges are magnified. There are many encounters requiring communication, from the nursing staff to the residents and attendings. That miscommunication can generate a lack of trust and compliance with the treatment, directly impacting the outcomes. – In a busy surgical schedule, those patients, because they require more resources or time, usually do not receive the same unbiased, effortless care as other patients. They are more likely to have a faster visit, receive ad hoc translator assistance, or even gestures-only communication. This receipt of negligence. For those who like financial consequences, think about where those medical errors can lead as well. In non-exhaustive ways, we can start doing better by using professional interpreters (not family members, friends, or hospital working staff), providing translated and visual materials, addressing the cultural barriers that might be playing a role, and using the plainest vocabulary possible. Besides patient contact, you can also indirectly support them by advocating for their proper care in your local institution, advocating for their proper care when caring for them in your team, and supporting or partnering with people and groups that have research and education initiatives focused on improving their care and addressing those disparities in surgery. I hope to have made you at least thoughtful about the matter. I am Latina, an aspiring surgeon, and I hope to be part of the change for that population as much as Association of Women Surgeons has been for women and [minorities](https://www.womensurgeons.org/page/ResourceCenter). ![](https://blog.womensurgeons.org/wp-content/uploads/2023/03/Brandao.Gabriela.png)Gabriela Brandão is a Brazilian medical doctor who aspires to become an Academic Surgeon in the United States. She is preparing to apply for the general surgery residency MATCH in the near future. Additionally, she serves as the founding president of the AWS UFCSPA Chapter and is scheduled to commence her tenure as a research fellow at the Beth Israel Deaconess Medical Center in Boston. Gabriela is a member of several esteemed organizations, including the Association of Women Surgeons, Latino Surgical Society, and Association for Academic Surgeons. Her research interests primarily focus on addressing disparities in surgery, surgical oncology, and promoting gender equity. Twitter: @BrandaoGR **Categories:** awareness, diversity and inclusion, health, Underrepresented in medicine, women --- ### [Intertwining Surgery and Law: A Medical Student’s Mission to Pursue a Medicolegal Career](https://blog.womensurgeons.org/intertwining-surgery-and-law-a-medical-students-mission-to-pursue-a-medicolegal-career/) **Published:** February 15, 2023 **Author:** Blog Team **Content:** By Alyssa Reese In life and in medicine, we are often pulled by intangible forces to the next steps in our path. We go forward with uncertainty, yet we look back into the past to see that everything made perfect sense. We see how our interests have guided us and how the seemingly winding road evolved into a linear course. I personally look back on how my interest in law has and continues to shape my career goals. My interest in law began in high school, as a member of my school’s mock trial team. I have many fond memories of meticulously preparing our cases, studying affidavits, and riding the bus to local tournaments. While I thought about pursuing a career in law when applying to college, I knew in my heart that I wanted to be a physician because of the patient care aspect of medicine. Nevertheless, I couldn’t leave my passion behind. Thus, I pursued degrees in both Biomedical Sciences and Legal Studies at the University at Buffalo (UB) and joined the UB Mock Trial Team. I loved how preparing for cross-examinations mirrored my clinical shadowing and how I could use my medical knowledge during cases. I also relished the opportunity to explore the realm of advocacy work and research as a Research and Public Policy Intern at Kids in Danger, Community Ambassador and Advocate for the Alzheimer’s Association, and Research Assistant for an attorney. When I applied to medical school, I was once again at a crossroads. I thought about applying to MD/JD programs, but was told by many that the degree combination was useless. People would say, “A jack of all trades, is a master of none,” and I received little advice on how I could keep my passion alive. I also wanted to keep the plethora of connections I had made in Buffalo. However, while UB has both an MD program and a JD program, there is no dual program. Ultimately, I decided to attend UB’s medical school and thankfully, I have found a number of mentors that encourage me to integrate my interests in legal medicine and surgery. As a medical student, I have founded the Buffalo Health Law Society, UB’s first interdisciplinary club for medical and law students. I also volunteer with medical-legal partnerships in Buffalo and Rochester, NY, and am aiding in the creation of a maternal-perinatal medical-legal partnership in Ithaca, NY. In terms of research endeavors, I currently have multiple projects that look at litigation involving surgical topics, medical legal curriculum, and the influence of medical-legal partnerships on patient outcomes. I have also met many physician attorneys and will be attending the American College of Legal Medicine conference this month. Looking back, I am thankful that I followed my heart and pushed to keep my interest in law alive during medical school. In my future career, I plan to eventually get my Juris Doctorate in order to improve my advocacy skills and be more involved with malpractice litigation as a plastic surgeon. I also plan to continue advocating for Alzheimer’s Disease research, child safety, and plastic surgery-related topics, and will continue to seek research questions that explore the overlap between plastic surgery and legal medicine. While the path to my goals still remains unclear, I look forward to forging a unique road as I intertwine law and surgery. *I would like to dedicate this article to my incredible high school Mock Trial Coach, Ms. Mary Pignato. Thank you for always encouraging me to be curious and pursue excellence. The Hilton “Dream Team” will forever hold a special place in my heart!* **![](https://blog.womensurgeons.org/wp-content/uploads/2023/02/Reese.Alyssa.png)Alyssa Reese** is a third-year medical student at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. She holds a BS in Biomedical Sciences and a BA in Social Sciences Interdisciplinary with a concentration in Legal Studies. She is the founder and Co-Medical Student Director of the Buffalo Health Law Society and serves as one of the Assistant Directors of the University at Buffalo Human Rights Initiative. Alyssa looks forward to pursuing a career in plastic surgery, and is particularly interested in pediatric and craniofacial surgery as well as breast and gender affirmation surgery. **Categories:** education, medical students, reflection, training, women --- ### [Couples matching in the age of virtual residency interviews: a resident’s perspective](https://blog.womensurgeons.org/couples-matching-in-the-age-of-virtual-residency-interviews-a-residents-perspective/) **Published:** February 8, 2023 **Author:** Blog Team **Content:** By: Mariana Tumminello, MD As the time to finalize rank lists quickly approaches, I can’t help but think back to the time when we were, as they say, “in the trenches.” To that time when the anxiety and nervousness had taken over both our lives. Compound this with the uncertainty of the first ever virtual interview season, and my Type A personality was hitting its limit. Would two programs really take us if they couldn’t get to know us in person? Would we both be making compromises, or would it just be one of us? As these thoughts flew through my head, I realized there was only so much I could control. Both myself and my partner had done the hard work of learning all we could and dedicating ourselves to this career we had chosen. Now, it was time to truly think about what we wanted for our future and what was important to us. The year was 2020. We had (foolishly) thought that COVID19 pandemic would quickly be over. No way would it affect our interview season in the fall! But alas, here we were, nine months into this thing, starting a virtual interview season. My husband, then fiancée, Brad was applying to Internal Medicine, and I was applying to General Surgery. We were trying to rack up as many interviews as possible to give ourselves the best chance of matching. We spoke to our medical school leadership and spoke to a few couples who had gone through couples matching, but no one could tell us what to expect this year. How could they? We were all in unchartered waters, trying our best to figure out what would come next. After going through this daunting process and coming out the other side, I realized a few things about myself and my partner that I didn’t know before. Yes, it was a hard and stressful time, but it was also a time where we were forced to communicate what was important to us as individuals and also learn to compromise to ensure fulfillment in both our careers going forward. Below are a few tips that we found helpful as we went through the virtual interview season. Hopefully, our experience can help a few others going through this spiderweb of a process to be successful. 1. Apply broadly, yes, but think about what is important to you both. We applied to a lot of programs—I’m not going to lie. Initially, we took every interview we were offered. We were just excited to be getting offers! As programs started rolling out their dates, we became pickier. Did we really see ourselves living in that city? Did we really want to be in a program that small? These were just a few of the questions we had to start answering early on. With these clear ideas in your head, it is easier to start making those early decisions about where you see yourselves living over the next 3-7+ years. 1. Email programs you are interested in and stay in touch. As we started making our interview schedules, we started really utilizing email as a tool to show our interest. Many times, Brad would get an interview at a program, and I had not, or vice versa. Programs are getting so many applications. I can’t imagine how difficult it is to choose one applicant over another. For programs we were really interested in, we started emailing. Brad would say how much he looked forward to interviewing and would ask if it was possible for the Medicine department to reach out to the Surgery department to give me an interview. From my side, I would email the Surgery Department, tell them how interested I was and why. While sometimes we may have not gotten a response, more often than not, programs would help us out by talking to each other on their end and making it work. We both got our fair share of interviews this way which allowed us to interview at some pretty great programs. 1. On interview days, mention your partner. They are a strength in this process. When I told people that Brad and I were couples matching, I got a range of responses. From “ooh that’s tough” to “ehh I would never do that, good luck..” Most people were under the impression that couple’s matching would make everything in this process harder. While it requires more thought and compromise, I realized that having a partner was my true strength. When I interviewed at my current program, I told my now PD that Brad had not gotten an interview with the Medicine Program. We talked about our upcoming wedding and how important it was for me to have him at a program in the same city. By the time my interview day had ended, Brad had an email inviting him for an interview. My PD reached out to the Medicine PD and got him an interview. That simple. He was my strength and I was his. 1. Keep an individual list as you go through. Update it in real time. As the interview season continued on, the monotony of Zoom took a toll. Which happy hour is tonight? What program is next? Anyone who has gone through this process knows the feeling I’m talking about. We found that the best way to keep our heads straight was to keep a dynamic list. After each interview, it would change. One program up—I liked their wellness initiatives. This program is down—not enough robotic experience. Each one of us had a list and changed it to suit our needs and what felt right to us. 1. Rank time! Make your own list based on what is important to you. The time has come for ranking! This is stressful, but exciting. It will also give you an opportunity for self-reflection. As you interviewed, what stood out to you at certain programs? What made you excited? What made you hesitant? We found that this time of self-reflection was necessary to really understand what we wanted and what programs felt the most right to us as individuals. I knew I wanted a program in a bigger city with strong robotics exposure and a county/community experience. Brad knew he wanted an “X+Y” program with good exposure to Cardiology. We ranked our lists accordingly. 1. Making “The List:” a good lesson in communication and compromise This was the part we were most worried about. So many thoughts were flying through both of our heads. What if my least favorite program was one of his favorites? What if I have to completely compromise what I want? We decided that we would open a bottle of wine for this part. Might as well enjoy it! We then dug in. Luckily, our top 5 programs were similar. We knew we both liked certain cities and certain types of programs. Now for the nitty gritty. What was it about one program or another that was better for him or I? This one has a better county experience and more flexibility with research. Ok this one up, this one down. No matches that were in different cities. That’s how we did it. It may have been painstakingly slow, but 2 hours and one bottle of pinot noir later, we finished. Compromises were made, but we were honest about what we wanted and what would make us both happy. We looked over our list one more time in the morning (without any wine in our systems this time), and submitted it. No looking back, no more doubt. It was out of our hands at this point! While this process is long and at times incredibly stressful, I look back on it as a time of growth. Our communication skills were put to the test. We learned to make compromises for one that we loved. And ultimately, it was the beginning of an exciting journey for which we had prepared for years. While the “Match Gods” will do what they may come in March, just remember, your partner is your strength. No matter if you match your 1st rank or 50th, you will be together pursuing what you’ve worked so many years to accomplish. Take a deep breath and enjoy it. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/02/Tumminello.Mariana.jpg)Mariana Tumminello is originally from New Orleans, LA. She graduated from the University of Notre Dame with a BA in Anthropology and Pre-Health Studies. She then returned home to attend LSUHSC School of Medicine in New Orleans. After couples matching with her husband, Brad, she moved to Washington DC to start her General Surgery residency at Medstar Georgetown/Washington Hospital Center, where she is now a PGY-2. She plans on pursuing a career in Colon and Rectal Surgery. **Categories:** family life, negotiating, networking, residency, self-care, training, women --- ### [Compassion as a Strategy to Mitigate Moral Injury in our Lives.](https://blog.womensurgeons.org/compassion-as-a-strategy-to-mitigate-moral-injury-in-our-lives/) **Published:** January 25, 2023 **Author:** Blog Team **Content:** By: Elizabeth Perazza Back to 2009 after 8 years of experience as a Board-Certified Urologic Surgeon, I was told by a supervisor that I was not contributing to the training program. This supervisor’s opinion led to a plan that resulted in my removal as faculty of the training program. I was 1 of 3 female urology attendings amongst 20-25 male attendings. For years in therapy with mental health specialists, I was able to overcome feelings of shame, inadequacy and incompetence that subsequently threw me to a diagnosis of adjustment disorder with depressive features. Moral injury is defined as the profound psychological distress that results from actions, or the lack of actions, which violate one’s moral or ethical code. Morally injurious events can include acts of perpetration or omission, or experiences of betrayal from leaders or trusted others. Moral injury is not a mental illness, although experiences of potentially morally injurious events can lead to negative thoughts about oneself or others, as well as deep feelings of shame, guilt or disgust which can lead to the development of mental health problems. Morally injurious experiences and the resulting guilt, shame or anger may contribute to stress reactions such as: - changes in sleep - significant and persistent negative changes in behavior or habits - difficulty concentrating - increasing mistakes - isolation - compulsive addictive behaviors for example (overworking, overeating, drinking) - weakened sense of empathy or compassion If the morally injurious situation was also a traumatic event, it can lead to symptoms of PTSD. Soon after I became separated from the faculty assigned to train Urology residents, I became more isolated, as described above. I did not find anyone in my workplace that was able to help me fight against the morally injurious event of my separation from the residency in an unjust and prejudiced manner. Unfortunately, there are no well demonstrated strategies established to prevent moral injury.. A Systematic review published in July 2020 summarized the evidence regarding mindfulness and compassion related qualities of healthcare professionals and quality of life. Compassion related interventions including loving-kindness meditations were found to be effective at improving quality of life. To heal from a moral injury there is a need for communalization of trauma and ethical listening. Creating the organizational conditions for a moral and ethical culture-one that acknowledges the ubiquity of moral challenges in healthcare- is essential for combatting moral distress. A moral and ethical culture includes communication, emotional support (t, education, bereavement support, and openness to conversations about ethics. Organizational designs can bring such practices to light and help workers see morally distressing events as organizational and occupational concerns rather than as personal failures. Although moral distress is unlikely to be eliminated, organizations must apply strategies and organizational designs to develop strong cultures of communication and psychological safety. Thankfully, fast forward 14 years after my removal as faculty of the only Urology Program in our country, (the program where I graduated from in 1999), my professional career has grown. I am under psychological therapy but do not use psychotropics. Our training program still has 3 Urology female attendings but there has been a slight increase in female residents. I hope that the readers of this blog will be able to identify with my story and that it will help create awareness of morally injurious events in our profession. Cordially, LatinaPRUroSurgeon **Categories:** awareness, health, reflection, self-care, training, women --- ### [Tips for Returning to Work as a Lactating Resident](https://blog.womensurgeons.org/tips-for-returning-to-work-as-a-lactating-resident/) **Published:** January 18, 2023 **Author:** Blog Team **Content:** by: Samantha J. Baker I am a PGY-5 General Surgery resident at the University of Alabama at Birmingham and returning from maternity leave for my second child as this blog post is being published. I am currently in the midst of the feeding, pumping, middle of the night do I “wake or pump” mental tango, and planning logistics about how to return to work mayhem. I had my first child as a third-year resident and was fortunate to pump for a year. At that time I leaned on friends, family, and colleagues to figure out how to continue to provide breast milk as a resident. To be honest, when I started out I felt like I had no idea what I was doing. I hope that this blog post will help anyone who is looking for somewhere to start or maybe plan for the future. I am by no means an expert. A year is a lot of time to invest in something and I am about to embark on that journey again. I will start with the most important point in my mind- **Fed is best**. Period. Whatever that looks like. There is so much pressure on women to breastfeed (and a lot of mom shaming). Before my first child , at every prenatal appointment, I was asked “are you going to breastfeed?” I would reply, “I am going to try,” which I felt- as a surgery resident- was the realistic response. You need to do whatever is best for you and your baby. Which brings me to the guiding principle (words from a very wise attending) that I used last time and will definitely be repeating in the coming weeks, **do it until it doesn’t make sense anymore**. If it doesn’t make sense for you, for your child, for your timing, your mental health, your sleep, whatever– then give yourself permission to stop. I want to recognize my bias upfront. I chose early on to exclusively pump. My baby and I were not great at breastfeeding, and it did not come or feel natural to me/us. I had never planned to go over a year and was willing to stop earlier. Some people breastfeed for the bonding connection and a whole other host of reasons, so these tips might not be the most helpful if you are looking for an exclusively breastfeeding relationship, mixed pumping/breastfeeding relationship, or for it to last longer than a year. Tips (not an exhaustive list and I apologize if it seems disjointed; I’ve been writing down my thoughts between feedings and unfortunately short naps): People - **Find a group either local or on-line**. At the very least it can act as a sounding board to help troubleshoot schedules, what to pack, what pump to buy, etc. I joined a Facebook group called Dr. Milk which is a physician’s group that requires an invitation and an NPI number to join. It was very helpful to read the group especially during middle of the night feeds or pumping sessions. They have posts about moving your freezer stash when starting a new job/fellowship, storing milk while at conferences and traveling, what medications are safe to take, and how to troubleshoot your pump- just to name a few. - Find out **if your** **program has any policies** or procedures in place to help pumping at work. If your program does not have a lactation policy, you can find information about[ implementing lactation policies by the General Surgery Program at the University of Michigan](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474976/). - **Reach out** to attendings or other residents who may have pumped at work for support. - **Lactation consultants** are great resources while inpatient. Once back at work, if you forget a pump part or are having issues, they usually have an office somewhere and may be able to give you spare parts (I forgot bottles once and tried to use specimen cups. It did not work. I walked over to their office, and they gave me bottles to pump with). If you deliver at the hospital where you are employed, ask the in-hospital lactation consultant for a **set of hospital compatible pump parts**. I kept them in my locker at work. I had to use them once when my portable pump broke and then a second time to replace some tubing. I always felt more comfortable knowing I had a backup plan at work. Places - Lactation rooms. Does your hospital have these? It is an ACGME **requirement that residents have access to a space for lactation**. The lactation spaces at UAB are nowhere near the OR (something our housestaff council is working on), so there are other designated spaces (workrooms with a sign, faculty offices, staff may close down a clinic room). I got a portable pump and pumped everywhere (running traumas, placing chest tubes, rounding, in clinic) and was less reliant on a room. But portable pumps do not work for everyone, and they can break, so it is good to know where you can sit and pump if needed. - Where will you store the milk once you pump it? Some people have access to a fridge in someone’s office or workroom. If not, there are chillers you can buy that will keep milk cold all day when you do not have access to a fridge. Things - **Buy 2 sets of pump parts for both your standard pump and portable pump, trust me.** That way if it is a really long day you can skip washing the pump parts or put them in the dishwasher for the next day because you have a second set that is already clean. - **Get a Wet bag.** There is no need to wash parts between use at work (in general, for term healthy kids). Instead throw the pump parts into a wet bag and put them in the fridge. Will save tons of time and need for counterspace/place to wash parts. - **Pump bag, ice packs.** There are a few bags marketed specifically for pumps that can be found online, and some are really fancy and pricey. You can also just use a large insulated lunch kit from Amazonas a **dedicated bag to hold all of your stuff**. Also, if you will have limited access to a refrigerator, then you will want something insulated, like a separate small bag with an ice pack for storage or one of the large chillers. - **Your flange size may change**. If you notice your output has decreased or pumping is no longer comfortable then it may be time to re-measure and resize. Other - **Pump between each case, no matter the turnover time**. This is some of the best advice I was given. On OR days I pumped between every case regardless of the interval. It is best to start a case empty. If the case is running long, then wait until a non-critical portion and ask to step out for a bit to pump. The key here is communication. It is possible to be a lactating/pumping resident and have effective, meaningful time in the OR. - Going back to work and need a small freezer stash? If your output allows, consider adding a pump session following a morning feed for the week or two before your return to work. This can help **create a small surplus you can freeze**. This milk can then be used for that first day you are back at work before you are able to bring pumped milk home for the next day. **Freeze in small (3 oz or less) amounts, lying flat, with as little air in the bag to facilitate defrosting**. - If you have a portable pump you are going to use at work, **start using the portable pump at home the week before you go back to work**. These pumps have a learning curve and you want to have an idea of how to use them before you start pumping between cases. I realized I needed to bring something to set up the pumps on so they would not touch the workroom counters. You will also learn if the pump does not work for you and if you need to come up with another plan. - There are lots of great pumps out there. I recommend that you do your own research to try to find the right one for you. If you have done all the research and still do not know where to start, I would consider getting the pump that one of your friends has. That way you have someone you can go to if you have questions or need to troubleshoot the pump. - Have a partner that wants to help? It is incredibly helpful and uplifting to **have your partner wash the pump parts** at the end of the day. After working 14+ hours and pumping every 3-4 hours all day, the last thing you want to do is wash the parts for the next day. - Some programs have **education stipends** that can be used to purchase portable pumps instead of books or question banks, etc. - Communication: You should **feel empowered to speak up for yourself** and ask to step out, but that isn’t always the case. Some programs have a policy where the Program Director reaches out to the rotation faculty prior to the resident starting that rotation. The PD lets them know that there is a lactating resident joining the service and to expect them to step out of the OR to pump. Think about how you will handle this before you are in that situation when you cannot wait any longer and need to step out. Ask around for advice if needed or **seek out an advocate to help set you up for success**. I was able to pump for an entire year last time. What will happen with this child… unknown. I will try to do that again but am willing to stop earlier if/when it doesn’t make sense to continue. I may try to breastfeed when at home and pump at work instead of exclusively pumping (so many fewer things to wash and drag around when getting out of the house, but we will see). I may try to create a large enough freezer stash that I do not have to pump as often as a trauma fellow next year. It is hard to predict what will happen. I would be remiss if I did not take some time to say thanks to my husband, friends, co-residents, program and program leadership for the support. It really does take a village and I was only successful because I had so many people who were willing and able to work with me to figure it out. Breastfeeding/pumping is hard; let’s be honest: being a surgery resident is hard, and being a new mom on top of that is a lot. Hope this blog helps and if you find yourself somewhere where you do not feel supported, consider broadening your search. There is a community out there. Through social media (Facebook, Twitter) we can support each other and try to make the transition back to work easier if possible. Please feel free to reach out to me with any questions. Like I said, I am not an expert but I am willing to share what I did, what supplies I bought, schedule I followed, etc. in case it helps someone else. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/01/Baker.Samantha.png)Samantha Baker is a General Surgery Chief Resident at the University of Alabama at Birmingham. During her residency training, she undertook dedicated research time studying surgical education and health literacy. She was able to obtain an additional degree from MGH in Surgical Education and is currently pursuing a PhD. She has two daughters that were both born during her clinical years as a Surgery resident (PGY-3 baby is 2 years old and PGY-5 baby is almost 6 weeks). She is excited to move back to her hometown, New Orleans, next year as the Trauma, Critical Care fellow at Louisiana State University. Email: sjbaker@uabmc.edu Twitter: @SamanthaBaker\_\_ **Categories:** career development, family life, health, parenting, residency, women --- ### [Intern Year Chronicles: Six Months In](https://blog.womensurgeons.org/intern-year-chronicles-six-months-in/) **Published:** January 15, 2023 **Author:** Blog Team **Content:** *By Alyssa Brown, MD PhD* It is New Year’s Eve, and I am in a reflective mood, or maybe I am trying to dodge studying for ABSITE. Either way, I have officially made it through six months of residency as a general surgery intern. Today, I am thinking to myself, have I grown and changed over these past six months? Have I become better at my job? Have I gotten better at suturing, driving camera, and using surgical instruments? Have I gotten better at coming up with plans? The answer is: I don’t know. The frustrating moments stick around longer than the triumphs. I still feel so dumb for grabbing the wrong end of a chest tube to place into the patient, handing off the wrong end of a cord to be plugged in, forgetting the name of the round ligament, never remembering which pressors do what, or forgetting a small task on the to-do list of the day from rounds. There are many more examples. There were triumphs of course, like getting a g-tube back into a child after hours of trying, discharging a long-term patient, and seeing a patient at their post-operative appointment doing well. There are moments that just make you laugh, like starting a trauma exam on the wrong patient, late-night mozzarella sticks with my night team, or playing a prank on a co-intern. I still often feel like medical students know more than me about topics in medicine. I feel like I don’t know enough operative technique in the OR. When I am doing TrueLearn questions, it is more a show of how many things I don’t know than what I do know. I wish this was a piece with a happy ending to say, “and then our narrator had the realization that she was doing phenomenal work, and she lived happily ever after.” This isn’t that kind of story. The first six months of intern year have been hard. It is such a steep learning curve, and I still feel like every day I want to be better. It is hard for me not to think, “wow, I should be better at this by now.” Maybe that is normal. Maybe always striving for more is what will make us better surgeons. All that being said, I wouldn’t go back and change to a different residency. I would still pick general surgery. I wouldn’t give up the friends I have made so far in residency and the bonds we have created. I am halfway through my intern year, and I feel a little lost if I am being honest. The question that wracks my brain on bad days is will I ever be good enough to be a surgeon, and it’s a question I’ve had since the day I decided I wanted to be a surgeon. I am not sure how to answer that, but I sure hope I am and know that someday I will. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/headshot_5x7_0449-731x1024.jpg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a Ph.D., before finishing her MD. She graduated with an MD from the University of Louisville School of Medicine in 2022, and her Ph.D. in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences in 2022. She is now a PGY-1 general surgery resident at Northwestern University in Chicago. She has been a part of the AWS Blog Subcommittee since 2018. You will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” embroidering, or off on a new adventure. You can find her on Instagram @Alyssa\_b\_futuremdphd and on Twitter @Alyssa\_B\_MDPhD. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency, training **Tags:** #surgeryresidency, residency, residents, resilience --- ### [Surgery Residency is Like a Family](https://blog.womensurgeons.org/surgery-residency-is-like-a-family/) **Published:** January 4, 2023 **Author:** Blog Team **Content:** By AlleaBelle Bradshaw, MD There are a lot of cliches from the interview trail, most of which are at least partially true. One of them is that residents and faculty will say something about how their residency is “like a family.” Of course, it is generally a positive thing that residents view their programs as families. I don’t mean to be the person that ruins this by taking it too seriously, but we should consider the meaning of something we have started saying almost automatically. I write to share my thoughts about what family means, how residency is like a family, and considerations for both residents and applicants when using the metaphor moving forward. My thoughts are colored by my personal experience with family. My family was a mostly traditional one with two parents and three kids. I am the youngest with two older brothers. We loved, learned, fought, and got close to falling apart more than once. You could say we did fall part at times. My brothers taught me so much and are, at least in part, the reason I am a doctor, but they weren’t always supportive. I am thankful for all the lessons and memories, but I also have to figure out which parts of those relationships I don’t want to learn from and carry forward. One of the definitions of family includes the descriptor of people “living together as a unit.” Even though we don’t live at the hospital, like trainees did in Halstead’s time, medical training is still called *residency* because of the extensive time at the hospital with our colleagues. It makes sense that the relationship dynamics start to resemble those of traditional cohabitating family members. Co-residents become like siblings with different experiences, who teach one another, give each other a hard time, and are there for one another. Given these aspects of residency and their similarities to traditional family members, it is not surprising nor unique for a residency program to be ‘like a family.’ The real question should be, what is that family is like? What are this family’s values? Are those values aspirational or realized? Is the program’s leadership respected, feared, and/or loved? Do the residents support one another? Overall, is the family a healthy one or a dysfunctional one? Of course, no program is perfect just like no family is perfect. (In actuality, the system is imperfect, making it effectively impossible to have an ideal program, but that’s a different topic.) There are good times and bad times. There are times of mistrust, miscommunication, and mistakes. The important part of family is how they treat each other when they meet these challenges. In a healthy program, residents support one another, and leadership supports the residents, especially during adversity. There are values upheld that include well-being and a growth mindset, knowing that work ethic and progress are predicated on those two things. Those values should be apparent in the program through the decisions and actions of the program’s leaders, both upper-level residents and faculty. When residents are telling applicants about our programs, we shouldn’t expect applicants to know what we mean when we say our program is like a family. We all have stories, examples, and more nuanced ways of describing our relationships with our co-residents and faculty; we should use them. Similarly, I would encourage applicants to ask questions when residents or faculty say they are like a family. Ask about values and the relationship dynamics between program leadership and residents, as well as between residents themselves. The virtual nature of interviews has made it as hard as ever to get an understanding of a program from just a few hours on interview day, but being thoughtful about how we’re describing our relationships is an important part of having successful residency Matches in the future. ![](https://blog.womensurgeons.org/wp-content/uploads/2023/01/Bradshaw.AlleaBelle.jpg)AlleaBelle Bradshaw, MD is a PGY-2 general surgery resident at MedStar Georgetown University Hospital and Washington Hospital Center. **Categories:** career development, education, family life, networking, residency, resources, self-care, women --- ### [Challenges for women in surgery](https://blog.womensurgeons.org/challenges-for-women-in-surgery/) **Published:** December 29, 2022 **Author:** Blog Team **Content:** By: Shiona Maria Benedict Fernandes “You will get married soon in the future. How will you be able to manage your family and your work life, if you choose this hectic lifestyle that surgery puts you through?” asked my mother back in 2020 when I had decided to tell her that being a surgeon was my dream. In addition to social deterrents, with women in surgery have also faced [sexual harassment. Which has frequently gone unreported](https://journals.lww.com/annalsofsurgery/Pages/default.aspx?PAPNotFound=true) and and a well documented[ pay gap](https://journals.lww.com/ijsgh/Fulltext/2018/07000/Women_in_surgery__challenges_and_opportunities.2.aspx). It has been [shown that lack of financial rewards and career advancement opportunities](https://journals.lww.com/journalacs/Abstract/2021/11000/Women_in_Surgery_Italia__National_Survey_Assessing.1.aspx) are two of the top challenges for female surgeons. In my opinion, medical schools and programs like AWS should create grants or scholarships for trans woman residents too. As to support their masters or research in surgery to encourage all women to continue their passion in surgery. *The data is taken from* [*Women in Surgery Italia: National Survey Assessing Gender-Related Challenges*](https://journals.lww.com/journalacs/Abstract/2021/11000/Women_in_Surgery_Italia__National_Survey_Assessing.1.aspx#) *\** According to the [Royal College of Surgeons of England](https://www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/), the ratio of men and women in the field of surgery in the UK is 8:1, which is a significant gap. So how do we encourage women to become surgeons? **By being a role model to them**. It is reported that female medical students have a [lack of female role models ](https://journals.lww.com/ijsgh/Fulltext/2018/07000/Women_in_surgery__challenges_and_opportunities.2.aspx)in surgery to look up to. Also creating awareness programs for young girls in medical schools and inviting senior female surgeons to share their experience in surgery and how they tackled the problems they faced during their journey are effective ways of encouraging women to take up surgery. Moreover, medical schools and hospitals can help in reducing the gender gap by developing policies on issues like [discrimination and harassment.](http://www.acs.org.au/content/dam/acs/rules-and-regulations/Code-of-Professional-) My final words for young female medical students and residents is don’t let anyone discourage you from becoming what you want. **If a potato can be a vodka then you can be a doctor**. Yes, it’s not an easy journey but **believe in yourself**. **Information about the author** ![](https://blog.womensurgeons.org/wp-content/uploads/2022/12/Fernandes.Shiona-Maria-Benedict-square.png)Hello guys, I’m Shiona Maria Benedict Fernandes from Tbilisi. I’m in my 3rd year of medical school. My field of interest is orthopedics. In my free time, I watch anime and write blogs for medical organizations. My instagram id is konnichiwa\_shiona. **Categories:** awareness, career development, medical students, Underrepresented in medicine --- ### [Finding Your Stage Presence](https://blog.womensurgeons.org/18660/) **Published:** December 13, 2022 **Author:** Blog Team **Content:** By Kimberly Lumpkins, MD, MBA I have a confession: I love public speaking. Standing on stage and feeling the audience connect with you is a magical experience. People often tell me that they couldn’t possibly be as comfortable on stage as I appear to be–that it must be some sort of innate and alien talent, but nothing could be further from reality. I began as a laughably awful public speaker, who was terrified of the stage. Back in high school, I joined the public speaking team where I was notable only for my abject incompetence. Memorized monotonous reading, check. A blizzard of “um” and “uh” peppered throughout every sentence, check. Gut churning nausea before every speech, check. I mutually parted ways with the team at the end of the year, in search of some other less miserable activity. So how did I progress from public speaking ignominy to finding genuine joy on stage? I’d like to share a few tips to help you find your speaking mojo. ***Memorized Monotony*** Many inexperienced speakers write out every single word of their presentation to create a detailed script. Like an actor, they memorize their lines perfectly. Unfortunately, we’re not actors and this doesn’t tend to work very well for us. Even when recited from memory rather than read aloud from notes, scripted speeches tend to sound stiff. At the last conference you attended, I’m sure you could instinctively tell when presenters were reading their script. Another critical weakness of fully scripted talks is that it is very easy to freeze when you make a mistake. You miss a line in your script and then can’t remember what line comes next, and now you’re panicking and your confidence is shaken. Instead, think about each slide as a cue for a conversation. What are you trying to say with this slide? Why is it important? How would you defend this slide if someone told you to cut it out of your presentation? The answers to those questions highlight what you need to convey on stage. The exact words you use aren’t important, as long as your message is clear! Write down the themes of the slide as cues for yourself, then work out the critical transitions between sections of your talk. Developing confidence in cued speaking takes practice. Lots of practice. This is where the residents reading this blog have a huge advantage—M&M conference. Residents tend to think of M&M as a tedious chore, but in reality, it’s a natural public speaking laboratory. Every time you present, you get the opportunity to practice. As a bonus, the time it takes you to prepare slides will decrease dramatically. I would credit the greatest improvement in my speaking skills to being absolutely fed up with making powerpoint slides week after week as a chief resident. I knew what needed to be said for each patient, so instead of making detailed slides covering each bullet point I just…presented the critical information! ***The Dreaded Um*** Filler words are the bane of public speaking–the “um” and “uh” that punctuate so many sentences on stage. Few of us use these words in natural speech, but set us behind the podium and they start to roll. It is so instinctual that you may not even be aware of how many you use. Nothing kills the flow of a talk quite like a torrent of filler words. As the speaker, a few seconds of silence while you search for the next idea feels like an absolute eternity to you—but to your audience, it is hardly noticeable. Embrace silence instead of filler words. How can you convince your brain that it’s okay to stay quiet while you’re gathering your thoughts? Try a core exercise from my misbegotten year on the high school speaking team. Enlist a colleague, friend, or your child (who will probably enjoy this tremendously) and equip them with the nastiest buzzer you can find. Think “mistake in the board game Operation” level nasty. Stand up and start rehearsing your talk, mimicking a performance environment as best as possible. Your partner in crime hits the buzzer every single time you utter a filler word. You may be shocked by how often the buzzer goes off. Now, as you can probably imagine, your anxiety about speaking will most definitely NOT decrease with this exercise initially—quite the opposite. But stick with it. Keep rehearsing over days and weeks with the buzzer. Following true operant conditioning, your brain will learn to avoid the buzzer by eliminating filler words. With practice, this really works. I’m living proof—I’ve hardly used filler words since I nearly wore out the team buzzer when I was 14. ***My Nerves are Shot*** Nerves are normal! I’m not going to pretend that there’s some magical nirvana ahead where you never get nervous before a talk. The key is to learn to manage your anxiety so it doesn’t derail you. 1\) Develop a pre-speaking ritual to focus your energy, and do it every time. Many people swear by meditation or guided imagery. For me, meditation isn’t my wheelhouse and it tends to make me more agitated. My pretalk ritual is a lot simpler: I put in an earpiece and play Sia’s *Unstoppable* on quiet repeat about 10 minutes before the talk. By the end, I know I’m unstoppable and I’m ready to go. 2\) Rehearse the first few slides obsessively. Nerves can derail you right at the beginning and throw you off for the rest of your presentation. When rehearsal time is limited, it’s a mistake to keep practicing the talk in its entirety. Instead, spend more time working on the opening until you can do it effortlessly. If you nail your opening, you’ll relax for the rest of the talk—even if it goes a little off the rails. I hope these suggestions will help you discover your inner stage presence! ![](https://blog.womensurgeons.org/wp-content/uploads/2022/12/Lumpkins.Kimberly.jpg)Kimberly Lumpkins MD MBA is Surgeon in Chief of the University of Maryland Children’s Hospital. She completed her pediatric surgical training at the Johns Hopkins/University of Maryland combined fellowship, and subsequently trained in pediatric urology at the Birmingham Children’s Hospital NHS Trust in the United Kingdom. She is a graduate of the executive MBA program at the Robert H. Smith School of Business, and now serves as a faculty affiliate of the Ed Snider Center for Enterprise and Markets at Smith. She is an Association of Women Surgeons Signature Speaker for 2022. **Categories:** AWS conference, career development, professionalism, training --- ### [Commemorating Native culture through medical school- My journey as an Indigenous medical student](https://blog.womensurgeons.org/commemorating-native-culture-through-medical-school-my-journey-as-an-indigenous-medical-student/) **Published:** November 30, 2022 **Author:** Blog Team **Content:** By Olivia Spaulding What is Native American Heritage Month? Every year the month of November is dedicated to celebrating Indigenous Peoples across the United States. It is a celebration of heritage, culture, and resilience amongst the first people of this nation. Dr. Arthur C. Parker, a Seneca Indian and co-founder of the Society of American Indians in 1911, organized American Indian Day beginning in 1915. In 1976, it expanded to a week-long celebration. It was declared a national month-long celebration in November of 1990 under the George H.W. Bush administration. More recently, Columbus Day, which is recognized on the second Monday of October, has been reclaimed in cities across the United States as Indigenous People’s Day. You can find more information on the National[ Native American Heritage Month website](https://nativeamericanheritagemonth.gov/about/). My Journey My name is Olivia Spaulding, and I am a second year medical student at Howard University College of Medicine. Being the only Indigenous medical student at my school can be daunting, especially in medical settings. In some instances, I question my own identity when asked questions about the indigenous community, wondering whether I am Native enough, or qualified enough, to answer these questions. Are my answers representative enough of all of Native America? I feel conflicted between assimilating into modern Western culture and maintaining who I am within my own heritage, leading to feelings of inadequacy and imposter syndrome. Native Americans represented less than 1% of the medical field as physicians [in 2018.](https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018) Of this percentage, even less are women pursuing surgical fields. Although this number is small, I find the strength to continue the pursuit of medicine in my indigenous identity and fellow indigenous brothers and sisters. Growing up in a rural Indigenous community, harvesting the land was a way of life for many families, including my own. Many summers between the school year were spent in the garden harvesting everything from corn to peas to watermelon and much more. I like to think the practice of harvesting kept me connected to my ancestors that first harvested this land. Despite this connection, I longed for more in life. I longed for a future that allowed me to remain connected to my ancestors and improve the lives of those around me in my community. I thought of careers that might help me to achieve this future, and I came across an application for hospital volunteers. I began volunteering at the local hospital the summer before I started high school. My experience there heavily influenced my decision to pursue medicine and surgery in particular. Most of my time was spent on one of the surgical recovery floors, ensuring the patients were comfortable postoperatively with warm blankets and ice chips, as well as preparing rooms – generally, just assisting in whatever way I could. In medical school, I was allowed the honor of using surgical instruments, such as scalpels and forceps on human cadavers in the Anatomy lab and threw my first suture on a pig’s foot. I’ll never forget being amazed at how small the kidneys were in my hands or how big the liver was. These experiences were my first tangible encounters with surgery and human anatomy. Since then, I have had the opportunity to observe several operations over the course of my academic career. Suiting up to go into the OR, I feel like a real life superhero. Seeing what I was learning in the classroom in real time was an adrenaline rush. Standing in the OR, watching surgeons pivot and rise to the occasion when dealing with expected and unexpected circumstances was exhilarating. I have also had the opportunity to volunteer alongside surgical oncologists at monthly breast cancer screenings, where I performed breast exams and escorted patients to radiology for diagnostic imaging. I will never forget these experiences – experiences that taught me more than any textbook or lecture could teach. Finding community in organizations such as the Association of Native American Medical Students (ANAMS) and Association of Women Surgeons (AWS) have provided a space less daunting and less alone. These organizations have connected me with many peers both at my home institution and across the nation. Student members of ANAMS are currently in the process of creating a surgical society for Native students. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/11/Spaulding.Olivia.jpg)Olivia Spaulding is a second-year medical student at Howard University College of Medicine and aspiring general surgeon. Olivia completed her Bachelor’s in Biology at the University of North Carolina at Pembroke and Master’s in Medical Nutrition at Arizona State University. She is a member of the Lumbee Tribe in North Carolina. She is passionate about sharing her journey with others in hopes to inspire and diversify the medical field. **Categories:** awareness, diversity and inclusion, medical students, women --- ### [Destination Wellness: The Occupational Domain](https://blog.womensurgeons.org/destination-wellness-the-occupational-domain/) **Published:** November 29, 2022 **Author:** Blog Team **Content:** By Kyla Wright “So, tell me – why general surgery?” My mouth begins reciting a premeditated answer before my mind has time to catch up. We are only a few weeks into interview season and, already, I must resist the temptation to let motor memory takeover and instead maintain some degree of authenticity in my words. Though interview season feels like an imitation game at times, it offers a unique opportunity for reflection: preparing for anticipated interview topics, applicants like me reflect on their values, strengths, weaknesses, and ability to cope with and face the challenges of a career in surgery. Many questions (E.g., What do you believe is the most rewarding aspect of a career in surgery? Can you maintain a work-life balance?) address a common theme – how will you achieve and maintain occupational wellness in your future career as a surgeon? Occupational wellness is a term that recognizes personal satisfaction and enrichment in one’s life through work. It recognizes the importance of traveling a career path through which you will be challenged and acquire skills that are both personally meaningful and gratifying for you. Though I was unaware of the term at the time, occupational wellness is something that I have contemplated frequently, both when deciding my future specialty and throughout the residency application process. For me, pursuing a career in a specialty that will continually challenge me both technically and intellectually, and provide me with the opportunity to make a profound impact in my patients’ lives, seemed essential to achieving occupational wellness. Admittedly, I’m writing this discussion in the position of *predicting* what features of a future career will make me happy and fulfilled. I’ve gotten glimpses into the gratification that comes with making an impact in a patient’s life, even if relatively small as a student, that I anticipate will only magnify as my responsibility in patient care increases. That said, with greater responsibility, I foresee the challenges I’ve encountered as a student will intensify in parallel – namely, coping with poor patient outcomes and avoiding so-called “burnout.” As a student, I’ve already received countless warnings of burnout – a feared syndrome characterized by emotional exhaustion and depersonalization that is perhaps one of the biggest threats to occupational wellness. And based on a quick search of the literature, the warnings are warranted: rates of burnout among physicians have increased (and job satisfaction decreased) over the years \[1, 2\] and, among surgeons, are higher in females \[3,4\]. There are many driving factors, including changes in the structure and process of health care, workload and job demands, culture and values, and work-life balance to name a few \[1,2\]. But the critical question is: what do we do about it? It starts by recognizing the problem, both at an institutional and personal level. Institutionally, we can improve occupational wellness and minimize factors contributing to burnout by aligning values and strengthening culture, promoting flexibility and work-life integration, providing resources to promote resilience and self-care, and cultivating and establishing communities that address the needs of different cohorts (e.g., women, physicians with young children) that may be at greater risk \[2, 5\]. On a personal level, we must recognize that the adaptive personality traits that make us thorough and caring providers to our patients are frequently accompanied by maladaptive traits that make it difficult for us to relax or set limits and easy to carry an excessive sense of responsibility and guilt \[6\]. Periodic self-assessment is imperative, aiming to identify which parts of our work and personal life are most meaningful and making those activities a priority \[2\]. So, as I reflect during my residency interviews on why I’m choosing a career as a surgeon and what aspects of my life and future career are most meaningful to me, I invite you to pause from your own careers and reflect as well: What is most important to you? *Why* do you do what you do? And if you don’t know where to start, I hope you find the links listed below helpful: Resources: Work-Life Integration: <https://www.facs.org/for-medical-professionals/news-publications/journals/rise/articles/work-life/> Avoiding Burnout & Promoting Resilience: [https://www.facs.org/media/v4udjmz0/08\_kaups\_avoiding-burnout\_promoting-resilience.pdf](https://www.facs.org/media/v4udjmz0/08_kaups_avoiding-burnout_promoting-resilience.pdf) Avoiding Burnout – the Personal Health Habits and Wellness Practices of Surgeons: [https://journals.lww.com/annalsofsurgery/Abstract/2012/04000/Avoiding\_Burnout\_\_The\_Personal\_Health\_Habits\_and.4.aspx](https://journals.lww.com/annalsofsurgery/Abstract/2012/04000/Avoiding_Burnout__The_Personal_Health_Habits_and.4.aspx) Stress & Burnout Among Surgeons: <https://jamanetwork.com/journals/jamasurgery/fullarticle/404847?resultClick=1> References: 1 Hunt, Kelly K., and Hannah F. Wingate. “Satisfaction and sustainability in a surgical career.” *Annals of surgical oncology* 25.10 (2018): 2785-2789. 2 Horowitz, Carol R., et al. “What do doctors find meaningful about their work?.” (2003): 772-775. 3 Shanafelt, Tait D., et al. “Burnout and career satisfaction among American surgeons.” *Annals of surgery* 250.3 (2009): 463-471. 4 Jackson, Theresa N., et al. “The physician attrition crisis: a cross-sectional survey of the risk factors for reduced job satisfaction among US surgeons.” *World journal of surgery* 42.5 (2018): 1285-1292. 5 Shanafelt, Tait D., and John H. Noseworthy. “Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.” *Mayo Clinic Proceedings*. Vol. 92. No. 1. Elsevier, 2017. 6 Gabbard, Glen O. “The role of compulsiveness in the normal physician.” *Jama* 254.20 (1985): 2926-2929. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/11/WRIGHT_Kyla_P3-scaled.jpg)Kyla Wright grew up in Spokane, WA and attended college at the University of Washington where she studied Neuroscience and Bioethics. She is currently a fourth-year medical student at NYU Grossman School of Medicine and is applying to general surgery residency training programs. Her fields of interest include Endocrine Surgery and Trauma/Acute Care Surgery, but she is looking forward to exploring each field of surgery further during her training! In her free time, she enjoys exploring NYC with friends, reading, enjoying the outdoors, dancing, and playing the piano! **Categories:** medical students, reflection, women --- ### [AWS Highschool Outreach Event: Becoming An Advocate For Women In Surgery](https://blog.womensurgeons.org/aws-highschool-outreach-event-becoming-an-advocate-for-women-in-surgery/) **Published:** November 18, 2022 **Author:** Blog Team **Content:** Earlier this year, I saw an opportunity to volunteer at the Association of Women Surgeons Highschool Outreach Event. I have never before come across a formal mentorship program for women high school students during my medical schooling in my home country, India. This made me curious, and I was very enthusiastic to get involved and contribute. The day consisted of impactful events, including guidance on crafting stories, speed mentoring, a suture workshop, and exposure for the high school students to some of the conference events, such as the Keynote Address and the Starr Medical Student and Resident Research Forum. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/11/HS-Outreach.jpg) The crafting stories session was highly informative and offered one on one guidance to the students. Dr. T. Salewa Oseni, a prominent breast surgical oncologist at Massachusetts General Hospital, led the students through an engaging story about her path to medicine. She spoke of how she was sure about wanting to pursue medical school, and due to its exorbitant cost, she explored alternative ways of financing her education. During a recruiting session, a mentor explained to her about army scholarships for prospective medical students. She chose to join the Navy based on her love for travel. Approximately a decade later, she reflected saying her experience in the Navy established unparalleled discipline in her, which became advantageous during surgical training, and fostered wonderful friendships across the country, making the experience life-changing. Dr. Gezzer Ortega spoke on the importance of how much one’s childhood experiences can influence their career paths. He proceeded to speak of how growing up, as a first-generation American, and the eldest child in the household, he helped his parents extensively when they faced a language barrier upon immigrating to the United States. These formative experiences paved the way for him to become substantially involved in medical research focused on improving language access and concordance for surgical patients. One of these endeavors includes his involvement in a study exploring if patient outcomes vary according to a hospital’s level of resources for interpretive services. These experiences shared by stalwarts in DEI surgery were impactful not only to the high school students but also to me. It taught me the weight of how important it is for me to reflect back on my dichotomous life experience, being equally brought up in the United States and India. Oftentimes the causes we choose to become advocates for, and our field-developing contributions stem from difficult life experiences or tough decisions we made during our formative years. After the insightful talks by Ms. Jamesa, Dr. Ortega, and Dr. Oseni, the high school students were given exercises to share their stories with the rest of us in the room. I had the privilege of listening to the story of a bright young woman regarding her experience with cerebral palsy and how she firmly chose not to hold it as a disadvantage in the way of her dreams. Yet, instead, used it to drive her to pursue medical education and training in neurosurgery. She spends a lot of her time learning about the marvels of the brain stemming from her curiosity about her condition. Gaining the opportunity to interact with highly motivated high school students reminded me of a valuable lesson as a woman medical student aspiring to pursue General Surgery. That there is always a way to flip what may traditionally appear to be a disadvantage as the very fuel behind the fire. Later in the session, I was responsible for teaching simple interrupted suturing to female high school students. Personally, volunteering at this event was very fulfilling and enlightening. One 15-year-old young woman, a Varsity Volleyball player, had undergone a devastating knee injury. She spoke of knowing first-hand how a physical injury can affect an athlete psychologically. She felt she was best suited for a career in Orthopaedic Surgery. I felt immense satisfaction in being able to teach a surgical skill to a woman as young as her and with so much more direction than I had at that age. **The Impact of Early Mentorship Focus For Women** Ms. Yoshiko Iwai, a medical student at the University of North Carolina School of Medicine, presented her study on “The Impact of Demographic Resemblance on Specialty Selection and Experience” at the STARR Medical Student and Resident Research Forum. Her study found that women were less likely to meet self-resembling physicians at a young age. They concluded that efforts to improve workplace diversity may increase the likelihood of exposure to self-resembling physicians. This outreach event is a perfect example of how the Association of Women Surgeons is pioneering change in access to early mentorship opportunities for prospective women medical students. Events like this one have an added benefit in theoretically increasing the proportion of women matriculating into surgical residency, with the conclusions of Yoshiko’s study and of numerous other studies that exposure to [same-sex mentorship ](https://pubmed.ncbi.nlm.nih.gov/32646583/) early on can be very effective in bridging the gender gap. Anecdotally, it was not until I was taken under the wings of Dr. Pavai, a highly revered woman Pediatric Surgeon in South India, that I had the confidence to accept Surgery as a career path for me. **Advocacy For Women In Surgery** Advocacy, in essence, is actively supporting the interests of a cause. Why is advocacy for women in Surgery the need of the hour? Advocacy for women in Surgery can increase the proportion of women in Surgery, improve the culture of surgical training for women, and even increase educational and leadership opportunities for women pursuing Surgery. Although there has been a [rapid increase](https://pubmed.ncbi.nlm.nih.gov/19680519/) in women in Surgery in the United States in the past three decades, this does not instantly put all surgical trainees and aspirants on an equal playing ground. In addition, the proportion of women in Surgery has not increased to the same extent in lower and middle-income countries. For example, in India, women surgeons represent only [2.4-2.8% ](https://www.womensurgeons.org/news/news.asp?id=386437)of all surgeons. Hence a mentorship focus on women pre-medical students and medical students can go a long way in bridging the gender gap among surgical trainees. Dr. Arriana Gianakos founded a “SpeakUp Ortho” coalition and is actively striving to improve the culture of Orthopaedic Surgical training for women trainees by encouraging them to speak up about their experiences during training. She spoke passionately about her vision behind this initiative at the Women In Medicine Summit 2022. “During my Orthopedic Surgery training, I was introduced to a culture of hostility, experiencing bullying and sexual harassment. When I tried to stand up for myself, I faced severe retaliation. I realized that this was a systemic problem affecting many worldwide.” She has co-authored many peer reviewed manuscripts to bring forth solutions to the widespread problem of gender inequity in surgical training. A study exploring gender disparities in awards given to surgical trainees found that female residents constituted only 31.4% of the award recipients and that female residents were overall 55.6% less likely to receive an award compared to male residents (statistically significant). The authors reflected that greater attention should be paid within residency training programs to gender disparities in [award winners](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489428/). Systemic gender biases can cause burnout, limit the future career potential of women surgical residents and discourage women from choosing a general surgical career. Beyond this, a [Chinese medical student survey](https://pubmed.ncbi.nlm.nih.gov/35581632/) this year indicated that 53.19% of medical student respondents believed Surgery was not suitable for women. When approximately 50% of graduating medical students are women, if surgical specialties are to undergo significant development in the future, women medical students must perceive it to be a professionally satisfying career path. The AWS Highschool outreach event was one of my first experiences in becoming an advocate for women in Surgery. My desire to become one stemmed from my primitive experiences as a first-year medical student in the anatomy lab when one of our mentors asked us what we wanted to specialize in. When my good friend said in response, “Cardiothoracic Surgery,” my professor said, “Why not Cardiology? Surgical specialities are difficult for women to pursue”. I, however, did not know how to take formal action towards advocacy for women in Surgery until I became extensively involved in women in surgery research, volunteered at the AWS Annual Conference, and sought mentorship from the leaders in the women empowerment space. In fact, research conducted on a similar [mentorship event](https://www.sciencedirect.com/science/article/abs/pii/S1931720422000605?via%3Di) carried out earlier by the Association of Women Surgeons, found that after attending the pilot mentoring event, over 70% of the underrepresented minority high school students felt capable of becoming surgeons, and over 80% were interested in gaining mentorship. Women medical students often think their voices will go unheard in their pursuit of becoming advocates for women in Surgery. However, they have tremendous potential to join the discourse on gender inequity in Surgery and create substantial change. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/11/Giri.jpg)Oviya Giri, MBBS, is an intern at the P.S.G. Institute of Medical Sciences and Research, India. She found her passion for surgery through her involvement in research related to pediatric pancreatic injury outcomes, congenital anomaly outcomes, and minimally invasive surgical outcomes. In addition, she trained for a competitive exam in Pediatric Surgery by shadowing and assisting the Pediatric Surgery team. Through that endeavor, she made strong relationships with her surgical mentors, giving her the confidence and desire to pursue specialty training in surgery. Growing up, being considered a creative child by her parents, she sought to bring out her creativity in the field of medicine to create impactful change. She was initially told that creativity and medicine couldn’t go hand in hand. After gaining clinical mentorship from leading pediatric urologists in India, Dr. Pavai and Dr. Sen, she became aware of how reconstructive surgery epitomizes creativity in medicine through her exposure to surgeries such as phalloplasties for congenital aphallia, and urethral duplication repairs. She aspires to walk in the shoes of her mentors and carry on their legacy. She has received awards and recognition for research presentations at local research forums and for her contribution to frontline work in the management of COVID-19 patients at P.S.G. Hospitals. In her time outside the hospital, she enjoys writing, making memes about her experiences in medical training, and watching comedy films. She recently founded a blog titled [“Loops and Loupes of Journeys,”](https://loopsandloupesofjourneys.com/) a magnification into the lives of surgeons. Her blog’s mission is to tell stories of surgeons, from their struggles to the pinnacles of their careers. She hopes to become a strong advocate for women in surgery, develop her biographical writing skills and become an academic surgeon-scientist in the upcoming years. You can find her on twitter [@OviyaGiri ](https://twitter.com/OviyaGiri)and on LinkedIn [@OviyaGiri.](https://www.linkedin.com/in/oviyagiri/) **Categories:** advocacy, career development, medical students, mentorship, Underrepresented in medicine --- ### [Association of Women Surgeons Foundation Awards Gala: A Wonderful Night with Friends and an Inspiration for the Future](https://blog.womensurgeons.org/association-of-women-surgeons-foundation-awards-gala-a-wonderful-night-with-friends-and-an-inspiration-for-the-future/) **Published:** November 11, 2022 **Author:** Blog Team **Content:** By Kathleen Romanowski, MD, MAS, FACS ![](https://blog.womensurgeons.org/wp-content/uploads/2022/11/OAFiles-55-scaled.jpg) I had not gotten dressed up for a night out in a long time. In fact, it is the rare day that I wear anything other than scrubs or pajamas. As I prepared to attend the Association of Women Surgeons Foundation (AWSF) Awards Gala, I was excited. Not only was I getting to wear a fancy dress for one of the first times in two and a half years, but I was also going to get to spend an evening with my friends. It has been a long time since we had the chance to gather in the same room to celebrate each of us and the friendships we have forged over the years and reward the best among us. The AWSF Awards Gala was an event that pre-pandemic, I looked forward to every year. It is hard to describe fully what makes it so special, but it just feels like coming home in a way. It is always fun to look around the room and see many inspiring women surgeons. Some are chairs of departments, the greats of American surgery, those who we aspire to be like. Some are my closest friends, my former co-residents, and those who we “grew up” with as surgeons. Some are the next generation of medical students and residents, future leaders, and hope for years to come. Together we are so much stronger than we are apart, and this feels especially true on this one night a year. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/11/S1P3152-scaled.jpg) Beyond being a wonderful place to catch up with other women surgeons, the AWSF Awards Gala is where the AWSF recognizes its award winners. From medical students to senior mentors, excellence in surgery is recognized each year. It is always so inspiring to hear about why each person was nominated. Their stories are all so varied, but they are each such amazing role models for others. The award winners this year were: The Dr. Nina Starr Braunwald Award: Patricia L. Turner, MD, MBA, FACS American College of Surgeons The Dr. Olga Jonasson Distinguished Member Award: Paula Ferrada, MD, FACS, FCCM, MAMSE Inova Healthcare System & University of Virginia Association of Women Surgeons Past Presidents’ Honorary Member Award: LD Britt, MD, MPH, FACS, FCCM East Virginia Medical School The Dr. Sally Abston Association of Women Surgeons Distinguished Member Award: Mara Antonoff, MD, FACS MD Anderson The Dr. Hilary Sanfey Outstanding Resident Award: Deshka Foster, MD, PhD Stanford University The Dr. Patricia Numann Medical Student Award: Paige Ashley Campbell, MD University of Chicago Pritzker School of Medicine The Dr. Charles W. Putnam Distinguished Mentor Award: Justin Dimick, MD, MPH University of Michigan Congratulations to all the award winners. You are all a credit to our profession and such an inspiration to us all. Consider [donating to the Association of Women Surgeons Foundation ](https://www.womensurgeons.org/donations/)and consider [joining the Association of Women Surgeons](https://www.womensurgeons.org/page/JoinAWS). If you are already a member and have a story to share please consider [volunteering to write a blog](https://www.womensurgeons.org/page/BlogApplication). ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/Romanowski-Blog.png)Kathleen Romanowski, MD, FACS is an Assistant Professor of Surgery at the University of California, Davis, and Shriners Hospitals for Children Northern California in the Division of Burn Surgery. She attended the University of Chicago Pritzker School of Medicine and completed her general surgery residency at the University of Chicago Medical Center. She did fellowships in Burn Surgery and Surgical Critical Care at the University of California, Davis, and Shriners Hospitals for Children Northern California. Kathleen is devoted to the care of the burn-injured patient and studies disparities in care and predictors of outcomes in elderly burn patients. She is an active member of AWS and is Vice Chair of the AWS Communications Committee and Faculty Co-Chair of the AWS Blog Sub-committee. You can find her on twitter at @KSRomanowski. **Categories:** AWS conference, women --- ### [An Interplay Between Invisibility and Hypervisibility while Pursuing a Surgical Subspecialty](https://blog.womensurgeons.org/an-interplay-between-invisibility-and-hypervisibility-while-pursuing-a-surgical-subspecialty/) **Published:** October 25, 2022 **Author:** Blog Team **Content:** By Natalia G. Penaloza My *latinidad* in the context of pursuing a surgical subspecialty has made me both invisible and hyper-visible. As a Latina in an operating room with a thousand moving pieces, from ancillary staff turning-over a room in under 30 minutes, scrub technicians meticulously following the surgery anticipating the next instrument, to nurses ensuring the patients are safe and comfortable, I was often identified as one of these healthcare workers. I take pride in knowing that I share some of the same qualities as them; efficiency, attention to detail, and empathy. Still, it is often a surprise to many when I introduce myself as the medical student on the team. The hyper-visibility is accompanied by my continuous effort to ensure I know all the equipment, anatomy, steps, complications, follow-up treatments, to know it all. If I don’t, I will not have represented Latinas and women in medicine well. Although the onus does not and should not lie on one individual to represent this vast heterogeneous group of people, this can make a nick at the[ 2.4%](https://pubmed.ncbi.nlm.nih.gov/34524137/) of Latina women physicians currently in the United States, with even fewer of us specializing in surgery as seen in the work by Dr. Romero that showed [<100 Latina surgeons](https://pubmed.ncbi.nlm.nih.gov/32447189/) across academic surgery faculty. Currently, the United States population is made up of [18.7% Hispanic/Latinx folks](https://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-reveal-united-states-population-much-more-multiracial.html) and this number is projected to rise to 28% by 2060. This alone is a call to action to increase Underrepresented in Medicine (URiM) physicians and trainees for increased race-concordant relationships, which have been shown to improve healthcare outcomes, reduce health disparities, and provide much needed care to [under-resourced areas](https://pubmed.ncbi.nlm.nih.gov/33403653/). It is important to maintain this at the forefront as Latinx communities are heterogeneous and vast and include Black, Indigenous, White, and other races within this ethnic group and can deeply affect Latinx and other under-resourced communities. Increasing the representation of URiM in surgery would help in addressing health disparities specific to surgical and surgical social responsibility care including the effects of [food insecurity on](https://pubmed.ncbi.nlm.nih.gov/33272853/) [surgery](https://pubmed.ncbi.nlm.nih.gov/35067460/), and connections between primary language and surgical outcomes, surgical complications, [and](https://pubmed.ncbi.nlm.nih.gov/34710627/) [readmission rates](https://pubmed.ncbi.nlm.nih.gov/34474213/). As a recipient of the [Association of Women Surgeons](http://www.womensurgeons.org) (AWS) and [Latino Surgical Society](http://www.latinosurgicalsociety.org) (LSS) Diversity, Equity and Inclusion (DEI) Award in 2021, I had the privilege of attending the AWS “Celebrating our Past, Transforming our Future” conference, where I was able to further learn about the arduous and fulfilling work that the AWS has done since its establishment to address the various stages in a woman’s surgical training. Organizations like the [AWS](https://www.womensurgeons.org/default.aspx) in conjunction with the [LSS](https://www.latinosurgicalsociety.org/) have been supporting and propelling Latinx women trainees to form strong connections with others in the field, such as through the DEI Award. Through this award, I was also able to access vast networking opportunities through both the AWS and LSS, and gain mentors dedicated to the advancement of women in surgical subspecialties, such as Urology. As Latinx Heritage Month comes to an end, I am encouraged by so many Latinx physicians and the growing number of Latinx surgeons who have come before me, served as possibility models, and have carved out paths for others to follow and build upon. Having the opportunity to be exposed to and participate in various pipeline programs and mentorship experiences, I understand the necessity of continuing cycles of mentorship to recruit and retain those who might be interested in surgical subspecialties. Through the support of organizations such as AWS and LSS I am empowered to continue addressing barriers to increasing representation in surgery, specifically Urology– from creating pipeline programs, increasing awards that help address systemic barriers specific to URiM students pursuing surgical subspecialties, and increasing opportunities for mentorship. The interplay between the invisibility and hyper-visibility that I along with many minoritized women pursuing surgery face nicks less as I continue to build community with other Latinas, women and allies within surgical specialties. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/10/Penaloza.Natalia-Garcia-200x300.jpg)Natalia Garcia Peñaloza is a fourth year medical student at the David Geffen School of Medicine at UCLA and Charles R. Drew Medical Education Program. She was born and raised in Cochabamba, Bolivia and has made the San Fernando Valley her home since migrating to the United States. She attended San Francisco State University and earned a Bachelors of Science in Biology with a minor in Latino/a Studies. Natalia also earned a Master’s of Bioinformatics and Clinical Research at UCLA between her 3rd and 4th year of medical school. Through her clinical rotations she was exposed to Urology, where she found a home in medicine and is pursuing this amazing surgical subspecialty. One of her goals is to be a leader in providing and bridging urological care for all, regardless of insurance status, socioeconomic level, race or ethnicity. She intertwines her formal education with her lived experiences with an aim to increase parity of Under-Represented in Medicine to the US population and to address health inequities that often plague under-resourced communities. Find her on twitter @NatGPenaloza **Categories:** awareness, diversity and inclusion, hispanic heritage, medical students --- ### [Tweetchatting 101](https://blog.womensurgeons.org/tweetchatting-101/) **Published:** October 5, 2022 **Author:** Blog Team **Content:** *By Camila R. Guetter, MD MPH* The Internet and social media have expanded our ways to communicate and interact with one another. In medicine and research, the Internet facilitates discussions and scientific advancements. Social media, more specifically Twitter, is a great forum for discussions on research/innovation, clinical care, and medical education in surgery. A specific strategic way to use Twitter to connect individuals and promote discussions on predetermined topics are Tweetchats. The Association of Women Surgeons has hosted many of these, approximately one per month for the past few years. You are likely to have come across an advertisement for one of these Tweetchats, also called #AWSChats in AWS. Other societies have also been using this tool regularly. Examples of recent AWS tweetchats (and topics discussed) include: - [Surgical education](https://blog.womensurgeons.org/awschat/need-for-surgical-education/) (August 1, 2022) - [Dear intern: welcome to residency!](https://blog.womensurgeons.org/awschat/welcome-to-residency/) (June 20, 2022) - [Increasing representation for LGBTQIA+ surgeons, trainees, and patients](https://blog.womensurgeons.org/awschat/increasing-lgbtqia-representation/) (May 23, 2022) - [Global surgery](https://blog.womensurgeons.org/awschat/changing-face-of-global-surgery/) (April 18, 2022) - [Surgical innovation](https://blog.womensurgeons.org/awschat/surgical-innovation-tweetchat/) (March 28, 2022) Although you may have come across our social media advertising for our upcoming tweetchats, maybe you feel like you don’t know enough about them, how to participate, or feel hesitant to join. Or even, maybe you have joined a tweetchat in the past, but did not know how to follow the discussion or participate effectively in the conversation. For those reasons, I have put together this blog article to share a little bit about the basics of tweetchatting and how to best take advantage of participating in one. **What is a tweetchat?** Tweetchats are pre-scheduled online discussions that take place on Twitter on a specific topic of interest. Participants log on Twitter at that specific date and time and follow questions that are posted from the host institution’s twitter account, or through a specific hashtag chosen for the tweetchat. Anyone on Twitter can participate in a tweetchat, if they are interested in the topic of discussion. These chats are also usually moderated by a few individuals who post questions and/or ensure that the discussions keep going. **What are the advantages of participating in a tweetchat?** It is a great opportunity to learn about new topics. It is an open space to people all over the globe to share their thoughts and experiences. It is also great to connect with people from various backgrounds, institutions, and countries, and expand your network. Lastly, if you are not available at the time, tweetchats allow you to participate asynchronously, as you can just access twitter later and look for the chat hashtag or click on the host institution’s profile and find questions, answers and threads you can still post comments to. **Should I prepare ahead of time for a tweetchat?** The most important thing is setting time aside to be able to get immersed in the discussion. If you do have to multitask, that is totally ok! It may just be harder to keep up with all the posts and discussions, so avoiding it as much as possible is helpful. It is also good practice to let your followers know ahead of time that you will be participating. You will likely be posting/commenting/retweeting a lot of things, and this can get overwhelming for other people that follow you if they are not interested in the topic. This way they can know and decide if they want to mute you for the evening, or if they actually want to join the conversation or closely follow your thoughts in the discussion! **The most important question: How does one participate in a tweetchat?** Log on twitter at the time and date of the tweetchat. Follow the chat hashtag or click on the profile of the host institution to find the questions for discussion. There is usually a message sent by the host institution or moderators letting participants know that the tweetchat started. Take the opportunity to introduce yourself in the beginning of the tweetchat and share why you are interested in this specific discussion. Now you can decide how much or how little you want to participate. It is totally acceptable to lurk the first couple of times until you get a better sense of how the tweetchat works. You can also like/retweet other people’s comments. Or if you are feeling comfortable, you can post original content (new post or respond to someone else’s comment with your thoughts). **Helpful tips:** Use this opportunity to start following individuals and institutions that also participated and/or moderate in the chat, you will start growing your network this way. If you post a new comment or answer, remember to add the tweetchat hashtag, and to tag other people that are in the discussion that could give any additional thoughts. Adding images and/or links to your posts are also likely to help increase visibility. Now that you know all you need about the basic principles of tweetchatting, we look forward to seeing you in the next chat and hearing your opinions and learning from your experiences! **![](https://blog.womensurgeons.org/wp-content/uploads/2022/06/DSC_2250-221x300.jpg)Camila R. Guetter, MD MPH**, is a General Surgery resident at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston, MA. Born and raised in Brazil, she graduated medical school from the Federal University of Parana in Curitiba, Brazil. She obtained a Masters in Public Health at Johns Hopkins Bloomberg School of Public Health before starting residency. She has been a proud and active member of AWS since 2015. She has been a part of the AWS Blog Committee since 2016 and has also served as the Vice Chair of the ​​AWS National Medical Student Committee. Camila is very grateful to be part of the blog team and to read the stories shared by surgeons and trainees from all across the AWS community. You can find her on twitter at [@camila\_guetter](http://twitter.com/camila_guetter). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat, networking, resources **Tags:** Tweetchat --- ### [Chronicles of a Latina in Medicine: My Calling to Surgery](https://blog.womensurgeons.org/chronicles-of-a-latina-in-medicine-my-calling-to-surgery/) **Published:** October 4, 2022 **Author:** Blog Team **Content:** *By Natalia Correa* Organized chaos flooded the seventh operating room in the form of three transplant teams from Miami, Charlotte, and Daytona Beach. The surgeons scrubbed, nurses counted, scrub techs gowned, and the anesthesiologist ventilated. Every moving piece fell into place, as we called for a time-out. Five sets of hands eloquently worked to isolate each organ and preserve its viability for the next body to appreciate its inhabitance. From the first incision to the last suture, I watched as the heart pumped, lungs inflated, and blood flowed. No lecture, video, textbook, or cadaver could emulate this process. Our heads bowed, as we thanked our patient for the gifts of longevity he offered to recipients of his heart, lungs, liver, kidneys, and pancreas. I stood enamored at the head of the operating table and felt reassured by the second chance offered to those receiving each carefully harvested organ. I always knew medicine would grant me the opportunity to impact many lives; however, this unique moment confirmed my calling to become a surgeon. I often found myself as the only Latina in the surgical setting and sought mentors who shared a similar experience. This isolation deters numerous minorities, but in my case, it was the fuel to my fire and my anchoring pursuit. As a Latina, I have strengthened the teams I was a part of with the ability to connect culturally and linguistically with non-English speaking patients. I translated for my preceptors, advocated for patients’ needs, and reassured families before every procedure. My name is Natalia Correa, and I am a fourth-year medical student at Florida State University College of Medicine. This month, I am applying for a categorical position in general surgery and I could not think of a better way to celebrate Hispanic Heritage Month than joining the [6% of Hispanic/Latinx physicians in the United States](http://aamcdiversityfactsandfigures.org/). Though the number falls to 4-5% for Hispanic/Latinx surgeons and even less for those who identify as women, I find strength in knowing I am exactly where I need to be. As a surgeon, I aim to advocate for diversity, support the goals of future underrepresented surgeons, minimize disparities, and promote health equity. Receiving mentorship from women in surgery has been essential to my resilience as a minority medical student and aspiring surgeon. It would be remiss of me not to mention the instrumental role that the Association of Women Surgeons played in my journey. In 2021, I received the Association of Women Surgeons Diversity, Equity, and Inclusion (DEI) Award to attend the virtual conference as a third-year medical student. This award allowed me to connect with leaders and mentors I would not have been exposed to otherwise. I learned about the [Latino Surgical Society](https://www.latinosurgicalsociety.org/) (LSS) and Association for Academic Surgeons (AAS) and became a member of both organizations shortly after. These organizations also connected me with an endless network of leaders and mentors who were incredibly eager to support my aspirations of becoming a surgeon. As a DEI award recipient, I gained access to unlimited inspiration, support, and opportunities. I became involved with the social media team for the Latino Surgical Society and have since been able to work closely with Dr. Minerva Romero Arenas on my personal and professional goals as an aspiring surgeon. At our monthly meetings, we discuss ways to improve my resume, how to excel as a visiting medical student, ways to strengthen my ERAS application, how to shine in residency interviews, and more. Dr. Romero has personally contacted her colleagues at the institutions I was visiting so I could have additional support and establish meaningful relationships as I prepare for the application and interview season. Dr. Romero is one of many selfless and accomplished leaders that AWS and LSS have. Evidently, the support gained from AWS, LSS, and AAS, especially as a minority, has been absolutely invaluable and instrumental in my success. If you take anything away from this, I implore all students to be persistent and eager in their journey. You never know who you will meet or what doors may open, but you should always be prepared to walk through them! ![](https://blog.womensurgeons.org/wp-content/uploads/2022/10/Natalia.jpeg) Natalia Correa is a fourth-year medical student at Florida State University College of Medicine. Prior to attending medical school, she completed her Bachelor’s in Exercise Physiology at Florida State University and Master’s in Medical Sciences at the University of South Florida. She was born and raised in Miami, Florida as a first-generation American with parents from Bogota, Colombia. Natalia has applied to match into General Surgery this year and is ecstatic to become the first surgeon in her family! Her most cherished accomplishments are sharing her journey as a Latina medical student to inspire the next generation and supporting the diversification of the medical field. As a surgeon, Natalia aspires to remain involved with medical education, serve as a mentor for future surgeons, and start her own scholarship program in the future. She has interests in trauma and acute care surgery, but she wants to keep an open mind as she continues her journey! In her free time, she enjoys traveling, exploring new places and tasting different cuisines. She cherishes the time she spends with her family and friends, especially when it involves going out to explore together! --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** hispanic heritage **Tags:** Diversity, diversity and inclusion, Hispanic Heritage Month --- ### [Social Dimensions of Wellness](https://blog.womensurgeons.org/social-dimensions-of-wellness/) **Published:** September 30, 2022 **Author:** Blog Team **Content:** By Whitney Jin I currently attend medical school in the Texas Medical Center (TMC)—the largest medical center in the world. It truly is its own concrete jungle–I joke that while looking for apartments to live in for medical school, I prioritized the TMC skyline over the downtown skyline for a more fitting view. As a student still in the preclinical curriculum, I find that it becomes tempting (and comforting) to fall into a routine of classes, clinics, co-curriculars, and catching up on sleep. The two-mile radius between campus and its adjacent hospitals means that the vast majority of students spend most of their productive hours in a classroom, hospital, or a research lab. While it is a true privilege to be surrounded by so many patients, with diverse backgrounds and illnesses, we must remember that within medical facilities, we only meet patients at a snapshot moment in their lives. That thirty-minute appointment in the clinic or the two-hour long operation in the OR only allow us transient access to patient stories. I believe that deepening the connection we have with our local and surrounding communities can help us understand the contexts in which people live, which can in-turn improve the care we provide for our patients. The Social dimension of the Wellness Model (National Wellness Institute) suggests that contributing to one’s own community and environment highlights the interdependence between us and the world we live in. It says: “You’ll take an active part in improving our world by encouraging healthier living and initiating better communication with those around you.” I believe this encapsulates the mentality that we as surgeons (and surgeons-in-training) should have—as healers, we should not only strive to heal the injured but also connect with our patients and their stories. This past summer, I was able to work with the vascular surgery department at our Veterans Affairs hospital. In clinic, I saw gangrenous limbs and patients recovering from amputations. In the OR, I assisted with amputations and bypass grafts for patients with peripheral artery disease, secondary to diabetes and smoking in many cases. As patients were getting prepped, many shared their stories with me and the rest of the operating team, perhaps as an attempt to lessen any pre-op anxiety or as a desire to connect on a personal and human level. These brief conversations, which often centered around family, stories from the armed forces, and personal interests, always reminded me that patients were more than just bodies to be maneuvered or fixed within a sterile operating field. It was always more personal than that. During my time at the VA, I also noticed a significant population of veterans who experienced homelessness. Many patients would undergo emergency life-saving amputations but would be left to fend for themselves in the post-recovery process when they would have no place to return to but the streets. This constantly reminded me of my time volunteering at the HOMES (Houston Outreach Medicine Education and Social Services) Clinic during my first year of medical school, where I also crossed paths with many veterans. As context, the HOMES Clinic is a primarily student-run clinic that serves to integrate community outreach, medical and social services, and a holistic approach to healthcare to serve Houstonians with unstable housing. From encounters at the HOMES Clinic, I witnessed how the lack of access to employment, housing, insurance, transportation, and access to basic necessities could directly impede recovery and rehabilitation. Ultimately, even if a surgeon prescribes a blood thinner or stents open the aorta, a patient is unlikely to recover without proper health education, post-operative care, or access to medication. I encourage each of us to continually reflect on the social dimension of wellness. I believe that my experiences with the HOMES Clinic and other outreach organizations will complement my future role as a surgeon. There are innumerable avenues through which we can better connect with the world around us, whether it be through volunteering in our local communities, advocating for the voiceless or marginalized patient, or broadening our presence to beyond the hospital walls. If we view our patients in isolation, we only deprive ourselves of the bigger picture that our patients exist within. Learn more about the HOMES Clinic[ here](https://www.homesclinic.org/mission). ![](https://blog.womensurgeons.org/wp-content/uploads/2022/09/Jin.Whitney-300x200.png)Whitney Jin, originally from Naperville, IL, is currently a second-year medical student at Baylor College of Medicine in Houston, Texas. She graduated with a B.A from Rice University and is thrilled to continue her medical school education just across the street. She is interested in pursuing academic surgery, although she remains undecided on which surgical specialty just yet. You can find her on Instagram or Twitter at @whitneyjin\_. *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care, women **Tags:** Wellness --- ### [Celebrating Hispanic/Latino Heritage Month 2022](https://blog.womensurgeons.org/celebrating-hispanic-latino-heritage-month-2022/) **Published:** September 25, 2022 **Author:** Blog Team **Content:** *By Minerva Romero Arenas, MD, MPH, FACS* In an ongoing partnership between the [Association of Women Surgeons](http://womensurgeons.org) and the [Latino Surgical Society](http://www.latinosurgicalsociety.org), we are proud to again bring you a Blog series for Hispanic Heritage Month (HHM). In this piece, I hope to highlight some important points we hope to bring to light during HHM. **What is HHM?** Every year, the US celebrates the history, culture, and contributions of Americans who immigrated or whose descendants originated from Spain, Mexico, the Caribbean and Central and South America. What started as a weeklong celebration in 1968, has now expanded to observation of HHM from September 15 to October 15. This period was chosen due to the significance of many Independence Day celebrations in those countries occurring in mid-September and Día de la Raza (Day of Heritage) being celebrated on October 12th. You can find more information on the [National HHM website](https://www.hispanicheritagemonth.gov/). **How have AWS and LSS worked together?** Our two organizations have mutually benefited from ongoing collaboration. Two Latina surgeons have held the position of LSS Liaison to AWS (Dr. Chantal Reyna, 2020-21 and myself, 2019-20). We have laid the foundation for starting the partnership and building joint programming and collaborations between our organizations. Our partnership has included the ongoing support of the AWS Mentoring Program for Students who are Underrepresented in Medicine. This program paired URM medical students with surgical mentors to help explore and develop their interest in careers in surgery. We are also proud to have initiated the [AWS DEI Awards](https://blog.womensurgeons.org/training/new-trainee-award-celebrating-diversity/) in 2020. The awards are presented to students and residents to attend the annual AWS Conference. The inaugural awards were granted in 2020 and included awards adopted by our partners the Society of Black Academic Surgeons, the Society of Asian Academic Surgeons, and the Association of Academic Surgeons. The awards were again granted in 2021 and the 2022 winners will be announced soon! **HHM social media profiles and blog series** – We were very proud to start highlighting LSS and AWS members through our social media campaigns. We also partnered with the AWS Blog Team to invite blog pieces for HHM. The LSS identified current and future surgeons to share with you their perspectives on being Hispanic/Latino in surgery. You can find the past blog pieces listed below and keep an eye out for the upcoming series between now and Oct. 15th. [AWS Celebrates HHM 2020](https://blog.womensurgeons.org/advocacy/hispanic-heritage-month/) [It’s a vast wonderful world: National HHM begins](https://blog.womensurgeons.org/uncategorized/its-a-vast-wonderful-world-national-hispanic-heritage-month-begins/) [It takes a village](https://blog.womensurgeons.org/residency/it-takes-a-village/) [Diversity in Strengths and Strengths in Diversity](https://blog.womensurgeons.org/medical-students/diversity-in-strengths-and-strength-in-diversity/) [There all along](https://blog.womensurgeons.org/uncategorized/there-all-along/) [Fixing the leaky pipeline](https://blog.womensurgeons.org/awareness/fixing-the-leaky-pipeline/) **Future Directions** We are excited to have a return to in-person events and our partnership will continue to drive this. The LSS will have a presence at the upcoming AWS conference and we are collaborating with other surgical societies to co-host an information booth at the ACS Clinical Congress to follow the AWS Conference. We are looking forward to the upcoming appointment of a new Liaison to the AWS. We would love to hear from our members how you think this partnership should move forward. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/09/Minerva.jpeg) Dr. Minerva A. Romero Arenas is an Endocrine & General Surgeon at NYP Brooklyn Methodist Hospital. She is an Assistant Professor of Surgery at [Weill Cornell Medical ](https://weillcornell.org/minerva-romero-arenas-md)[College](https://weillcornell.org/minerva-romero-arenas-md). Dr. Romero Arenas completed a fellowship in Oncologic Surgical Endocrinology at the University of Texas MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She earned her Medical Doctorate and Master of Public Health degrees from The University of Arizona College of Medicine and the Zuckerman College of Public Health. She studied Cell Biology and French at Arizona State University as an undergraduate. Her interests include benign and oncologic endocrine neoplasms, hereditary syndromes, health disparities, quality improvement, global health, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations, such as the Association of Women Surgeons, [Tour for Diversity in Medicine](http://tour4diversity.org), [Latino Medical Student Association](http://www.lmsa.net), [National Hispanic Medical Association](http://www.nhmamd.org), and [Building the Next Generation of Academic Physicians](http://www.bngap.org). She is a Founding Member of the [Latino Surgical Society](http://www.latinosurgicalsociety.org). She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** hispanic heritage **Tags:** Hispanic Healthcare, Hispanic Heritage Month --- ### [Trial by Fire](https://blog.womensurgeons.org/trial-by-fire/) **Published:** September 22, 2022 **Author:** Blog Team **Content:** *By Alyssa Brown* I sat through orientation with a terrified look. We practiced placing central lines, arterial lines, and nasogastric tubes. They poured knowledge into us to try to prepare us, but I knew it probably wouldn’t be enough. I was starting my intern year in the surgical intensive care unit (SICU). The night before my first day in the SICU, I lay in bed and had questions flying through my head: would I be able to keep up? Would I be a good surgeon and resident one day? How bad is this going to be? Will people on the team like me? Will my black cloud have faded? My alarm jolted me awake as the sun started to peek through the blinds. I tossed on my scrubs and headed in. The SICU was packed with patients, nurses, and residents. The hustle of the morning and the newness of the interns to the hospital were evident. Our SICU workroom was small, but we packed in: three interns, two nighttime PGY-2s, the daytime PGY-2, PA, two medical students, and a PA student. We started sign-off, and I began to realize that these patients were mine now, which may seem like an odd thought, but in medical school there were fail-safes – you had a resident watching over you. I realized that I still had upper levels and help, but I was now writing the orders and responsible for their care. I made it through my first day with a lot of confusion and not a terrible amount of hubbub, but we also had four hours of protected education time that day. By the time I got home at 7pm, I had started to feel off. My skin started to feel prickly, and I was getting cold sitting outside. I took my temperature, and it was normal, but I went ahead and tested for Covid-19. Two little lines showed up. I cursed, called my chief, texted the intern group chat, texted the SICU team, and called the employee hotline (in that order). I was told that I needed five days and a negative test. I felt miserable that I was putting more work on the other interns in the SICU. I didn’t like feeling like I was causing the other residents to pick up my slack while I was out sick. I spent the next four days sitting on my couch and napping. I thought I would be more productive, but I was knocked out. I appreciated that my co-interns checked on me and offered to bring food. I made it through my quarantine, and it was like the first day all over again but now I felt behind everyone. The other interns had five days on me. I struggled to present patients and make plans for them. I felt like everyone else knew what they were doing. I felt like the medical students were doing a better job than me. I was lost. Also, the SICU was bursting at the seams with patients. On one weekend, we had four people out of twenty-two getting massive transfusions, two eventually coded, and two got emergently intubated. It felt like getting hit by waves in the ocean. As soon as one hit, you would take half a breath and get hit by another. I didn’t feel like I was keeping up. If I’m being honest, I started to question if I was cut out for surgery residency. I wondered if I was going to get better at this, if my knowledge and skills would catch up. There was not an insignificant number of tears shed, mostly out of frustration. I wanted to do better. I wanted to be better. By the end of the second week, I was tired of feeling like I couldn’t do anything right. I had put in medications wrong, I wasn’t great at reading chest x-rays, interpreting arterial blood gases, or really coming up with a good daily plan for my patients. I was lucky that my partner came to visit around this time. I got my first day off since being away for Covid, and we spent the day at Costco and buying groceries. It made me sad that it wasn’t that fun of a trip for him. I was at the hospital by 6am and got home most of the time just after 7pm, but I appreciated him being there. He made me food, which I appreciated like a good hug. One of the attendings pulled me aside after rounds one day for feedback. She asked how I felt that I had been doing, and I told her that I didn’t feel like I was doing a good job. I told her that I was incredibly frustrated that I was not better at all of it. She gave me some advice on how to improve and what to focus on, but most importantly, she sensed something else. She said, “you deserve to be here.” She said, “you worked hard and did the work to deserve a spot in residency, so don’t beat yourself up so much believing that you are not good enough or that it was just luck.” It was like a veil had been lifted. She hit the nail on the head with this statement. At least in part, I had been beating myself up in the feelings of imposter syndrome. I would like this story to have a happy ending. I would like to say that by the end of the month, I was on top of my game, but I can’t. I felt better at some of the day-to-day tasks of the SICU and presenting patients, but I still didn’t and don’t feel like I am confident in my abilities. I think that will take time. It will take time to get comfortable in residency day in and day out. It will take time to feel confident and leave some of the imposter syndrome behind. As one mentor used to say, “this is the hardest that this will ever be.” Logically, I believe him, but that doesn’t mean that sometimes the irrational part of my brain doesn’t take over and make me question whether or not I will ever be able to do this. For now, though, I am going to continue to work hard and tell myself that I will get better and more confident and that I deserve to be here. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/headshot_5x7_0449-731x1024.jpg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a Ph.D., before finishing her MD. She graduated with an MD from the University of Louisville School of Medicine in 2022, and her Ph.D. in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences in 2022. She is now a PGY-1 general surgery resident at Northwestern University in Chicago. She has been a part of the AWS Blog Subcommittee since 2018. You will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” embroidering, or off on a new adventure. You can find her on Instagram @Alyssa\_b\_futuremdphd and on Twitter @Alyssa\_B\_MDPhD. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, residency **Tags:** COVID-19, Imposter syndrome, New Intern --- ### [Medicine is personal; deep down to your soul](https://blog.womensurgeons.org/medicine-is-personal-deep-down-to-your-soul/) **Published:** September 16, 2022 **Author:** Blog Team **Content:** *By Anuja Mali* “To know even one life has breathed easier because you have lived. This is to have succeeded.” – Ralph Waldo Emerson One of the truths about choosing to study Medicine is that, from the moment you decide to go down that road, you are bombarded with the same question. **“Why medicine?** You’d think that once you get into medical school, you’ll never be asked that question ever again, but you are. I am a first-year medical student aspiring to become a surgeon. I know I know- SURGERY? And how are you so sure about it? You have just started your med school. You haven’t even seen the patients. Do you even know how much time and hard work it takes to become a well-renowned surgeon? So, how do I respond when people ask me if I’m scared about how long it takes to become a doctor? There’s the classic “you’ll get older anyways so you may as well be a doctor! For me this is different. “There is a special joy that comes with the practice of surgery. Surgeons, indeed, are distinguished by the art and craft of their ability to perform surgical procedures or operations.” Medicine is different for different people. Most likely, it’s something along the lines of you love patients; you are an obsessed huge geek about the body. Most likely you care about social justice issues and strongly believe in the right of health for all. You probably are passionate about innovative care, observing the microscopic organs, maybe discovering treatments, and giving your time for the benefit of others. The main thing you’re missing out on is being the leader and the paycheck of course but those things come with time. And as a disclaimer: the length of training is a non-issue to me. We live our dream every day and if it’s what you want and what you’re passionate about there is no reason to elude your calling. Each person defines success in different ways. To know even one life has been improved by my actions affords me immense gratification and meaning. That is success to me. I want to have the ability to provide care and treatment on a daily basis as a physician. I hope not only to care for patients with the same compassion with which physicians do but to add to the daily impact I can have by tackling large-scale issues in health. And not to forget the day when I’ll do my first surgery when I will treat my first patient or listen to the heartbeat of the first child I will deliver as a doctor. **To me, empathy is the essence.** There is something sacred, and empowering, about providing support when people need it the most. I think medicine is rewarding and eye-opening but simultaneously challenging and helping people at their most vulnerable times is a privilege. My reason for sticking with medicine from 6th grade for all these years is due to my intrinsic and fierce desire to help and save the lives of others. I want to be a hero, not with weapons or superpowers, but with a scalpel. The knight in shining scrubs. It’s such a profound feeling that it’s quite hard to explain what it’s like. It’s not something that can be learned; you can’t be taught to want to be a doctor. That intense thirst for medicine, it just is, and there is truly no other way to put it. Truth be told, it’s not something you can explain in simple terms. It’s a very personal dream; a very strong dream. And the desire to help others is unexplainable. But you’re the only one who knows why you go into medicine. And why you want to pursue the hard journey. And why you want to go through it all. I have no doubt that the next ten years will be similarly unpredictable, but I can assure you that no matter what obstacles I face, my goal will remain the same. And I know with certainty that this is the profession for me. **Medicine is personal; deep down in my soul.** ![](https://blog.womensurgeons.org/wp-content/uploads/2022/09/IMG_1035-9-16-768x1024.jpg) Anuja Mali is a first-year medical student aspiring to become a trauma surgeon. She is driven by curiosity to understand human health, especially in women! She is also passionate about academic research and can’t wait to approach clinical practice. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** #WhyIAWS, Medical Student Members, medical students --- ### [From Ecuador to Wisconsin, now a categorical surgical resident](https://blog.womensurgeons.org/from-ecuador-to-wisconsin-now-a-categorical-surgical-resident/) **Published:** September 11, 2022 **Author:** Blog Team **Content:** By Gopika SenthilKumar I met Dr. Figueroa during his post-doctoral research work at the Medical College of Wisconsin. He is part of a small group of international medical graduate (IMG) surgical residents who matched into a categorical position. In comparison, most IMG residents match into a one/two-year preliminary program. His story and advice will hopefully serve as an inspiration for future generations. Dr. Figueroa’s family played a huge role in his decision to pursue medicine and surgery. “Having my dad and grandfather both being surgeons, I was always surrounded by medicine since very early,” he says. “When I was 5 years old, I was driving around town with my grandpa, and suddenly he got a call to see a very sick patient in the ED. I remember entering the emergency department with him and waiting outside of the patient’s room. That day I felt deeply attracted by the hospital setting and the work that people do to help someone going through a difficult day.” Fast forward to his medical school years, he received an opportunity to do an observership in the Trauma Surgery department at Virginia Commonwealth University. There, he says he was “able to learn how mature trauma systems work to enhance favorable outcomes in their communities. The state-of-the-art technology and educational curriculum in academic centers became my inspiration to pursue my residency in the US.” As an IMG, he says that he often felt like his future was uncertain. He often heard discouraging stories, found many closed doors, and had to change plans due to COVID-19. Nonetheless, Dr. Figueroa says that “all these situations in my journey have helped me shape a more resilient person.” When asked what he believes greatly influenced his ability to match into a categorical residency position, Dr. Figueroa shares that it was “building networks early in medical school through organizations, such as the Panamerican Trauma Society (PTS). These opportunities opened doors to do observerships and research in the US, which then helped me expand my network further for a successful match into surgery.” If he had to do it all over again, Dr. Figueroa shares that he would start his Step 1 and Step 2 CK preparations earlier, along with his medical school coursework. “It helps save time and money in the long run. Additionally, if you clear the steps while you are still a medical student, you can apply for hands-on surgical clerkships, which are better than observerships. Thus, it may increase your chances of getting more interviews.” He further advises future applicants to “Plan your goals early. Build connections with people through organizations like the Association of Women Surgeons, Panamerican Trauma Society, and the American College of Surgeons. You will always find someone willing to mentor you, and even get you involved in research experiences that will help you build into a better professional. Try to get hands-on experiences to become familiar with the US healthcare system. Finally, do not let anyone discourage you. The process is long, and it comes with many obstacles, bad days, and uncertainties. Do not work to check off tasks or to build a strong CV only. Work with the goal of becoming a better professional for your patients, as the latter makes the journey more meaningful.” ![](https://blog.womensurgeons.org/wp-content/uploads/2022/09/IMG-blog-4.jpeg) Dr. Juan Figueroa was born and raised in Cuenca, Ecuador. He attended medical school in his hometown, at the Universidad del Azuay medical school. He then completed a post-doctoral research fellowship in the Trauma Surgery Department at the Medical College of Wisconsin, in Milwaukee. He is currently pursuing his general surgery residency training at the University of Texas Medical Branch, as a categorical resident. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** #IMG, medical students --- ### [The journey back to the US for surgical residency](https://blog.womensurgeons.org/the-journey-back-to-the-us-for-surgical-residency/) **Published:** September 2, 2022 **Author:** Blog Team **Content:** *By Gopika SenthilKumar and Jamesa Fabien* Dr. Anil Paramesh is a US citizen who was born in Detroit. He grew up there for eight years, after which his family moved back to India. He has numerous family members who are physicians and was exposed to medical specialties from a young age; this inspired him to pursue surgery. He says “this was because of the “quick-fix” mindset, where a surgeon sees a sick patient in the ER and is able to fix them immediately in the OR. The results of this “quick fix” become evident immediately. I also loved the experience of being in the OR right from the start.” He pursued the rest of his education, including his graduate medical training in India, and returned to the US for surgical residency. When asked if he considered returning to the US for medical school, he shares, “I did consider returning to the US for med school, but some of this was cost prohibitive. It is actually a cheaper option to come directly for residency.” His mentors and advisors suggested that he complete his medical school in India as well. Dr. Paramesh, however, was always set on coming back to the US for his surgical residency. “I believe the residency training here is much more standardized to a higher level, and I wanted the best training I could get. “ The most challenging part of his story was that he was considered a foreigner in both countries. “In India, I was considered a foreign student because I was American. So, I was never allowed to sit on any government entrance exams because I was not an Indian citizen. I had to get my visa renewed to stay in India every year. I remember this one episode when I was in the middle of the final exam season, and I forgot to renew my visa. I actually had the police show up to the medical school to arrest and deport me! It took a lot of frantic phone calls to let me stay. On the flip side, I had to struggle when I returned to the US, as I was now an IMG. As you may know, residency spots are much harder for IMGs, especially in surgery. So, it seems I had challenges in my education on both sides. I still scold my dad about his decisions on this!” Having numerous family members in the US was invaluable for Dr.Paramesh when he moved back here for residency. He says, “it helped make the transition back to the US easier. While I was making the interview rounds pre-residency, I was able to work in several doctor’s offices to give me some experience as well.” Nonetheless, he says that the journey to residency in the US was quite challenging. He does believe that the opportunities for IMGs have improved since his residency years. “IMGs are better prepared now for a residency in the US, than during my era. Many foreign medical schools allow for international rotations in the US, compared to a few decades ago. This makes it much easier for IMGs to have a true sense of what residency in the US entails, and better prepares them for this. I wish I had this opportunity when I was a med student, as medicine is practiced very differently in different countries.” He advises the future generations of IMGs to “be humble, and never give up trying to learn, no matter how trivial it may seem. Some of the best advice I have been given as a resident was from junior medical students, nurses, and other allied staff. A resident may be proud that they have passed medical school and have a lot of medical knowledge, but the best residents are those that are efficient. And efficiency comes from knowing the ins and outs of a hospital system. And that inside knowledge comes from those that have worked there longer than you (nurses, staff, etc.). So, take advice to heart when you are given it. You will be so much better for it.” ![](https://blog.womensurgeons.org/wp-content/uploads/2022/09/IMG-2.png) Anil Paramesh, MD, MBA, FACS is a Professor of Surgery, Urology, and Pediatrics at the Tulane University School of Medicine and serves as the Surgical Director for Kidney/Pancreas and Living Donor Transplantation. Dr. Paramesh completed his medical school at the Kasturba Medical College in Mangalore, India. Following this, he completed his General Surgery residency at the North Oakland Medical Centers/Wayne State University in Michigan. From there, he went on to complete a Multiorgan Abdominal Transplant Fellowship at the Mount Sinai School of Medicine in New York City. He then went on to obtain his MBA at the Tulane University Freeman School of Business, with a focus on Strategic Management. He currently performs liver, pancreas, and kidney transplantation in both adult and pediatric patients. He also performs hepatobiliary surgery, living organ donation, and dialysis access. Dr. Paramesh has numerous publications and presentations at national and international meetings. He serves/has served as the national Medical Advisor for the Association of Organ Procurement Organizations (AOPO), Medical/Tissue Director of the Louisiana Organ Procurement Agency, Director for the Louisiana Chapter of the National Kidney Foundation Board, and transplant advisor for the ESRD Network 13 Medical Review Board. He serves/has served on several regional and national committees for transplant organizations, including the United Network of Organ Sharing (UNOS) Committee on Minority Affairs, the American Society of Transplant Surgeons (ASTS) Standards Committee, and the ASTS Legislative/Regulatory Committees (which he currently chairs). Dr. Paramesh has extensive experience in healthcare education. He currently trains medical students, residents, and fellows in surgery and organ transplantation. At the Tulane University School of Medicine, he serves as the Associate Clerkship Director in Surgery for medical students, and he helps create the curriculum for medical student and resident education. He organizes extramural educational courses/simulations for healthcare professionals. He is the recipient of several teaching awards for these efforts and holds scholarships to help him to do this. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** #IMG, Medical Student Members, medical students --- ### [Interview with Dr. Carolina Torres Perez-Iglesias](https://blog.womensurgeons.org/interview-with-dr-carolina-torres-perez-iglesias/) **Published:** August 14, 2022 **Author:** Blog Team **Content:** *By: Gopika SenthilKumar and Jamesa Fabien* This first post of the International Medical Graduate Blog Series highlights Dr. Carolina Torres Perez-Iglesias’ path to surgical residency training in the US. She was born and raised in Lima, Peru, where she also attended medical school. She had a broad interest in general surgery and chose to explore the field further by doing international surgical rotations in places like Germany and the US and by volunteering with groups such as Operation Smile. During her last mission trip after completing medical school, she met Dr. Michael Kelly, a plastic surgeon from Miami. “We started operating together, and we just clicked. He impressed me with his clinical and technical skills, and I knew then I had to seek training in the US.” she says. “At that time, I didn’t know other people doing a surgical residency in the US. I didn’t have a mentor or people I could ask for advice.” Dr. Kelly helped her find rotations in the US and was an incredible sponsor in guiding her through the residency application process. After applying through the Match, Carolina started her journey in general surgery as a preliminary resident, a very common pathway for International Medical Graduates (IMGs) that come for residency training in the US. Although she felt that the training received that first year was excellent, she recognized something was missing: guidance and sponsorship on how to find a categorical position. Carolina chose to apply to positions in other programs and finally took a PGY-2 preliminary position at Boston Medical Center (BMC). Doing a second preliminary year at a new institution is not a common route for IMGs (most will stay for a second year at the program where they did a PGY-1), but in her case, she decided to follow her intuition and made a bold decision with the hopes of finding the support that missing. “Despite some of my mentors advising against this decision and many sleepless nights discussing options with family and friends, I decided to take the risk and hope it would be the right decision.” After a stressful year, Carolina found a categorical position at Beth Israel Deaconess Medical Center. She reports being extremely thankful for the immense support received at BMC and believes this journey took her where she was supposed to be. She says: “in medicine, we are often used to getting one win after the other. It is not uncommon to see an undesired outcome as a failure, but sometimes it is meant to open a new door of opportunity. It is necessary that we accept that, before we can commit 100% of our efforts and focus on this new possibility.” Her current program went above and beyond in establishing a pathway for her to conduct research during her residency training. Inspired to help those that came after her, she spearheaded a mentorship program for preliminary IMG residents at BIDMC in 2021 and the initial response has been very favorable. She passionately shares the details of her program – “We pair each resident with a mentorship team composed of a faculty mentor and a resident. There is value in pairing a resident with a mentor who is also an IMG or has been a preliminary resident, however, mentees also benefit greatly from the diversity in our department and passion to support junior trainees, despite not necessarily having similar immigration, racial, ethnic or social backgrounds. The pairing process is individualized based on the resident’s characteristics, interests and needs. Residents fill out a checklist during their meetings to check progress on important milestones that will make them strong applicants for a categorical position, such as ABSITE studying, letters of recommendation, wellness and stress management.” Dr. Torres Perez-Iglesias’ incredible work exemplifies a structure that can be broadly implemented for preliminary residents throughout the country. “The preliminary journey is very stressful. A positive outcome (finding a categorical position) will be primarily a result of your hard work and determination, but there is also the factor of luck. The number of positions that open every year for preliminary residents varies and that’s why it is so important that all preliminary residents have resources to cope with the stress and uncertainty – which in many cases can affect their performance during residency.” Throughout the conversation, Dr. Torres Perez-Iglesias highlights the importance of having a mentorship network of people that can support your different needs – “Finding a mentor as a minority student is not easy and you might not succeed in finding the perfect mentor on your first try, but you need to keep looking and being proactive about it”. She advises future medical students interested in surgery to prepare their applications and reach out to different people about their experiences. “Keep their advice and journeys in mind as you go through your journey, but don’t assume that what others are doing is going to be the best for you. Collect all the information you can, and then make your own informed decision. Another thing I learned the hard way is that no one is going to advocate more for you than yourself, so don’t be afraid of self-promotion”. Lastly, Dr. Torres Perez-Iglesias emphasizes the importance of looking back at one’s journey and giving back to those that come after them. “The mentorship program for IMGs has been an incredible learning opportunity and one of the most rewarding experiences during my residency journey”. She founded it based on the needs identified when she was a preliminary resident and hopes that others can now benefit from it. ![](https://blog.womensurgeons.org/wp-content/uploads/2019/11/TorresPerez.png) Dr. Carolina Torres Perez-Iglesias was born and raised in Lima, Peru, where she completed her medical school training. She is currently a 4th-year general surgery resident at Beth Israel Deaconess Medical Center in Boston, MA. Her interests include surgical education, health systems evaluation, and advocacy for diversity and equity in medicine. She enjoys reading, podcasts, and hanging out with her dog Lucy. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, mentorship, training **Tags:** #IMG, mentorship --- ### [International Medical Graduates in Surgery - Blog Series](https://blog.womensurgeons.org/international-medical-graduates-in-surgery-blog-series/) **Published:** August 13, 2022 **Author:** Blog Team **Content:** By Gopika SenthilKumar and Jamesa Fabien An international medical graduate (IMG) is a physician who received their medical degree from a medical school located outside the United States and Canada that is not accredited by a U.S. accrediting body, the Liaison Committee on Medical Education, or the American Osteopathic Association. While some IMGs complete the entirety of medical school outside of the U.S and follow a different curriculum, some international medical graduates attend ‘Off Shore’ schools. These medical schools closely follow the curriculum of U.S medical schools; students complete two years of basic science study outside of the U.S (most often in the Caribbean) and complete their clinical training in teaching hospitals or clinics in the US, Canada, or sometimes the UK. In contrast to IMGs, international students from around the country can choose to pursue their undergraduate and medical education in the US. These students may seek visas to complete their residency training in the US, however, their journey differs from IMGs as they hold degrees from US accredited medical schools. Through this blog series, we share stories and lessons learned based on interviewers with IMGs who have successfully secured surgical residency positions in the US. This series is curated and brought to you by members of the Association of Women Surgeons National Medical Student Committee. Gopika SenthilKumar is a 4th-year MD-PhD student at the Medical College of Wisconsin, Milwaukee WI. She is a current Mentorship Coordinator for the committee and is an Executive Director for F1Doctors – a national, student-led mentorship platform for international students pursuing medical education in the US. Through these roles, she hopes to increase access to quality mentorship for students throughout the world. Jamesa Fabien, born and raised in the Caribbean island Dominica, is a 4th-year medical student at Ross University School of Medicine, Barbados. She is the current chair of the National Medical Student Committee. Through her involvement in AWS, she hopes to serve as an Ambassador for international medical graduates by helping to pave the way, generating awareness, and by coordinating projects geared at increasing support for IMGS. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, training **Tags:** #IMG, medical students, residency, Resident Mentor --- ### [Destination Wellness- The Intellectual and Spiritual Domains](https://blog.womensurgeons.org/destination-wellness-the-intellectual-and-spiritual-domains/) **Published:** August 8, 2022 **Author:** Blog Team **Content:** *By Nikita Machado* “Physician, heal thyself!” Across history, these words have been attributed to different sources, including Jesus in the Gospel of Luke, the Genesis Rabbah in 300 B.C, and the Greek playwright Aeschylus, in whose play Prometheus Bound the chorus laments [“Like an unskilled doctor, fallen ill, you lose heart and cannot discover by which remedies to cure your own disease.”](http://faculty.fairfield.edu/rosivach/cl106/aiskhylos-prometheus.htm) Oh, the irony. As physicians, and more specifically surgeons, we are part of a rare group of people. We care tremendously for the health and well-being of our patients– going out of our way to ensure the best outcomes we can for them. However, self-care often falls by the wayside, and we don’t give our own minds and bodies the fuel and care they need to perform optimally. [As current data shows](https://doi.org/10.1097/SLA.0B013E31824B2FA0), those who listen to their inner cues and [pay attention to their wellness](https://doi.org/10.1016/J.AMJSURG.2017.06.022) can sustain a fulfilling career over a long period of time. [The previous post](https://blog.womensurgeons.org/self-care/destination-wellness-the-physical-domain/) dealt with the significant and outwardly visible benefits of physical wellness. Equally important but intangible are the concepts of intellectual and spiritual wellness. In its simplest form, people who strive for intellectual wellness are focused on maintaining good mental health and intellectual growth, while keeping a creative spark alive. We see this every time we meet a new challenge, learn a new skill, or try new experiences. Those hobbies that we gave up because our careers became so all-consuming are the very ones that might restore that spark of joy that drew us to medicine in the first place. Some physicians play in amateur concerts, others make it a point to finish a list of highly rated book titles every year. The surgeon who mentored my husband during his residency is a skilled woodworker in his spare time. And me? My husband and I are passionate escape room enthusiasts, determined to complete an escape room in all 50 states, having just finished our 100th. The point is to find a skill/hobby/experience that is not necessarily related to medicine, but which allows our minds to grow in tangential, unexpected ways. Something which broadens our horizons and shows us a different way to look at things; something that exposes us to new processes and beliefs and bolsters critical thinking. This kind of intellectual growth helps us in the practice of surgery as well. It allows us to approach complex cases from different angles, maintain the skills that allow us to be lifelong learners, and helps us to better cope with the innate stresses of a surgical career. As an undergraduate and medical student, I found a creative outlet in reading and writing fiction and poetry. Immersing myself in worlds outside the practice of medicine helped take my mind off daily stresses. In essence, this was escapism of the best kind. Even as a busy resident, I promised myself I would never let that reading habit go. Regardless of how busy my rotation was at the time, I would keep books loaded on my iPhone or Kindle for easy access. This allowed me to read whenever I found spare moments during the day, and I looked forward to those moments with eager anticipation. Spiritual wellness, on the other hand, focuses more on recognizing a sense of purpose and meaning in life. The practice of medicine, by nature, gives most physicians an in-built sense of purpose and a drive to serve others. It ensures that we operate at the highest moral and ethical level that we are capable of. Whether we as physicians practice a specific faith, whose tenets remind us to treat those who are suffering with kindness, mercy, and compassion, or whether we strive to live by a personal moral code and philosophy that ensures the best for our patients, we are all on the same page. As a Catholic, faith has always played an important part in my life. I believe it inspires me to be a caring physician, focused on every aspect of my patient’s well-being. The lessons of humility, love, and service are what I carry with me into my daily practice. Patients are often hesitant to bring up topics of faith and spirituality with their physicians, believing that science and spirituality cannot co-exist. However, acknowledging their anxiety and need for emotional and spiritual support can often strengthen the bond between physician and patient, center them in the disease process and help us communicate with them in a deeper way. Spiritual wellness, in both regards, helps us to make sense of our place in this world, to be grateful for the innumerable blessings we have been given, and to cope with the challenges, difficult outcomes, and even losses of the patients we hold dear. There are a number of resources online that can help you get started on your journey to spiritual wellness, but the simplest ones I could find all seem to say the same thing – *Take your time to think about and process daily events. Write them down. Pray or meditate as per your preference to find a moment of calm in the storm. Read about the experiences of those further along this journey to wellness (yes, physicians can sometimes be philosophers) and travel when you can. There’s nothing like an unexplored horizon to truly remind us of our place in this world and how infinite the possibilities for our lives and careers truly are.* In the meantime, I’m off to do another escape room with my husband, preferably in an unexplored city, with prayers and gratitude for the privilege of this profession and the colleagues who make it possible. Even on the hardest days, we wouldn’t have it any other way. Resources for Intellectual and Spiritual wellness: 1\) https://nationalwellness.org/resources/six-dimensions-of-wellness/ 2\) <https://www.spiritualityandhealth.org/resources> ![](https://blog.womensurgeons.org/wp-content/uploads/2022/08/7.27.jpeg) Dr. Nikita Machado (in the photo with her husband Dr. Terence Jackson, after their 98th escape room) is the 2022-2023 Endocrine Surgery Fellow at Yale New Haven Hospital. Having completed her surgical residency at University Hospitals Cleveland Medical Center, she spent three years in practice as a general surgeon at University Hospitals Conneaut, Ohio. Her main areas of focus are surgical education and healthcare equity for underserved populations. When she is not at work, you can find her traveling across the country with her husband and two dogs, doing escape rooms, and honing her baking skills. You can find her on Twitter at @machado\_nikita. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care **Tags:** inspiration, wellbeing, Wellness --- ### [THE INCREASING NEED FOR SURGICAL EDUCATION IN THE DEVELOPMENT OF FUTURE SURGEON LEADERS: AN UPCOMING TWEETCHAT](https://blog.womensurgeons.org/need-for-surgical-education/) **Published:** August 1, 2022 **Author:** Blog Team **Content:** *By Dr. Anastasios Mitsakos* Medical education has always been an integral part of our profession as physicians and surgeons. From ancient times, the Hippocratic oath binds us “to teach this art, without fee or indenture; to impart precept, oral and all other instructions, to indentured pupils who have taken the Healer’s oath.” Especially considering the combination of art and science in the field of surgery, education of medical knowledge, as well as surgical technique, leads to the evolution of successful future leaders. Furthermore, the science behind educational practices has caused more and more surgeons to consider surgical education as an up-and-coming significant component in surgical research, with a lot of studies focusing on ways to improve continuous training, mentorship, and coaching for medical students, residents, and faculty. A growing body of literature has focused on the importance of high-quality surgical education in residency training programs. In addition, constructive feedback has been shown to improve communication and education practices between educators and trainees. Various models have been used to that goal, in an attempt to facilitate the different learning and coaching styles. Intra-operative teaching has always been one of the cornerstones of surgical training and the Zwisch scale, as well as the BID model (Briefing-Intraoperative teaching-Debriefing), has assisted in providing appropriate feedback between the parties involved. More recently, phone apps such as the SIMPL app have provided residency programs with an easy and accessible way to have quick and objective feedback models for operative autonomy. Outside of the operating room, preparation for exams has been facilitated with the utilization of the SCORE curriculum, which has been increasingly used by residency programs with the goal of improving day-to-day resident education and increase in annual ABSITE scores and residency board exam pass rates. --- **Please join us on Monday, August 1, 2022, from 8-9 PM EST for an AWS TweetChat addressing topics such as the role of simulation in surgical training, the enhancement of trainee autonomy intra-operatively, studying and test-taking skills in preparation for ABSITE and residency board exams, and ways to improve medical student participation and evolution during the surgical rotation. Respondents will include Dr. Christian de Virgilio (**[**@drdevirgilio**](https://twitter.com/drdevirgilio)**), Dr. Mo Shabahang (**[**@ShabahangMo**](https://twitter.com/ShabahangMo)**), and Dr. Anastasios Mitsakos (**[**@AnastasiosMits3**](https://twitter.com/AnastasiosMits3)**). Questions will be posted directly from the** [**@WomenSurgeons**](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Ftwitter.com%2FWomenSurgeons__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UNk9nfm0%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=%2BtEJEMY1BPcjQqtnZIFybPiSYK9pB%2FK%2BuWf%2BXpmZkFo%3D&reserved=0) **Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this**[ **tutorial**](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__http%3A%2F%2Fblog.womensurgeons.org%2Fmedical-students%2Fbeyond-the-basics-of-tweeting%2F__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UH7HLDER%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=KfiBo6A70VlffaJp8Mn9kz12YBY7SF2igEx%2F8dbTeRs%3D&reserved=0) **written by Dr. Heather Yeo (**[**@heatheryeomd**](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Ftwitter.com%2Fheatheryeomd__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UObtPBLT%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=lIHUfxruDcFIhtmJgMNusR1ass7wxTd%2BpEDleERU2VE%3D&reserved=0)**) to know more. We will be discussing the following questions during our tweet chat:** Q1: What are some of the deficiencies in surgery residency program education practices? Q2: How can residents improve their intra-operative participation and autonomy? Q3: What is the importance of simulation in current surgical education? Q4: How can educators be more efficient in improving communication and mentorship with their trainees? Q5: What are some tips and advice for improvement in test-taking skills in annual ABSITE and residency board exams? ![](https://blog.womensurgeons.org/wp-content/uploads/2022/08/unnamed.jpeg) Anastasios Mitsakos, MD, was born in the beautiful city of Athens in Greece. He entered the Military Medical School at the Aristotle University of Thessaloniki after high school, where he trained both as a physician and a navy officer. His continuous passion for improved training and advanced research and education led him to further pursue a career in the United States, where he came as a surgery resident at East Carolina University in Greenville, NC. With a persistent interest in surgical education and the role of simulation in its advancement, Dr. Mitsakos completed a Surgical Education Research Fellowship during his research year in residency. Focusing on complex abdominal operations and amelioration in the delivery of cancer care, he recently managed to match in Surgical Oncology Fellowship and will be continuing his training starting next summer at Moffitt Cancer Center in Tampa, FL. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** education, medical students, residents, Surgical Education, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Time to leave the (training) nest: Finding your first attending job](https://blog.womensurgeons.org/time-to-leave-the-training-nest-finding-your-first-attending-job/) **Published:** July 26, 2022 **Author:** Blog Team **Content:** *By Kimberly B Hoang* The job search for the first attending position is likely the first time in over a decade where surgical trainees face real choices and autonomy regarding their future. Before this, we are told where to work by the MATCH, what to study in medical school, and how to spend almost every waking minute during residency. Our training programs dictate our rotations, the ACGME dictates our success, and even our relationships / personal lives are invariably somewhat dictated by external forces not in our control. It is, therefore, little surprise that many struggle with a seemingly overwhelming number of choices when looking for their first attending job. This time there is no set “process”, no rank list, and no MATCH algorithm to guide you. In fact, there is little transparency about job availability, details, candidacy, and competitiveness, especially as we continue to increasingly subspecialize. Coupled with the reality that many are navigating the process during an extremely busy chief or fellowship year, the task can range from challenging to outright unsuccessful. In fact, [20-40% of physicians switch jobs ](https://comphealth.com/resources/millennial-doctors-survey/)[within the first 2-5 years](https://resources.nejmcareercenter.org/article/moving-on-issues-to-consider-when-making-a-career-move/). To avoid becoming a statistic, here are a few points to consider: 1. **(Really) Know thyself.** After years of carrying out others’ plans and orders, this is the most important point: what do you *want?* Start broad, then get very detailed. I encourage senior residents to prepare their letters of intent or cover letters at the beginning of the job search. It forces many people, for the first time, to really think about the specifics of where they want to be 5-10 years from now and how to get there. Things to consider: 2. What kind of cases do you want to do? How much OR time fulfills you? 3. What are your career interests outside of the OR (e.g. organized surgery, administration, research, education, entrepreneurship, other)? 4. What does your ideal week look like (e.g. percent time clinical versus research versus admin, family and personal blocked off time)? 5. What does “good compensation” mean to you? How do you define “work/life balance”? 6. Where do you want to live? 7. What are the true dealbreakers and priorities? In fact, no job will be perfect. Decide what truly matters on your list and what you cannot live without. You may have to do certain cases you don’t enjoy as much to live closer to your extended family. You may have to take a pay cut to have the lab and start-up package you need for a successful research career. 8. **Make yourself known.** The surgical attending job market often relies heavily on word of mouth for some of the more desirable jobs. We often hear about positions before they are publicly posted, and the more we know about our trainees’ wishes (see #1), the better we can send the right opportunity your way. Be vocal, open, and honest with your mentors and attendings. 9. **Get your paperwork in order.** Spruce up (or just create) your CV and cover letter before you start the search. Make sure your emails and cover letters are succinct and easy to read. Chairpersons, Department/Division/Section heads, and search committees are full of busy and tired doctors. Use bullets, provide good data, and make yourself standout. 10. **Find the networks that matter.** National surgery job boards, subspecialty physician recruiting firms, and of course, cold calling/emailing all are helpful options. The best networks though, are the personal ones comprised of your friends, colleagues, those who trained you, and those you trained with. Some mentors are frankly more active in assisting their trainees find jobs than others. Identifying which network will be the most fruitful for the specific job you are looking for is crucial. Often, national meetings a year or two before your graduation can be great times to meet department leadership from across the country who are looking to hire in the near future and do preliminary meet-and-greets. 11. **Who will vouch for you?** Once jobs are interested in you, they will often ask references and colleagues at your program about you and your work. These references can be extremely valuable in the small world of surgery, particularly academia. Know who will really advocate for you and promote your career. Nothing is worse than a reference who is powerful or influential, but lukewarm. 12. **Broaden your search.** Be aware that many trainees experience a highly insular surgical environment in most training programs – often with one culture, in one overarching institution, and likely in an academic environment. Between medical school, residency, and maybe fellowship, you’ve probably experienced about 2-3 academic centers. Be open to interviewing at practice organizations, models, or jobs that seem different from where you trained – you may surprise yourself. 13. **Interview well and understand the culture.** Interview smartly and keep your ear to the ground. Do your research about the leadership and departmental culture that may or may not be presented at the interview. Use the same networks you made to find interviews to figure out if a job offer and future department will actually be a good fit. Will your future partners be mentors, colleagues, or competitors? 14. **Know your worth.** Now that you have your offer, is it fair? Knowing your worth is crucial and can be difficult, given increasingly diverse situations with quite variable pay (i.e. academic versus private practice compensation, start-up packages, long term benefits). However, good subspecialty resources exist, and this knowledge will power your negotiations. More than one offer in hand or a prior offer can be a practical way to understand your worth if you are having a hard time discerning this. 15. **Be wise about your offer.** Women are often counseled that w[e do not negotiate enough](https://hbr.org/2003/10/nice-girls-dont-ask) with significant [long-term financial and professional implications](https://hbr.org/2014/06/why-women-dont-negotiate-their-job-offers). Negotiate if you feel the offer doesn’t reflect your worth. Have a physician-contracts focused lawyer review your term sheet or contract to make sure you have not missed anything. And lastly, circle back to the priorities I mentioned in #1, and ensure your contract adequately reflects them. Like all things, finding the “right” job is usually hardest the first time around. Remember: there is no perfect job – but there *are* jobs that can fulfill a surgeon long term. A wise first choice is professionally, personally, emotionally, and fiscally beneficial. Whether or not your first job ends up being your last, make sure to relish that, finally, the choice is yours. Kimb![](https://blog.womensurgeons.org/wp-content/uploads/2022/07/Headshot-edited-199x300.jpg)erly Hoang, MD is an Assistant Professor in the Department of Neurosurgery at Emory University and Winship Cancer Institute in Atlanta, Georgia. She specializes in neurosurgical oncology, particularly the treatment of difficult-to-access brain tumors near eloquent regions. Her research lab focuses on microrobotics, microelectromechanical systems, device development, and clinical outcomes research for brain tumors and neurosurgical oncology. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** advice, career development, job searching, training --- ### [Essentials for the Zoom Interview Trail](https://blog.womensurgeons.org/essentials-for-the-zoom-interview-trail/) **Published:** June 30, 2022 **Author:** Blog Team **Content:** *By Alyssa Brown* In the summer of 2021, I moved back to Louisville with a 12 foot moving truck full of stuff—ready to start my last year of medical school. I was aware that I would need things for Zoom interviews, but I was unaware of how many logistical hoops there would be to jump through. Call me crazy, but when I was looking for apartments, I tried to find one that had an area where I could easily do virtual interviews. Despite my best plans, I spent the night before my first interview pushing furniture around my apartment trying to find the perfect location. I originally had my set-up in my second bedroom, but this room faced the train tracks. The trains would rumble past once or twice an hour, and I decided I could not risk the noise disruption. I tugged my desk through the small door frame and pushed it to my “dining room.” I pushed it against my dining table. You may be thinking… but Alyssa, why not just use your table? Well, the table has one wobbly leg that despite my best home DIY skills would not stop shaking, so whenever I took notes on my notepad, the whole table would start shaking, moving my camera, laptop and everything else. I did not want my interviewers to think I was always in an earthquake. Now, I tried about 14 different lamps and lighting configurations, including one that made me look like I was about to haunt the program interviewing me. I have finally found a good distance for the ring light. It is now far enough to not permanently scorch my retinas and not make me look like a ghost. Some people suggested multiple ring lights, but I found that one worked well for me. I had my overhead light on, blinds throughout my apartment closed and the right light aligned in front of me, about three or four feet away from me. I do recommend keeping the blinds in your apartment closed. The light coming through windows changes during the day and can lead to some weird shadows. I have included the brand of ring light I used, it was cheap and got the work done. I don’t think you need to spend too much, but it is a necessity for virtual interviews. My laptop sat at eye level on a 6-quart bucket from a kitchen supply store that I normally used to store flour. Surprisingly, this makes a great laptop stand, and it is relatively cheap. I recommend just stacking your laptop on whatever brings it to eye level, which is different for every person. I liked that this had a wide base, so it was less likely to move when I was typing or writing notes. My ring light sat behind my laptop. I had a metal laptop stand to tilt my laptop, but I found it more likely to move or shake. It is subtle, but it is important to have the camera at eye level. You can test by hopping on a call with friends. Additional things that I picked up included: a 100-foot ethernet cord, mouse to attach to laptop, keyboard, and wireless headphones. The ethernet cable is great because it can circumvent any Wi-Fi issues you might have. I also recommend a mouse and keyboard since your laptop may be propped up. The wireless headphones are mostly an aesthetics thing, but it comes in handy. If you use the typical headphones with a cord, the microphone is often in the cord, which will rub consistently against your blouse or suit creating an annoying sound. I have a pair of headphones that go over my ears and have a microphone that can be set in front of my mouth on hand in case anything goes wrong with my wireless headphones. A lot of people wore AirPods, but I do not own any, so I got a cheap Bluetooth pair that worked great. This may seem a little anxiety ridden, but it is better to be prepared than not. Also, I chose to keep my laptop plugged into my charger consistently. I had a backup charger in my desk. I also kept my phone close by and fully charged in case I needed to quickly switch over to my phone due to technology issues. For my background on Zoom, I tried to pick things that were important to me and fun to talk about. I relate the Zoom background to a personal statement. A plain background is totally fine and acceptable. A plain background is better than a bad background. I started doing anatomical embroideries during the pandemic, and I bake all the time, so they are easy things for people to ask me about during the interviews. I had a head and neck anatomical embroidery and a personalized cutting board in my background. There are some general things to avoid: black backgrounds, large reflective things, too many things, anything that looks dirty, and facing towards a large room. I suggest having your laptop facing a wall. It may look odd in your apartment but trust me. It is very weird to have a large room behind you, and it will look weird with lighting. Also, do not face your bed if you can help it. If you cannot get a good background or need to face a room, the blur background filter is your best friend. I also suggest trying a couple of outfits before your first interview. It tends to be better to wear a solid colored blouse and suit. Some patterns can look very distracting on Zoom, which I realized after looking like a mirage in polka-dots. On the morning of the interview, I would eat some a breakfast casserole that I meal prepped. I would make my full pot of coffee for the day. I made sure I had all the little things I wanted near me: pen, paper, chapstick, coffee, brush for last minute hair fixes, and water. I also would put a snack near me, in case I didn’t have a long break to grab something during the day. Things will go wrong during interviews – people will be late, people will forget who they are interviewing, Zoom or other platforms will go down, and you may get cut off mid sentence – but you can always adjust. Remember to be flexible and laugh off the issues and mistakes. This is an important time to be yourself. All of these are small things, but it is just a way to present yourself and make yourself more comfortable. I liked having a routine so that I could be in the right state of mind for an interview. The goal is to have the interviewer focus on you, not everything else. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/headshot_5x7_0449-214x300.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is in her fourth year of medical school and has matched at Northwestern for general surgery residency. Her thesis research is on diaphragm muscle mitochondrial function and morphology, which she will defend in March. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram [**@Alyssa\_b\_futuremdphd**](https://www.instagram.com/alyssa_b_futuremdphd/?hl=en) and on Twitter [**@Alyssa\_B\_MDPhD**](https://twitter.com/Alyssa_B_MDPhD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** career development, interviews, virtual interviews --- ### [Gunning for Gun Safety: How you can join the movement](https://blog.womensurgeons.org/gunning-for-gun-safety-how-you-can-join-the-movement/) **Published:** June 22, 2022 **Author:** Blog Team **Content:** *By Tamilarasy (Tami) Vasanthakumaran* Imagine this: you see a disease kill and wound thousands of people every year. You know what needs to be done to stop it. What is the next best course of action? Gun violence is a public health epidemic with an urgent need to act on the regulation of firearms and gun safety legislation. It is [defined](https://www.cdc.gov/violenceprevention/firearms/fastfact.html) as violence, such as homicine, crime, attempted suicide, suicide, unintentional death or injury, which results from the use of firearms such as pistols, shotguns, assault rifles or machine guns. The small town of Uvalde witnessed a massacre at an elementary school when an 18-year-old gunman shot and killed 21 civilians, of which 19 were young children. Prior to this, another racially motivated shooting occurred in Buffalo, where an 18-year-old man shot and killed 10 people, all of whom were black. More recently, another shooting in Tulsa, Oklahoma where a man bought a firearm just hours before shooting 4 people at a hospital, including orthopedic spine surgeon Dr. Preston Phillips and sports and internal medicine specialist Dr. Stephanie Husen. This recurring nightmare has to stop. But how do we wake up from a nightmare that keeps repeating? There is currently an ongoing national debate on access to firearms and gun control. The physicians’ and surgeons’ perspective sheds light upon this through a unique lens, as they are often the first to see the devastating injuries inflicted on people following gun violence. As a medical team, we come together and work together, giving our everything to make the best out of the most unjust of situations. Bullets to the heart, bullets to the head, bullets right through the patient. As the tragedies of gun violence bring us together, I hope we use this unity to bring much-needed change. I’m seeing many members, institutes, committees, and societies of the medical community voice their rage, frustration, and demand for change on [social media](https://twitter.com/search?q=%23DoctorsForGunSafety&src=typeahead_click&f=top). I hope the voices are heard. Moreover, I hope the message is understood. This chaos ultimately led me to wonder: What can I do? As a medical student, resident, fellow, surgeon, or just as a human – we can easily be part of the action: 1\) Spark a conversation – With family, friends, colleagues, patients, and strangers (either in-person or online #DoctorsForGunSafety) and educate people with what you know, how injuries and death from gun violence are more of a health risk than many diseases, the current gun policies, what needs to change. 2\) Join a grassroots movement or advocacy group ([Amnesty International](https://www.amnesty.org/en/what-we-do/arms-control/gun-violence/), [March for Our Lives](https://marchforourlives.com/), [The Brady Campaign](https://www.bradyunited.org/), [CSGV](https://www.csgv.org/), [GunFreeKids.org](https://twitter.com/gunfreekids)) – connect with others, inspire each other on ways to promote gun safety, collaborate, and campaign. 3\) Public health research that promotes gun safety – get involved in creating evidence-based research needed to implement change. 4\) Strengthening gun safety advocacy – investigating and offering solutions to the socioeconomic risk factors which predispose a population to gun violence (such as unemployment, mental health, etc.), strengthening and educating communities, etc. I hope that, together, we can honor these many lost lives by working towards a future without such fear in anyone’s minds. 5\) Voicing your thoughts & voting – speak to politicians (state and federal representatives) about your concerns with current gun policies and the recent events surrounding gun violence. Ask them about what firearm safety bills and other safety policies they hope to support and when they hope to act towards these ideas. Vote and support members who share your concerns and show active work towards a solution! Your vote matters! Each vote adds to helping the right people being voted into the office to make real change. Now is the time to start these important conversations. This is a bigger issue than being left or right. This is an issue of every parent’s worry as they drop their children at school every day. This is an issue of black, indigenous, and people of color (BIPOC) populations being hypervigilant when in public. This is an issue of surgeons and ER doctors praying that gun violence victims enter the hospital with signs of life. This is an issue. An issue needing action more than anything, an action which I hope you take. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/06/tami-289x300.png)Tamilarasy (Tami) Vasanthakumaran is a student at Harvard University Global Clinical Scholars Research Training program, after completing her medical degree in India. Born and raised in North America to Sri Lankan immigrant parents, Tami’s decision to step out of her comfort zone and study medicine in India was influenced by a childhood trip to distribute funds she raised for victims of the 2004 Tsunami. This journey taught her the importance of being a global citizen who promotes compassion, intersectionality & inclusivity. As Associate Resource Development Coordinator at AWS, she is excited to work with the committee and play her part to advocate ways to transcend disparities in surgery. Tami speaks 4 languages and enjoys spending time with loved ones, writing, creating digital art, trying new food, and going on big and small adventures! You can follow her on Twitter @ItsTamilarasy. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** global action, Gun Violence, public health --- ### [The Same but Different](https://blog.womensurgeons.org/the-same-but-different/) **Published:** June 10, 2022 **Author:** Blog Team **Content:** *By Priya Dedhia, MD, PhD* Emily was one of my first friends when I started as an attending surgeon. It was like we were destined to be friends—during the shutdown in March 2020, Emily texted me when she saw someone who looked like me walking near her house. We found out that I lived 1 block – a 4-minute walk – away, so we started going on pandemic walks together regularly. We commiserated about being junior attendings and not being able to operate… but also secretly enjoyed being able to finish overdue manuscripts and sneak in workouts in the middle of the day. We learned that we both had “tiger parents” that led to deep-seated feelings of always needing to do more. We talked about our moms, who both thought we were about as far from the ideal Asian daughter as was possible. We confessed that, sometimes, we were hesitant to voice our opinions publicly for fear of being labeled as “loud” or “aggressive.” We spent hours talking about how being Asian was and wasn’t an underrepresented minority. We got frustrated about how Asians are underrepresented in leadership positions and have the lowest political representation of any racial or ethnic group, but [most Asians are not considered minorities by the NIH or other national organizations.](https://diversity.nih.gov/about-us/population-underrepresented) Emily and I also talked about how lucky we have been that we are not the only underrepresented minorities at our institution… that we are able to discuss all of these things because we not only have each other, but also other friends and mentors from diverse backgrounds. Then on March 26, 2021, six Asian women were killed in Atlanta. My academic community came together to provide support to each other and create an Asian Pacific Islander Desi American (APIDA) employee resource group. Participating in these virtual get-togethers, I was taken aback by how some of my colleagues had been treated during the pandemic. I couldn’t believe that patients canceled appointments or asked my friends and coworkers if they got the “China flu.” Worse still, I realized I never talked to Emily about any of this. I was lulled into thinking we had similar experiences since we were both Asian. I spent the next several days thinking about how I could ask Emily about her experience. I thought about the words, I thought about the location, even the time of day. I finally realized that nothing would feel right because broaching this topic in our friendship felt intimidating to me. So, then I just asked her. What happened? Did anyone say anything to her? Did she feel unsafe? We spent the next few hours talking about Emily’s experiences, which were so different from my own despite both of us being Asian. Emily told me about the offensive comments her patients made. She told me about how, until then, she was achieving the American dream – a job where she literally saved lives, a nice house with gorgeous plants on the porch, and a fiancé who loved her. But for the first time, she felt unsafe in our hometown. Because despite having been born and raised in this country and accomplishing more than most people could in their lifetime, she couldn’t change the way she looked – Chinese. This conversation was the first of many where we talked about being Indian or Chinese and how our experiences were sometimes very different even though we were both Asian. Until that point, our friendship was based mostly on our common interests and shared experiences. But it wasn’t until I took the time to really understand what made us different that we became closer. For me, my friendship with Emily brought new meaning to Asian American and Pacific Islander Heritage Month: it’s not only about honoring our similarities, but also about celebrating how our differences weave together to create a diverse and compassionate community, right here in our own neighborhood. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/06/priya.jpg)Dr. Priya Dedhia, MD, PhD is an Assistant Professor in the Division of Surgical Oncology at The Ohio State University. As an endocrine surgeon, her clinical and research efforts focus on improving treatment options available to patients with thyroid, parathyroid, and adrenal disease. Her background in cancer biology and generation of patient-derived organoids uniquely positions her to develop models for difficult to study endocrine cancers. Dr. Dedhia received her MD and PhD at University of Pennsylvania. She completed her General Surgery residency at the University of Michigan and Endocrine Surgery fellowship at the University of Wisconsin. In addition to her clinical practice, Dr. Dedhia runs a lab that uses 3-dimensional organoid models to study endocrine cancers. She is thankful to organizations like the Association of Women Surgeons and the Society of Asian Academic Surgeons for creating space for conversations about diversity in surgery. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** aapi, diversity and inclusion, Friendship --- ### [All the Unsaid things: Perspectives from Asian American Women in Surgery](https://blog.womensurgeons.org/all-the-unsaid-things-perspectives-from-asian-american-women-in-surgery/) **Published:** June 3, 2022 **Author:** Blog Team **Content:** *By Annabelle Fonseca* I was invited to write a perspective piece on being an Asian woman in surgery in honor of Asian American/Pacific Islander Heritage month. Given the diversity of the Asian American and Pacific Islander community, I couldn’t think of a better approach than to reach out to multiple people and include a breadth of perspectives and lived experiences. I reached out to friends and colleagues from my surgical journey thus far and asked if they would be willing to speak with me or provide me with some insight on their journey, as an Asian American woman in academic surgery. People were generous to a fault with their time and thoughts. I received emails and calls, and sometimes both, from residents, early- and mid-career faculty in academic surgery, as well as from people who were in academic surgery and have since left. Below is my attempt at summarizing what I heard, without taking away from the intent of the conversations. **Background** Several faculty and trainee surgeons felt that their cultural identity was the reason they went into surgery. Some said that their experiences of family members finding it difficult to navigate healthcare spaces due to linguistic and cultural unfamiliarity, or being treated poorly due to their differences were the reason they went into medicine. Faculty who work with diverse groups of patients and larger proportions of minority patients said that they were able to use their cultures and their diversity to help bond with and establish trusting relationships with their patients. Several surgeons indicated that their diversity and cultural heritages were their strengths. Some said that their immigrant parents pushed them to excel and taught them the value of persistence and hard work despite obstacles along the way. While everyone I spoke to loves their job, and many volunteered that there is nothing else they could see themselves doing, everyone spoke of several challenges, particularly workplace and career development challenges. **Career development challenges** *“No one shows you the handbook of unspoken rules” “Being unable to climb the academic ladder due to lack of support makes me question “Why am I doing this?” “It’s much harder to find mentors if you don’t play golf and watch football.”* Lack of mentorship was very frequently cited as a barrier to career development, both by trainee and faculty surgeons. Several surgeons felt that this was not intentional, but that people tend to mentor others like themselves, leaving minority surgeons of all types less likely to have mentorship. Some faculty surgeons noted that they did not feel the lack of mentorship when they were residents and that they had felt supported during their residency training years, however mentors were harder to find as they progressed through early and mid-careers. Some trainee and faculty surgeons indicated that they didn’t necessarily *“know or understand the rules”*. Pregnancy was also thought to be an impediment to people’s careers. Surgeons reported being discouraged from going into surgery as medical students, as well as going into competitive or historically male subspecialties as residents. Some faculty surgeons reported that the lack of mentorship and sponsorship and/or departmental support in their career advancement led to a feeling of apathy. This was also reported as the reason for leaving academia. **Workplace Challenges** *“Walking a razor’s edge” “Do twice as much to be taken half as seriously”* A few surgeons indicated that they felt judged by their race, and they wanted to be seen as “a surgery resident” or “a surgeon” instead of the Asian surgical resident or the Asian female surgeon. **Attitudes and Perceptions** Every surgeon across all levels of training and career reported that they felt that they had been described in terms of biased and unflattering personality descriptors in evaluations they had received. Some residents felt that it was difficult to know what aspects of surgical training they needed to work on because several of their evaluations also listed sometimes contradictory adjectives. *“You are either passive and indecisive or aggressive and pushy”*. Several surgeons volunteered words that were used to describe them in evaluations, that are shown in a word cloud. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/06/wordcloud-300x148.png) *“You don’t look like a surgeon” “Where are you from?”* Several surgeons reported that in their interactions with patients, hospital staff, and sometimes other colleagues, they were made to feel like they were different or “the other”. Some residents spoke of undermining and microaggressions in the OR and in the hospital, particularly by non-physician care providers in the hospital, but felt that they weren’t adequately backed up by their teams and colleagues when this happened. When asked how they felt in their workplaces, the most commonly used words were “underestimated” and “under-valued”. Surgeons reported feeling like their voice was not heard as much as others. Younger female faculty reported being treated dismissively at times by their colleagues as well as male residents, and not enough departmental support when this happened. **What helps** A thread that ran through several conversations was that people realized that their situations were much better than those in previous years, and that the challenges they faced were much smaller than those faced by their surgical predecessors. They expressed gratitude that they were able to be surgeons and have at least part of the life they envisioned for themselves. Surgeons who worked in self-described supportive environments with supportive chairs, senior faculty and mentors reported that their environments and advocates made it easier for them to continue to feel like they belong. Some surgeons mentioned that some of their strongest mentors were non-minority men, particularly during residency and fellowship training. Residents reported that having mentors, particularly female mentors who had already navigated a male dominated hierarchical field could discuss with them what barriers to anticipate and how to approach situations in a manner that would maximize their likelihood for success. Surgeons also reported that having other Asian and other minority colleagues to speak with were helpful, and that shared experiences made them feel like they were able to develop a community. **What do you want others to know?** Some surgeons said that they felt like people assumed that they grew up relatively privileged, and they wanted to dispel the notion that all Asians are affluent or well-educated. They indicated that the myth of the model minority glossed over the nuanced cultural difference between groups, and that thinking about them as a non-underrepresented minority ignored the fact that “Asian” comprised so many different ethnicities, several of which are very underrepresented. Several surgeons mentioned their childhoods, growing up in immigrant working class families, and with English as a second language. Some credited their parents for their focus on academics, so that they were able to have a stable footing in society and lives that were more financially stable than their parents. A surgeon said that one of the reasons she relied on academics in school is because she felt like she didn’t belong and that in academics, she found something she was good at. More than one surgeon said that they didn’t want to be identified solely on the basis of their race/ethnicity and gender and how they are different (as they felt happens currently). I have included some quotes below: *“We are all here to do the same job-taking care of patients, and we are just as good at doing it as everyone else.” “Don’t say something to me that you wouldn’t say to a male surgeon.” “When there are obvious micro or macroaggressions that happen in public and no one around says anything, it is isolating. It’s not that I can’t stand up for myself. But it shows me how much I am valued or not.”* **If you could wave a wand and change things:** *“…the secret handbook of dos and don’ts that no one told me about”* Most surgeons said the things they would change are connected to mentorship: more mentors, more visible Asian American female mentors, mentors who could have pointed out obstacles and how to navigate them, mentors who could show them how to have a seat at the table, mentors who could point out the unwritten rules. Others pointed out the need for more advocacy in the Asian American physician and surgeon community. **The Future** Every surgeon that chose to discuss a forward-looking perspective indicated that things were improving, and that they sensed a shift for the better. As surgery is changing and becoming more diverse, it was felt that the challenges they face today will continue to improve. People indicated that there are now visible Asian American and female leaders as well as other leaders from minority groups, and that this growing representation and diversity would create a more inclusive environment that allows for growth in academic surgery. Several residents and faculty surgeons expressed a feeling of wanting to pay it forward- of wanting to mentor other medical students and residents and to show them that it was possible to be themselves, to be Asian American women and successful surgeons. *“Don’t let people tell you that you’re too quiet or too bubbly.”* **My Perspective** When I first reached out to friends and colleagues to ask them for their thoughts, I didn’t expect to receive the amount of information that I did. Reading through my compilation of the emails and notes from phone and Zoom conversations was saddening. While I expected that a lot of us had shared experiences, the pronounced feeling of being underestimated, undervalued and isolated, that most surgeons also felt that they could not discuss with anyone else since they would be misunderstood, was disheartening. Surgical training teaches you to be a good soldier, and as a friend put it “*show up, put up, and shut up*”, but the expectation of most good soldiers is that their hard work would pay off ultimately. My sense is that the seeming lack of this paying off was what was most discouraging, particularly to early and mid-career surgeons. It’s not all doom and gloom though. Almost everyone reported supportive families and/or a community of friends that helped them through their surgical journey. Community can be found through many avenues and in many ways. Shared experiences can help build and make us come together as a community. And here, I will interject with a plug for Society of Asian Academic Surgery (SAAS; [https://www.asiansurgeon.org](https://www.asiansurgeon.org/))- an organization I only discovered 2 years ago. Founded to focus on the personal and professional development of Asian academic surgeons and promote underrepresented populations in any arena of academic surgery, it is a place to find community, mentors and advocates who can point out obstacles and how to navigate them, and the elusive secret handbook of rules. I want to thank all the amazing surgeons- trainees and early/mid-career faculty- who were so generous with their time and thoughts. I apologize that I was not able to include everything everyone said, but this includes something from every written or verbal conversation. I hope this was able to do justice in conveying thoughts, concerns and hopes. Any faults in how this is written and/or errors in interpretation or communication are entirely mine. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/06/Fonseca.jpg)Annabelle Fonseca, MD, MHS is a surgical oncologist at the University of South Alabama. She completed medical school in India where she was born and raised, followed by residency training in general surgery at Yale University School of Medicine, where she also obtained a Master of Health Science Degree. She completed fellowship training in Complex General Surgical Oncology at The University of Texas MD Anderson Cancer Center. Following this, she joined the staff at the University of South Alabama as an Assistant Professor. Her clinical focus is on hepato-pancreato-biliary and other foregut malignancies, and her research focus is in disparities in access to complex oncologic care in foregut cancers. You can follow her on Twitter @afonsecaMD. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** aapi, diversity and inclusion, representation --- ### [Destination Wellness - The Physical Domain](https://blog.womensurgeons.org/destination-wellness-the-physical-domain/) **Published:** May 27, 2022 **Author:** Blog Team **Content:** *By Dr. Jaime D. Lewis* **The Clinical Practice Committee is again submitting a series of blog articles regarding a topic of common interest. Domains of wellness are variably defined and may be considered to include: [occupational, social, emotional, spiritual, intellectual, and physical](https://cdn.ymaws.com/members.nationalwellness.org/resource/resmgr/pdfs/sixdimensionsfactsheet.pdf?_gl=1%2Au4bg9u%2A_ga%2AMzY5MzI5OTk0LjE2NTI5MDQ4Mjg.%2A_ga_H93QPV9JN3%2AMTY1MjkwNDgyOC4xLjEuMTY1MjkwNDk3MS4w&_ga=2.160004221.1537214623.1652904828-369329994.1652904828). In this blog, I focus on the physical domain.** As a trainee, I found it difficult to schedule personal appointments and set a schedule for eating and working out. As a medical student, I often couldn’t even figure out when I’d be able to go to the restroom next. How could I plan meals and health care appointments? As a resident, I exercised very little except as during my two years of research. My diet at the hospital consisted of peanut butter and graham crackers. I nearly burned my house down one post-call day when I fell into a deep sleep on the couch waiting for ramen noodles to cook. If I had taken them as a trainee, my wellness inventory would have been sparse and my burnout level high. As a junior attending with a young family and a multitude of stressors, I felt the full impact of self-neglect. After a very challenging period of time and with some help, I recognized that I must make personal wellness a priority. Though it sometimes feels selfish and self-indulgent, I am fully aware that I cannot take care of others if I do not take care of myself first. Family needs are my primary concerns and my clinical and educational responsibilities are quite important, but meals, physical activity, and activities that support my physical and mental health are prioritized on my daily schedule. [When I talk to patients and students about physical activity and diet recommendations, I know that I am following many of them and working to improve in areas where I am lagging](https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf,%20https://www.pcrm.org/good-nutrition/nutrition-programs-policies/2020-2025-dietary-guidelines,%20https://pubmed.ncbi.nlm.nih.gov/22388107). In addition to maintaining healthy habits outside of the hospital, it is [important to recognize the physical impact of our jobs on our bodies](https://pubmed.ncbi.nlm.nih.gov/29282463/). In recovering from a chronic injury that I thought was due to long distance running, I discovered (with the help of the physical therapist I initially fought so hard to avoid due to the time commitment required to undergo treatment) that the injury stemmed in large part from my occupation. With my physical therapist and a personal trainer, I have worked on strength training and body position awareness, now take short breaks while operating to allow fatigued muscles a moment to recover, and often work at a standing desk in my office. I have started to talk to my trainees about the impact of our jobs on our long-term physical capacity to facilitate their understanding of the importance of ergonomics. While I have generally been able to set my own priorities and thus limits at this point in my career, there are many social and organizational barriers to wellness. For medical students and residents, I am encouraged by the requirement for programs to support trainee wellness. It can be hard to get all of the recommended activities and foods in daily. Thus, it’s important to recognize the value of 30 minutes of physical activity a few times a week and a healthy plant-based meal on the weekend. As an attending, it is possible to block out personal health days just as one would block out vacation or education days. It might also be possible to manage your schedule to go to the gym or take a run or walk several days a week. In “finding time” to do the things that contribute to wellness, it is i[mperative to manage the free time that does exist](https://www.ted.com/talks/laura_vanderkam_how_to_gain_control_of_your_free_time). I encourage each of us to evaluate our personal levels of physical wellness to determine if we are on a trajectory that will support longevity and fitness or if changes might improve that path. Peace. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/05/jaime-running-300x225.png)Dr. Jaime D. Lewis (in pink in the photo running Moonbow 50k in 2019) is an Associate Professor in the Division of Surgery Oncology and a Career Advisor in Student Affairs at the University of Cincinnati College of Medicine in Cincinnati, Ohio, where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Her practice is dedicated to the care of those with diseases of the breast. Dr. Lewis is also committed to improving wellness and professional development opportunities for those who pursue careers in surgery. Outside of the hospital, she is an avid road and trail runner and loves nothing more than spending time with her family. You can find her on Twitter and Instagram at [@JaimeDLewisMD](https://twitter.com/jaimedlewismd?lang=en). --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care **Tags:** clinical practice, health, self-care, Wellness --- ### [Increasing LGBTQIA+ Representation in Surgery: An Upcoming TweetChat with the Association of Out Surgeons and Allies (AOSA)](https://blog.womensurgeons.org/increasing-lgbtqia-representation/) **Published:** May 21, 2022 **Author:** Blog Team **Content:** *By Dr. Arushi Goel* What is pride? What is the importance of being able to be comfortable in your own skin, to be accepted as you are? For centuries, members of the LGBTQIA+ community have fought for their rights, their inclusion in society, and the freedom to openly express themselves as who they are. Despite improvements, the battle is far from won. Being different is never easy, but what separates members of the LGBTQIA+ community from members of other minority/identity groups is the added challenge, the “choice” to just blend in knowing that to show yourself is dangerous when the world is all too happy to show you the way out. At the core of the multitude of struggles undergone by the LGBTQIA+ community, there lies a simple need for the freedom to be… the freedom to be accepted for who they are and the freedom from fear to express themselves as such. It is a freedom that every human deserves, yet the choices faced by many members of the LGBTQIA+ community working within the surgical field are anything but free. They struggle with deciding what and how much to share, whom to tell, how to present, and/or which pronouns to use when calling themselves by name… often all while knowing that each moment, each instant, and each so-called “choice” could have a lasting and profound impact on their relationship with their colleagues and patients as well as the future of their career. A [recent study published in JAMA Surgery](https://pubmed.ncbi.nlm.nih.gov/34668969/) found that lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) surgical residents experienced a greater degree of harassment, bullying, and discrimination when compared to their non-LGBTQ+ peers. Attending surgeons were the most common source of issues. As noted in the [response by Dr. West](https://pubmed.ncbi.nlm.nih.gov/34668960/), this work provides an important starting point for “an overdue conversation about a number of issues that reside within the house of surgery.” The article found that mistreatment of LGBTQ+ residents contributed to a higher tendency to leave their academic training programs at a time when increased representation within the surgical workforce is sorely needed. As members of the LGBTQIA+ community and as allies, it is time for a change. It is time to move the conversation forward to help create places where all surgical residents and all surgeons are welcomed and able to train. Around the world, members of the LGBTQIA+ community face different barriers. In some countries, people have the freedom to declare their pronouns of choice and have access to rights like legal marriage, while in others, being discovered as “different” could put both their career and life in jeopardy. In the United States and India, we don’t have laws that prohibit members of the LGBTQIA+ community from choosing to practice medicine, but society can still become a roadblock when tradition and expectations dictate the way a person, the way a surgeon “ought to be.” It is time to take a good hard look at ourselves and think: If put on the spot, how would we treat someone with the same qualifications but a different identity than our own. As an ally, if the answer makes us uncomfortable, we know where to begin. --- **Please join us on Monday, May 23, 2022, from 8-9 PM EST for an AWS TweetChat about increasing representation for LGBTQIA+ surgeons, trainees, and patients! The chat will be moderated by members of the Association of Out Surgeons and Allies (AOSA). The questions will be posted directly from the** [@WomenSurgeons](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Ftwitter.com%2FWomenSurgeons__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UNk9nfm0%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=%2BtEJEMY1BPcjQqtnZIFybPiSYK9pB%2FK%2BuWf%2BXpmZkFo%3D&reserved=0) **Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this**[ tutorial](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__http%3A%2F%2Fblog.womensurgeons.org%2Fmedical-students%2Fbeyond-the-basics-of-tweeting%2F__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UH7HLDER%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=KfiBo6A70VlffaJp8Mn9kz12YBY7SF2igEx%2F8dbTeRs%3D&reserved=0) **written by Dr. Heather Yeo (**[@heatheryeomd](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Ftwitter.com%2Fheatheryeomd__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UObtPBLT%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=lIHUfxruDcFIhtmJgMNusR1ass7wxTd%2BpEDleERU2VE%3D&reserved=0)**) to know more. We will be discussing the following questions during our tweet chat:** **What are the necessary components of a program or institution that aims to support providers who identify as LGBTQIA+?** **What training/educational materials are available for those who wish to be allies?** **When was AOSA started? What are some of the initiatives being led by this organization and how might one get involved?** **What are some short-term and long-term goals of AOSA?** ![](https://blog.womensurgeons.org/wp-content/uploads/2022/05/Picture1.png) Arushi Goel, MBBS, is an intern at Sri Ramachandra Medical College and Hospital in Chennai, India. Passionate about surgery since the very beginning, she believes in being the kind of doctor who doesn’t just treat but heals her patients. She loves teaching and public speaking. She serves as a Board Director for Doctors For A Cause, as the Head Advisor for the Task Force for Differently Abled, and as the Asia and Australia Regional Representative on the National Medical Student Committee of the Association of Women Surgeons. Beyond medicine, her creative interests extend into dancing, writing, and cooking. She lives by the motto: “Heal the ones you can, inspire the rest.” In the future, she aims to become a renowned beacon of hope, positivity, and self-love while striving for mastery in her passionate pursuits inside and outside of the field of surgery. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #AWSTweetChat, #diversityandinclusion, Diversity, diversity and inclusion, representation, Surgical Education, womeninmedicine, womeninsurgery, WomenSurgeons, workplace --- ### [We Shouldn't Need A Guide to Answering Potentially Illegal Questions](https://blog.womensurgeons.org/we-shouldnt-need-a-guide-to-answering-potentially-illegal-questions/) **Published:** May 6, 2022 **Author:** Blog Team **Content:** *By Sana Khan, MD* My residency interview preparation consisted of introspection, reviewing commonly asked questions, and looking over my submitted application. I picked my answers apart and ensured I was pleased with my responses to the ever-so-important “Tell me about yourself” and “Why surgery?”. I thought about which hobbies I wanted to speak about, and then wondered if I was embarking on tangents about the gym. I decided against disclosing my exact workout routine, unless specifically asked. I tried to avoid sounding underprepared or too rehearsed. I even thought about which surgical instrument I would be, just in case I was asked. I chose what I knew best as a medical student: the retractor. Like a retractor, I did my best to help in the OR, assisted with visualization and tried not to get in the way. During my preparation, however, I was woefully aware of the possibility of encountering questions that I perhaps could not prepare for. Whether you scour online forums or scroll through “med-twitter”, you will find numerous anecdotes shared by applicants who were asked illegal, or potentially illegal, interview questions during their residency interviews. I was introduced to this phenomenon by a report by [*Hern et al.*](https://pubmed.ncbi.nlm.nih.gov/27049540/) from 2016 about the prevalence of potentially illegal interview questions among all specialties and their impact. Illegal interview questions include questions about marital status, family planning, age, religion, and sexual preferences. Potentially illegal questions are those that allude to an applicant’s membership in these protected classes. If an applicant is not hired, illegal and potentially illegal questions can be used as evidence of discrimination. Unique to the Residency Match, interviewers can also commit match violations by asking applicants where else they interviewed and how high they plan to rank their program. Unsurprisingly, women were more likely to encounter questions about marital status and family planning than men. Surgical specialties, including neurosurgery, orthopedic surgery, obstetrics and gynecology, and general surgery, were found to be the most likely to ask about applicants’ memberships in the mentioned protected classes. Applicants reported feeling uncomfortable when programs asked potentially illegal questions and subsequently lowered the programs on their rank list. After four years of medical education, large student loans and power dynamics leave residency applicants in a vulnerable position, where speaking up and reporting is not the norm. During my interviews, I remember feeling helpless when receiving inappropriate comments about my appearance or on how well I spoke English (which I have been able to pick up in my 20 years of living in Canada). My focus was on showing that I was not offended so I did not make the interviewer uncomfortable. Similar to the theme in *Hern et al.’*s paper, these programs went to the bottom of my rank list. A guide to answering potentially illegal questions should not be necessary in a field where professionalism is emphasized so heavily. Ideally, the effort made by applicants preparing for illegal interview questions would be shifted to programs ensuring these questions are not asked during residency interviews. The reality is that programs that choose to ask illegal questions will continue to do so until a culture of accountability is achieved. Applicants can report programs that breach match policies and ask illegal questions to the NRMP at <policy@nrmp.org>. ![Sana Khan](https://blog.womensurgeons.org/wp-content/uploads/2022/05/Sana.jpg)Sana Khan, MD, is an incoming general surgery intern at Wayne State University School of Medicine, recently completing her medical education at Saba University School of Medicine. She grew up in Toronto, Canada and attended University of Toronto where she majored in Biology and minored in Sociology and Social Geography. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** professionalism **Tags:** diversity and inclusion, interviews, residency --- ### [Asian Americans in Medicine: Bridge-Tenders for Diversity](https://blog.womensurgeons.org/asian-americans-in-medicine-bridge-tenders-for-diversity/) **Published:** May 2, 2022 **Author:** Blog Team **Content:** *By Lily Cheng* Last March, eight people – including six Asian women – were killed in a targeted hate crime in Atlanta, Georgia. [In the year since, NBC News reports that 74% of Asian American Pacific Islander (AAPI) women have experienced racism or discrimination](https://www.nbcnews.com/news/asian-america/74-asian-american-women-experienced-racism-year-new-report-says-rcna18626). Since the beginning of the pandemic, there has been a rise in hate crimes against Asian Americans and Pacific Islanders, mostly against Chinese-American women. What these last few years of the pandemic have highlighted for me is how lucky I have been in my life so far to be relatively removed from discrimination and hate. I was born in China, but my parents immigrated to the U.S. when I was five years old so that my dad could get his Ph.D. at Purdue University. Even in the middle of Indiana in the early 90’s, I remember only one incident when I experienced obvious racism first hand (our car was keyed while we were out fishing). After my dad finished his Ph.D., our family moved to the San Francisco Bay Area where Asians are so integrated into the community that my high school was majority AAPI. In this environment, I never felt my race or gender was a hindrance. When I fell in love with surgery, I didn’t think twice about being a woman in surgery, and I didn’t think of myself as a minority. I was lucky to match at UC San Francisco, where strong women leaders, including Dr. Nancy Ascher as chair and Dr. Linda Reilly as program director, had made women in surgery the standard. My graduating chief class of seven was made up of six women. Similarly, Asians are now fortunate to be relatively well-represented in medicine. Despite comprising 7% of the U.S. population, [**Asians represent 17% of physicians in the U.S. and are the second most represented race after White (56%)**](https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018). While this statistic doesn’t take into account the different ethnicities that comprise “Asian” or acknowledge the “bamboo ceiling” that may keep Asians from ascending into leadership positions, the fact is that there are 3 times more Asian physicians than there are Hispanic (5.8% vs. 18.4% of the U.S. population) or Black (5% vs. 13.4% of the U.S. population). I hadn’t given much thought to the position of Asian women until the last few years when the turmoil of the pandemic exposed some of America’s most xenophobic sentiments. At the same time that Asians are making huge strides in America (Parasite won Best Picture at the Oscars, Boston elected an Asian American woman as Mayor), [**anti-Asian hate crimes increased 339% in 2021 with women being particularly targeted**](https://stopaapihate.org). All of this has made me appreciate the relative advantages I’ve enjoyed as an Asian woman before the pandemic, something not all minorities can claim. In a way, being Asian in America is like being a woman in surgery – we’ve been accepted as part of the in-crowd, but once in a while, we’re reminded that we’re still “other.” As an aspiring surgeon-scientist, I often hear about being a “bridge-tender” – channeling knowledge from bench to bedside and back again. I think we as Asian Americans, the most prevalent and perhaps the most “accepted” minority in medicine, can also be bridge-tenders in a way—using our unique position to advocate for diversity. As in science, diversity breeds innovation and drives progress. Though we’ve come a long way, the last few years remind us there is still progress to be made. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/05/lily-245x300.jpg)Lily S. Cheng, MD, is an Assistant Professor in Pediatric Surgery at Texas Children’s Hospital (Baylor College of Medicine) in Houston, Texas. She has an interest in congenital colorectal surgery and is currently working to improve the understanding and management of Hirschsprung disease. You can find her on Twitter @LilySCheng. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** aapi, diversity and inclusion, womeninsurgery --- ### [The Balance Beam](https://blog.womensurgeons.org/the-balance-beam/) **Published:** April 29, 2022 **Author:** Blog Team **Content:** *By Sara Ashai* There are days where everything goes wrong, but there are also days where everything goes right. Most days, we sit somewhere in the middle. Our voice stays quiet some days, some days it wants to yell, and some days our voice yells at ourselves. When I was a first year medical student, I was quiet. I came straight through undergrad and was one of the youngest in the class. I felt scared to speak up. I came into medical school wanting to do psychiatry. Interpersonal skills with patients are one of my strengths and I was passionate about mental health, so I thought psychiatry fit that scheme. As the first year continued, I spoke to residents who told me that there was a need for more Pakistani women to go into OB/GYN or any surgical field. Thus, I considered it quietly. Never did I consider myself to be a surgeon or even interested in it. Before my OB/GYN rotation started in October of 2021, I had a meeting with my research mentor, who is a South Asian urologist. I expressed to her how I feel as if my “personality” does not mesh. She responded saying, “I think it’s only in your head.” She was right, it was only in my head. I then mustered up the courage to speak up. During my OB/GYN rotation, I used my voice to express my interest. I used my voice to volunteer to do extra nights than required. I used my voice to ask to talk to attendings about OB/GYN life. Initially, I was scared to do this. I had thoughts in my head telling me “they are too busy” and “what if they say no.” But what if they say no? *Our thoughts prevent us from taking risks because of fear of failure.* You have to let it go. **If you feel like this, make a list of all the times you take a risk and note the outcomes.** Each time you take a risk, ie. use your voice to talk to an attending or ask to work on a project, you will develop a piece of your voice. *Your voice will become stronger.* The power of our voice is so much stronger than we can imagine. In a world in which social media is dominant and becoming the platform to network, it can be overwhelming for those who are quieter. Two years ago, I did not believe I could be a surgeon. My voice was diminished. But, you cannot convince anyone else that you are capable of being a surgeon until you believe that yourself. In order to do that, turn to the thing that keeps you going when all else fails. For all those struggling with that voice inside your head, **you can print out your clinical evaluations through your 3rd year and post them on your mirror for validation every morning.** I know it sounds silly to write down good things about yourself but it’s true. If you tell yourself you’re okay, you will be okay. Your voice and thoughts are on opposite ends of a balance beam. When your voice falls down, your thoughts purge your brain. When your voice is too high, you just talk with no thought. The goal is to be right in the middle. For those first- and second-year medical students, figure out where your weaknesses lie and work on those. When I was a first year medical student, I was quiet. I had lost my voice. I had lost my standing. For me, writing helped me rebuild my voice. I encourage every incoming medical student to find that medium that allows you to find and re-find your voice because when everything else goes awry, that medium will be your balance beam. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/04/sara.jpg)Sara Ashai is a fourth year medical student at The University of Maryland School of Medicine. She is originally from Dallas, TX and attended The University of Texas at Austin, where she studied biology. She is planning to apply into OB/GYN and is very passionate about encouraging minority women to go into surgical fields. Her hobbies include: bullet journaling, spin classes at her local spin studio in Baltimore, and spending time with her family. Twitter handle- @saraashai --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, reflection **Tags:** aapi, AWSBlog, bravery, diversity and inclusion, mentorship, womeninsurgery --- ### [Growing Pains](https://blog.womensurgeons.org/growing-pains/) **Published:** April 22, 2022 **Author:** Blog Team **Content:** *By Olivia Cheng* “What are you doing?” This was the forever question my mentor would ask me in the operating room when we worked together. It was often paired with “Go faster,” “Slow down,” or “Stop thinking so much.” Anyone who has worked with her knows that she is quick and efficient but safe. She would only push you to be better. I have been incredibly fortunate these past four years to have such a mentor with whom I have connected so well. Naturally, I was drawn to her as a fellow Burmese-Chinese female surgeon but she is so much more. She has been my most valuable ally and harshest critic. There was always something I could do better, and I liked that about her. It was what drew me to surgery from the beginning – the aspiration to obtain perfection that was just within your grasp, but ever so slightly out of reach. It was addicting. Surgery was historically an apprenticeship where a budding surgeon would be taken under the wing of a more seasoned and skilled practitioner. Although surgery has since transformed into a profession from a trade, mentorship continues to be a necessity in surgery; without it, we cannot grow to our fullest potential. It is comforting to have someone you can emulate and see yourself as – a tangible entity of your future career and goals. She was that mentor to me and I had been looking forward to operating with her until I graduated from residency. There comes a time we all have to grow up. On a 24-hour call night I had with her, I braved a question that had been burning in my mind for weeks after I noticed her contemplating how to get rid of her office plants. I had been afraid to ask for fear of it being true: “Are you leaving?” Her back turned to face me and she paused, as if to find the right words to say, or perhaps in shock that I even asked the question. She had not told anyone yet. Her answer was as cool and direct as the surgeon she is — “Yes.” There was a sinking feeling in my chest as that word pierced through me like a stab wound; before this moment, it was inconceivable and now it was the reality. There comes a time for all of us when we have to spread our wings and fly farther from the nest than we have before. This was only the beginning for me. She was making the bigger step in finally leaving the city where she had trained since her residency, as well as the mentor whom she trained under for so many years. It was a hard decision for her to make but she had come to terms with it being time for a change. Being the amazing surgeon she is, I know she will only exceed expectations in her new city and job. She reassured me she was still within reach and that we would still keep in touch despite being on opposite sides of the country. The day before she left, she knocked on my apartment door to drop off a machine for making ice cream and another for bread, two things she knows I love, and we hugged one last time. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/04/IMG_2614-300x300.jpeg)Olivia Cheng is originally from Queens, New York. She attended Stuyvesant High School in Manhattan and subsequently received her B.S. at Stony Brook University where she completed her B.S. double major in Pharmacology and Cinema & Cultural Studies. She stayed on at Stony Brook University School of Medicine for her M.D. and is a member of the Gold Humanism Honor Society. She is currently a fourth year General Surgery resident at New York-Presbyterian Brooklyn Methodist Hospital. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** #mentors, #womeninsugery, womeninmedicine --- ### [“Why is there a dentist in the operating room?”](https://blog.womensurgeons.org/why-is-there-a-dentist-in-the-operating-room/) **Published:** April 15, 2022 **Author:** Blog Team **Content:** *By Juliana Gomez, DDS* I loved dentistry. The autonomy of private practice, the (relatively) shorter training, the immediate gratification when you are able to fix a problem or alleviate someone’s pain in a single visit. My path was altered when I chose to pursue Oral and Maxillofacial Surgery (OMFS) residency—but I remember my time in dental school and the smiles that I fixed quite fondly. That being said, the last filling that I performed was in school about three years ago, and I do not exactly miss doing root canals. Dentists are experts in treatment of the mouth, where they cover an enormous range of disciplines- surgery, prevention, restoration, and preservation of the health of the oral cavity. We work closely, on occasion, with our dental colleagues. Oral and maxillofacial surgeons have a much different scope of practice than dentists. After graduating dental school (NYU 19’), I began an intern year prior to formally applying for the OMFS Match. During that time I spent a full year on a busy Oral and Maxillofacial Surgery service at the University of Florida in Jacksonville, FL and earned a certificate in Oral and Maxillofacial General Surgery in June 2020. By this point, I had under my belt undergraduate, dental school and an intern year- so 8 years post-secondary education, having completed undergrad in 3 years. Matching into OMFS residency was a breath of fresh air. Interestingly, it was a double celebration, as OMFS applicants find out that we have also been accepted to the medical school associated with our residency program as part of the match. We then sign a contract for 6 years of residency training (4 with the non-MD track) and get started. I was fortunate enough to match into Ascension Macomb-Oakland Hospital in Detroit, Michigan. The OMF surgeon is an expert in facial surgery, and can subspecialize in a number of fields via 1-3 years of fellowship training. These include head and neck oncologic resection and reconstruction, cleft and craniofacial surgery, plastic and reconstructive surgery (independent track) and full body and facial cosmetic surgery to name a few. OMFS are the referral service for reconstruction of the head and neck, thoracic and extremity reconstruction at some institutions. We are even the surgical airway consult service at some institutions. We are experts in sedation anesthesia and perform general anesthesia, spending about half a year or more on anesthesia service as residents. We spend time on general surgery service to obtain a general surgery certificate, perform endocrine surgery, and are consulted to provide surgical access for anterior cervical spine surgery or perform enucleation of the globe of the eye, for example. The scope of OMFS is extensive as supported by our 13-19 years of post-secondary education as well as our dual graduate degrees, and overlaps with plastic surgery, ear nose and throat surgery, general surgery, anesthesiology, dermatology and ophthalmology to name a few. However, not too many providers of all levels are aware that we exist- or that we are a FACS specialty with an extremely broad scope. As an on-call OMFS intern, I was consulted on emergent airways, complex panfacial trauma, to control a sentinel bleed from a laryngectomy site, to drain a post thyroidectomy hematoma impinging on the airway, to address infected clavicular hardware, infected spine hardware, to work up facial cleft patients, and to perform lateral canthotomies, tonsillar and peritonsillar procedures, to work up a necrotizing fasciitis of the gluteal region for reconstruction by our team and temporal artery biopsy to diagnose giant cell arteritis, for example. All of this in addition to managing patients on our orthognathic surgery, head and neck oncologic and extremity reconstruction, cleft and craniofacial, trauma, temporomandibular joint surgery and reconstruction teams, as well as the oral trauma and dental cases. Having put this all in perspective, I am still in training, and I do not yet have the MD behind my name (depending on the program we get this around PGY-4,5). So, I am a dentist by training with the above supplemental experience in an expanded scope specialty, for which I am extremely grateful. OMFS’ train extensively to be able to do what they do, and I plan to use my remaining years of residency to become proficient in all this specialty has to offer. Referring to the question I have been asked much too often- the ‘dentist’ is in the operating room because they are highly qualified to be there and have the training to support it. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/04/Screen-Shot-2022-02-01-at-10.37.19-AM-275x300.png)Juliana Gomez, DDS is a second-year resident in the Department of Oral and Maxillofacial Surgery at Ascension Macomb-Oakland Hospital in Detroit, MI. She completed undergraduate studies at Florida Atlantic University and went on to earn her DDS at New York University College of Dentistry. She completed a one-year certificate in Oral and Maxillofacial General Surgery at the University of Florida-Jacksonville prior to beginning residency in Detroit and is currently obtaining her MD at Wayne State University, School of Medicine. Currently, she is the conference chair for the medical student division of AMWA. Dr. Gomez’s academic interests include head and neck reconstructive surgery, treatment of maxillofacial pathology, and extremity reconstruction. --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** education, medical students, training --- ### [The Changing Face of Global Surgery: An Upcoming TweetChat](https://blog.womensurgeons.org/changing-face-of-global-surgery/) **Published:** April 11, 2022 **Author:** Blog Team **Content:** *By Dr. Dominique Vervoort* [Five billion people](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext) continue to lack access to safe, timely, and affordable surgical healthcare when needed. As a result, more than 17 million people die from surgically treatable conditions every year, more than five times as many deaths as due to HIV/AIDS, tuberculosis, and malaria combined. Contrary to historical misperceptions, surgical healthcare is[ favorably cost-effective](https://link.springer.com/article/10.1007/s00268-013-2243-y), including when compared to many common global health interventions. Moreover, without investing in surgical healthcare, low- and middle-income countries are projected to face a potential loss of socioeconomic growth of[ up to $12.3 trillion by 2030](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext). Surgical healthcare was once coined the “[neglected stepchild of global health](https://link.springer.com/article/10.1007/s00268-008-9525-9)” by Dr. Paul Farmer and Dr. Jim Kim. Progress in recent years, with the growth of academic global surgery and national and international policy commitments, suggests that surgery may no longer be a neglected stepchild; however, it is clear that there is much work left to do. Trainees around the world have taken a central role in the growing field of global surgery through advocacy, peer education, research, and policy. For example, the[ International Student Surgical Network (InciSioN)](https://incisionetwork.org/) is the world’s largest global surgery trainee organization with over 8,000 members in over 100 countries. InciSioN provides a platform for students, residents, fellows, and young doctors to get involved with global surgery and foster a social network of future global surgeons, obstetricians, anesthesiologists, and global surgery researchers. In addition, it leverages its network to sustain a grassroots movement for global surgical advocacy. For example, National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) driven by countries’ Ministries of Health have seen the[ involvement of trainees](https://e-jghs.org/search.php?where=aview&id=10.35500/jghs.2019.1.e39&code=9986JGHS&vmode=FULL) at stakeholder meetings (e.g., InciSioN Colombia) and in data collection (e.g., InciSioN Nigeria). Beyond InciSioN, trainees are increasingly involved through subspecialty-specific organizations, academic global surgery centers, societal initiatives, bilateral partnerships, and individual advocacy through social media. As a result of the growth of the field of academic global surgery and the emergence of national and international trainee organizations in global surgery, the future of global surgery is bright. However, this surge in interest has also highlighted under-discussed areas that must be addressed, including the ethics of trainees’ clinical involvement in global surgery as well as prevailing neo-colonialism in many global surgical and global health activities. The involvement of visiting trainees in global surgical activities should adhere to[ strict ethical and mutually agreed upon requirements](https://journals.lww.com/journalacs/Abstract/2022/02000/Ethics_of_Educating_American_Global_Surgeons__An.20.aspx) to not negatively affect local teams (e.g., displacement of local trainees). Similarly, at an academic level, equity should be prioritized within research activities and collaborations; recent findings suggest that high-income country researchers continue to be predominant in first and last authorship positions in[ global surgery](https://gh.bmj.com/content/6/10/e006672) and[ global health](https://gh.bmj.com/content/4/5/e001853.long). Providing access to life-saving and life-changing surgical healthcare for the world’s population will require not only a recognition of the indispensable role of surgical healthcare in health systems; it will also require recognition of existing disparities, power imbalances, financial and programmatic inefficiencies, and the importance of locally-driven interventions. Only so can we truly ensure that surgical healthcare is no longer the neglected stepchild of global health. --- **Please join us on Monday, April 18, 2022, from 8-9 PM EST for an AWS TweetChat about Global Surgery! The chat will be moderated by Dr. Geoffrey Anderson (**[**@GeoffAndersonMD**](https://twitter.com/GeoffAndersonMD)**), Dr. Rashi Jhunjhunwala (**[**@rashijjw**](https://twitter.com/rashijjw)**), Dr. Nancy Abu-Bonsrah (**[**@BonsrahNancy**](https://twitter.com/BonsrahNancy)**), and Dr. Dominique Vervoort (**[**@DVervoort94**](https://twitter.com/DVervoort94)**).** The questions will be posted directly from the [@WomenSurgeons](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Ftwitter.com%2FWomenSurgeons__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UNk9nfm0%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=%2BtEJEMY1BPcjQqtnZIFybPiSYK9pB%2FK%2BuWf%2BXpmZkFo%3D&reserved=0) Twitter account. You can also find them by following the hashtag **\#AWSchat.** If you have not participated in a tweet chat with us before, check out this[ tutorial](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__http%3A%2F%2Fblog.womensurgeons.org%2Fmedical-students%2Fbeyond-the-basics-of-tweeting%2F__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UH7HLDER%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=KfiBo6A70VlffaJp8Mn9kz12YBY7SF2igEx%2F8dbTeRs%3D&reserved=0) written by Dr. Heather Yeo ([@heatheryeomd](https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Ftwitter.com%2Fheatheryeomd__%3B!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UObtPBLT%24&data=04%7C01%7C%7C4358bec88ca94db17dc408da173c6222%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637847845371660435%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=lIHUfxruDcFIhtmJgMNusR1ass7wxTd%2BpEDleERU2VE%3D&reserved=0)) to know more. We will be discussing the following questions during our tweet chat: - What role(s) can trainees play in the field of (academic) global surgery? - What are the benefits for trainees to get exposed to (academic) global surgery? - What barriers have you observed and/or experienced when seeking to get involved in the field of global surgery? - What are the ethical considerations of trainees’ involvement in the field of global surgery, whether academically or clinically? - What actions must be taken to decolonize global surgery? - Why is gender equity in global surgery critical to ensure access to safe, timely, and affordable surgical healthcare for the world’s population? ![](https://blog.womensurgeons.org/wp-content/uploads/2022/04/Picture1.png) Dominique Vervoort, MD, MPH, MBA, is a PhD student in Health Services Research at the Institute of Health Policy, Management and Evaluation and Division of Cardiac Surgery at the University of Toronto. Dominique completed the Paul Farmer Global Surgery Fellowship at Harvard Medical School, is Advisor to the Global Surgery Foundation, Advisor to the Johns Hopkins Global Surgery Initiative, co-Founder and past co-Chair of InciSioN – International Student Surgical Network, and Founding President of the Global Cardiac Surgery Initiative. He can be found on Twitter[ @DVervoort94](https://twitter.com/DVervoort94). --- *Our blog is a forum for our members to speak, and, as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #womeninmedicine #womeninsurgery #residencyinterviews #AWSTweetChat #AWS #AssociationofWomenSurgeons, collaboration, Global Surgery, internationalcollaborations, Surgical Education, Tweetchat, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Waiting Your Turn: Part 2](https://blog.womensurgeons.org/waiting-your-turn-part-2/) **Published:** March 30, 2022 **Author:** Blog Team **Content:** By Alyssa Brown In 2019, I stood by and watched as my friends and classmates matched. It was the spring of my first year in the PhD program. I had made the flight down to watch them match. It was a bittersweet feeling to see my medical school friends find their new homes. It made me acutely aware that they were passing me by. On the plane ride back to Minnesota, I wrote about this [experience](https://blog.womensurgeons.org/medical-students/waiting-your-turn/). I also wrote about my anxiety of returning to medical school in 2021 and knowing no one. That Match Day made it very real for me. This year, it was my turn. I had applied, interviewed, and ranked programs. I had gone on second looks, and I spent the last day before certifying my list on the phone agonizing over rankings of different programs. Some of the same thoughts ran through my head. Would I be happy there? Would I make friends? Would I make it as a surgeon? I certified my rank list a week before defending my thesis. As I sat on a high floor office in the hospital looking out over Rochester, Minnesota, I felt sad and a tear came to the corner of my eye. I felt nostalgic. It was the same view I had that I used to have from my balcony when I lived in Rochester during my PhD. I had spent many days and nights looking out at that view. The realization came that I would be moving again. I would have to make new friendships and find new mentors and adapt again. I would be leaving my friends and mentors in Louisville and Rochester. I would be leaving the families I had built there. In June, I will be packing up my things and starting again on a new journey. On Match Day this year, my partner, Jarel, joined me. I knew under 10 people in my 150 person medical school class, and there were only two who I thought of as friends. Jarel and I found seats in the last row. The whole day felt more surreal than anxiety-provoking. As students and families nervously twittered around the ballroom, Jarel and I just sat there sipping our drinks. Finally, the envelopes were passed out. I didn’t try to peer through it under the lights. I didn’t feel ready to open it. Opening it meant that I would know where I was moving. It would make this process concrete. If I didn’t open it, I could keep living in blissful ignorance. The countdown started, and classmates tore open their envelopes. Cheers rang out across the room. I still stood there watching. Jarel didn’t try to get me to open it. He knew I would on my own time. After five minutes, I finally took the letter out of the envelope, but I still hesitated to unfold it. It was hard for me to process that I had been waiting seven years to open an envelope that would set me on a course. I had waited for this. I finally opened it and scanned down to the bolded program name. Instead of saying anything, I just hugged Jarel for a long time. I knew the onslaught of text messages asking where I was going would start, but I wanted to live in this bubble a little longer. The rest of the day was a blur of friends, phone calls, and text messages. I was and still am overwhelmed. I am left with the same anxieties I have always had. Will I be happy in this program? Will I be successful? Will I be a good surgeon? Will I make friends? Even when having these thoughts, I think of the incredible women and people behind me on this path. The people that have brought me through these seven years. The ones who believed in me, pushed me, and encouraged me. I am too lucky to have all of these amazing people with me. After all this waiting, so much will change, but much will stay the same. The people who support me are always an invaluable part of my journey. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/headshot_5x7_0449-731x1024.jpg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is in her fourth year of medical school and has matched at Northwestern for general surgery residency. Her thesis research is on diaphragm muscle mitochondrial function and morphology, which she will defend in March. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram [**@Alyssa\_b\_futuremdphd**](https://www.instagram.com/alyssa_b_futuremdphd/?hl=en) and on Twitter [**@Alyssa\_B\_MDPhD**](https://twitter.com/Alyssa_B_MDPhD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** Match, Match Day, medical students, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [SURGICAL INNOVATION: AN UPCOMING TWEETCHAT](https://blog.womensurgeons.org/surgical-innovation-tweetchat/) **Published:** March 25, 2022 **Author:** Blog Team **Content:** *By Dr. Mark Cohen* Surgeons are frequently engaged in the incorporation of new technologies in their practice. In the operating room, the clinic, and even the board room, they combine technical skill with creative problem solving to improve tools and techniques for patient care, making them natural innovators. Surgeons are also keenly aware of how healthcare delivery and patient workflow can affect outcomes and overall costs. While surgical training and faculty development continue to evolve, one area that remains a challenge is educating surgeons how to navigate innovation, commercialization, and entrepreneurship more effectively. Even surgeons who have had a lifetime of clinical training and experience may lack the necessary tools, skills, and network to successfully take an innovation from an idea to an actual product or service that can impact patient care. Moreover, with increasing pressure to meet productivity metrics, a surgeon’s ability and bandwidth to learn the complexities of commercialization is often quite limited. Having a good idea and turning it into a meaningful innovation that will positively impact society requires a good understanding of the process of innovation and commercialization. This is not a sprint but rather a well-planned journey that will take many turns and bring you to several forks in the road where you need to decide the path you want your innovation to take. It starts with defining the right problem to address and then brainstorming ideas that solve the problem. Those ideas then need to be iteratively tested and evaluated by a variety of stakeholders and customers who can help focus the idea to something that is more valuable to them and has meaningful impact. Once a good idea is developed into a strong value proposition, it needs resources and the right team to move it forward. Bringing others into your innovation and creating a shared vision to move it through the commercialization process requires you to develop skills in giving a compelling pitch. After deciding on what is the specific problem you want to solve, the next phase of the innovation process is ideation and brainstorming potential solutions. The best brainstorming often involves team-based brainstorming where you can look at the problem from multiple perspectives and lenses. Diversity of team-based brainstorming can add significant value to identifying novel as well as improbable solutions. In many programs these teams often involve physicians, engineers, business experts, IP lawyers, and customers experiencing the problem. At this phase, no idea is a bad one and it is important to look at every angle and possibility. Generating multiple solutions can be helpful not only to identify weaknesses in each idea, but also to identify which ideas have the best chance at solving the problem so that you can narrow down your solutions to one lead idea with which to move forward. Communicating your vision requires a combination of tools and formats that share one theme–engage the listener and encourage them to ask for additional information. Brevity is critical but can be difficult for innovators who are inherently excited about their vision and all that is possible. Carving your message to its core elements takes effort. The good news is that brevity and clarity can bring insight to both the innovator and the audience. A brief message is more likely to engage the audience and win you the chance to say more. Probably the greatest skill successful surgeon innovators develop is the ability to communicate and create a meaningful vision and path for the future that other stakeholders and investors can get behind. This involves not just a solid understanding of the path to the clinic/market that the innovation or technology has to take, but also who your audience is that you are pitching to and what they are looking for in an innovation to support it. Many times I have seen great ideas fail because the surgeon could not convey their innovation in a way business and industry investors could understand and support. I cannot stress enough the value of a clear vision, a strong value-proposition, a solid team, and a low/tolerable-risk path to the clinic. Having taught innovation and entrepreneurial skills to medical students, surgical residents, and surgeons of every level for almost a decade now, I have gleaned many pearls from mistakes I have made in my own commercialization efforts as well as watching others navigate these roads. One fact of the real world, which daunted me a bit when I first heard it, is that over 95% of healthcare innovations fail to get to the clinic and over 70% of venture-backed innovations fail to get to market. This however should not steer you away from innovation and trying to create meaningful impact for your patients and society. For the surgical innovator, this is a labor of love and something you are passionate about and want to help your patients or advance your field, so you are willing to put in time to move it forward. It is important to realize that as a busy surgeon or surgical trainee this is extremely difficult to do alone and it is crucial to build a diverse and solid team that can help move this forward in ways you could not do by yourself. I often tell my academic colleagues that getting venture funding for an innovation can be compared in some ways to getting an NIH R01 grant funded. Both are unlikely to be successful on the first try, but the key is perseverance and learning how to set yourself up better for success. VC investors in many ways have similarities to an NIH study section. Both want a disruptive innovation that will advance the field; both want a great team to move the project forward to success; both want a clear stepwise plan for milestones and success; and both want a project that has a favorable risk/reward ratio that generates almost guaranteed success for their investment. Similarly, both turn down a vast majority of the proposals they get for the same reasons above. There are ways however to set your innovation up for success to better mitigate these barriers to funding and make it easier to build excitement among stakeholders and investors. Learning these skills can save you time in navigating your innovation pathway as well as avoiding pitfalls that can sink your idea before it can get to the clinic. Understanding your innovation ecosystem where you are practicing is a crucial first step in knowing both early opportunities as well as barriers you need to navigate to grow your idea. --- **Please join us on Monday, March 28, 2022, from 8-9 pm EST for an AWS Tweetchat about surgical innovation!** This chat will focus on how surgeons can be better innovators and bring great ideas from concept to the clinic for impact. Some topics covered will be team building, industry-academic partnerships, navigating regulatory pathways and funding innovations. The chat will be moderated by Dr. Monica Jain and other surgeon innovators from around the country. We will also be welcoming experts in this space from academia, industry, and the venture capital/finance sector that can help answer your questions around bringing surgical innovations to the clinic. The questions will be posted directly from the[ @WomenSurgeons](https://urldefense.com/v3/__https:/twitter.com/WomenSurgeons__;!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UNk9nfm0$) Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this[ tutorial](https://urldefense.com/v3/__http:/blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/__;!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UH7HLDER$) written by Dr. Heather Yeo ([@heatheryeomd](https://urldefense.com/v3/__https:/twitter.com/heatheryeomd__;!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UObtPBLT$)) to know more. We will be discussing the following topics during our tweet chat: Q1: What are some barriers to moving innovations forward at your institution? Q2: How do busy surgeon-innovators build strong and diverse innovation teams? Q3: Where do I find funding for my innovation to get things moving forward? Q4: How do busy surgeons find time to innovate when this is not paid effort or protected time to work on innovation projects? Q5: How can I get better recognized for my innovation efforts to get more time and resources from leadership? Q6: Where can I develop more innovation/entrepreneurial skills to help me focus and move my ideas forward? Q7: What do I do when my innovation seems to be stalled-out or hits a barrier I cannot overcome? ![](https://blog.womensurgeons.org/wp-content/uploads/2022/03/Picture1-2.png) Mark Cohen, MD, FSSO, FACS, is the Vice Chair in Surgery for Clinical Operations; a Professor of Surgery, Pharmacology, and Biomedical Engineering; and the Director of the Center for Surgical Innovation, Medical School Path of Excellence in Innovation and Entrepreneurship, and the Center Initiative in Medical and Surgical Extended Reality at the University of Michigan. His clinical practice involves endocrine surgery, specifically thyroid surgery for benign and malignant disease, minimally invasive parathyroid surgery and adrenalectomy, and surgery for advanced melanomas, including hyperthermic isolated limb perfusion. He is particularly interested in the development of targeted cancer drug delivery systems and has been a leading advocate for the importance of surgical innovation for many years. He can be found on Twitter [@MarkCohenFACS](https://twitter.com/MarkCohenFACS). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #AWSTweetChat, communication, Industry, Surgical Innovation, Translational Research, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Medical students: The Happy AND Productive](https://blog.womensurgeons.org/med-students-happy-and-productive/) **Published:** March 24, 2022 **Author:** Blog Team **Content:** By Oshadhi Rodrigo A happy AND productive medical student? Yes it’s possible, and no I’m not lying. Medical school can be tough. The long hours spent reading and the rest spent at the hospital can be exhausting at times, but you don’t have to put your happiness and mental health at stake to perform well! Here are my tips to accomplish both. **Plan your week ahead and plan it smart!** Write down your top priority goals for the week so you can allocate enough time to prepare for those. As your week goes by, have a mini task list for the day with not more than five things to do. Staying organized and being aware of your plans will give you mental clarity and it will keep you on top of your game! **Find the time of day you have razor sharp focus**. It can be any time of the day, early mornings at your desk, afternoons at a coffee shop, at the library or late at night. These are your super hours! You will understand and remember your material better during this time rather than pulling an all-nighter. **Take one day at a time**. It’s pointless asking medical students not to stress so I’m not going to. But you don’t have to stress about everything at once. Worry about one thing at a time. It’s impossible on a human level to get everything done in one day and it’s alright. **Take refreshing breaks**. Step outside and get some air, talk to a friend, exercise, dance, Have a snack, sing your lungs out! Do something fun and something that you love. It helps to avoid burnout. **While you recharge, do not think about work.** **Keep your cheer squad close!** There are going to be days you don’t feel your best. It happens to everyone, you’re not alone. Having friends and family who have your back is a blessing during tough times. **Have mentors**. You need expert advice and guidance from pros. They have been there and gone through the same process. It will give you new insight about things. **Don’t chase perfection**. Circumstances won’t be ideal all the time. There will be last minute changes of plans, some things will be postponed, some will be rescheduled and sometimes the situation will be quite uncertain. So start with what you have, with what you know, do your best and avoid putting unnecessary pressure on yourself! It’s okay to not have everything figured out. **Have hobbies and interests completely irrelevant to medicine!** It can be cooking ,painting, hiking, yoga, writing… even fifteen minutes spent on these daily will help you calm down and rejuvenate. **Celebrate all your victories!** Doesn’t matter how small. Reward yourself. You’re doing your best! It’s important to take time to relax and have a healthy mindset about everything. If you’re happy and content there’s nothing that you can’t do. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/03/Picture1-1.png) Oshadhi Rodrigo is a fourth year medical student at Tbilisi State Medical University, Georgia. She is interested in pursuing a surgical speciality and is an advocate for empowering ladies in surgery. In her spare time, you can find her watching a sunset or playing with her fur babies. Instagram handle – oshii\_rodrigo --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** education, medical students, mental health, womeninmedicine, womeninsurgery --- ### [Is Surgery for Me?](https://blog.womensurgeons.org/is-surgery-for-me/) **Published:** March 16, 2022 **Author:** Blog Team **Content:** By Ariana Naaseh, MD I was one of the medical students who always swore there was absolutely no way I’d become a surgeon. I’d heard too many stories about surgeon personalities and the terrible attempt at work/life “balance” the career afforded. Rumors consisted of surgeons yelling at staff and trainees, throwing instruments in the operating room, or belittling or ignoring medical students. Surgeons were rumored to have no continuity of care and operate solely as technicians. On my first day of my surgery rotation, I walked in with low expectations. Much like most medical students, I expected to wake up too early, stay too late, eat no food, never use the restroom, and be yelled at or made to feel silly at some point in the day. Throughout the course of my 8-week rotation, I was pleasantly surprised and absolutely enamored. I encountered surgeons who asked me my name, ensured I was participating and learning throughout cases, and engaged with me both inpatient and outpatient to create plans and take ownership over patient care. I learned that surgeons see their patients pre-op, post-op, and often follow patients for years and years. I learned that patients saw their surgeons as leaders in their care and often felt the most trust in them. I learned that it took a great deal of time and effort to build a strong connection so that your patient would be comfortable with and allow you to operate on them during their most vulnerable times, especially in the most emergent of settings. I was hooked. I observed caring, compassionate, and humble role models. I observed surgeons collaborate effectively on multi-disciplinary teams. I saw the need to communicate with case managers, social workers, physical and occupational therapists, and so many more hospital team members to effectively provide care. I noticed those surgeons who thanked their residents, offered frequent praise to their medical students, and inspired those who were in their presence. I knew then that surgery was for me. I could not deny that I would likely encounter surgeons in my career who were exactly as the rumors painted them. I knew, though, that by choosing to become a surgeon I was joining a group of hard-working, committed, and incredibly gifted people. A group of people who could simultaneously assert themselves in the operating room but remain respectful of those around them. A group of people who could both expect a great deal of their trainees and medical students, but prioritize teaching and learning. A group of people who make time to check in with their patients after a long day of cases. A group of people who sacrifice so much time and energy during transformative years of an adult’s life to become the best surgeon they can be and provide the most optimal patient care. I could not be prouder to be a part of this amazing profession and look forward to the countless medical students that become entirely surprised during their rotations and choose to join us. With enough incredible people within the field, soon we will look towards a future in which we are not fighting these long-standing stereotypes. Congratulations to all of the newly matched surgeons! ![](https://blog.womensurgeons.org/wp-content/uploads/2022/03/Picture1.png) Ariana Naaseh, MD is a first year general surgery resident at Washington University in St. Louis. A life-long Californian, she received her undergraduate degree in Cognitive Science from University of California Berkeley and her M.D. at University of California, Irvine School of Medicine. She is passionate about not only surgery but mentorship, education, and health care disparities. While she remains undecided on her future sub-specialty, she knows it will involve medical student education and public health. In her free time, Ariana loves traveling, exploring new restaurants and bars, being outside or in a body of water, and running her heart out at her local Orangetheory. You can follow her on twitter at @ariananaaseh. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** medical students, surgery, Surgical Education, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Pursue Your Passion with Purpose](https://blog.womensurgeons.org/pursue-your-passion-with-purpose/) **Published:** March 10, 2022 **Author:** Blog Team **Content:** By Megan Jenkins Turner, DO Growing up, my dad always told me “***endeavor to persevere***.” I can honestly say I had no idea what that meant until recently. Particularly when **I found myself unmatched after graduating medical school** in May 2021. It was March 2020. I was an M3, four days into my General Surgery rotation, when COVID pulled medical students from in person rotations to online ones. This remained the case for several weeks. I was planning on becoming a medical oncologist, fervently preparing for the match – **I never considered pursuing surgery until I was pulled from my rotation**. Long story short I ended up applying for internal medicine (IM), interviewing for IM, and subsequently **withdrawing my application** from the match in January 2021 all because **one of my mentors saw a talent in me that at the time I had yet to see in myself**. I attempted to SOAP into a general surgery residency position in March 2021 but was unsuccessful. **Hurdle after hurdle, “no” after “no”, dead end after dead end – I graduated medical school, unmatched**. I was surrounded by my 200+ classmates all whose dreams were coming true. I smiled and took pictures (albeit begrudgingly). I felt joy for those around me while ***choosing* to feel encouraged that there was still a chance** for me to have that too. I dodged question after question from loved ones because, **although I was certain I would become a surgeon, I was not sure how.** I needed time to figure it out. As the weeks unfolded, **I was told by one surgeon that I had a 0% chance of matching** into a surgical residency, and that if **I did I would always be “average.”** Simultaneously, a world renowned surgeon stated confidently that I was in the **top 5%** of students he worked with in his 30+ year career. This got me thinking, **how was I going to pursue my passion with purpose?** Was I going to ***react*** and listen to the naysayers who didn’t know me? Or was I going to ***respond*** to the passion and purpose burning inside me supported by those who saw my capabilities first hand? The answer was easy: **I would endeavor to persevere**. If there is a will there is a way. Today, I am a **current preliminary surgical resident** at a large academic institution obtaining said position mid-July of 2021, after the match. I have also signed a contract to **begin as a PGY-2 categorical general surgery resident** in July at a community program where I will train to become a rural general surgeon. **If there is a will there is a way**. **Ultimately, surgery chose me**. After much contemplation, I wholeheartedly chose surgery in return. Of course, there were a multitude of difficulties and sacrifices along the way but I will save that for another time. I believe that throughout life uncertainty, failure, and disappointment are inevitable. Hand in hand, I also believe **it is our *choice* to use these setbacks as opportunities** – to grow, to learn, and to always **pursue our passion with purpose**. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/03/aws-.png) Megan Jenkins Turner grew up in Houston, TX. She attended a small school in East Texas called Stephen F. Austin State University graduating in 2016 with a degree in Biochemistry. Subsequently, she earned a Medical Sciences Masters degree at The University of North Texas Health Science Center in 2017 in Fort Worth, TX. Megan began medical school at UNTHSC Texas College of Osteopathic Medicine and graduated in 2021. After switching specialties during the Pandemic, Megan obtained a preliminary surgery position at the University of Illinois at Chicago General Surgery Residency Program. In January 2022, she was offered and accepted a categorical PGY-2 position at Franciscan Health General Surgery Residency Program in Olympia Fields, Illinois where she will continue her training. Megan is passionate about mentorship and advocating for women in surgery. She routinely speaks at events encouraging students to pursue their calling. Megan is routinely active on her Instagram page @curleysurgeon where she shares her perspective as a surgical resident. In her spare time, she enjoys reading crime fiction and weight lifting at the local gym! Ultimately, Megan’s goal is to practice rural general surgery after graduation in 2026. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** Match, residency, womeninsurgery, WomenSurgeons --- ### [Cirujana – Thoughts of a Latina Surgery Resident](https://blog.womensurgeons.org/cirujana-thoughts-of-a-latina-surgery-resident/) **Published:** March 4, 2022 **Author:** Blog Team **Content:** I’m standing in the Trauma Bay with my heart racing, anticipating the arrival of a gunshot wound victim. Although I’m in my fourth year of residency, an incoming trauma activation still feels as thrilling as it did intern year. Before the arrival of our patient, one of the ER nurses performs a timeout and identifies the members of the treatment teams. She looks at my male attending and calls his name, after which her eyes move right past me as she mentions the other members of the trauma team by name, including the physician assistant and the intern. The patient rolls in shortly after, and my name has not made it to the activation record, even though I am the senior resident. I know it’s a bold assumption to make that I am often overlooked based on my ethnicity and gender, but it’s hard to not make this conclusion. Time and time again, I am not recognized as a physician – but am called a nurse, a lab tech, or occasionally even a housekeeper. While every role is valuable and is essential for the hospital to function smoothly, it still stings to not be recognized as a member of the treatment team when I am working 80-hour weeks and committing myself tirelessly to my patients. My female colleagues face similar situations, but it seems to be magnified in my case. Could this be due to my naturally quiet nature and short stature? Absolutely. But has this problem lessened over the past 4 years even after I’ve found my voice and built confidence in my clinical decision making? Not a bit. I worry that I find myself in this situation so often because there are no other Latina residents or faculty members in the department of surgery at my hospital, despite our location in a city with a large Hispanic community. While my small frame and long black hair are similar to the appearance of many of the nurses rather than any of the surgeons, I am still frustrated by the biases I experience every day. I can admittedly understand why others might simply assume my role based on appearance, but I also strongly feel that this is a stereotype worth overcoming. I know that one of the most important solutions is on the large-scale, i.e. increasing diversity amongst all healthcare providers. However, I also know that I need to do my part as well – both for future Latina providers and for my patients. I should not – and I will not – stand in silence and be ignored. I will correct and remind people a thousand times if I have to. At the end of the day, my patients are the top priority – and their care is likely to be compromised if I am not recognized as a key member of the treatment team. I am proud to be a Latina surgeon, and I will not be overlooked. *The author of this article is a general surgery resident with an interest in trauma and critical care. She wishes to remain anonymous, as her objective in writing this article is to call attention to an important issue faced by numerous individuals in healthcare, not just her.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** #Latinosurgicalsociety, #LatinxinMedicine, diversity and inclusion --- ### [What Do You Expect of You?](https://blog.womensurgeons.org/what-do-you-expect-of-you/) **Published:** February 23, 2022 **Author:** Blog Team **Content:** By Tiffany R. Sanchez & Angel D. Chavez Rivera ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/Picture1.png) As new leaders of the Association of Women Surgeons Chapter at San Juan Bautista School of Medicine in Puerto Rico, we asked for a lot of help from surgeon mentors. We wanted to put our best foot forward for our student group; as such, we set a goal to introduce our members to mentors willing to help students interested in surgical careers, and we made an effort to invite those with diverse backgrounds to the mentorship program. Our first speaker this year was **Dr. Rose Lewis**, a pioneer in plastic surgery. **She is the first female, African-American plastic surgeon in the world.** She attended the University of California at Berkeley and graduated in 2.5 years. Then, she spent the following 8 years in graduate school, working in laboratories and other science-related positions. Afterward, Dr. Lewis went to medical school at University of California San Francisco. Upon graduation she earned an internship at Mt. Zion in general surgery and completed a two-year plastic surgery residency in Phoenix. Later, she spent 25 years in San Francisco practicing at both Children’s Hospital and Mt. Zion, in addition to running her own practice to better serve her local community. It was an honor to introduce a legend, and it felt magical to be in her presence. Dr. Lewis shared her knowledge for a successful future in surgery as well as personal experiences of when she was a medical student applying to residency. Each piece of advice she shared was a gold mine, so much so that we want to relive the experience again. Her advice on: **Being a woman** > *“It’s always going to be a little bit harder if you’re a woman, and if you’re a woman of color it’s going to be harder still because nobody expects anything of you and that’s just the reality of the way things are. And- So what? What do you expect of you? And that’s what’s really important. What do you expect of you?”* **Specializing** > *“Depending on what type of surgery you want to do, I recommend trying to do an elective in that particular area while you’re a medical student. Clerkships help you make your decision on what you want to go into.”* **Rotations** > “*My three rules to live by during rotations are: First, show up on time in the morning for rounds- make sure you can get there early. Second, don’t complain about everything- residency and internship is difficult. There’s going to be a lot of pressure on you, you’re going to be expected to work very hard. There’s going to be a lot of hours you’re going to have to put in. Go ahead and get it done! Third, when you’re taking care of patients, take the initiative to read ahead of time about the patient’s disease, so when you are questioned, you’re ready.”* **Matching** > “*Don’t be concerned if you don’t match. Don’t panic- I didn’t match. It doesn’t mean anything frankly- you can still get a position and it’ll still be good.”* **Letters of Recommendation** > “*Make a relationship with the chief of the department in whatever type of surgery you want to go into. It’s a good idea to have someone that knows you well, that works with you, that thinks you’re wonderful and wants to write you a glowing letter.”* **Emotions** > “*Don’t get discouraged. It’s very hard to get a specialty rotation in surgery, even general surgery.”* We appreciated each minute she gave us. We were so thrilled that the event was a success and that our members were able to meet Dr. Lewis. It was a beautiful way to start the semester and an empowering beginning. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/Picture2.png) Tiffany R. Sanchez is a medical student at San Juan Bautista School of Medicine in Puerto Rico. She attended Cornell University where she graduated with a bachelor’s in nutrition with a concentration in dietetics. She was born and raised in New Jersey by Peruvian parents. She is currently the president of the Surgery Interest Group. So far, Tiffany has helped different communities in Puerto Rico through multiple initiatives. Tiffany petitioned to the governor of Puerto Rico to proclaim March as Colorectal Cancer Awareness Month. She also advocates for health equity on the island through means of education and health policy for HIV prevention. She is involved in research focusing on the prevalence of fibromas, colon cancer rates in PR, and wrote three chapters in a Translational Surgery Handbook with Harvard Medical School Teaching Hospital. She was a Top 5 finalist in the American College of Surgeons Clinical Congress 2021 History of Surgery Poster Session where she presented on the subject of Inca Craniotomy. She recently received the Diversity Equity & Inclusion Conference Award and the California Society of Plastic Surgeons Travel Scholarship. In April, she will travel to California to participate in the PREPPED Program, a national program sponsored by the Plastic Surgery Foundation, American Council of Academic Plastic Surgery, ConnectMed International, Arthur L. Garnes Society, and University of California San Diego Division of Plastic Surgery. In her free time she enjoys playing video games, shopping and painting. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/02/Picture3.png) Angel D. Chavez Rivera attends San Juan Bautista School of Medicine in Puerto Rico. He graduated from Georgetown University with a Master’s of Science in Physiology. He was born in Peru and grew up in Florida. He is the Vice President of the Internal Medicine Interest Group, Surgery Interest Group, and Association of Women Surgeons. So far, he helped different communities in Puerto Rico through multiple initiatives. Angel petitioned to the governor of Puerto Rico to proclaim March as Colorectal Cancer Awareness Month. He also advocates for health equity on the island through means of education and health policy for HIV prevention. He is involved in research focusing on the prevalence of Parkinson Disease, colon cancer rates in PR, and wrote three chapters in a Translational Surgery Handbook with Harvard Medical School Teaching Hospital. Angel was a top 5 finalist in the American College of Surgeons Clinical Congress 2021 History of Surgery Poster Session with a subject on Inca Craniotomy. He recently received the Diversity Equity & Inclusion Conference Award. In April, he will travel to California to participate in the PREPPED Program, a national program sponsored by the Plastic Surgery Foundation, American Council of Academic Plastic Surgery, ConnectMed International, Arthur L. Garnes Society, and University of California San Diego Division of Plastic Surgery. In his free time he enjoys exercising, video games, and watching movies. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** advice, medical students, residency, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Surgical Ergonomics and the Surgeon: An Upcoming TweetChat](https://blog.womensurgeons.org/surgical-ergonomics-and-the-surgeon/) **Published:** February 14, 2022 **Author:** Blog Team **Content:** By Dr. Talar Tejirian The medical field is considered to be intellectually challenging and demanding of time. Physicians are expected to be available for patient care with little consideration of their personal time. As surgeons, we chose our specialty knowing that we would be dedicating a large portion of our time to our career. However, we rarely consider the high physical demands of our job. Surgery is a mentally, emotionally, and physically demanding career. Unfortunately, the physical demands of operating have long been ignored both by individual surgeons and surgical societies at-large. Finally, we are now discussing the health of us surgeons. A surgeon’s physical health is an important part of our overall well being and career longevity. Ergonomics is a key factor in our success, as is physical preparedness, training, and recovery. Studies show that almost three quarters of surgeons report some form of physical pain, most commonly with the back, neck and arm/shoulder. These reports of pain are universal, span all surgical specialties, and are equally prevalent between traditional and minimally invasive surgeons. Meanwhile, the “surgeon culture” seems not to encourage us to admit that such a problem exists. Surgeons and their team are typically not proactive in preventive measures towards physical health. Surgeons often ignore their signs and symptoms until it is pathologic. The physical toll from the act of operating can result in numerous consequences for surgeons, including the abrupt and unwelcomed end of one’s career. I learned the true reality of these consequences when my career was cut short 20 years too soon. It took the need for cervical spine surgery and subsequent permanent nerve damage to my arm to realize that we surgeons must prioritize our physical health. Ideally, surgeons should manage their career to minimize risks of physical injury. We can maximize and improve the health of us surgeons by focusing on improving ergonomics in the operating room and protecting non-negotiable time for physical training and recovery. Prevention is key. Improving ergonomics in the operating room involves many facets. First, dedicated ergonomics training is needed starting in medical school and continuing through residency and among seasoned surgeons. The training should be both general and individualized. As the ergonomic challenges to each surgeon are unique, training programs and hospital systems should invest resources to maximize the ergonomic benefits to each individual surgeon’s height, body habitus, and other physically unique aspects. In addition, simple practices, such as micro-breaks, can be incorporated with universal benefit. However, ergonomics alone is not enough; it is only one piece of the puzzle. If we are to really maximize surgeon physical health, we must consider the physical training and recovery needed for this very physically demanding profession. Just as athletes train their bodies to maximally perform their jobs, we as surgeons must routinely do that as well. The physical training must start from day one, and just like clinic time or meetings, it needs to be regularly scheduled. Professionals such as occupational and physical therapists who understand the physical demands of operating should be used to assure the highest level of training and recovery. Focusing on the physical health of the surgeon is a new, but salient concept. It requires a significant culture change which includes recognizing the problem and finding permanent solutions to minimize harm to surgeons. Surgical ergonomics and surgeon physical training are key components. Surgeons need to recognize that physically suffering and living with pain is not an acceptable part of our job. We can and hopefully will improve this for the good of our colleagues and our profession as a whole. Please join us on Monday, February 21, 2022, from 8-9 pm EST for an AWS Tweetchat about Surgical Ergonomics! This chat is being hosted in partnership with SAGES and will focus on all aspects of our surgical career that affect our body mechanics and, thus, physical well being. The chat will be moderated by Dr. Talar Tejirian and other guests from SAGES (@SAGES\_Updates). We will also be welcoming non-surgeon experts in the field that can help answer your questions regarding appropriate posture, exercises, stretching, and so on. The questions will be posted directly from the[ @WomenSurgeons](https://urldefense.com/v3/__https:/twitter.com/WomenSurgeons__;!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UNk9nfm0$) Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this[ tutorial](https://urldefense.com/v3/__http:/blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/__;!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UH7HLDER$) written by Dr. Heather Yeo ([@heatheryeomd](https://urldefense.com/v3/__https:/twitter.com/heatheryeomd__;!!N7dcXh3-ZA!Nf1ca9iX8y8Hz-SkRwjwUNJFuk605qSFUS1KSAIPW-KOSs1j7E9GWbLGCiU1UObtPBLT$)) to know more. We will be discussing the following topics during our tweet chat: Q1: Why is surgeon physical health important? What are the consequences of not paying attention to the physical health of the surgeon? Q2: How can we surgeons change the collective mentality of the ideal physically super-human surgeon? Q3: What are the components of surgeon physical health? Which parts of the body are most at risk? Q4: Why is ergonomics important both in and out of the operating room? How can we improve open, laparoscopic, and robotic surgery to reduce injury? Are there products available that can help maximize ergonomics? Q5: What are the limitations to surgical ergonomics? How can residents and medical students also maintain appropriate physical health while training under the rigors of their attending surgeons? Q6: Why do surgeons need physical training? How can we best obtain that training? What are sample exercise routines that can help surgeons? Q7: Is physical recovery needed? What is the best way to allow our bodies to heal? --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #womeninmedicine #womeninsurgery #residencyinterviews #AWSTweetChat #AWS #AssociationofWomenSurgeons, ergonomics, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons, workplace --- ### [Meet the Blog Team](https://blog.womensurgeons.org/meet-the-blog-team-2/) **Published:** February 13, 2022 **Author:** Blog Team **Content:** The Association of Women Surgeons (AWS) Blog was started in 2013 by some amazing female surgeons. We have appreciated the support and growth of the blog since then. We love sharing the stories of women in surgery across the country and the world. Every week, we publish your stories, and we hope they uplift you as much as they uplift us. While we are often working behind the scenes, we wanted to take the opportunity to introduce ourselves. We are surgeons, residents, and medical students from across the country. Some of us have worked on the team since its inception in 2013, while some of us joined more recently. While we come from different backgrounds and places, we share a common love of the AWS Blog and celebrating the stories of others. Thank you again for supporting the blog. If you want to submit a piece, please do so at this link:[ https://www.womensurgeons.org/page/BlogApplication](https://www.womensurgeons.org/page/BlogApplication) Team Bios: Alyssa Brown is a fourth year MD-PhD candidate at University of Louisville and Mayo Clinic Biomedical Engineering and Physiology. She is currently applying to general surgery residency. She has been on the team since 2018. She has loved writing pieces for the blog, and she has loved celebrating the successes of the AWS Blog team members. Kathleen Romanowski, MD, MAS, FACS, is an Associate Professor of Clinical Surgery at the University of California, Davis and Shriner’s Children’s Northern California whose clinical practice is Burn Surgery. She has been on the blog team since 2019 and became the Faculty Chair of the Blog Subcommittee in 2020. She has loved getting to share her journey through writing blog pieces and enjoys reading about all of the authors’ experiences through editing the pieces of others. It has been a pleasure to work with the students, residents, and surgeons who make up the AWS blog subcommittee. Carol Shi is a fourth year medical student at the Warren Alpert Medical School of Brown University. She is currently applying to OB/GYN residency. She served as the New England Regional Representative on the AWS National Medical Student Committee in 2020-2021. She has been on the blog team since 2021 and has loved reading and editing blog posts. Dr. Tiffany Sinclair is a general and endocrine surgeon at a crossroads between training and attending life. She is currently doing acute care and trauma surgery locum work while looking for a job as an academic endocrine surgeon. She has served on the AWS Blog committee since 2020 and has enjoyed writing pieces for the blog, as well as following along on so many other women’s journeys through the world of surgery. Sarah Tevis, MD, is an Assistant Professor of Surgery and a breast surgical oncologist at the University of Colorado. She has been a member of the Association of Women Surgeons since 2011 and has served on the AWS Blog Committee since 2020. Her research is focused on improving breast cancer patient centered care throughout the care continuum by developing a web page plugin that provides definitions of medical terms in radiology and pathology resports and links to trusted websites, developing a personalized decision aid for breast surgery that incorporates predicted post-operative quality of life, and developing innovative educational tools to prepare patients for the psychosocial and sexual side effects of breast cancer treatment. Camila Guetter, MD, MPH, is a general surgery resident at Beth Israel Deaconess Medical Center/Harvard Medical School. She has been an active AWS member since 2015 and a member. She has been in the AWS Blog Committee since 2016 and has also served as the Vice Chair of the ​​AWS National Medical Student Committee. Camila is very grateful to be part of the blog team and to read the stories shared by surgeons and trainees from all across the AWS community. Cheryl Zogg, PhD, MSPH, MHS, is an MD-PhD candidate at Yale School of Medicine. She has been a member of the AWS Blog since 2018. In addition to her role on the blog, Cheryl is proud to be an active part of the AWS Twitter Communications Subcommittee and to serve as the Resource Development Coordinator for the National Medical Student Committee. She has previously been the Chair (2020-2021) and first Research Coordinator (2018-2020) of the National Medical Student Committee, acting as the medical student representative to AWS Council in 2020-2021. Cheryl is thrilled to be a part of this amazing team and looks forward to many years ahead with AWS to come! --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** leadership **Tags:** #womeninsugery, AWSBlog, ILookLikeASurgeon --- ### [Mental Health and Wellness in Surgery: An Upcoming Tweetchat](https://blog.womensurgeons.org/mental-health-wellness-in-surgery/) **Published:** January 10, 2022 **Author:** Blog Team **Content:** *By Dr. Scarlett Hao and Dr. Halle Ellison* A critical point to address when discussing wellness is the lack of shared understanding in the language we use to think and talk about wellness. We use words like wellness and well-being interchangeably. There are similarities, yet each term has a different meaning. [Wellness](https://www.merriam-webster.com/dictionary/wellness), the focus of this post is, “the quality or state of being in good health especially as an actively sought goal.” We suggest considering wellness holistically, with [eight interrelated domains](https://pubmed.ncbi.nlm.nih.gov/28761196/) coming together to form a whole. These domains include physical, intellectual, emotional, social, spiritual, occupational, financial, and environmental wellness (Figure 1). They are preferred for being broad, multidimensional, and naming areas not traditionally included in discussions about surgeon wellness. We have unique needs and values. Wellness domains may not have equal importance for individuals, and can vary over time, reflecting that wellness is not “one size fits all.” The key is understanding that any domain can influence and contribute to others, and therefore to one’s experience and quality of life. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/1.png) *Figure 1. Eight Domains of Wellness. Reprinted under Creative Commons License* *(Source: Wikimedia)*Just as illness to health exists on a continuum, so do wellness and mental health (Figure 2). A similar challenge in lack of shared understanding exists for the term “mental health.” Elements of mental health may be represented across physical, emotional, and social wellness domains. With this perspective, mental health incorporates broad areas like feelings and emotions, self-care, stress, relationships, community, and connection. Thinking about mental health in discrete yet related components may help us better understand and communicate our needs. Although expressing individual needs is important, focus on the individual level is not sufficient. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/2.png)![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/3.png) *Figure 2. Conceptual illustration of mental health as a continuum, adapted from the Mental Health Continuum Model (*[*Keyes*](https://pubmed.ncbi.nlm.nih.gov/12096700/)*)*To improve mental health and wellness in surgery, it is time to focus on systems-level change. Consider the annual American Board of Surgery In-Training Examination (ABSITE®). The ABSITE is a high-stakes exam. Despite its role as a formative assessment, results are often interpreted and applied in a summative manner. The internal value placed on one’s score and external use of scores are sources of stress for residents. Scores have been used for residency promotion and fellowship application, and to predict passing the General Surgery Qualifying Exam. One’s score may be associated with the perception of self-worth, misinterpreted as a measure of competence, and lead to comparison, guilt, or shame. High-stakes exam preparation can have negative effects on physical, emotional, financial, and social wellness, regardless of exam performance. ABSITE score reporting offers an opportunity for systems-level change with the potential for a positive impact on multiple wellness domains. Imagine if reports only included content categories and keywords for incorrect responses. Imagine that numerical values for percent correct, standard score, and percentile were not reported. How might resident mental health and wellness be impacted by these changes? This thought exercise is meant to encourage thinking about both systemic challenges and solutions related to wellness in surgery. Applying systems thinking can help surgeons develop both infrastructure and processes to support wellness across the continuum of education and practice. By making mental health and wellness professional goals in surgery, we can advance our collective capacity for improvement, both now and in the future. Please join us on **January 17th at 8-9 PM EST** for an AWS Tweetchat about Mental Health and Wellness in Surgery. The chat will be moderated by Dr. Scarlett Hao ([@scarletthaomd](https://twitter.com/ScarlettHaoMD)), Dr. Halle Ellison ([@hbemd](https://twitter.com/hbemd)), Dr. Taylor Riall ([@TaylorRiall](https://twitter.com/TaylorRiall)), Dr. Christie Buonpane ([@clbuonpane](https://twitter.com/clbuonpane)), and Dr. Andrea Riner ([@AndreaNRinerMD](https://twitter.com/AndreaNRinerMD)). The questions will be posted directly from the [@WomenSurgeons](https://twitter.com/WomenSurgeons) Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this[ tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweet chat: - What does wellness mean? - Can you teach wellness? - Whose responsibility is wellness in surgical education? - How can training programs structure/processes support, improve the mental health of surgical residents? - How might mental health impact and be impacted by other wellness domains? - How might the movement to pass/fail in UME and USMLE impact ABSITE scoring in the future? ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/a.png) Scarlett Hao, MD, is a PGY-5 general surgery resident at the Brody School of Medicine at East Carolina University. She received her medical degree from University of Maryland School of Medicine. Dr. Hao is a founding member of the department wellness team that leads initiatives to promote resident and faculty well-being and evaluates system barriers to wellness. She is also serving her second year on the wellness task force for the AAMC’s Organization of Resident Representatives. Outside of surgeon well-being, Dr. Hao is pursuing a Masters in Public Health and a career in academic surgical oncology, with a focus on disparities in cancer care. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/b.png) Halle B. Ellison, MD, FACS, is the inaugural Director of Student Wellness at Geisinger Commonwealth School of Medicine (GCSOM). She also oversees the Personal and Professional Development Theme within GCSOM’s Total Health Curriculum. Dr. Ellison is Assistant Professor of Surgery and Palliative Care. She completed her General Surgery residency at Geisinger, remaining as faculty, then as Associate Program Director for the General Surgery Central Residency. She is one of few dually certified surgeon-palliative care specialists. She has completed a Medical Education Certificate Course, Surgical Education Research Fellowship, Certificate in Applied Surgical Education Leadership, and is completing a master’s degree in Patient Safety and Healthcare Quality. Her professional interests include areas that impact learners and learning across the medical education continuum. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** ABSITE, AWSChat, mental health, residency, residents, training, Wellness, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Staying Well While Treating the Sick](https://blog.womensurgeons.org/staying-well-while-treating-the-sick/) **Published:** January 6, 2022 **Author:** Blog Team **Content:** *By Dr. Brienne Ryan* Trying to stay well is no easy feat in the time of COVID, for both those in the medical field and those not. Many of us who have weathered the oscillating storms of this virus over the last two years find ourselves entering the New Year with yet another wave of nauseating apprehension and dread. What will the next few months look like? Will elective cases be canceled again? Will I graduate with enough cases? How will I deal with another COVID variant? Even before COVID descended upon our lives, surgical programs across the country had started to adopt a wide range of policies embracing “wellness.” With its ambiguous definition, wellness remains an elusive concept in the surgical world, often eliciting a clash of opinions between the new generation of surgeons and the old. Gone are the days of the 100-hour work week, long stretches of back to back call shifts and post-call operations. One of the earliest manifestations of modern residency wellness may be the transition to an 80-hour work week and the acknowledgement that residency could provide adequate training without the grueling hours and harsh teaching environment. More recently, wellness initiatives across surgical programs have included things such as complimentary meals, group events, access to therapists, and time off. What impact these initiatives have on overall wellness within a given residency is variable. And this may be the nature of wellness itself. *Highly variable.* It is by no means a “one size fits all” concept. More importantly, it is a work in progress – being molded and contoured by each successive surgical class, impacted by the environmental and social challenges of a given year. For those of us who have endured nearly our complete residency being intermittently interrupted by COVID restrictions, wellness may simply be a return to normalcy. As the leader of a residency program wellness committee, I find myself constantly struggling to conceive new ideas for wellness initiatives. The most meaningful and successfully implemented policies developed organically. As an intern, I suffered a profound personal loss. Mixed in with feelings of grief and shock were guilt, fear, and disappointment. Guilt when my fellow interns had to pick up an extra call shift. Fear of asking my chiefs for more time with my family. Disappointment in myself for not being able to recognize or express what I needed most while mourning. A few months later when the opportunity to participate in a committee dedicated to implementing wellness endeavors was presented, I eagerly volunteered. I wanted to enact changes that would allow subsequent residents to feel that they could voice their concerns, feelings, and challenges without the stigma of weakness that has become woven into the fabric of surgical training. As surgical residents, it is a deeply ingrained habit to keep our heads down and plow forward with persistence and resilience. Generations of surgeons before us cultivated an environment that emboldened fatigued, burnt-out residents to stay a little longer…work a little faster…be a little tougher. Those of us who have embraced wellness are aggressively fighting this narrative, but it often feels like an up-hill battle. The pushback can come from all sides – and sadly, from within ourselves. I am proud to be part of a residency that has embraced wellness as an important educational tool. Initiatives have ranged from wellness days off after weekend shifts, to dedicated debriefing sessions after emotional encounters, and of course, all the gatherings that COVID will allow. We listened to each other when we said what was most important in our lives, and we changed our policies to reflect that. Whether it be including significant others at all work-related outings or changing the framework of teaching sessions, the changes enacted reflect the concerns and wishes of our collective group, because the most important concept of residency wellness is listening to the residents. Mastering wellness is an ongoing task. If you are interested in developing a wellness program at your residency, there are numerous resources available through AMA, AAMC and even a cursory search of PubMed will supply you with jumping off points. Stay well in the New Year. ![](https://blog.womensurgeons.org/wp-content/uploads/2022/01/1.05.22.jpeg) Brienne Ryan is a current PGY3 surgical resident interested in pursuing a fellowship in Vascular surgery. She completed her undergraduate degree at Syracuse University followed by a Master’s degree at Roswell Park Cancer Institute. She obtained her M.D from the University at Buffalo. Her interests include surgical education, surgical wellness, and research focusing on quality initiatives and pre-operative optimization. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* --- **Categories:** self-care **Tags:** Wellness, work-life balance --- ### [Musings of a Surgeon](https://blog.womensurgeons.org/musings-of-a-surgeon/) **Published:** December 29, 2021 **Author:** mcooke@amrms.com **Content:** *By Dr. Sandra Krishnan* “Words are, of course, the most powerful drug used by mankind.” ― Rudyard Kipling ‘Do you want to do surgery?’ ‘Yes, very badly.’ ‘Anticipation is one of the most important qualities a surgeon must have and you anticipate instinctively, I am sure you will make a great surgeon.’ This was a conversation that took place 20 years ago, etched into my brain and effortlessly, I am transported back to the scene. Three of us in a procedure room, an extremely senior and intimidating plastic surgeon, a patient, and the lowly intern, myself. The plastic surgeon was about to remove her dressing, it was standard; plastic surgeons perform intricate wound reconstructions. Sometimes they are grafts, a piece of skin harvested from one part of the body and sometimes flaps, tissue thicker than skin; regardless of what method is used. The recipient site is looked after gently to inspect the graft or flap and not peel away tissue. So here I was, at my short plastic surgery term watching as he pulled the equipment trolley towards him and proceeded layer by layer, becoming deliberate as he headed towards the skin. I realized that he had a dressing set ready to clean the wound and redress it. I moved towards the trolley, took some tape and cut it equally, and stuck it to the side rail, so that the tape would be ready to secure the dressing. He turned around, looked at what I was doing, went back to his wound and without missing a beat, we had that brief conversation. To be honest I can’t remember a smile, I can’t remember much more, but obviously I didn’t need to remember it all, I understood that I was on the right track, and pledged to myself to keep going. I did eventually learn a lot in theater, despite my being ‘just an intern;’ he would teach me the fine art of plastic surgery tissue handling, which was different. There was a ‘holy’ respect for tissues, and he literally held my hands to teach me how to secure a square knot. Towards the end of that term, there was a day when the registrars were not around, and I was holding the pager. A patient came in with a traumatic injury to the tip of the little finger. I took the patient to the theater and debrided, trimmed, and reconstructed the wound. There was an inquiry the next day on why I was alone (it happened somehow) holding the pager and how I managed to do the procedure. I am so proud to say that the patient did well. Robert Greene in “Mastery,” describes mastering a skill as, “Making your way to the inside.” According to him, when we begin something new, we are on the outside looking in. It is not until we put in the work, learn the details, and experience the good and the bad, that we begin making our way into the “inside.” It was a six week posting, for a feel of what plastic surgery is like and to teach us basics. I never saw this plastic surgeon again. But every time I use a particular needle holder and utilize a pair of toothed Adson forceps to meticulously bring skin together, I think of him and pay a silent, internal tribute. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/12/AWS-blog.png)Sandra Krishnan is a Consultant Surgical Oncologist; Breast, Melanoma and General Surgeon. She is an Educator, Writer, Speaker. She has recently created Note to Myself, What I wish I knew in my 20s, an online program for women; empowering women while raising funds for charity. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship, reflection **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [Gender Equity in Global Surgery: Disparities from an International View](https://blog.womensurgeons.org/gender-equity-in-global-surgery-disparities-from-an-international-view/) **Published:** December 17, 2021 **Author:** Blog Team **Content:** *By Ala Khalid* In the USA, **more than** **half** of all medical residents are women; meanwhile[ **less than half**](https://bmjleader.bmj.com/content/leader/early/2020/10/20/leader-2019-000199.full.pdf) of surgical residents are women, there is a significant amount of research focusing on understanding this **gap** in terms of gender-based **disparities and inequalities.** I remember a couple years ago when I was obsessed with watching medical franchises like *ER* and *Grey’s Anatomy*; I got that inner excitement to become a surgeon. Throughout my days in medical school and before I started my clinical years, I had that perception of a *dreamy* *sparkly* welcoming work-place, where women are treated equally, leading departments, performing surgeries, and saving lives. Flash forward to when I started rotating in the hospital, I realized my *happy-go-lucky* world was far from the reality of women in surgery. Every day I come across a new barrier, a substantial obstacle, a big rock in this bumpy road of being a woman in surgery. **What are These Disparities of Women in Surgery?** – Cultural & Societal Discouragement: 750 medical students at Harvard were surveyed; both men and women reported high rates of[ ***verbal discouragement***](https://pubmed.ncbi.nlm.nih.gov/31599803/), but more women perceived ***gender-based*** discouragement concerning **marriage** and **childbearing**. Another study to evaluate all surgical cadres in South Africa reported 17% of participants were discouraged by male colleagues and 36% of participants reported a negative experience as[ **bullying**](http://sajs.redbricklibrary.com/index.php/sajs/article/view/3391). – Lack of Parental Leave policies: A qualitative feminist study in New Zealand & Australia, interviewed former women surgeons, that[ chose**c to leave the**](https://pubmed.ncbi.nlm.nih.gov/30739689/) **field** due to six new factors: *unavailability of leave*, a *distinction between valid and invalid reasons for leave*, *poor mental health*, *absence of interactions* with the women in surgery section of their professional body and other supports, fear of *repercussion*, and lack of pathways for *independent and specific support*. – Pay Gap: Differences in salaries for women have been a longstanding burden of inequality since they joined the workforce. A Japanese study indicated that male surgeons made significantly more than females, even when adjusting for age, marital status, and number of children, current position, and working hours: indicating that[ **men earn more after**](https://jphe.amegroups.com/article/view/6432) **marriage**, contrasted with most **women**, who earn **less** after marriage. – Microaggressions: Defined as verbal or nonverbal behaviors, subtle and insidious negative comments that **marginalize** females as implications of[ **gender inferiority**](https://jtd.amegroups.com/article/view/41967/html). Represented by **mansplaining**, men co-opting women’s ideas, speaking over them during group meetings, and labeling them with **sexist stereotypes** *(“bitchy”, “bossy”, or “aggressive”),* and sexist *humor* and jokes. These actions can be intentional or unintentional, commonly not acknowledged, yet occur frequently. – Burnout: Overwhelming time commitments, lack of **work-life balance**, and disruption of personal life have all been cited as reasons for burnout, a common phenomenon among surgeons and surgical trainees. Nearly half the surgical resident workforce in US has reported burnout: one in 20 have reported **suicidal ideation** as a result of these workplace challenges. How do we Make a Change? Advocacy! Many organizations have been advocating gender equality, supporting and mentoring women and gender minorities; Association of Women Surgeons (AWS) founded in 1981 by Dr. Patricia Numann, has been providing ceaseless support to nearly 3,000 members including all genders from 40 countries. Women Surgery Africa (WiSA) is an initiative formed in 2015 aiming to empower and support African women in surgery through partnership with (RCSI) and AWS. Another example is Gender Equity Initiative in Global Surgery (GEIGS) in collaboration with Harvard PGSSC in 2019, aiming to advocate for gender equity and support women and gender minorities in Surgery, Anesthesia and Obstetrics (SAO) fields. More than 325 students, trainees and surgeons representing over 55 countries have been involved in the initiative, and 129 mentees have been matched to mentors worldwide. \#HEforShe:Men need to develop lifelong relationships with female colleagues and recognize the benefit of their own reciprocal mentorship and **allyship**. Men should not stand on the sidelines, but rather engage and support as they work with women for gender equality in surgery.[ *\#HeForShe*;](https://www.heforshe.org/en) Social **movement** initiated by the **United Nations** as an invitation for men and people of all genders to stand in solidarity with women to create a bold, visible and united force for gender equality. Global Surgery as a Lifesaver:[Global surgery](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext) is a movement that has diffused worldwide to achieve 2030 agenda goals, which is to provide safe and timely surgery, anesthesia, and obstetrics to those in need of care; and to do this we need to ensure a more equitable and inclusive environment for those currently underrepresented in surgery. There is a great opportunity for the profession of surgery to increase the number of women in the profession, while simultaneously improving overall career satisfaction by creating new policies for a better work–life balance. ***Fearless women have overcome these challenges.*** ***Fearless women will break the cycle, close the gap, and demolish all barriers until they win this marathon***! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/12/12.15.jpeg) Ala Khalid is a final year medical student at University of Gezira, Sudan. Aspiring to become Pediatric Surgeon. Interested in Global Surgery, Health systems strengthening, Gender equity and Women health. Her hobbies include cooking, gardening and photography. Follow her on social media at: Twitter: AlaKhalid\_ and Instagram: Surgicala\_ --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** global surgery **Tags:** Gender Disparities, Gender Equity, Global Surgery --- ### [You can’t be what you can’t see.](https://blog.womensurgeons.org/you-cant-be-what-you-cant-see/) **Published:** December 8, 2021 **Author:** Blog Team **Content:** *By Sheina Theodore, MD* I was born and raised in NYC. The product of two Haitian immigrant parents. I saw my parents sacrifice everything for me, just so that the playing field would be leveled. I was fortunate to have them pushing me and making it possible for me to seize many opportunities. One of which was my acceptance into The Sophie Davis School of Biomedical Education, a B.S./M.D. program whose mission was to increase the number of minority physicians in order to care for underserved communities. Through this program, I participated in many community outreach efforts. These efforts were centered around understanding the barriers to health care, treating the patient as a whole (understanding different cultures, beliefs, socioeconomic situations, and how all this can deeply affect the overall wellbeing of our patients), and recruitment of future leaders who will aid in carrying out the mission of the school. I always knew how important this mission was and still is, but this importance was highlighted by a specific patient encounter. There was an African American patient who was described at sign out as “very difficult and had issues understanding his care”. At the time of rounds the patient was so happy to see a black doctor. He stated that he had never had a black doctor, much less a black surgeon. With further discussion he explained to me that he had been too embarrassed to ask questions this far into his difficult hospital course, which included multiple admissions for complex issues over the last few months. He didn’t understand the “lingo” used and he was uncomfortable with speaking up. He told me all about his niece and how smart she was. He said, “I know she can be whatever she wants to be when she grows up, but I’m going to tell her I met a doctor and that she can do it too.” He thanked me for my time and congratulated me on my success. Although this may seem like a positive encounter, I was disappointed. I was disappointed that he had felt unseen and unheard. I was disappointed that someone who had been in and out of the hospital system had never seen a black doctor or surgeon. How can we do better for all our patients? Surgeons are leaders. They are advocates for a diverse patient population. In order to provide excellent care, there must be insight into the specific challenges that a patient may face based on a multitude of characteristics. This care is also only provided by a team effort. All members of the team being equal and, not only integrated, but deeply included. The differences we have amongst ourselves and our patients should not divide us, but instead they should strengthen our bonds. The team should reflect the diversity of the patients served. The more diverse the team and leadership the more attractive the environment will be perceived by potential trainees. Everyone looks for a sense of belonging. This starts with an inviting, diverse, and equal environment. It continues with active and ongoing efforts to achieve diversity, equity, and inclusion (DEI) competencies. This can be accomplished by starting early with medical students or even undergraduates – implementing information sessions to debunk the myths and misconceptions which keep our field from achieving our DEI effort goals. Our patients deserve this. You can’t be what you can’t see. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/12/Theodore-300x251.png)Sheina Theodore, MD is a surgical critical care fellow at Boston Medical Center. She is a native New Yorker and first generation Haitian-American. She received her B.S. from The Sophie Davis School of Biomedical Education (CUNY, City College) and went on to receive her medical degree at Geisinger Commonwealth School of Medicine. Her professional interest includes becoming an acute care surgeon, a surgical educator, and a health care advocate for the underserved. You can follow her on twitter at @S\_Theodore\_MD --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, diversity and inclusion, education, leadership, reflection, training --- ### [Behind the Knife’s Take on ABSITE Preparation](https://blog.womensurgeons.org/behind-the-knife-absite-preparation/) **Published:** December 5, 2021 **Author:** Blog Team **Content:** *By Shanaz Hossain and Shreya Gupta* With the arrival of December, ABSITE (American Board of Surgery In-Training Exam) looms on the mind of every general surgery resident. For interns taking the exam for the first time, the ABSITE is a 5-hour standardized exam that consists of ~250 multiple-choice questions and is taken at the end of January. The test is graded on a percentile curve specific to each year of graduation. Behind the Knife’s surgical education fellows, Dr. Shreya Gupta (S.G.) and Dr. Shanaz Hossain (S.H.), discuss test preparation strategies to #dominate the ABSITE. Shreya is currently a PGY-4 at Case Western Reserve/University Hospitals while Shanaz is a PGY-3 research resident at the Cleveland Clinic. **There is a plethora of available resources, such that it can be overwhelming for surgical residents with limited time outside of the hospital. How do you figure out what to use?** S.H.: There are so many options to choose from! I remember as an intern, I was inundated with so many recommendations that it was hard to know where to start! I found it helpful to categorize resources according to its role in my study plan – I have “reference”, “review” and “ABSITE” books. From there, I trialed each option in the categories until I figured out which one I learned best from. Listed below are a few options I found for each category: Reference Textbooks: - Sabiston’s *Textbook of Surgery* - Schwartz’s *Principles of Surgery* - Greenfield’s *Surgery* Review Books: - Clinical Scenarios in Surgery - The Mont Reid Surgical Handbook Dedicated ABSITE Review: - Fiser’s *The ABSITE Review* - Behind the Knife’s ABSITE Review Podcasts and *ABSITE Podcast Companion Book* Textbooks are still pretty expensive, so check with your program (or some of the senior residents) to see whether a textbook is provided or if it is accessible electronically! S.G.: That’s the key – find one book and stick with it. If you can’t learn from one, switch to another. These books all cover the same content at the end of the day. For senior residents, transition to advanced references as you progress through training – appropriate resources include: - Cameron’s *Current Surgical Therapy* - Fischer’s *Mastery of Surgery* Textbooks are also not the end all be all, especially in the current era of technology. Medical education as a whole is undergoing a transformation, including surgical training – and I’m not just saying that as a member of the Behind the Knife team! Everyone learns differently, so if textbooks don’t click with you, look into comprehensive online curriculums and podcasts. The SCORE curriculum and SESAP are online compendiums that both have the benefit of integrated questions. With regards to podcasts, we obviously love Behind the Knife! There’s also a lot of other surgical societies with their own podcasts for their subspecialities. S.H.: Speaking of questions, there are multiple question banks available– don’t feel pressure to do them all! Pick one and finish it. We were advised to complete a minimum of 1000 questions before ABSITE, but more is always better. Make sure to review each question. You’re only hurting yourself if you’re simply going through the motions to reach that 1000-question milestone without understanding the reasoning behind each correct AND incorrect answer. Question bank options include: - SCORE - TrueLearn - Decker - SESAP *\*Note:* The textbooks and question banks listed are offered as suggestions. These lists are not comprehensive. **Alright, you broke down the resources, but that still is a pretty daunting list to work through, especially given the size of these textbooks! How do you tackle all your readings and questions?** S.G.: Longitudinal studying is crucial, especially given the breadth of information we need to retain. Residents should be reading from those “reference textbooks” throughout the year to build their knowledge base. I aim to read a certain number of pages from a textbook every day. Podcasts are also a great way to stay current on new research and topics of debate while multitasking (i.e. commuting to work, cleaning, running errands, etc). S.H.: Each patient also serves as a learning opportunity as you rotate through different services! In terms of questions, I aim to complete 10 questions a day and ramp this up when it gets closer to ABSITE. A lot of the question banks also have an accompanying app, so you can do questions on the go! When I’m in dedicated ABSITE studying, I also bring out my ABSITE review books and flashcards to improve my knowledge recall. **What are some additional ABSITE-specific study strategies?** S.G.: ABSITE preparation should be incorporated into your overall study plan for the year. After you get your score back, use the list of missed topics to make your study schedule. For interns who never took ABSITE before, take a practice test and use those missed topics to guide your plan. Focus on your areas of weakness to maximize points. The SCORE curriculum is also helpful as a longitudinal study guide. S.H.: CRAMMING DOES NOT WORK! Trust me, I learned the hard way. ABSITE is a marathon, not a sprint. Starting early also gives you the flexibility to adapt your question and reading goals to variable clinical schedules. Include dedicated reviews – use review books or flashcards (including Anki) to refresh information. Also, figure out a way to hold yourself accountable to your study plan, whether that be a study buddy or an individual reward system. S.G.: Remember to review nutrition formulas, cancer stages, genetic syndromes, and statistics right before the test! These topics refuse to stick in our brains because we don’t use the information on a daily basis, but are easy points on the exam! S.H.: As with any standardized exam, get a good night’s sleep and eat a solid breakfast for brain fuel! Pace yourself during the exam. You got this! Please join us on December 13th at 8-9 PM EST for an AWS Tweetchat about ABSITE preparation with Behind the Knife. The chat will be moderated by Dr. Shreya Gupta (@shreyaguptaMD) and Dr. Shanaz Hossain (@ShanazHossainMD) of Behind the Knife. The questions will be posted directly from the [@WomenSurgeons](https://twitter.com/WomenSurgeons) Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this[ tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweet chat: - What resources did we find the most helpful with exam preparation? - What is your advice for developing a specific study plan? Any tips for studying for the ABSITE? - Any study aids or mnemonics that you found particularly helpful? - What do you find helpful to do the night before or the day of the ABSITE? - How does ABSITE preparation differ from studying for the boards? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/12/Gupta.png) Dr. Shreya Gupta is a PGY-4 general surgery resident at University Hospitals/Case Western Reserve. She completed her undergraduate degree at the University of Pittsburgh followed by medical school at Sidney Kimmel Medical College in Philadelphia. Shreya has also completed a research fellowship at the National Cancer Institute. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/12/Hossain-732x1024.png) Dr. Shanaz Hossain is a PGY-3 general surgery resident at the Cleveland Clinic. She completed her undergraduate degree at the Johns Hopkins University and obtained her MD from University of Pittsburgh. She is interested in pursuing HPB Surgery vs Surgical Oncology for fellowship. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** ABSITE, board prep, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Mentorship in Neurosurgery from the Lens of a Black Muslim Medical Student](https://blog.womensurgeons.org/mentorship-in-neurosurgery-from-the-lens-of-a-black-muslim-medical-student/) **Published:** December 2, 2021 **Author:** mcooke@amrms.com **Content:** *By Habiba Abdullahi* Neurosurgery was something I chose quite early on in life. For many people, something or someone was the reason they chose neurosurgery. For me, it was after reading ‘Gifted Hands’ by Dr. Ben Carson. I was barely 12 then but I decided within me that I would pursue neurosurgery. I was in awe throughout reading the book. 12-year-old me had no idea how the journey would be and all the steps I would need to take to eventually reach my goal. All I knew was I had a dream and I was going to protect and achieve that dream, no matter how long it takes. I kept this dream to myself and never publicly expressed my plan to pursue Neurosurgery till my late teens. It was in grade 11 of high school that I began to publicly express my wish to pursue neurosurgery. I remember a friend, who was also a medical student then, telling me it is practically impossible for me to go through that long journey because I am a woman, and I might as well give up right from the get-go. I am thankful I ignored that statement. Over the years, I have received numerous similar comments from many other people. I was simply told I cannot have it all. If I dare to pursue neurosurgery, then I will have to give up creating a family in the future. I don’t quite understand, or rather, I refuse to understand what the concept of “having it all” is. In my first year of medical school, I stumbled upon a quote on social media by a prestigious Trauma and Critical care surgeon which goes: “My best advice is to stop thinking of work and life as a balance- that implies they are opposing forces and will only set you up to fail. Surgery doesn’t stop my life and my life doesn’t stop surgery. I am a better surgeon because I am a wife and a mother. And I am a better wife and mother because I am a surgeon.” I have practically memorized this statement because it resonates with me. Mentorship is everything. It has been a life-changing experience for me. What I did not realize early on was its significance. I had initially thought that just putting in the hard work was all that was needed. I was awfully wrong, and I am glad I caught that early on. For such a long and relatively strenuous journey, mentorship is certainly needed. I am grateful to the women in surgery that are paving the way and acting as role models. They are more than just mentors to me. There is a saying, “the mediocre teacher teaches, the good teacher explains, and the superior teacher inspires.” All the mentors I have made so far have inspired me in more than one way. I was fortunate enough to attend a webinar organized by the Dandy Walter Neurosurgical society titled Women in Neurosurgery. There, I got to hear distinguished women in neurosurgery from all over the world speak about their journey. If I wasn’t fully convinced to pursue neurosurgery, then that webinar alone would have won me over. Mentorship and representation go hand in hand. Seeing black, hijabi Muslim women in the field of surgery warms my heart and fuels me. Seeing people that look like me in leadership positions, attending the conferences, publishing the papers, performing the surgeries makes me believe that it is indeed possible. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/12/AWS-profile.png)Habiba Abdullahi is a 4th-year medical student at Near East University School of Medicine interested in neurosurgery, pediatrics, brain tumors, and research. Her hobbies include reading, writing, cycling, and baking. Follow her on social media at: Twitter: habibaabdalla\_ and Instagram: habibasanusi\_ --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** AWSBlog, DEI, womeninmedicine, womeninsurgery --- ### [A thank you letter to the surgeon who believed in me](https://blog.womensurgeons.org/a-thank-you-letter-to-the-surgeon-who-believed-in-me/) **Published:** November 25, 2021 **Author:** Blog Team **Content:** by Sarah Adkins-Jablonsky Dr. P, I learned how a gallbladder is removed before I learned to drive. To think I had these opportunities because of you, while my mom rationed food stamps, is a privilege I still can’t quite fathom. Shadowing you at 15 changed the trajectory of my life. Not that I couldn’t be what I wanted to be, but I didn’t know what I could be. I wasn’t sure what a university was or what medical school was, but 10 years later I am finally here in my first year of medical school, on a full ride scholarship, destined to be a doctor not like you, but a doctor like me. Because I saw myself in you, you believed in me, and that belief feels more powerful than any surgical tool. From recommendation letters, to taking my frustrated calls about getting Cs in organic chemistry, to snail mail about the need for women in surgery, to paying for my MCAT classes, I have never doubted your complete faith in my ability to continue the path. Though I have my parents’ full support and admiration, it has been something else to have someone rooting for me who had gone through university, medical school, and became a doctor. Changing a patient’s present reality makes you a great doctor; changing someone’s future makes you a great mentor. I am still deciding what kind of doctor I want to be, but I know what kind of mentor I want to be — one who is there, every step of the way, overcoming obstacles with mentees. In part because of what you have invested in me, I have likewise become a mentor to many women, many of whom want to go into medicine through programs like Big Brothers Big Sisters, the Underdocs, and American Physician Scientists Association. To be there for these women is a way to tell you thank you for being there for me. Last week, my colleagues could not find the gallbladder for one of our “first patient” donors. I smiled and thought of the surgeon who removed it. I wondered if beside the doctor there a 15-year-old was, staring in awe, destined to be a physician, too. Sarah Adkins-Jablonsky ![](https://blog.womensurgeons.org/wp-content/uploads/2021/11/Sarah.jpeg) Sarah Adkins-Jablonsky is a first-year student at the Alabama College of Osteopathic Medicine and an Ensign in the United States Navy through the Health Professions Scholarship Program. She earned her PhD in Biology, BS in Biology, and BA in Studio Art at the University of Alabama at Birmingham. You can find her on Twitter and Instagram at @admiraladkins. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, mentorship **Tags:** Gratitude, Medical Student Members, medical students, mentorship --- ### [The True Cost of ABSITE Prep](https://blog.womensurgeons.org/the-true-cost-of-absite-prep/) **Published:** November 20, 2021 **Author:** Blog Team **Content:** *By Martha Godfrey* Everyone thinks in dollars and cents when it comes to the cost of preparing for the American Board of Surgery In-Training Examination (ABSITE): $150 for a textbook, $295 for a question bank. While there are always financial considerations made when developing a study strategy, the true cost of a better ABSITE score is quantified not in dollars, but rather in minutes. Studies have shown that residents who spend more time studying for the ABSITE tend to do better. This is certainly not surprising. Unfortunately, this means when a resident is asked to score above a certain percentile on the ABSITE, they are functionally being asked how many more minutes than their peers are they willing to devote to studying for a standardized test. It serves as an annual opportunity to demonstrate how much more a resident (and potentially their families) are willing to give up for the job. This certainly is not the goal of ABSITE, but with emphasis placed on high ABSITE scores, the test has become a ruler not simply for knowledge, but also for dedication…and as a result sacrifice. As one of the most important elements in doing well on ABSITE is time, that time has to come from somewhere. So where does one find the time to study? For me personally, it means getting up earlier, staying at work later, and spending most of my weekends doing questions. This is likely the case for any resident wishing to do well, however for those of us with families or significant obligations outside of work, the implications of this are farther reaching. Dedicating this time means not just sleeping less, but also missing out on date nights, family dinners, and bedtime stories. During ABSITE season everything in my dual career household changes. My husband’s workload increases dramatically, as he takes on nearly all of the household work and childcare load that we usually share. Those without children are often unaware of the second job I’m responsible for when I go home each day. I’ve even had a male peer with children tell me they don’t have the same strain in their homes during ABSITE because their partner does the majority of the housework and childcare year-round. For me however, doing well on ABSITE is not simply a reflection of how much work I put into studying, but it is also a reflection of how much my family is willing to sacrifice to support me becoming a surgeon. Residents are often advised to improve ABSITE scores through a conversation about study materials and strategies, while avoiding the harsh truth. In order to improve a score, residents, who are already strapped for time, have to identify additional time they must take away from something else and instead allot it to studying. In doing this they must also identify others who can then fill in the gaps at home or elsewhere created by pulling that time. Ultimately, it is the identification and commitment of time to study as well as support from others that is the key to ABSITE success, without it no question bank or organized study strategy is enough. References: Godellas CV, Hauge LS, Huang R. Factors affecting improvement on the American Board of Surgery in-training exam (ABSITE). Journal of Surgical Research. 2000 Jun 1;91(1):1-4. Godellas CV, Huang R. Factors affecting performance on the American Board of Surgery in-training examination. The American journal of surgery. 2001 Apr 1;181(4):294-6. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/11/unnamed-200x300.jpeg)Martha Godfrey, MD, MS is a PGY-5 general surgery resident at the University of Florida- Jacksonville and former fellow of the American College of Surgeons – University of Wisconsin Surgical Education Research Fellowship. After college at the University of Chicago she became an English teacher in Western China with the Peace Corps. She then completed medical school at Emory University. Following residency she will be continuing her training in the 2 year AAST Acute Care Surgery Fellowship at the University of New Mexico. Outside of work, she is a wife and mother to two small children who keep her busy. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** education, family life, parenting, reflection, residency --- ### [Chasing “More”: The Cost of Applying to a Competitive Surgical Specialty](https://blog.womensurgeons.org/chasing-more-the-cost-of-applying-to-a-competitive-surgical-specialty/) **Published:** November 12, 2021 **Author:** Blog Team **Content:** *By Kelly Spiller* During a posterior cranial vault expansion on my pediatric plastics rotation, I was assigned a simple task: to stand at the back table and obtain bone shavings from the skull flap. Taking care not to fracture areas of thin bone, I went to work with the scraper, slowly filling the cup beside me with bone shavings. Holding the cup up to my attending, I asked him after a few minutes, “How does this look?” Quickly glancing up from the surgical field, he responded, “More.” Ten minutes and a few hundred scrapes later, I filled another cup to the brim. “How about now?”, I inquired. Peering over his loupes, he laughed and responded, “Kelly, I’m a surgeon. We always want more.” Reflecting on his response that day, I recognized the greater truth in his sentiment. Throughout my medical school journey, I have constantly chased “more” with one goal in mind: to match to plastic surgery. With the conclusion of one milestone, I jumped to my next project, all too aware of the[ **competitiveness of plastic surgery**](https://www.ama-assn.org/residents-students/specialty-profiles/residency-match-7-most-competitive-medical-specialties) and the[ **impressive statistics of previously matched applicants**](https://www.nrmp.org/wp-content/uploads/2021/05/MRM-Results_and-Data_2021.pdf)**.** Now that my residency applications are submitted and I reflect on my experiences, I can’t help but wonder: what personal sacrifices did I make in pursuit of plastic surgery, and was it all worth it? The most powerful instance when I realized the cost of chasing “more” was the day I received my USMLE Step 1 score. Traditionally[ **regarded by program directors**](https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf) as one of the most important components of the plastic surgery application, I knew the pressure was on to perform well. For the better part of 9 months, I dedicated my life to test preparation, spending each waking moment squeezing in additional Goljan podcasts, Sketchy videos, and UWorld questions. I kept picturing how happy I would feel upon achieving my goal score, and I rationalized skipping family gatherings, nights with friends, trips to the gym, and even meal preparation as acceptable in the pursuit of an excellent score. When I finally received my Step 1 score three weeks after my test, I was flooded with happiness and rushed to tell my family that I had achieved my goal. However, after a mere 15 minutes, my elation was replaced by an unsettling, unexpected emotion: emptiness. Rather than celebrating my accomplishment, my mind focused on the next set of hurdles. I thought, “Ok, now if I can get *more* publications, be elected as the Plastic Surgery Interest Group President, and win *more* scholarships, maybe *then* I’ll match into plastics.” After my experience with Step 1, I realized the extent to which my self-worth was tied to external academic achievements. In some ways, I think my insatiable desire for “more” allowed me to be productive during medical school and to accomplish my academic goals. However, at the same time, my personal relationships, mental health, and physical well-being suffered at the expense of my desire to become a plastic surgeon. During my last two years of medical school, I realized that while it is okay to feel proud of my accomplishments, it is equally important to derive self-worth from relationships and hobbies that bring me joy. By allowing myself to view activities like going for a run, cleaning my apartment, or Facetiming friends as productive, I have achieved better balance in each aspect of my life. As explained by former Coca-Cola CEO[ **Brian Dyson**](https://www.markturner.net/2015/05/10/text-of-brian-dysons-commencement-speech-at-georgia-tech-sept-1991/)**,** in life, you choose a set of balls to juggle. Some balls, including family, friends, physical well-being, and mental health, are made of glass: they will crack or even shatter when you drop them. Other responsibilities such as research, school, and leadership are made of rubber. If you set these down, they will bounce back to you. So no matter where you are on your journey to surgery, choose carefully when setting your priorities. Because when you lay aside certain aspects of your life, you can’t always get “more”. **Links:** <https://www.ama-assn.org/residents-students/specialty-profiles/residency-match-7-most-competitive-medical-specialties> [https://www.nrmp.org/wp-content/uploads/2021/05/MRM-Results\_and-Data\_2021.pdf](https://www.nrmp.org/wp-content/uploads/2021/05/MRM-Results_and-Data_2021.pdf) <https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf> <https://www.markturner.net/2015/05/10/text-of-brian-dysons-commencement-speech-at-georgia-tech-sept-1991/> ![](https://blog.womensurgeons.org/wp-content/uploads/2021/11/Spiller.jpeg) Kelly Spiller is a fourth-year medical student at Wright State University applying to Integrated Plastic Surgery this fall. Originally from Cincinnati, Ohio, Kelly obtained her Bachelor’s Degree in Molecular and Cellular Biology at Vanderbilt University prior to attending medical school. Her mom, a dedicated PACU nurse of 25 years, inspired her to pursue surgery. However, she became interested in plastic surgery after working in a lab studying congenital craniofacial abnormalities during her undergraduate years. As the first person in her family to obtain a bachelor’s degree and to pursue medicine, mentorship and teaching are of utmost importance to her. She hopes to continue her involvement in both areas during residency to make room for more female, first-generation students in plastic surgery. Her research interests include reconstruction of congenital craniofacial abnormalities, traumatic lower extremity reconstruction, and breast reconstruction after mastectomy in the obese population. She is also passionate about global health and has traveled to Jamaica with Wright State’s Global Health Scholars program. Outside the hospital, Kelly can be found hiking, running, traveling, and spending time with friends and family. Find her on Instagram: @kelly.e.spiller. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, residency **Tags:** career development, Match, Medical Student Members, medical students, medstudents, residency, surgical residency --- ### [Faculty Recruitment Strategies to Improve Diversity](https://blog.womensurgeons.org/faculty-recruitment-strategies-to-improve-diversity/) **Published:** November 3, 2021 **Author:** Blog Team **Content:** *By Tanya Anand, MD, MPH and Elizabeth Shaughnessy, MD, PhD* A diverse faculty is important for an institution’s continued growth and relevance to its community. Significant investment is required outside of the direct faculty job interview to improve diversity and achieve this goal. Each step of the recruitment process, i.e. the creation of the ideal candidate profile, recruitment of the search committee members, the active (not passive) hunt for the interested candidate, and the retention of that candidate are all equally important. Successful diverse faculty recruitment strategies are ones emphasizing retention, as well. The “leaky pipeline” and the inequity of minorities at the upper echelons of academia are indicators of what we must overcome. With that said, successful faculty recruitment strategies are ones in which institutional leadership plays an active role, and where the organization ensures that growth is fostered and promotion does not lag. The recruitment process does not end when the contract is signed. Equity in recruitment must be prioritized at every level of the organization for the effort to be meaningful and sustained. Departmental and institutional leadership needs to allocate resources to several large areas: 1) Choosing search committee members who will bring unique perspectives; 2) Actively widening the recruitment net and improving the diversity of the candidate pool; and 3) Once hired, investing resources in programs that mentor the under-represented minority faculty and providing role models and senior leadership advocates for his/her/their advancement. Search committee composition can influence the recruitment process. Guidelines typically do not detail criteria for representation that promote a critical mass of diverse individuals on the committee. These members may vary based on experience level, professional affiliation, role in their local community, or other stakeholders within the organization. They can serve as “equity advocates” and achieve a consensus on the candidate to create a more inclusive job description. Once assembled, the committee must identify the needs of the community and the organization to create the ideal candidate profile for the search. Active rather than passive recruitment practices should be encouraged. The amount of effort placed on recruiting a diverse faculty member is really the most visible indicator of the organization’s commitment to the cause. The search should be broad, i.e, potentially creating a wider job description, and ads should be placed in arenas where underrepresented minorities will have greater exposure to the job announcement. This includes contacting professional organizations with a strong commitment to diversity, networking within the field, and actively reaching out to trainees soon to be entering the job market. Retention of talented individuals from diverse backgrounds is critical. Thus, an aggressive and early mentoring plan tailored to the candidate’s needs is vital. In addition, the individual recruit should have a senior advocate to guide the faculty member through the process. This is important for retention of diverse faculty and potentiates further recruitment of individuals from underrepresented backgrounds. At the end of the day, the goal is to improve the care and service delivered to the community. This is best accomplished with diverse individuals united toward a common goal. **Bibliography** Arjani S, Tasmin S, Sumra H, et al: It begins with the search committee: Promoting faculty diversity at the source. *Am J Surg*,[ https://doi.org/10.1016/j.amjsurg.2021.08.027](https://doi.org/10.1016/j.amjsurg.2021.08.027) Bhalla N. Strategies to improve equity in faculty hiring. *Mol Biol Cell*. 2019;30(22):2744-2749. doi:10.1091/mbc.E19-08-0476 Dai, Jessica C., Nnenaya Agochukwu-Mmonu, and Adam B. Hittelman. “Strategies for attracting women and underrepresented minorities in urology.” *Current urology reports* 20.10 (2019): 1-7. Harvey EJ, Ball CG: Gender (and other) equality, diversity, and inclusion in surgery*. Can J Surg*, 2019;62(5):292. Doi: 10.1503/ejs.014619 Kaplan SE, Gunn CM, Kulukulualani AK, Raj A, Freund KM, Carr PL. Challenges in Recruiting, Retaining and Promoting Racially and Ethnically Diverse Faculty. *J Natl Med Assoc*. 2018;110(1):58-64. doi:10.1016/j.jnma.2017.02.001 Mahta D. Bediako Y, de Winde CM, et al: Ways to increase equity, diversity and inclusion. *eLife,* 2020,9:e60438. Doi: 10/7554/eLife.60438 Rosencranz KM, Arora TK, Termuhlen PM, et al.: Diversity, equity and inclusion in medicine: Why it matters and how do we achieve it? *J Surg Ed,* 202:78(4):1058-1065. Sarmishta S: 6 Degrees—RBC Report, All of us: What we mean when we talk about inclusion. *6Degrees*, 2017:20. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/11/Anand.png)Dr. Tanya Anand, MD, MPH is a Clinical Assistant Professor at the University from Arizona. She is originally from Southern California. She attained her undergraduate degree from Loma Linda University and worked for several years as a licensed Clinical Laboratory Scientist. Concomitantly, she completed her MPH degree at the University of Southern California, with an interest in health policy and epidemiology. She completed medical school at St. George’s University in Grenada, WI, and did her residency at Kern Medical Center in Bakersfield, California. Her interest in Trauma, Acute Care Surgery, and Critical Care led her to complete a 2-year fellowship at the University of Arizona. Her research areas of interest are diverse and seek to improve all aspects of care of the critically ill trauma, acute care, and burn patient. She is interested in understanding the impact of inflammation upon resuscitation and glycocalyx integrity in the critically ill trauma patient. In addition, she has a passion for exploring avenues to improve patient equity in healthcare access. She is certified by the American Board of Surgery in General Surgery and Surgical Critical Care; She is a member of multiple professional societies, including the American College of Surgeons, Association of Women Surgeons, and the American Medical Association. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/11/Shauguhnessy.png)Dr. Beth Shaughnessy, MD, PhD was born and raised in the Chicago area, with her undergraduate years spent at the University of Illinois at Urbana-Champaign. She returned to Chicago for medical school at the University of Illinois at Chicago. Following general surgery residency at the University of Illinois’ program, including Cook County Hospital, she pursued a fellowship in surgical oncology at the City of Hope National Cancer Center outside of Los Angeles. She is currently a professor of surgery at the University of Cincinnati. Her research interests include understanding aspects of benign breast disease as it relates to cancer development, as well as environmental influences. Dr. Shaughnessy has long been involved with the Association of Women Surgeons; she serves as the newly installed president. She lives with her husband in Cincinnati, with their son away at college. She enjoys yoga, bicycling, the arts, and gardening. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, diversity and inclusion, leadership --- ### [Being a Surgeon and a Mother](https://blog.womensurgeons.org/surgeon-and-mother/) **Published:** October 31, 2021 **Author:** mcooke@amrms.com **Content:** *By Allison Letica-Kriegel and Erika Rangel* From a young age, I wanted to be a doctor. First a veterinarian, then a pediatrician, and finally a surgeon. I think, actually, I’ve always identified as a doctor, well before I was one. Shortly after I stepped into the operating room, I knew this was where I wanted to spend my career. And from that moment, my identity as a surgeon started to form. As the years of medical school and residency passed by, my identity became so strongly tied to being a surgeon, and being a resident, that it was hard to imagine there was space for anything else, although I also always knew that I wanted to have kids. The mantra in my head, whether self- or externally-imposed, had always been work first, everything else after. I imagine many of us in surgery share this sentiment, and sometimes that makes it difficult to conceive of starting and maintaining a family as a surgeon, especially when there are not adequate policies in place to support childbearing. Recognizing the need for better parental support, the American Board of Surgery (ABS) [recently changed their family leave policy](https://www.absurgery.org/default.jsp?news_familyleave1021) to allow four weeks of parental leave, separate from vacation, and the Accreditation Council for Graduate Medical Education (ACGME) now requires institutions to provide at least 6 weeks of paid parental leave at least once during training. I’m hopeful that these changes will encourage more women to consider having babies during training. However, delivery and postpartum are discrete periods in the spectrum of childbearing and we need to continue to consider other factors, such as becoming pregnant, sustaining a safe pregnancy, and supporting women beyond the “fourth trimester” during their return to work. We now know that female surgeons, compared to non-surgeon counterparts, are [more likely to delay childbearing, require assisted reproductive technology to have children, and experience major pregnancy complications](https://jamanetwork.com/journals/jamasurgery/article-abstract/2782357). Female surgeons have more than double the rate of miscarriages compared to the general population of similar age. The measurable obstetric health risks should make us question if we are creating a safe environment for women to conceive and carry a baby to full-term. When female surgeons do experience infertility, miscarriage, or complications, we should ensure that they receive the time and coverage to attend to their health. After returning to work postpartum, many surgeon mothers [struggle to find time and space for lactation, with many ceasing breastfeeding earlier than they wished due to these challenges](https://jamanetwork.com/journals/jamasurgery/fullarticle/2675992). We should work to ensure that all hospitals have adequate lactation spaces and accept that breastfeeding mothers must take periodic breaks from the operating room to pump. While we have made progress in supporting surgeon mothers, including significant [recent improvements in protected leave](https://www.absurgery.org/default.jsp?news_familyleave1021), we still have work to do. I was and am lucky to have role models ahead of me that have shown me that your identity as a mom does not need to come at the cost of your identity as a surgeon, and vice versa. But that doesn’t mean that balancing both isn’t tough. It does not serve surgeon mothers to ignore or undermine these challenges, and I hope that we can continue to pave a smoother path for those that follow. Please join us on Monday, November 15th from 8:00-9:00 pm for an AWS Tweetchat about Being a surgeon and mother. This chat will focus on fertility, breastfeeding, and motherhood. The chat will be moderated by Dr. Allison Letica-Kriegel ([@AllisonLetica](https://twitter.com/AllisonLetica)), Dr. Erika Rangel ([@ErikaRangelMD](https://twitter.com/ErikaRangelMD)), Lyndsay Kandi ([@lyndsaykandi](https://twitter.com/lyndsaykandi)), and Dr. Mecker Möller ([@MeckeritaMoller](https://twitter.com/MeckeritaMoller)). The questions will be posted directly from the [@WomenSurgeons](https://secure-web.cisco.com/1MtFqT-O5CXcfHrUG01FhP-v20gOUIzpRck2R4HSDw20PWd4KTzoE-7PqhF8-ph7aSNF54CxFKMS1h_D2-OUXp3jCvCJ3b0yrT9CtJgkymdfbOGcpdkm4gzCLhz_dJQgt4YB8jIYTbCmfdgHtpkYL73qWCU-wFGrBxt5XUWCjg-PYYdk48Jy86_EN0k6uU6qpap-gnziH9i14eYetT7JOxI5qlL74zWBd4WYAc7dPmbnPDI-wkEaf_TJovOa1hQCVH5m_Q4lBkP9FcFe3tDq7Yg/https%3A%2F%2Ftwitter.com%2FWomenSurgeons) Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this[ tutorial](http://secure-web.cisco.com/1IQnZG6TAnWuwwb-2xeWDSzHQmKuWGlxWJC5JlFzzSzsn4Hh5jU6XaXbUgq0v60nQH3q0BerMeC6i-K9NWM0bGctWtF_y5VgUtcbCXbpX9oaVZSARE7YiJr9nXQ_IcOKDU8TQKsucoisiAUwBu33jF00GadScW0uX_dQbjOWnNvBW-31X9XwH0hSoq6ijb9iqCh8003C1wzjTPGeOm8ZBZcC_TLyrbsganynxDFuPduM0BtAlB7SUKpf87UyY2ygB7zk5FaAEomBXlG4mRd6l3w/http%3A%2F%2Fblog.womensurgeons.org%2Fmedical-students%2Fbeyond-the-basics-of-tweeting%2F) written by Dr. Heather Yeo ([@heatheryeomd](https://secure-web.cisco.com/1VnOROMove6T34j7PbWdQYgyOGZwGzIzaFd0chSyw_Xt9YshykJMxcFVhGj-pnn-6CAyhE4GJ4tmR1ZAQeb5vB86wDHpWpJIP3pZACiyfNQHNdjsI5c_j31ZGFe4dGeJJXSphyAtmXBPpvyotfOgnxWgTBDE-jVNLh_iEVmslxPIoE1HUGL0duS-Q2HHcq6cksVCPttEdqZHseqgonZSrlOFVrHRkt0ke5mzawUS5rWp2RVgz8NLQ2eSCj5dSCc05lgOY61eF4l-EEsy4h2K_EQ/https%3A%2F%2Ftwitter.com%2Fheatheryeomd)) to know more. We will be discussing the following topics during our tweet chat: (1) infertility, (2) pregnancy, and (3) breastfeeding and the postpartum period. **Questions to be discussed:** 1. What are the biggest challenges that pregnant surgeons face? What type of accommodations do you think are ideal for pregnant surgeons, specifically trainees? How do we implement these without unfairly increasing workload for trainees who are not having children? 2. Assisted reproductive technology is time-consuming and expensive. How can female surgeons manage ART, especially while in training? 3. What were the biggest challenges you had trying to breastfeed while you were a surgical resident? Do you think lactation policies are helpful to set expectations for faculty that they support postpartum residents? What policies or accommodations should be in place to ensure that surgeon mothers can continue to breastfeed for as long as they wish? 4. What tools have surgeon mothers used to balance work and life? 5. There has been a lot of attention on improving parental leave. Are there other aspects of parental support that you feel would be helpful? 6. How do you think the current environment surrounding parenting affects resident burnout and wellbeing? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/Letica.png) Allison Letica-Kriegel, MD, finished her PGY3 year at Massachusetts General Hospital (MGH) in June 2020 and has been working as the Surgical Quality & Safety Fellow at Memorial Sloan Kettering Cancer Center since that time. Aside from patient safety and experience, she is interested in physician well being and improving policies for female surgeons who choose to have children during training and beyond. Alli plans to apply for a pediatric surgery fellowship shortly after her return to residency next June. She currently lives in NYC with her husband (a cardiothoracic surgery resident) and their 15-month-old son. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/rangel.png) Erika Rangel, MD, MS, FACS, is a general surgeon and surgical intensivist at the Brigham and Women’s Hospital. Her academic interests center on defining the challenges facing surgeons starting a family, demonstrating how these impact burnout and career dissatisfaction, and using evidence to inform policy change to better support alignment of personal and professional priorities. Some of her initiatives are now used nationally in the Wellness Toolkit for Supporting Parenthood in Surgery as part of the SECOND Trial. As half of a dual-surgeon couple and the mother of a residency-born child and two NICU babies, she is passionate about supporting surgical trainees in navigating competing family and career demands. She lives near Boston with her husband, Shawn, a pediatric surgeon at Children’s Hospital Boston, her two boys, a golden retriever, and two pandemic cats. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** family, family leave, ILookLikeASurgeon, lactation, maternity, paternity, policy, training, Women in Surgery, WomenSurgeons --- ### [The Many Forms of Mentorship](https://blog.womensurgeons.org/many-forms-mentorship/) **Published:** October 18, 2021 **Author:** mcooke@amrms.com **Content:** *By Hope Feldman and Rebecca Hoffman* A mentor is defined in the dictionary as “an experienced and trusted advisor.” This may be an accurate definition, but it is rather vague. It does not begin to address the many shapes and forms that a relationship between mentor and mentee can take. It comes as no surprise then that I was recently asked by someone on Twitter how one goes about finding a mentor. How can someone find a person to fill such an ill-defined role? I have been very fortunate that in my almost eight years of medical training, I have found several individuals who I would describe as my mentors. Mentor A: This individual is a phenomenal surgeon. I admire her work ethic and her commitment to patient care. Her office door is always open if I have a question about work or life. She recognizes my potential and encourages me to always strive to be better. Mentor B: This individual is a brilliant clinical researcher who has spent his career designing impactful studies. We spend several hours each weekend walking around the city discussing events of the week, research ideas, or life in general. He has taken the time to get to know my family. He has provided me with the tools that I need to thrive in an academic setting. Getting to learn from him has been a privilege. Mentor C: She is a role model and a friend. She holds me to incredibly high standards and pushes me to do more than I knew I was capable of achieving. I enjoy visits with her children, and I know that if I ever needed anything, she is someone that I could call. I have learned and grown and thrived because of these relationships. I hope that in my role as mentee, my eagerness to learn and willingness to be challenged has made my mentors feel that it was time well spent. In my new role as a resident member on the Association of Women Surgeons Communications Committee Twitter Sub-committee, it is my hope that we can foster discussions that allow people to learn from those who have been there before and perhaps meet new people along the way. **Mentee-ship: Maximizing a relationship** The mentor-mentee relationship can and should be as dynamic as any other relationship—and should be treated as a living, breathing, growing relationship that is allowed and expected to take many forms over time. Sometimes mentors stay mentors. Sometimes they become sponsors and sometimes the relationship fizzles with time. I think it is important for new trainees especially, to realize that as your needs and interests change—and they will—that you will have mentors that can change with you, but you will also have those who help you along the way and lead you to new mentors as you grow. The fun in being a mentor is fostering that growth, seeing the change, and supporting our mentees in their endeavors. These relationships are hard to force. There shouldn’t be pressure to attach to a mentor until it feels right. How do you know it’s right? The relationship should feel somewhat natural; the mentor should be someone you respect and whose opinion you value and trust. Your mentor should respect your goals and desires, and understand you, your interests, and push you to succeed. They should be aware of opportunities that may benefit you and your career. My most influential mentor knew me better than I knew myself—I don’t know how she did it but it is the kind of mentor I strive to be. Advice for incoming surgical trainees? Spend a little time getting to know yourself in your new role. What excites you? Who is exciting? Who do you like to be around? Who might open your eyes to opportunities and experience, outside of the operating room? Don’t put too much pressure on yourself or the relationship early on. It will come. Be communicative with your mentor. Be open to trying new things. Be open with your mentor in order to get honest advice and support. Enjoy the relationship! Be excited about this new chapter in your life and soak it all in! Please join us on October 18, 2021 at 8-9pm Eastern Standard Time for an AWS Tweetchat about “What I wish I knew when…”! This chat will focus on providing a look at different steps in a surgeon’s career and words of wisdom from women who have done it before. The chat will be moderated by Dr. Tania Arora (@TaniaKArora), Dr. Becky Hoffman (@drbeckyhoffman), Dr. Callie Thompson (@callie\_mt), Dr. Imani McElroy (@IEMcElroy) and Dr. Brooke Bredbeck (@BrookeBredbeck). The questions will be posted directly from the [@WomenSurgeons](https://twitter.com/WomenSurgeons) twitter account and you can also find them by following the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this[ tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweetchat: (1) choosing a residency, (2) finding a mentor, (3) starting a family, and (4) negotiating my first contract. Questions to be discussed: Q1. With residency interview season beginning, what are some things you wish you knew when you were considering programs and making your rank list? Q2. Mentorship can play a very important role in developing as a surgeon. What are some things you wish you knew about mentorship or being a mentee when you began residency? Q3. “How does she do it all?” and “Work life balance” are expressions used to describe commitment to people/things outside of work. What does this look like in your life? If you have children, what are some things you wish you knew when starting a family? Q4. For the attendings: what are some things you wish you knew when choosing your first job or negotiating a contract? For residents: What factors will be important to you when deciding on a fellowship program or job? Q5. What are some things you wish you knew when you chose surgery? What are your favorite parts of this career and what are things you had not expected as a medical student? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/feldman.jpg) Hope Feldman, MD, is currently completing her second of two research years as a Thoracic Surgery Research Fellow with the Department of Thoracic and Cardiovascular Surgery at MD Anderson Cancer Center where she is fortunate to have found several wonderful mentors. She is also a general surgery resident at Geisinger. Dr. Feldman is endlessly grateful for the guidance and support she received at the Albert Einstein College of Medicine and that she continues to receive through the Geisinger general surgery residency program. You will have the opportunity to meet some of Dr. Feldman’s mentors on Monday, October 18th at the #AWSchat. She can be found on Twitter @HopeFeldmanMD. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/hoffman.jpg) Rebecca Hoffman, MD, is an Assistant Professor of Surgery at the Geisinger Commonwealth School of Medicine, a Colon and Rectal surgeon at Geisinger Medical Center, and the Vice Chair of Education and Research for the Geisinger Surgery Institute. She has had the privilege of having the most amazing mentors–all the way from her first adult job at the Children’s Hospital of Philadelphia, to her medical school, residency and fellowship training at the University of Pennsylvania and Washington University in St. Louis, and to her current amazing colleagues and friends. Mentorship is what keeps her motivated and excited to come to work each day! Dr. Hoffman can be found on Twitter @drbeckyhoffman. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, ILookLikeASurgeon, mentor, mentorship, residency, Resident Mentor, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Celebrating our Past, Transforming our Future: Reflections on making the AWS 40th anniversary celebration video](https://blog.womensurgeons.org/celebrating-our-past-transforming-our-future-reflections-on-making-the-aws-40th-anniversary-celebration-video/) **Published:** October 14, 2021 **Author:** Blog Team **Content:** By Tiffany J Sinclair, MD As a member of the AWS Residents and Fellows committee, I had the privilege of putting together a video in celebration of AWS’s 40th anniversary that will be presented at the upcoming conference. I am by no means a professional video editor, but it is one of my hobbies and I was excited to have the opportunity to pay homage to our wonderful organization. In honor of the conference’s theme “Celebrating our Past, Transforming our Future,” several other members of the committee and I decided to interview a few of our past presidents for the video. We wanted to hear about their favorite AWS memories, their most meaningful experiences, and their thoughts on where our organization is headed in the future. In total, we interviewed five of our past presidents: Drs. Patricia Numann, Margaret Dunn, Leigh Neumayer, Beth Sutton, Myriam Curet, as well as our current president Dr. Marie Crandall. As I listened to their stories and watched the videos of the interviews conducted by others, I was once again blown away by the trails that these amazing women blazed. It was remarkable to hear so many of them say that they had never met another woman surgeon before attending one of the first informal breakfasts, which began in 1981 and were held at the ACS Clinical Congress. For many women, these breakfasts were their only opportunity to interact with other women surgeons. While we’re a long way from achieving gender parity in surgery, these are experiences that very few female trainees have today. I was impressed by their stories of how the organization officially came into being in 1986 and how much they accomplished in a few short years; how they took a few women gathering for breakfast to a full-fledged organization with influence in the surgical community. These ladies were the masterminds behind getting the first women elected and appointed to positions of leadership within our field – to the ACS Board of Governors, the Board of Regents, and the American Board of Surgery. Our founding president, Dr. Numann, was even elected as President of the College in 2011, becoming only the second woman to ever hold this prestigious position. By banding together and supporting each other, they were all uplifted. This is a lesson that endures time and one we could all do well never to forget. As we concluded each of the interviews, we asked our past presidents what they thought the future holds for AWS. While it’s clear that women have come a long way in establishing our rightful presence within the surgical community, they all shared a similar sentiment – we still have a long way to go. We must actively recruit individuals who are under-represented in medicine to surgical specialties. We must continue to promote women, and especially minority women, into positions of power. We must ensure that our trainees are learning in an environment free from discrimination and surrounded by mentors and colleagues that “look like them.” All of this is essential to providing optimal patient care, reducing disparities in access to care, and fostering role models for tomorrow’s leaders. If our past is any indicator, the future of AWS looks bright. I am proud to be part of an organization that has paved the way for us young female surgeons and is committed to addressing and correcting the inequities that have plagued medicine, and in particular surgery, from time immemorial. I hope you will be joining us for the [upcoming conference](https://www.womensurgeons.org/general/custom.asp?page=AnnualConference) being held virtually on October 16th and 17th where we will continue the discussion of how AWS can contribute to the ongoing betterment of our surgical community. I could only capture a fraction of AWS’s rich history and contributions to the field of surgery in a 17-minute video, but I think it embodies our essence – an organization that encourages women surgeons to engage, empower, and excel. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/02/tiffany-241x300.png)Tiffany Sinclair, MD is a general and endocrine surgeon. She obtained her medical degree from the University of Pennsylvania and completed her general surgery residency at Stanford Health Care in 2020. She graduated from her fellowship in endocrine surgery at the Cleveland Clinic in July 2021. She hopes to pursue a career in academic surgery. Her research interests include medical student and resident education and fertility among women surgeons. She is the ACS Resident and Associate Society liaison to the Women in Surgery Committee and an active member of AWS, the AWS Communications Committee, and the Blog Sub-committee. You can find her on Twitter: @thefancysurgeon. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWS conference, career development, networking, reflection --- ### [There All Along](https://blog.womensurgeons.org/there-all-along/) **Published:** October 11, 2021 **Author:** Blog Team **Content:** *By Betzaira G Childers, MD* My family left all our belongings, extended family, and all we knew to immigrate to the United States when I was a young girl. These were the days before social media and internet, so I grew up knowing only my immediate family with little knowledge of my extended family still in Mexico. As far as I was concerned, it was just us, and we were alone. Effectively, my parents’ only goal was for us to excel and have opportunities they never had. And so, when it came to our new life in the US, we worked hard. All of us. We certainly didn’t stop to smell the roses. My parents worked long days and multiple jobs. We had no extracurricular activities and didn’t celebrate holidays as they simply cost too much. My oldest sister served as our babysitter when we weren’t sitting quietly at a corner table at the restaurant where my mom worked. My siblings and I often felt our immediate family was a bit of an island, floating out in the middle of nowhere, without a community or a place where we belonged. Our island of a family was rattled earlier this year when my mother was diagnosed with advanced stage cancer. True to her character, she met it with determination. Admittedly, my siblings and I were unhinged. Fortunately for us, I was wrong about being all alone all those years. Friends and family that I recalled only by name, or a remote story came to our rescue without batting an eye. Day after day and month after month they stayed alongside us for what turned out to be a treacherous storm. It was my first time experiencing this fortress of courage and love from my own community, my lineage, my people, my heritage. I was wrong all along. We were never alone. Though my family lost more than we can replace, we also found our connection to home. Hispanic Heritage Month is special to me because it recognizes my family’s journey and the community that connects us all. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/Childers.jpeg) Dr. Childers is a clinical PGY4 general surgery resident at The University of Cincinnati. She completed two years of basic science research in pancreatic cancer at UCSD in the lab of Dr. Andrew Lowy while also serving as the San Diego Center for Precision Immunotherapy fellow. Dr. Childers has research interests aimed at understanding and manipulating the immune environment to elicit treatment responses in various cancer types. She is a resident member of the Association of Women Surgeons and American Association for Cancer Research. Dr. Childers was a full scholarship track and field athlete for The University of Texas at Austin and qualified for the Olympic Trials in 2012. She represented Team USA at the 2012 Bupa Great Edinburgh Cross Country Competition. She doesn’t enjoy cooking, loves international travel, and is always up for a run. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** hispanic heritage **Tags:** Diversity, Hispanic Healthcare, Hispanic Heritage Month, ILookLikeASurgeon --- ### [My Favorite Weekend of the Year](https://blog.womensurgeons.org/my-favorite-weekend-of-the-year/) **Published:** October 7, 2021 **Author:** Blog Team **Content:** *by Kathleen Romanowski, MD* Since I attended my first Association of Women Surgeons (AWS) Annual meeting 6 years ago, the weekend before the American College of Surgeons meeting in October has become one of my favorite weekends of the year. The feeling of attending this meeting can be hard to describe to those who have never had the opportunity to attend, but I will try. Imagine walking into a surgical meeting. You look around surveying the room, looking for a place to sit, maybe trying to see if you know anyone there. As you look around you realize that this meeting has a very different look to it. Instead of the usual sea of black suits with a few pops of color, you encounter a sea of color with a few dark color suit spots. Rather than a largely male crowd, you are surrounded by a multitude of female faces of all colors and shapes. As you make your way through the room you overhear conversations about children, research ideas, nannies, fashion, and the latest surgical techniques. You see faces you recognize as your mentors and those that you idolize, the leaders in the surgical world. You sit next to your former (or current) co-residents and catch up on their lives. You meet new medical students and residents who will be the future of our profession. As the conference begins you listen to presentations on new research that your fellow women surgeons have done. You listen to inspiring talks about how to progress through your career and how to deal with pitfalls you might come upon. You get inspired and rejuvenated through the shared experience of those who have also chosen to practice surgery. You realize you are surrounded by people who, at least somewhat, understand your world and the triumphs and the setbacks that are associated with that world. This year’s installment of the AWS Annual meeting, “Celebrating our Past, Transforming our Future,” will occur virtually on October 16th and 17th. Registration is still available at:[ https://www.womensurgeons.org/event/2021annualconference](https://www.womensurgeons.org/event/2021annualconference). There are so many offerings that appeal to me at this meeting. I am excited to hear the medical students and residents present their research; I am looking forward to the History and Evolution of AWS Keynote address; and I expect to learn a lot from the negotiation breakout session. These are just a few of the offerings at the meeting this year and I am sure there is something that will appeal to most people. The full schedule can be found here:[ https://www.womensurgeons.org/page/ConferenceProgram](https://www.womensurgeons.org/page/ConferenceProgram). While I am excited for the meeting this year, I won’t lie and say I am not eagerly awaiting a return to in-person conferences. I miss the camaraderie and catching up with friends, mentors and colleagues who I don’t get to see or talk with on a regular basis. I miss stepping out of my busy life for a few days to not only relax, but recharge and recenter. I always leave the AWS Annual meeting with new friends, new ideas, and a fresh perspective that allows me to return home and conquer some of the daily annoyances with a better attitude. Despite the fact that this conference will be virtual, I am sure that I will take many of the same things from this gathering of amazing women and I am sure that this will be one of my favorite weekends of the year! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/Romanowski-200x300.jpeg)Kathleen Romanowski, MD, FACS is an Assistant Professor of Surgery at the University of California, Davis and Shriners Hospitals for Children Northern California in the Division of Burn Surgery. She attended the University of Chicago Pritzker School of Medicine and completed her general surgery residency at University of Chicago Medical Center. She did fellowships in Burn Surgery and Surgical Critical Care at University of California, Davis and Shriners Hospitals for Children Northern California. Kathleen is devoted to the care of the burn injured patient and studies disparities in care and predictors of outcomes in elderly burn patients. She is an active member of AWS and is a member of the AWS Communications Committee and Faculty Chair of the AWS Blog Sub-committee. You can find her on twitter at [**@KSRomanowski**](https://twitter.com/ksromanowski?lang=en). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWS conference, current events, education, mentorship, reflection --- ### [Diversity in Strengths and Strength in Diversity](https://blog.womensurgeons.org/diversity-in-strengths-and-strength-in-diversity/) **Published:** October 4, 2021 **Author:** Blog Team **Content:** *By Marianna Hernandez Brandi* When my mom and I moved to Cincinnati, OH in 2005, I was placed in an English as a Second Language (ESL) class. I remember when the teacher would come into my home room and call out for me in front of all my classmates to announce that it was time for our one-on-one session. I was always so annoyed. I did not have much of a background, if any, in speaking English, but I felt that being singled out daily inhibited me from being able to fully immerse myself in the classroom with the other students. It took me less than a month to complain enough to my mom about this situation for her to advocate for me to no longer attend ESL classes. Throughout my life, I never felt that I was particularly gifted at test taking or school. In elementary school and high school I was “above average”, as they say, but I never thought of myself as overtly talented in the classroom. It took me only three months, however, from when I first immigrated to the states to feel 100% assimilated to American culture and the English language. My parents and I realized that I had an ability to incorporate myself within a culture and a society without much difficulty at all. This is a skill that I continued to use throughout most aspects of life all the way from starting college, studying abroad, and being on medical school clinical clerkships to making relationships with mentors and classmates. I say all this not to highlight how wonderful I am at adapting to new environments, but to call attention to the fact that this attribute has been celebrated and exalted by many throughout my life. Although initially labeled as “above average” when I was younger, I quickly went to being “hardly average” when it came to standardized test-taking and performing well in the classroom. I always had the great luck and privilege, however, to have mentors and colleagues that value the diversity in my strengths and appreciate my attributes in a similar way than one might celebrate a strong test-taker. In this day and age, more attention is being given to the power of a diverse workforce. We are beginning to, as a society, grasp a better understanding and form a more wholesome picture of what makes a “strong student” or a “good doctor”. This is giving room for individuals with varying strengths to have a seat at the table. I know that I would not be where I am and would not be entering a surgery residency application season, were it not for the army of individuals who have celebrated my accomplishments and strengths even when they have looked different from my peers’. My task to you all, whether a student, faculty member, or whomever you may be: build each other up and continue to celebrate diversity in strengths, as it will make room for a stronger workforce and a more representative and diverse future for us all! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/Mariana-300x199.png)**Marianna Hernandez Brandi** is a fourth-year medical student at University of Cincinnati College of Medicine applying into General Surgery this fall. She received her B.S in Neuroscience and B.A in Italian Studies from The Ohio State University in Columbus, OH. She is interested in many fields within General Surgery and is excited to see what she ends up pursuing. In her spare time, she enjoys spending time with her family and friends, trying out new restaurants and traveling to new places. You can follow her on Twitter @mariannahb\_ --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, hispanic heritage, medical students, reflection --- ### [Celebrating the first women surgeons in the US: Inspiration for future progress](https://blog.womensurgeons.org/celebrating-the-first-women-surgeons-in-the-us-inspiration-for-future-progress/) **Published:** October 1, 2021 **Author:** Blog Team **Content:** *by Nallammai Muthiah* Statistics are relatively easy to find these days. It does not take many Google searches to realize that surgery and most surgical subspecialties, even in 2021, are still male-dominated. Today, women make up more than 50% of all U.S. medical students and 40% of general surgery interns. Yet further down the pipeline, only 20% of practicing general surgeons are women. These discrepancies are even starker for some subspecialties. The reasons are likely multifactorial and challenging to disentangle. All that to say, such statistics can feel disheartening. There is a “flip side” to the coin. Women have made immense progress over the last 150 years, breaking through the proverbial glass ceiling again and again. That is worth celebrating. So, let us return to a time when women had no pre-existing paths along which to guide their careers, a time when bias against women was frankly explicit, a time when the uncertainty of success was as fundamental as whether society would allow a woman to practice medicine at all. In 1849, [Dr. Elizabeth Blackwell became the first woman to earn a medical degree in the U.S](https://www.womenshistory.org/education-resources/biographies/elizabeth-blackwell). After having been rejected from more than 20 medical schools, it is thought she was only accepted to Geneva Medical College as a practical joke. Her society, institution, and even classmates expected her to fail. But she did not. In fact, she earned the gold medal at Geneva. Still, she could not match into residency programs. She eventually also lost vision in her left eye. Did this end her medical career? Absolutely not. Dr. Blackwell went on to open the New York Infirmary for Women and Children and Women’s Medical College of New York. The Blackwell Medal was established in her namesake. Dr. Blackwell got her foot in the door, and despite perceptions by every level of her social circle, she found a way to adapt to her unforgiving environment. [Dr. Mary Edwards Walker, in 1855, became the second woman to earn a medical degree](https://www.womenshistory.org/education-resources/biographies/mary-edwards-walker) from Geneva (after Dr. Blackwell). Once the Civil War began, Dr. Walker hoped to aid the Union Army’s efforts as a surgeon. She was refused because she was a woman. Did this stop her? Again, absolutely not. Dr. Walker went on to serve as an unpaid surgeon volunteer for the U.S. Army, providing medical care to those wounded on the front lines. After advocating for herself, she became the first U.S. woman surgeon. This theme of selflessness and advocacy permeated Dr. Walker’s career. She created an organization for families to visit their wounded loved ones and boldly advocated for women’s rights after the war. To this day, Dr. Walker remains the only woman awarded the Medal of Honor. Women pioneers exist in every surgical field. Below is a timeline of the approximate times when some of the first women surgeons started practicing in their respective subspecialties. Each learned to navigate the structural limitations posed by their environment. What do I take from these pioneers? Qualities—adaptability, perseverance, grit—I hope to emulate in my future career. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/Screenshot-2021-10-01-104559-300x110.jpg) Today, I serve AWS as Mentorship Coordinator. The value of mentorship for women and minorities in surgery cannot be overstated. Women like Dr. Blackwell and Dr. Walker were firsts in their fields. They had no precedents to follow. Still, they achieved incredible feats for any person—not just women—of their time. They served as mentors for generations to come. Previous blog posts have focused on effective mentorship. A common theme is that perhaps mentorship ought not to be a one-way relationship between two people, but rather a network connecting multiple nodes. When “nodes” are connected to those further along in their careers *and* those earlier in their careers, each node reaps the benefits of simultaneously serving as a mentor and mentee. Our team is working to create such a network within AWS’s own *Brown & Garcia-Sancho Mentorship Program*. The goal is to create “mentorship trees” within an international community of surgeons, medical students, undergraduates, and high schoolers. We are excited to transform the theories of effective mentorship into reality. So here we are in 2021, *creating* *programs* for future women to learn from their predecessors. Yes, we still have a long way before achieving equity in surgery. But today, let us celebrate how far we, as a society, have come. Let us be grateful for the people who helped us get here. Let us draw from the perseverance of Dr. Blackwell, Dr. Walker, and the first women surgeons to remind ourselves that, even in the face of the most challenging obstacles, we can still find a path forward. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/10/929-blog.jpeg) Nallammai currently serves as Mentorship Coordinator for the AWS National Medical Student Committee. She earned her Bachelor’s Degree from Cornell University and is now a fourth year medical student at the University of Pittsburgh School of Medicine. She is currently a Clinical Scientist Training Program scholar at PittMed, where she is researching effective surgical treatment options for pediatric patients with drug-resistant epilepsy. Among her passions are service and mentorship. During medical school, she created and has since overseen a Clinical Experiences course at PittMed which offers medical students the opportunity to engage with local high school students, inspiring them to pursue careers in medicine. On the national level as Mentorship Coordinator, she organizes the Brown and Garcia-Sancho program, analyzes the effectiveness of the program, and seeks to share the value of mentorship with as many as she can reach. **Categories:** mentorship **Tags:** #womeninsugery, ILookLikeASurgeon, WomenSurgeons --- ### [It Takes a Village](https://blog.womensurgeons.org/it-takes-a-village/) **Published:** September 27, 2021 **Author:** Blog Team **Content:** *By: Ana Sofia Ore, MD MPH* My journey away from home started before residency, when I moved to Boston to start my research training. I had fears of how welcoming the city would be to a hispanic woman starting to immerse into surgical research and training. I was fortunate to then match for residency here. It’s been five years since I moved to Boston, and it truly feels like home. But what makes it *home*? The answer is simple. The community I have here. When I think of **\#HispanicHeritageMonth**, that’s the first thing that comes to my mind. I think of the community that I am now a part of and the importance of having that in my personal and professional life. A major part of this community are my co-residents. I feel incredibly blessed having peers that understand me, in some cases have similar backgrounds as me, share my goals and fears about the future, and understand how difficult it is to have our loved one’s thousands of miles away. Having a conversation in Spanish in the resident lounge after a very long hard day at work is invaluable and it can fix any bad day. The pandemic has been emotionally challenging for a lot of people and it can be especially terrifying to know that you are so far away from your loved ones. Travel restrictions and immigration delays have made it almost impossible for many of us to travel home. Many of us have not seen our families since the pandemic started and having a supportive environment at work has made it all much more tolerable. Another big part of my community is our large Hispanic patient population. I am grateful I can offer them relief by having a conversation in Spanish and make them feel understood and validated. There is no better sense of belonging than being able to care for your community and to try to break down the barriers that impact their care. My community also lives at home. Having a hispanic partner that shares my values and introduced his Bostonian/Dominican culture into my life makes me feel supported and is the foundation of why I can call this city home. Sometimes you are lucky and will find your community immediately, sometimes you have to work hard to build it. When choosing where to live, whether it’s for residency, fellowship or to practice, having a sense of belonging is something that no one tells you to prioritize. I can’t emphasize enough how important this has become in my life and the positive impact it has on my wellness and ability to keep working hard in order to continue to achieve my goals. Being a female hispanic surgeon in training is challenging. Being a foreigner is sometimes terrifying. But finding a community and feeling like you belong has been crucial during my training. It truly takes a village. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/ana-241x300.jpeg)Dr. Ana Sofia Ore is a general surgery resident at Beth Israel Deaconess Medical Center in Boston, MA. Currently starting her first year of research elective. She is a postdoctoral research fellow at the National Center for Functional Glycomics at Harvard Medical School and is focusing on translational colorectal cancer research. Born and raised in Lima, Peru, after finishing medical school, Ana Sofia joined the Master of Science in Clinical Research program at the Dresden International University in Germany. After graduating she moved to Boston where she completed a research fellowship at the Pancreas and Liver Institute at BIDMC. During this time, Ana Sofia also received her MPH from the Harvard T.H. Chan School of Public Health with a concentration in Clinical Effectiveness and Public Health Leadership. She is the founding Chair of the Diversity, Inclusion and Advocacy Council for all residents and fellows at BIDMC, and is passionate about health disparities and improving surgical outcomes in underrepresented populations. In her free time, she enjoys cooking Peruvian food and hiking in New England. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, hispanic heritage, reflection, residency, URiM --- ### [How summer schools can fill the gap in Global Surgery knowledge of medical students and surgeons](https://blog.womensurgeons.org/how-summer-schools-can-fill-the-gap-in-global-surgery-knowledge-of-medical-students-and-surgeons/) **Published:** September 23, 2021 **Author:** Blog Team **Content:** *By Gabriela Azevedo Sansoni* Global Surgery is a hot topic, but is it often part of formal [curricula](https://pubmed.ncbi.nlm.nih.gov/28767491/) for [medical students](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119110/#) and surgical trainees? A lot of [papers](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015709/) [have](https://pubmed.ncbi.nlm.nih.gov/25911458/) been published calling attention to gaps in education about Global Surgery, and more generally, Global Health, in medical education. In theory it would be possible to squeeze in another mandatory course and add a few more hours of lectures and seminars for the already busy students and residents. But would it be efficient? I, of course, don’t have this answer. I do think, however, that Global Surgery is an important yet not-often-mentioned topic, particularly compared with other surgical specialities. Global Surgery education should guide and capacitate surgeons (and nurses, anesthesiologists, OR assistants, etc) to work in different settings with varying levels of resources. I am privileged, in a certain way, for having personal and educational experiences in low and high resource hospitals, middle and high income countries. I am interested, in the future, to practice in diverse environments, so I felt that I needed a better understanding of the topic. Since I know that my university does not include extensive lectures about the topic, I decided to apply for a scholarship to the Utrecht University Summer School. I was very grateful to receive a fee-waiver that allowed me to join their programme on Global Surgery & Ob-Gyn. I was in a virtual classroom together with other medical students, surgical residents, and surgeons. The environment was super international – I was following the courses from Rio de Janeiro, Brazil and there were colleagues from Ghana, Sierra Leone, Hong Kong, Germany, Suriname and the Netherlands, just to mention a few. The lectures were given by equally international specialists which made the whole course a real co-learning experience. It was a safe space for listening to diverse experiences, viewpoints, and teachings from different places without the (neo-)colonizing [approach](https://www.facs.org/publications/newsletters/ras-news/january-2021/global-surgery) that is sadly sometimes observed in Academic Global Surgery & Global Health. Everyday there would be an open invitation for someone to discuss a relevant case to start the day. I had the opportunity to present a case from my hemato-oncology internship done in Brazil that served to kick off the Global Oncology day of the summer school and to shine a light on how low resource places deal with the high burdens of oncological diagnosis, treatments, and follow ups. Some interesting ethical questions arose – for example, what if you are practicing in a low resource country that allows you to be creative and use techniques and materials that would never be approved by the high resource country where you trained as a surgeon- would you operate the patient using these? Some heartbreaking stories were told – have you heard of Chanceline, who had to walk 5h to the doctor’s [appointment](https://www.youtube.com/watch?v=mjxjKuMkTgw) when she was pregnant? And also some heartwarming moments happened – when everyone shared pictures of the sky of where they were or when someone’s baby loudy announced it had woken up to the whole Zoom meeting just after one of the heartbreaking stories. Overall, I found the summer school to be the right fit for me to engage with a subject in which I felt my knowledge was lacking. [Similar](https://www.conted.ox.ac.uk/courses/global-surgery) [programmes](https://med.umn.edu/surgery/global-surgery-disparities-program) exist in Europe and beyond, and I recommend anyone interested in learning more about Global Surgery to spend part of their summer (or fall, or winter!) focusing on it. Gabriela Azevedo Sansoni is a student at the International Medical School University of Milan. She is the president and founder of the Association of Women Surgeons chapter in her university and coordinates different projects with her peers that aim to bring surgery closer to medical students. Instagram @awsunimi Website: <https://womensurgeons.wixsite.com/milan> --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, education, global surgery, medical students --- ### [It’s a vast wonderful world: National Hispanic Heritage Month Begins](https://blog.womensurgeons.org/its-a-vast-wonderful-world-national-hispanic-heritage-month-begins/) **Published:** September 16, 2021 **Author:** Blog Team **Content:** By Chantal Reyna, MD It is that time of year… National Hispanic Heritage Month!!! From September 15th to October 15th, it is time to recognize the Hispanic and Latinx communities. <https://www.hispanicheritagemonth.gov/> highlights the celebration of the Hispanic and Latin cultures and provides a list of activities throughout the month. AWS is supporting this month by working with the [Latino Surgical Society](http://www.latinosurgicalsociety.org) and creating a Sunday Blog Series dedicated to National Hispanic Heritage Month, written by Hispanic/Latina AWS members. As awareness of diversity increases and research aims at health disparities, some questions arise regarding Hispanic vs Latin terminology. Previously, these terms have been used interchangeably in both vernacular and research language starting in the 1970s as a general catch all phrase. I recently recognized this while working on a health disparities talk and noticed that some papers used Hispanic and some used Latina, but did not define the differences if any. However, there are differences between the two based on colonization and language. Wikipedia states “[*Hispanic* includes people with ancestry from Spain and Latin American Spanish-speaking countries, while *Latino* includes people from Latin American countries that were formerly colonized by Spain or Portugal.](https://en.wikipedia.org/wiki/Hispanic_and_Latino_(ethnic_categories))” For me, I like visuals as it allows me to easily see the similarities and differences between the populations: ![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/HHM-1-300x169.jpg)[![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/HHM.tiff)](https://blog.womensurgeons.org/wp-content/uploads/2021/09/HHM.tiff) More recently, language has been shifting. Latinx is a new pan-ethnic, gender neutral term being introduced to describe the U.S. Hispanic and Latin Population. A [Pew](https://www.pewresearch.org/hispanic/2020/08/11/about-one-in-four-u-s-hispanics-have-heard-of-latinx-but-just-3-use-it/) research study showed that while the label is being applied, only 3% of the described population use the term and less than a quarter have even heard the term. With all the changes and increasing awareness, the important thing is that there is a vast array of cultures that should be recognized during National Hispanic Heritage month. Please take the time to educate and immerse yourself in this wonderful world. Resources <https://www.pewresearch.org/hispanic/2020/08/11/about-one-in-four-u-s-hispanics-have-heard-of-latinx-but-just-3-use-it/> <https://www.britannica.com/story/whats-the-difference-between-hispanic-and-latino> [https://www.reddit.com/r/coolguides/comments/iwgpdu/dont\_panic\_read\_this\_guide\_on\_latino\_vs\_hispanic/](https://www.reddit.com/r/coolguides/comments/iwgpdu/dont_panic_read_this_guide_on_latino_vs_hispanic/) ![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/Reyna-240x300.png)Dr. Chantal Reyna is a fellowship trained, board certified surgeon, specializing in diseases of the breast. She completed general surgery residency at the University of Nevada School of Medicine, University Medical Center and Children’s Hospital of Nevada. Following her passion for breast cancer care, she pursued a fellowship in breast surgical oncology at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. She is now the Medical Director of the Crozer Health Breast Program and Chief of Breast Surgery. Her research interests include minimizing axillary surgery. She is a member of the Society of Surgical Oncology, the American Society of Breast Surgeons and Association of Women Surgeons. She holds committee positions in several of the organizations. She is an avid soccer fan and enjoys reading and traveling internationally. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, mentorship, networking, Underrepresented in medicine --- ### [The Rising Force of Female Neurosurgeons](https://blog.womensurgeons.org/the-rising-force-of-female-neurosurgeons/) **Published:** September 8, 2021 **Author:** Blog Team **Content:** *by Alex Miner* Two years ago, on my first day of medical school, I was touring the hospital with a group of classmates when our tour guide asked us if we knew which specialties we were interested in yet. I had just finished four years of neuro-oncology research after college and had fallen in love with neuroscience and neurosurgery about a decade before that; for a brand-new medical student, I had an unusually clear picture of what I hoped my future as a surgeon-scientist would look like. I had been asked this question before, and had received enough incredulous reactions about how the training for neurosurgery was too long, too hard, or too unsuited to starting a family, that I had learned to modulate my response. Instilling some amount of ambivalence into my answer seemed to make people more comfortable, less intimidated, and less likely to question my decision. However, before I could give my carefully crafted reply, the girl next to me said resolutely, “Oh, it’s neurosurgery for me”. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/Screen-Shot-2021-09-08-at-6.10.35-PM-300x277.png)As it turns out, I would be one of not two, but three women in my class of only 43 students who had their heart set on a career in neurosurgery. These wonderful women would become both my inspiration and support system throughout our medical school experience. Our small group of future female neurosurgeons is a microcosm of the rising force of women in neurosurgery on the national level. Neurosurgery, along with orthopedic surgery, interventional radiology, and cardiothoracic surgery, is one of the few remaining medical specialties with a stark gender disparity. Women currently account for only 1 in 20 of the practicing attending neurosurgeons in the country and hold even fewer of the leadership positions within departments and national organizations. Although it wasn’t until 1960 that the first woman became board-certified in neurosurgery, the field has come a long way since then. As of last year, 19.3% of neurosurgical residents are women, compared to only 12% in 2009, and 92% of neurosurgical residency programs include female trainees. There are now 5 female chairs of neurosurgery departments and Dr. Shelly Timmons became the first woman to serve as president of the American Association of Neurological Surgeons (AANS) in 2018. I have been lucky enough to come across a few phenomenal female neurosurgery mentors, and even though they trained in an era when they were unlikely to have found female mentors of their own, they often remark that they don’t see themselves as trailblazing female neurosurgeons, they are just great neurosurgeons, period. In a way, it is this mentality that has allowed the field to grow and diversify so genuinely. The women who have changed the face of neurosurgery are, at their core, just surgeons who were determined to do what they love despite the obstacles they would face. There is also a natural camaraderie among the women in neurosurgery. The [Women in Neurosurgery (WINS)](https://twitter.com/WINSneurosurge1) organization was founded in 1989 to bring together the small community of practicing female neurosurgeons, which at the time was only 23 women, and has grown to have over 200 members who gather at national meetings and collaborate on various diversity, mentorship, and research initiatives. I recently attended the first session of a new WINS mentorship program that pairs groups of medical students with female neurosurgery residents to offer advice and a sense of community throughout their journey to neurosurgery. It was incredibly heartening to spend an evening chatting with driven women from around the world who could one day be my colleagues. For once, there was no questioning or cautioning, just support, encouragement, and a shared love for an amazing profession. Many people say choosing your specialty in medicine is about finding your people, and I can’t think of a group of women, however big or small it may be, I’d rather spend the rest of my career with. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/Women-in-Neurosurgery-Books-300x149.png) *Biographies by women in neurosurgery documenting their unique experiences, written by Katrina Firlik, Frances Conley, and a collection of current WINS members.* ![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/The-Neurosurgeons-Studio-300x151.jpeg) *Painting of a female surgical team in the OR by neurosurgeon and artist Kathryn Ko.* ![](https://blog.womensurgeons.org/wp-content/uploads/2021/09/Alex-Miner-Bio-Pic-300x295.jpg)Alex Miner is a third-year medical student at Virginia Tech Carilion School of Medicine in Roanoke, Virginia. She received her B.A. from Vanderbilt University where she majored in Neuroscience, Molecular & Cellular Biology, and Italian, and her M.S. in Biomedical Science from the Icahn School of Medicine at Mount Sinai. Prior to medical school she completed her master’s thesis on genetic mechanisms of drug resistance in glioblastoma and worked as a figure skating coach and science teacher in New York City. Her current academic interests include neuro-oncology, global surgery, science writing, medical humanities, and data science. Outside of the lab and hospital you can find her reading, running, and on Twitter @AlexMiner93. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, gender differences, mentorship, Neurosurgery --- ### [How was your day?](https://blog.womensurgeons.org/how-was-your-day/) **Published:** September 2, 2021 **Author:** Blog Team **Content:** By Alyssa Brown How was your day? This is always such a loaded question. It also probably explains why I don’t call my family and non-medical friends as much while I’m on the trauma ICU rotation. I want to tell them everything I saw that day, but I also don’t. I know they probably don’t want to hear it—the gruesome details of: unhelmeted motorcycle accidents, stabbings, shootings, and car accidents. The patient list keeps stacking up as we move through the 24 hour shift, and the pager keeps ringing. As a patient is discharged from the ICU, another gets admitted and takes their place. They ask me how my call was – I usually reply “busy” and keep it at that. They don’t need to know I watched a septic patient code twice, a gunshot victim come in dead on arrival, or about the knife wound that wouldn’t stop bleeding. They don’t need to know that I’ve changed my scrubs twice because of blood splatter or that I have eaten mostly Zesta crackers and peanut butter for the last 24 hours. They ask if I got any sleep, and I reply “some”. I think dozing off for a few minutes in the workroom counts. These are details that are best left to the people inside this world. To the outside world, I am just coming and going from the hospital. The details to them remain a vague mystery. On the first day, I mentioned to my parents what we had done. A burn patient needed a central line and a motor vehicle accident patient needed to have his abdominal wound closed. They shuddered. They clearly did not want any details. They didn’t want to hear about it. I guess it makes sense. How many people realistically want to listen to the stories of death and destruction? They wanted their daughter to be a doctor. They didn’t and probably don’t quite grasp what I am seeing every day in the trauma ICU. With people in medicine, we share everything in gory detail. We share war stories of terrible cases. It is a little macabre. We all have our stories. I think it is just our emotional processing of this daily and repeated trauma in front of us. In the darkness though, there were moments of light. There were some people who got better. There were many small miracles too: a patient waking up to talk to their family before later passing, patients being surrounded by so many family members and friends, family’s deciding to donate the organs of their loved ones. Also, sometimes, we just had to laugh at the unexpected. We laughed with our patients and together with the team sometimes. One day, I couldn’t find the team, until I peered into the breakroom and found them snacking on some sherbert pilfered from the fridge. The attending called it sherbert rounds, and he stated we needed something good to start the day. We laughed until we cried the day that we ordered Thai food, and when it didn’t show up, we realized we had ordered it from New Mexico rather than Kentucky. Some days these laughs and small miracles were how we survived. There is a code in medicine that what we do stays within the bounds of the hospital and the people that work there. It is so hard to explain “how was your day?” I don’t usually have a good answer to outsiders, and I don’t want to be too honest. I do wish they could stand at the window some days and see the care and compassion of the people inside. I wish they sometimes understood a little better how the day had been. Maybe it is a balance between letting friends and family see a small window in, but not revealing too much of the full picture. Either way, I know the small miracles, big miracles, and laughs are sometimes what sustains us through the darkest times. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/08/Brown.jpeg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She just started her fourth year back at Louisville (clearly). Her thesis research is on diaphragm muscle mitochondrial function and morphology. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past two years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram @Alyssa\_b\_futuremdphd and on Twitter @Alyssa\_B\_MDPhD. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** #AssociationofWomenSurgeons, ICU, medical students, trauma, womeninmedicine, WomenSurgeons --- ### [Coming Home](https://blog.womensurgeons.org/coming-home/) **Published:** August 26, 2021 **Author:** Blog Team **Content:** By Alyssa Brown I left Louisville 2 years and 51 weeks ago- now I am back. When I moved to Minnesota to get my PhD, I knew that I would come back. It was always a temporary goodbye to the hospital. Graduate school was difficult in its own ways. I loved my years spent in research, but I missed the operating room and patients. I snuck back into the operating room many times over those three years; I couldn’t help myself. Now, I am back, back for my fourth year of medical school. Two days after unloading my car and moving truck, I started a month-long acting internship in the Trauma ICU. It was my acting internship in general surgery and I barely slept the night before. I packed my tote bag with all the essentials, found my white coat, and headed in at 4:30 am. The roads were empty and quiet. I had forgotten that feeling. The silence of the mornings going into the hospital. As soon as I got to 9 West, I met my team and tried logging into the electronic medical record. I had prepared by making sure my log-in worked over the weekend, but of course, I could not log in once I got to the hospital. I spent the next 20 minutes of precious pre-rounding time on the phone with the help desk trying to get logged in. Finally, 2 minutes before rounds started, I was able to see the patient list. I felt like an idiot. It was my first day back in years, and I already felt behind. As we began to round with the team, I had a surprising happy reunion. The third-year resident was my classmate from medical school. It required some explaining for everyone else on the team to understand why I was now a fourth-year medical student while he was a third-year resident. It was so nice to see a familiar face in the hospital. During rounds, I immediately noticed that I had forgotten many things in my time away, but I also remembered many things. So many things immediately felt familiar. The rhythm of rounds and the “ducks in a line” feeling of rounding felt so good. I kept writing things down in my little notebook to look up later. After rounds, the intern had me tag along for a consult. It was a complicated case – a man with terminal cancer who had attempted suicide. The family decided to withdraw care and the consult ended with us pronouncing the patient’s death. It really punctuated the change from my PhD program to my MD program. In my PhD program, I was learning and doing experiments, which were stressful, but it was a very different stress from the hospital. It was not life or death for anyone involved. I could go home after a day in the lab and relax and move on. After a day in the hospital, I am often still left thinking of what I could have done differently or what I could have done better for the patientLater that afternoon, I went to see a patient by myself, and I was so nervous that I wouldn’t remember the questions to ask. The nerves faded as soon as I walked into the room. To use the overused metaphor, it was like riding a bike. I was shaky at first, but I felt occasional moments of stability and regained some confidence. After a week, it felt like I had never left. I would wake up, throw on my scrubs, compression socks, and clogs. I still got lost like I did during third year, but I remembered how to do the basics. I tried to figure out ways to help the team, even with small tasks or jobs. I loved waking up every day to come in. The hardest part of the transition was returning to patient care and handling the emotional toll of the Trauma ICU. We had many deaths, but we also saved many lives. As one attending pointed out, we remember the bad ones more than the good. I had not forgotten that part of medicine, but I had had a three year break from it. I am still the black cloud that I was before. I am still trying to figure out how to distance myself some days from the emotional toll of medicine, especially with the incredibly sick patients, like the ones in the Trauma ICU. I will continue to remember the moments of light though. The first rotation back will always be the hardest. I had forgotten so many things, but, more importantly, I remembered, like I always have, my love of surgery. I love being with patients, spending time in the operating room, and working with the team. As I move onto pediatric surgery, It feels so good to be home. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/08/Brown.jpeg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She just started her fourth year back at Louisville (clearly). Her thesis research is on diaphragm muscle mitochondrial function and morphology. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past two years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram @Alyssa\_b\_futuremdphd and on Twitter @Alyssa\_B\_MDPhD. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** #AssociationofWomenSurgeons, #womeninresearch, medical students, Surgical Education, womeninmedicine, womeninsurgery --- ### [Infertility and Pregnancy in Women Surgeons: Taking Action to Create a Welcoming Practice Environment for Women Surgeons](https://blog.womensurgeons.org/infertility-and-pregnancy-in-women-surgeons-taking-action-to-create-a-welcoming-practice-environment-for-women-surgeons/) **Published:** August 20, 2021 **Author:** Blog Team **Content:** By Alyssa D. Brown, Morgan S. Levy, and Amelia G. Kelly As many as 1 in 4 women physicians will be [diagnosed with](https://pubmed-ncbi-nlm-nih-gov.access.library.miami.edu/25273522/) [infertility](https://pubmed-ncbi-nlm-nih-gov.access.library.miami.edu/27347614/). Unfortunately, this number is likely [higher for those in surgical specialties](https://pubmed.ncbi.nlm.nih.gov/25260684/). A variety of factors relating to the stressful lifestyle of medicine and medical training likely contributes to this high infertility rate. These factors include delayed childbearing, irregular work hours, and lack of partnership, among [other reasons and factors](https://pubmed-ncbi-nlm-nih-gov.access.library.miami.edu/31738214/). As more women continue to join medicine, and generally train as surgeons, infertility and family building are concerns that many will face. Even on this blog, multiple surgeons have shared their challenging journeys through infertility, egg freezing, and struggles with building a family. In addition to challenges becoming pregnant, female surgeons face unique burdens once they achieve pregnancy. [Recent studies](https://jamanetwork-com.access.library.miami.edu/journals/jamasurgery/article-abstract/2782357) have shown an increased risk of pregnancy complications and loss among surgeons, particularly when operating for more than 12 hours a week while pregnant. This paper also highlighted how postpartum, female surgeons are also more likely to have musculoskeletal disorders related to pregnancy and postpartum depression, adding to their overall maternal morbidity. Women in procedural specialties are also [less likely to breastfeed](https://jamanetwork-com.access.library.miami.edu/journals/jamainternalmedicine/fullarticle/2674255e%20Mothers.%20JAMA%20Intern%20Med.%202018;178(8):1130%E2%80%931132.%20doi:10.1001/jamainternmed.2018.0320), which is likely related to the demands of the surgical working environment. In spite of the aforementioned challenges, family building and planning are rarely addressed in medical education at any level of training, especially in surgical specialties. For a long time, these subjects have been taboo within the medical community and even more so in male-dominated specialties. This pressure to keep family building topics out of the medical sphere ultimately leads to [less open discussions and more burnout.](https://pubmed-ncbi-nlm-nih-gov.access.library.miami.edu/32472336/) To allay this pressure, many women will therefore get their information from peers, online support groups, or places like the Association of Women Surgeons (AWS) Blog. As leaders in the [American Medical Women’s Association Physician Fertility Initiative](https://www.amwa-doc.org/our-work/initiatives/physician-infertility/), we have listened to the stories of many women physicians who have experienced these journeys and are [taking action to improve family building for women physicians](https://www.instagram.com/p/COA0PsMheHI/?utm_source=ig_web_copy_link). Over the years, the AWS Blog has been an inspiring platform for women to share their powerful stories, including those about [fertility ](https://blog.womensurgeons.org/awareness/egg-freezing-facts-for-female-physicians/)[preservation](https://blog.womensurgeons.org/health/my-saggy-ovaries/)[,](https://blog.womensurgeons.org/family-life/peri-menopause/) [infertility treatment](https://blog.womensurgeons.org/awareness/egg-freezing-facts-for-female-physicians/), [pregnancy](https://blog.womensurgeons.org/awareness/making-it-work/), [breast feeding](https://blog.womensurgeons.org/family-life/comfortably-chaotic/), [family buildin](https://blog.womensurgeons.org/parenting/building-family-surgery/)g, and [being a mother](https://blog.womensurgeons.org/family-life/keys-to-success-in-arranging-childcare-for-surgeon-parents/) in [surgery](https://blog.womensurgeons.org/family-life/on-being-a-mom-surgeon-and-wife/). This platform allows women surgeons to normalize the unique challenges that they face as women in surgery, including when trying to build a family. To promote the health and success of women in surgery, we must continue to have these conversations, both online and in the operating room. This will help to ultimately create a surgical practice environment that is more adaptable to childbearing. These changes will not only lead to healthier moms, but also encourage more women to pursue and feel welcome remaining in careers in surgery. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/08/Brown.jpeg) Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, [before finishing her MD](https://blog.womensurgeons.org/medical-students/waiting-your-turn/). She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. Her thesis research is on diaphragm muscle mitochondrial function and morphology. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved [writing pieces](https://blog.womensurgeons.org/medical-students/black-clouds/) for the [blog](https://blog.womensurgeons.org/mentorship/prosciutto/) over the [past](https://blog.womensurgeons.org/medical-students/the-distance-between-two-worlds/) [two years](https://blog.womensurgeons.org/medical-students/confessions-of-an-ill-equipped-third-year-medical-student/). During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram [**@Alyssa\_b\_futuremdphd**](https://www.instagram.com/alyssa_b_futuremdphd/) and on Twitter [@Alyssa\_B\_MDPhD.](https://twitter.com/Alyssa_B_MDPhD) ![](https://blog.womensurgeons.org/wp-content/uploads/2021/08/levy-1.jpeg) Morgan S. Levy is a second year MD and Master’s in Public Health Student at the University of Miami Miller School of Medicine. She graduated from Lafayette College in 2019 with a Bachelor of Science in Biology, with a minor and honors in Psychology. Prior to medical school, Morgan served as an AmeriCorps member at Zufall Community Health Center. Her research interests include gender equity in medicine, infertility, and gynecologic cancers. She plans to pursue a career in Obstetrics and Gynecology. Morgan’s hobbies include kickboxing, cooking, reading, and hanging out with her cat, Kacey. Connect with Morgan on Twitter and Instagram @MorganSLevy ![](https://blog.womensurgeons.org/wp-content/uploads/2021/08/kelly.jpeg) Amelia G. Kelly is a fourth year obstetrics and gynecology resident at New York University Grossman School of Medicine. She is planning on pursuing a fellowship in Reproductive Endocrinology and Infertility. She attended medical school at Weill Cornell Medical College She is the resident co-chair for the American Medical Women’s Association Fertility Committee. In her free time, she enjoys skiing, hiking, and jogging outside as well as spending time with friends and family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life, parenting **Tags:** #infertilitysucks, parenting, pregnancy, womeninsurgery --- ### [Taming the Shrew Called Anxiety](https://blog.womensurgeons.org/taming-the-shrew-called-anxiety/) **Published:** August 12, 2021 **Author:** Blog Team **Content:** By Jamesa Fabien A million thoughts raced through my mind: “Need to do well on Step” “Need to publish” “Need to network” **“Need to be** **EXTRAORDINARY!!!”** I struggled to focus on the text before me, but the concert of thoughts dancing in my mind won the competition. I crumbled in defeat, unable to do what needed to be done in the moment. This was the story of my first few semesters at medical school. I knew that I wanted to be a surgeon and that it would be a challenge. However, instead of being able to rise to the challenge, I was repeatedly crushed by anxiety and fear of failure and these posed an even greater challenge. I sought desperately to find solutions. First, I tried meditation in my quest to get my life back on track. My first attempt actually raised my anxiety; I could not turn off my thoughts. I wanted to be great at meditation and expected to be healed instantly; however, just sitting there and achieving nothing at all when I had so much work to do DROVE ME NUTS! Frustrated by my failed attempts at meditation, I tried painting, but I completely missed the point, wanting to be an overnight Picasso. Mediocrity was not an option. I was devastated by the amateur quality of my initial efforts. With increasing desperation, I enrolled in therapy. I would have amazing sessions with my therapist – arriving super anxious and leaving somewhat calm; only to find that good old anxiety came right back knocking on my door like a dearly beloved neighbor. The problem was not that these methods lacked the potential to be effective; it was that **I was so caught up in my end goal of becoming a successful surgeon that I was not enjoying the journey.** The exhilarating journey of a student in medical school, the gratifying journey of being able to focus my mind through meditation and find peace through painting **I was not truly living my best life.** As my feasible options decreased, I kept trying and failing until at some point **SOMETHING MAGICAL HAPPENED!** I began to love those moments when I would sit in silence and focus on my breathing. It became a joy taking a break from my mind. I came to the realization that the world is so much more beautiful when you practice mindfulness, when you take a moment to get out of your head and just bask in the uniqueness of the situation around you. I also began to cherish every brush stroke, learning to enjoy the process of giving birth to something unique and letting go of the quality of the final product. I learnt to think like my therapist – to be as kind to myself as she was to me; to practice gratitude; to celebrate my wins – the big, the small, the in-betweens; to accept that it is ok to be afraid, without letting the fear control me. Above all else, I learnt to hand over my battles to God. **As a result of my struggle with anxiety, I have become a better person and ultimately, I will be a better surgeon. Far too often we fixate on our destination – our goals, and forget to enjoy the journey. I’m forever grateful that my struggle with anxiety caused me to wake up.** ![](https://blog.womensurgeons.org/wp-content/uploads/2021/08/Picture1.png) Jamesa Fabien is a rising third-year medical student at Ross University School of Medicine. She is a native of the nature island of the Caribbean, Dominica. She is an artist and nature enthusiast. Jamesa currently serves as Diversity and Inclusion Co-Coordinator on the AWS National Medical Student Committee and as Co-Chair of the AWS Instagram Sub-Committee. She is passionate about encouraging others, especially the under-represented, to pursue their dreams. She believes that despite what your circumstances may look like, it is of paramount importance to remain faithful and keep working hard for the results you want to see. In her spare time she channels her creative energies into painting, specializing in medical and Christian based art. She can be found on Instagram @jamesafabien and her artwork can be found on her Instagram business page @youngandhustlinng --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, reflection **Tags:** anxiety, Medical Student Members, medical students, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Studying for the USMLE as an IMG During the COVID-19 Pandemic and Working as a Research Trainee: My Experience](https://blog.womensurgeons.org/studying-for-usmle-as-img/) **Published:** August 5, 2021 **Author:** Blog Team **Content:** By Susana Fortich, MD Nothing had prepared me for what to expect when I made the decision to start studying for the USMLE step exams in December 2019. This is one of the most demanding experiences you will have as a medical student. But, for me, it was a little different. I had already worked as a physician for a year in my home country, Colombia, before I decided to prepare for this journey. So, restarting a study routine was one of the biggest challenges for me. I moved to the United States in January 2020 and I enrolled in a well-known course to prepare me for Step 1. I diligently worked daily on a series of question banks that were commercially available. This test is about consistency and discipline. Repetition was for me the key to success. Then the pandemic came, and all courses were cancelled. It was challenging to stay focused after being home all day studying for Step 1. My advice to my fellow-IMGs? Remind yourself of the goal, remind yourself where you come from and what you want to achieve. The pathway for me, as an IMG, is not easy, and I know it. But I hope that my hard work will pay off. Without noticing, nine months passed and I had not seen my family. The pandemic not only prevented me from spending time with my family, but it also took the opportunity from being able to obtain clinical experience in the United States. Virtual observerships became my only option. My goal is to be able to match to a surgical training program and it was recommended that I pursue research training as well. I found a position in Florida within a surgical department of a well known health care facility. Since the start of this new challenge, my days have been filled with studying for Step 2 CK and learning how to manage databases and conduct clinical research. I am faced with challenges daily and I have learned how to organize myself and how to ask clinical questions of interest for follow-up projects. I have since passed Step 2 CK, and I see slowly that my name is appearing on published manuscripts. I feel confident in the process of my growth and development and I am most grateful for the opportunities that I have been given. I am extremely thankful for having met the people that I have as all of them have helped me along in this most exciting ride. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/08/aws--854x1024.png) Susana Fortich is an international medical graduate from Colombia. She graduated as an outstanding student from Universidad del Norte, Colombia. In the future, Susana hopes to pursue residency training in General Surgery in the United States. She is an avid soccer fan and player, an advanced scuba diver and an amateur photographer. Twitter: @SusanaFortichS --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** #IMG, COVID-19, USMLE, womeninsurgery, WomenSurgeons --- ### [COVID-19 Pandemic: Experiences of a Surgical Resident in a COVID-19 Dedicated Hospital](https://blog.womensurgeons.org/covid-19-experiences-of-a-surgical-resident/) **Published:** July 30, 2021 **Author:** Blog Team **Content:** By Dr. Maymona Choudry When the first case of COVID-19 broke out in the Philippines, in an attempt to limit the spread of the infection, “Community Quarantine” by the government, with varying levels of strictness were imposed throughout the country. In March 2020, the government of the Philippines under President Rodrigo Duterte imposed an Enhanced Community Quarantine (ECQ) in Luzon, which placed restrictions on the movement of the population except for necessity, work, and health circumstances. For me, it felt somewhat surreal. I thought to myself that the infection would not reach our region in Visayas. However, when we had our first case in Cebu province, we started to receive directives from our Department Chair to change our schedules, and go on skeletal duty. In Visayas, as cases of COVID-19 infection were on the rise, Vicente Sotto Memorial Medical Center was designated as the dedicated COVID-19 hospital in the region. In preparation for this, the Infection Control Committee (ICC) of the hospital was able to come up with a screening protocol and classification system of patients suspected to have COVID-19 infection. Healthcare workers became the front-liners in this pandemic. During the first few weeks, we would receive a lot of relief goods from different organizations and companies, delivering us meals and goods such as surgical masks, N95, and other personal protective equipment. In the Department of General Surgery, when we first had an encounter in the Surgical ICU with a critical case of COVID-19 positive patient in a previously negative patient, that was the moment that everything changed. This was the time that I felt the virus was as close to me as the air I breathe. Knowing the imperfections of the triage and the screening processes, I felt that wearing an N95 mask was not enough. The department started taking drastic measures to ensure the safety of the residents, and our schedule was changed, wherein we would stay at the hospital for duty for 7 straight days, then go on home isolation for 14 days of quarantine. Aside from this, the hospital required us to attend training sessions on the basics of what we needed to equip ourselves with if we ever encountered a suspected COVID-19patient. In the Operating Room (OR) and Emergency Room (ER), we were directed to wear level IV PPE during our encounters with suspected patients. The COVID-19 pandemic has taken a toll on each and every person, especially the front-line health-care workers. It is much more difficult than it looks, especially when we were not even sure of what we were up against. The sense of duty and responsibility that each one of us has to carry is one of the most admirable characteristics that I see in my colleagues every day. The risks and adversities that each of us shoulder every day for the sake of our patients, our families, and our country is the most valuable asset that each person has contributed in our fight against the virus. Due to this pandemic, a “new normal” has emerged in healthcare practices that demonstrates how flexible and adaptable medicine is to changes and trends in the environment. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/07/Picture1.png) Maymona Choudry, MD, MPH, was born in Kingdom of Saudi Arabia. She completed her undergraduate studies in Bachelor of Science in Nursing at Ateneo de Zamboanga University. At the age of 18, she proceeded to complete her graduate studies with a dual degree in Doctor of Medicine and Masters in Public Health from the same institution. She is a General Surgery resident at Vicente Sotto Memorial Medical Center, Cebu City. Her interests include Thoraco-Cardiovascular Surgery, Global Surgery, Surgical Critical Care and Public Health. She is a member of Association of Women Surgeons, American College of Surgeons, Philippine College of Surgeons, and many more. Her hobbies include writing articles, reading journals, and participating in various medical and surgical webinars. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** #globalpandemic, COVID-19, Philippines, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Spread the girl power](https://blog.womensurgeons.org/spread-the-girl-power/) **Published:** July 22, 2021 **Author:** Blog Team **Content:** By Alesha Ramírez Lobato Since I started as a medical student at one of the best universities in Mexico, I have thought about everything that facilitated me getting there. Mainly, I know that it was my parents who have supported me throughout my life on every occasion, but when I looked around and saw a room full of women, that’s when I knew the other reason. Getting to study for one of the most demanding careers has not only taught me medical or surgical skills, it has also taught me to break down barriers, limits, and stereotypes. Matilde Montoya was the first female doctor in Mexico, the country where I am from. This woman is not only an example to follow, and worthy of admiration for her perseverance and dedication, but she is also the reason why many Mexican women doctors can be in an operating room, hospital, or clinic nowadays. Dr. Montoya managed to break through and leave a huge and indelible mark in a territory in which we continue trying to advance today. Her story, apart from being inspiring for women, is also inspiring for society. She was supported by her mother but also found support in the president of Mexico at that time. Being able to guide a person to reach the top and also teaching that person to guide another is not a question of gender, it is a question of selfless altruism, of being able to create great things together and create a growth system for each other. Women can guide other women and other men, as well as vice versa. We must not forget that we are all part of the team and play key parts in this field. Our fight in the operating room should not be to be there – our fight is for the life of the patient, our fight is together as a team and not as gender rivals. Breaking stereotypes is one of the things that I have enjoyed doing the most throughout my entry into medicine. This goes from breaking them for myself to being able to help others break them. I also want to create an environment that promotes diversity and inclusion – taking into account race / ethnicity, sexual orientation, culture, socioeconomic level, and religion. We must strengthen each and every one of the areas that lead us to a diversity of thought and more inclusive growth and innovation, because we must not forget that a woman can inspire others by breaking stereotypes that are often one of the biggest obstacles we face as a society. It is essential that we support each other and help deconstruct this environment – spreading equal treatment, support, respect and, above all, taking female power out of the shadows. We must change imagining for creating opportunities for women to develop their full potential, and we can achieve that by planting the seed of change from within. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/07/aws-blog-pic-7.21.png) My name is Alesha Ramírez Lobato, I am a third-year medical student at Instituto Tecnológico y de Estudios Superiores Monterrey in Mexico City. I am currently the vice president of a student chapter that is part of the AWS. I am interested in choosing pediatric surgery in a few years and for now one of my greatest passions is to share a little of what I know with others and thus help them, I am a creator of medical content on tiktok with more than 20 thousand followers, you can find me @alesharmz.med --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** #diversityandinclusion, #girlpower, ILookLikeASurgeon, women of color, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Practicing medicine and surgery in different languages](https://blog.womensurgeons.org/practicing-medicine-and-surgery-in-different-languages/) **Published:** July 14, 2021 **Author:** Blog Team **Content:** *By Gabriela Azevedo Sansoni* One of the keys to a good healthcare professional and patient rapport is communication. This may seem obvious because it is very generic and can be applied to all human relationships, however, it is often overlooked or forgotten until a certain challenge or barrier makes you face this obvious truth. I have learned this lesson early in my medical education. I moved from Brazil to Italy to study in a six-year programme fully taught in English (mind you, by *Italian* professors). Since we train in Italian hospitals, we naturally need to become fluent in the local language by the end of the second year. Thankfully, I passed my Italian language exam by the end of the first year and achieved this requirement early on. To make things more interesting, however, I moved to the Netherlands in my third year for a research project, and extended my stay for some clinical and surgical rotations. Learning Dutch was completely different from learning Italian, it has been a bit over a year since I first opened a grammar book to study it and I am still an intermediate level speaker despite all my efforts. During a Nephrology rotation in the Netherlands, we had a very complex patient that came from Angola. I immediately suggested I could help, and went to visit her with a Dutch colleague. We introduced ourselves in the local language and I didn’t mention that I spoke Portuguese fluently because she seemed to understand Dutch well enough. However, when describing one of her symptoms, namely *fever*, she got stuck with the word and mumbled *febre* to herself. I realised it was the right time to intervene and re-introduce myself, this time in Portuguese. She was extremely happy with the fact and gave a lot more details about the history of her disease. When it comes to surgery, the drawbacks of thinking in a different language appear in the quickness of some interactions and informal chats during the surgical procedure. I can’t complain, however, because I had a very good team that was open to explaining things slowly for me if needed and I did not have any responsibility regarding explaining procedures to patients. Amid pandemic I was lucky to organize one of my rotations in a university hospital in my hometown, Rio de Janeiro. I knew it would be a challenging job, but I couldn’t wait to see patients who speak Brazilian Portuguese and do the anamnesis in my mother tongue. Moreover, I don’t think of stopping there. There are a few places I am curious about in terms of the health system and patient care. Some of them require fluency in another language, such as Luxembourg and its fluency in French *and* German requirements for foreigners. It is true that your native language is the one you feel more comfortable with during a medical visit. I often wait until I am on vacation in Brazil to book a medical appointment. This knowledge certainly motivates me to learn foreign languages up to the highest level possible, because if I ever need to use them for work I will have to be as fluent as a native speaker in order to offer the best care possible. Gabriela Azevedo Sansoni is a student at the International Medical School University of Milan. She is the president and founder of the Association of Women Surgeons chapter in her university and coordinates different projects with her peers that aim to bring surgery closer to medical students. Instagram @awsunimi Website: <https://womensurgeons.wixsite.com/milan> --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** communication, languages, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Avoiding Bias in Letter Writing](https://blog.womensurgeons.org/avoiding-bias-in-letter-writing/) **Published:** July 8, 2021 **Author:** Blog Team **Content:** *By Dr. Chantal Reyna* It [has been shown](https://www.journalacs.org/article/S1072-7515(19)30017-1/fulltext) that implicit bias exists within letters of recommendation written for medical students applying for residency. In regard to gender, female applicants [were more often described](https://www.mdpi.com/2075-4698/10/2/31/htm) using grindstone phrases such as “hardworking,” and their letters were more likely to include descriptions of their personal life and physical appearance. Meanwhile, males [were more often described](https://www.mdpi.com/2075-4698/10/2/31/htm) using standout adjectives such as “accomplished.” Their letters also included more references to research activities. These biases extend to underrepresented minority (URM) applicants as well. [Black applicants](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181659) [were more often described](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181659) as “competent” compared to white applicants who were more commonly described by “standout” phrases, even after controlling for USMLE scores. [Rojek et. al](https://pubmed.ncbi.nlm.nih.gov/30993609/) showed that word differences between non-URM and URM applicants’ letters had more competency based adjectives in non-URM letters while more personal attributes were used in URM letters. While these findings have been documented in residency applications, implicit bias can potentially affect a variety of letters of recommendation. It is important to minimize bias when given the opportunity to support someone’s growth and future. Letters are meant to provide the reader with an idea of the applicant’s professional ability and provide evidence to support it. There are several ways to accomplish this: 1. Use formal titles and surnames. 2. Describe accomplishments and ability. 3. Use observations and be specific. 4. Use standout objectives such as “excellent,” “accomplished,” “skilled,” “knowledgeable,” “insightful,” “resourceful,” etc. See the list of resources below for a more comprehensive collection. 5. Consider running your draft through a [gender bias calculator](https://www.tomforth.co.uk/genderbias). There are also pitfalls to avoid. These include: 1. Avoid physical descriptors. 2. Avoid describing effort and communal phrases such as “hardworking,” “affectionate,” “kind,” “warm,” etc. 3. Avoid doubt raising phrases such as “while not the strongest.” As we grow in our profession, we are given the privilege to help others follow in our footsteps. Writing letters of recommendation is an honor and privilege which demonstrates that the upcoming generations value our opinions and appreciate our support. Over the last several years, more effort has been directed to addressing implicit bias and increasing diversity, equity, and inclusion within the medical field. One area that we must tackle includes reducing bias in letters of recommendation. List of resources: 1. [Avoiding gender bias in reference writing, by the University of Arizona](https://csw.arizona.edu/sites/default/files/avoiding_gender_bias_in_letter_of_reference_writing.pdf) 2. [Best Practices for Reading and Writing Letters of Recommendation, by Lehigh University](https://advance.cc.lehigh.edu/sites/advance.cc.lehigh.edu/files/Letters%20of%20Recommendation%20One%20pager.pdf) 3. [Avoiding Bias in Recommendation Letters, by Georgetown University](https://crf.georgetown.edu/avoiding-bias-in-recommendation-letters/) ![](https://blog.womensurgeons.org/wp-content/uploads/2021/07/Reyna-240x300.jpeg)Dr. Chantal Reyna is a fellowship trained, board certified surgeon, specializing in diseases of the breast. She completed general surgery residency at the University of Nevada School of Medicine, University Medical Center and Children’s Hospital of Nevada. Following her passion for breast cancer care, she pursued a fellowship in breast surgical oncology at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. She is now the Medical Director of the Crozer Health Breast Program and Chief of Breast Surgery. Her research interests include minimizing axillary surgery. She is a member of the Society of Surgical Oncology, the American Society of Breast Surgeons and Association of Women Surgeons. She holds committee positions in several of the organizations. She is an avid soccer fan and enjoys reading and traveling internationally. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, gender differences, medical students, residency, Underrepresented in medicine --- ### [Comfortably Chaotic](https://blog.womensurgeons.org/comfortably-chaotic/) **Published:** July 1, 2021 **Author:** Blog Team **Content:** *By Amy Tefft* I started my intern year with an 8-week-old, but it was months before some of my colleagues knew that I had a child. I was quietly pumping alone in the bathroom, in between writing notes and orders and rushing to check more tasks off my to do list. At first, I didn’t want anyone to know I was a mom because I thought they might question my ability to perform my job. I didn’t bring it up because I didn’t feel like I owed anyone an explanation as to why I thought that now was the right time to build my family. At the time, I was the only woman in the program with a child. That was a scary prospect as a new intern and mom. It’s amazing how much has changed since that day. I’ve had two more children in my second and third years of residency. We have added four more pups to the family making a grand total of five dogs and three kids running around our house. My residency program now has several surgeon moms and dads. It’s not easy, and most days are exhausting. I come home from a 24-hour shift to three kids that have slept all night and are ready to play. Recently I came home to a baby with a GI bug who only wanted mom. This was soon followed by a trip to the ED with a dehydrated child with me barely making it out of the Emergency room before I succumbed to the dreaded stomach bug also. The night quickly became eventful,but I wouldn’t change it. The fact that I wake up in the morning with everything I’ve ever wanted isn’t lost upon me. I know that with everything in life this is all fleeting. So, I’ve learned to embrace the chaos of the life that we have created. As doctors, we witness the fragility of life every day. And if I have learned anything repeatedly, it is that time is a precious commodity. We are not promised or guaranteed anything. I think the hardest thing to overcome being both a surgical resident and a mother is managing guilt. Motherhood is fraught with guilt. When I started residency, I would feel incredibly guilty if an emergency kept me late at work. To make matters worse, I would feel guilty about being home and not being at work. The guilt still rears its head occasionally, but I have gotten better at accepting things that are out of my control as a resident. Car accidents happen, people get sick, and I must be at work when those things occur. I have fought very hard to become as efficient as possible to maximize my time at work and at home. My husband keeps the family going daily, and without him I wouldn’t have survived the last 4 years. If our roles were reversed, I’m certain I wouldn’t be as level-headed and reasonable as he manages to be. Motherhood is a test of patience and resilience, and so is residency. Most people look at us and don’t know what to say when we tell them we have three kids and a house full of dogs while I am completing a surgical residency. My husband has also obtained his MBA and worked full time. We created our lives, and our own version of happiness. And though we are tired, we have been incredibly fortunate. I am thankful for the journey and the people who have been our biggest supporters along the way. We are looking forward to the last year of residency and the next steps of our journey. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/07/Tifft-300x300.jpeg)Dr. Tefft is originally from Northfield, VT. She received her undergraduate degree from UC San Diego and her MD from the University of Vermont. She is about to start her 5th and final year as a general surgery resident at the University of Kentucky. When she is not at the hospital you can find her spending time with her family in Lexington, KY. After residency, she will be taking a position as a General Surgeon in Morehead, KY. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life, parenting, reflection --- ### [Achieving Diversity Through Inclusive Leadership](https://blog.womensurgeons.org/achieving-diversity-through-inclusive-leadership/) **Published:** June 28, 2021 **Author:** Blog Team **Content:** *By Monica Jain, MD and Sadia Tasnim, MD* Diversity and inclusion stimulate energy and drive performance – every individual that brings their unique perspectives to the team promotes creativity and innovation, improved decision-making and problem-solving, and enhanced engagement and well-being. P&G CEO Geraldine Huse creates cognitive diversity by “nurturing disagreement” and listening to every voice.In healthcare, we are working to mirror the corporate world with such an open philosophy on diversity. However, progress towards achieving diversity in medicine has been slow.Achieving institutional diversity requires inclusive leaders like Geraldine Huse. Unfortunately, [only 40% of executives](https://corpgov.law.harvard.edu/2019/05/20/unleashing-the-power-of-diversity-through-inclusive-leadership/) believe that fostering inclusiveness is a part of their responsibility as leaders. Inclusive leaders exhibit *awareness* and *commitment*. Here, we break down these traits within the context of the healthcare field. *Awareness:* Leaders empower people. They actively embrace peoples’ diverse perspectives. They give people opportunities.Inclusive leaders ensure fairness, respect, a sense of belonging, and psychological safety in order to allow all people to express their diverse perspectives. They understand the necessity of this, especially with regard to women, racial/ethnic minority populations, or others who may be outnumbered and/or historically neglected. Recognizing the lack of underrepresented minority individuals serving as faculty at academic medical centers, in 2010, a group of physicians founded [Building the Next Generation of Academic Physicians](http://bngap.org/about-us/) (BNGAP), an organization with the mission of helping “diverse trainees become aware of, interested in and prepared to explore academic careers.” BNGAP has provided underrepresented trainees with a forum to discuss their perspectives and longitudinal support, successfully heightening trainee career awareness, participation, and accomplishment. Inclusive leaders must be aware that they may have personal biases or blind spots. Being humble, keeping an open mind, and listening without judgement and with empathy is crucial to overcoming these biases or blind spots. Inclusive leaders are continuously developing their cultural intelligence. They understand that they must confront their institution’s weaknesses, barriers, and challenges in order to move forward on the path to diversity. Some institutions have established Employee Resource Groups (ERGs), where people are given a place to discuss the issues that affect them. These issues can then be escalated to a higher level, and leaders can take responsibility and manage them appropriately. [Cardinal Health boasts seven ERGs](https://www.cardinalhealth.com/en/about-us/our-people/diversity-and-inclusion/employee-resource-groups.html) which “help foster an inclusive and engaged workforce” and “help develop future leaders.” Each ERG is sponsored and supported by one senior executive. Furthermore, employees have also established three Multicultural Councils (MCCs) which “foster a diverse, inclusive workplace aligned with the organizational mission, vision, goals, business practices and objectives.” Through these groups, employees have held difficult conversations with senior leaders and have been able to stimulate real change in the culture of the organization. Another tactic is a concept advocated by Quint Studer, a nationally recognized healthcare organizational leadership coach, called “managing by walking around.” In this approach, leaders learn what is going on at the ground level of the organization by “rounding” – on the floors, in the ICUs, in the ORs, in imaging, in the pharmacies, in the sterile processing rooms, etc. Dr. Jain – By talking to physicians, trainees, nurses, clinical partners, pharmacists, technicians, environmental services, administrators, other employees, and patients, we harvest the collective insight of the people on the front lines in the institution. We can assess the pulse and can prescribe the necessary treatments to align the culture of the institution with the goals of diversity and inclusivity. A simple conversation on current events with a parking attendant at my institution brought a completely different perspective on the social injustices occurring across the globe and how they affected individuals, minority groups, our organization, our city, our country. This new insight eventually led to institution-wide conversations and projects to address connection, solidarity, and healing. Finally, leading by example is a necessity – inclusive leaders are constantly practicing awareness, and they are also constantly assessing their own impact. Inclusive leaders should demonstrate authenticity in and accountability for their actions. *Commitment:* Our institutional leaders’ primary goals are to define a vision for a better future and then motivate people to work towards that future.An inclusive vision is framed by the interests of all of the people touched by the institution, i.e. faculty, employees, patients, and the community at large.This vision aligns people and develops a sense of shared responsibility within the institution. The construction of diverse, cross-functional teams, in which no single group comprises a majority stake, allows all people’s voices to be heard and further drives collaboration and success. Mentorship and/or sponsorship from members within or outside of an institution is fundamental in promoting the advancement of people from minority backgrounds and generating the critical mass of desired diversity. Dr. Tasnim – As a minority woman of Islamic faith who moved to the United States on myown, I had experienced numerous struggles to even get to the point of interviewing for a surgical residency. During my residency interviews, one of the Associate Program Directors appreciated these struggles on his own, the very first time I met him. He immediately recognized the need for guidance and mentorship, especially in such a competitive field, and went above and beyond to connect me with the right people. And he envisioned the impact this would have, not only on the life of one surgical trainee, but also on the lives of all others following the same path. If the culture at an institution does not allow for such a vision, inclusive leaders change the culture to reflect the diversity and the institutional priorities. Through the establishment of concrete, relevant, measurable, and time-limited goals for diversity and inclusion, inclusive leaders provide focus, clarity, and practicality to their visions. For example, establishing a policy of transparency in the hiring and promotions processes engenders institutional accountability. Furthermore, a department chair can set a [goal of 30% diverse faculty hires within 2 years](https://bulletin.facs.org/2021/01/shoring-up-the-pipeline-increasing-diversity-in-surgery-by-enhancing-equity-and-inclusion-in-the-surgical-learning-environment/), and utilize this not only as a target, but also as a benchmark to monitor the department’s progress. Successful inclusive leaders can then communicate their best practices to other divisions, other departments, other centers, etc. and contribute to shifting the culture of the entire institution, and eventually, the entire industry It is unquestioned that diversity is obligatory, irrespective of the industry. Inclusive leaders who pay extraordinary attention to awareness and who are committed at the highest level are the keys to initiate and maintain diversity in healthcare. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/monicajain.png) **Dr. Monica Jain** is a General and Endocrine Surgeon and the Surgical Innovation Officer at Cedars-Sinai Medical Center. With a background in Biomedical Engineering and Healthcare Innovation, Dr. Jain is passionate about narrowing the divide between innovative technologies and their clinical applications. She has also developed and directed multiple leadership courses with the goal of empowering future physician leaders. She has consulted for and mentored numerous healthcare startup companies, and works on several leadership, education, clinical efficacy, human factors, and quality improvement projects. In her free time, she loves exploring the Los Angeles culinary scene and hiking with her husband and 1 year old daughter. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/sadia-tasmin-1.png) **Dr. Sadia** **Tasnim** was born and raised in Dhaka, Bangladesh. She completed her undergraduate degree at the University of Houston and her medical education at the University of Texas Medical Branch at Galvston, Texas. She is currently a surgical resident at Cleveland Clinic Foundation, Ohio. Her research interests include genetics, cardiothoracic, healthcare disparities, surgical education. In her free time, she enjoys painting, watching movies, exploring coffee shops, cooking, and baking. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** #diversityandinclusion, leadership, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [The Courage to Redefine Your Career While Ignoring “The Noise”](https://blog.womensurgeons.org/the-courage-to-redefine-your-career-while-ignoring-the-noise/) **Published:** June 23, 2021 **Author:** Blog Team **Content:** *By Dr. Brittany Johnson* I started my journey in medicine boldly confessing to my mother at the age of five that I was “going to be a doctor.” My trademark of setting a goal and never giving up established itself early. Today, I have fulfilled that promise, but this story has a twist. Halfway through my pediatrics residency, I decided to pursue pediatric surgery. There was great gravity in this decision. This would mean an additional nine years of training minimum, in addition to four for medical school and three for pediatrics residency I was already committed to. I attempted everything to run from this path. I negotiated the possibility of committing to less training; compensating by “enjoying more of my life”. Maybe what everyone said about surgical training was correct and by making this decision, especially late in training, I was doomed to always put career first and family second. Pediatric surgery fellowship is competitive. Was I willing to leave an all but guaranteed fellowship match and budding career as an academic neonatologist to chase a nearly “impossible” (so I was being told) goal of academic pediatric surgery? This decision was one of the most difficult I’ve made in my life. It required a deep dive into who I was as a person and physician. This too was my introduction to those I have fondly named “The Noise”. “This is crazy”, “Surgery is hard”, “You won’t match into pediatric surgery”. The Noise was loud, deafening actually, and *almost* stopped me. The Noise seems more powerful because it is the loudest voice in the room; the one that is constantly talking. It will always be there. The key for me…and you…is to ignore it. The encouragers are more plentiful than you realize, they just aren’t talking as much or as loud as The Noise. The real lesson I want to share is the only voice that truly matters is *yours.* What will make you happy? What is your heart telling you to do? What decision will lead to a passionate, joy filled professional life for you? Have the courage to ignore The Noise and redefine your life in any way you please – regardless of the current phase of your career. Pursuing a career in surgery is one of the best decisions I’ve made. Through the discomfort of changing paths, I unexpectedly unlocked my confidence and ability to be who I was always created to be. I have faced challenges for sure, but overcoming them awakened the skills I needed for the journey that, without this decision, would have forever remained dormant. Let’s be honest. The Noise sees in you what you may not see in yourself. It is *trying* to stop you. Are you going to let it? If your gut instinct is pushing for a change; DO IT. The desire is there because your inner being is trying to ignite the person you are truly meant to be. Ignore The Noise and let Her out. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/Brittany-Johnson-MD-1-1-240x300.png)Dr. Brittany Johnson is a native of Atlanta, GA where she completed her undergraduate and medical training at Spelman College and Morehouse School of Medicine respectively. Having completed her first residency in general pediatrics at Baylor College of Medicine/Texas Children’s Hospital, she entered a general surgery residency and is currently a third year general surgery resident at the University of Mississippi Medical Center. Dr. Johnson is an avid researcher publishing work in the areas of pediatric firearm injury, pediatric trauma, and general pediatric surgical care. Additionally, Dr. Johnson has a strong interest in global health with trips to Gaborone, Botswana and Mombasa, Kenya with a focus on HIV care and general pediatric surgery. She will continue her dedication to children’s health with plans to pursue pediatric surgery fellowship and a career as an academic surgeon. You can follow her on Twitter at @brittljohn. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, reflection, women --- ### [Common Sense Karaoke: Tips and Tunes for Internship from Our Playlist to Yours](https://blog.womensurgeons.org/common-sense-karaoke-tips-and-tunes-for-internship-from-our-playlist-to-yours/) **Published:** June 19, 2021 **Author:** Blog Team **Content:** *By Sara Swango, Jeremy Kauffman, Erin Feeney* If you are reading this and are a newly-minted surgery intern – congratulations! You’ve put in tremendous time and effort to arrive at this point and accomplished this milestone in the midst of a public health crisis – for this you should be very proud. We’re excited to welcome you all as our new colleagues! Although this next phase of your training will likely be the most challenging to date, it brings you one step closer to what we believe is the most exciting career that exists. As we (Erin, Sara, and Jeremy) considered what pearls of advice to share with you as you begin internship, we were inspired by a recent visit to the local karaoke lounge – the first such visit since the pandemic effectively shut karaoke down. No doubt by now you are familiar with the age-old surgery maxim: “Eat when you can, sleep when you can, and don’t f\*ck with the pancreas.” To that dictum we propose this addition: “Sing when you can, dance even if you can’t, and it’s never too soon to start compiling your OR playlist.” With this in mind, we have distilled several life lessons for internship from a few of our favorite karaoke tunes. We hope you will find them amusing, even if not particularly helpful. 1. The Beatles, “With a Little Help from My Friends” – “I get by with a little help from my friends.” Perhaps the most important advice we can offer is that internship is a team sport. If you try to get through it alone, there’s a good chance you’ll burn out in a blaze of isolation and infamy. Take time early to invest in friendship with your colleagues – go to a game, see a show, have one another over for dinner – these are the people you will spend the next five-plus years of your life with so you might as well learn to like one another, and more importantly, to trust one another. 2. The Chainsmokers, “Paris” – “If we go down, then we go down together.” Inevitably you will find yourself in a situation where things go south and you will be tempted to pass the blame onto one of your colleagues – don’t do it. Related to point one, your co-residents are your family in the hospital, and if you don’t have one another’s backs, then no one will. Throwing another person under the bus, whether they deserve it or not, is never cool. 3. Survivor, “Eye of the Tiger” – “Don’t lose your grip on the dreams of the past. You must fight to keep them alive.” No matter how robust your wellness routine, at some point during intern year you will find yourself on the brink of burnout. The idealism you started with will be reduced to the naked instinct to survive. And that’s okay. But when the dust settles and you have a moment to reflect, remember the dreams that got you here, look ahead to the light at the end of the tunnel, and don’t let anyone or anything kill your optimism. Invest time in those hobbies and relationships that will carry you through when times get tough. 4. James Taylor, “Shower the People” – “Shower the people you love with love.” It’s hard to stay in touch with family and friends during intern year. They may not understand why you can’t give them the time you used to. Be that as it may, working 80-hour work weeks in a thankless job that pays less than minimum wage is no excuse to neglect your loved ones. You won’t be home for every holiday or attend every birthday, but you can find a way to make the people you care about know you still do… so call your mother and father, make time for your significant other, message your friend on her birthday – invest in the ones who have invested in you. 5. Tim McGraw, “Humble and Kind” – “Always stay humble and kind”. Internship will afford you abundant opportunities for frustration and anger, at which point you may feel inclined to lash out at those perceived to be responsible for said frustration. It may seem hard to believe now, but at some point six months from now you may begin to feel like you actually know what you’re doing and are suddenly God’s gift to the field of medicine. That may very well be true, but just remember – it’s never okay to treat someone with disrespect, whether they are the chairperson of surgery, the med student on a consulting service, a difficult patient, or the person cleaning the floors. Do yourself a favor and treat others like you would wish to be treated. 6. John Mayer, “Half of my Heart”- “Half of my heart’s got a grip on the situation, half of my heart takes time.” Surgery training is a marathon, not a sprint. One moment you’ll feel like you’re getting the hang of things and the next moment you’ll feel utterly incompetent. Be patient with yourself. Enjoy the journey. Put one foot in front of the other and keep walking. And when you stumble, get back up. 7. The Rolling Stones, “You Can’t Always Get What You Want” – “You can’t always get what you want. But if you try sometimes, well, you might find, you get what you need”. Enough said. 8. Gotye, “Somebody That I Used to Know”. Surgical training will change you. By the end of intern year, you will have grown in more ways than you can imagine possible. There may be parts of yourself that you don’t even recognize. That’s okay. Training is long and you’ll have plenty of opportunities to decide what kind of doctor and what kind of surgeon you want to be. Trust the process and as long as you continue working toward who you want to be and toward being the surgeon your patients deserve; you’ll be just fine. 9. Bleachers, “I Wanna Get Better” – “Hey, I wanna get better!” Whether you had a tough day in the operating room, or are leaving the hospital feeling on top of the world, remember to maintain a mindset of always striving to improve. It’s okay if the starting blocks at the beginning involve mastering things that seem small, and it’s okay to make mistakes so long as you learn from them. With the fast-paced nature of residency it can be hard to carve out time to reflect on a case or the management of a patient, but identifying what went well (and what didn’t) is an important part of the process. Seek feedback often. A huge part of success as a resident is learning to respond constructively to feedback, and this too is a skill that gets easier over time. 10. Counting Crows, “Big Yellow Taxi” – “Don’t it always seem to go, that you don’t know what you’ve got ‘til it’s gone.” It can be easy to lose sight of gratitude on days when you’re pushing yourself to the limit and the work is still piling up. Maybe it feels like it’s been a while since anybody noticed the behind-the-scenes work you do to ensure your patients receive quality care. If you notice you’re feeling more frustrated than usual or your patience is running thin, take a step back and remember why you’re here, that even though the work is brutally exhausting at times, it is a privilege to care for patients and to learn the art of surgery. Don’t let the challenge of the job stop you from cherishing the best parts of residency. So there you have it – a little karaoke wisdom for your listening pleasure. As you dive into the excitement, terror, exhaustion, exacerbation, and joy that is intern year, remember that you’re not alone, you’ve got everything it takes to succeed, and it’s okay to not take yourself too seriously – in fact, we encourage it. Come join the AWS Twitter Committee and the RAS-ACS Membership Committee, and our moderators Dr. Tiffany Sinclair (@thefancysurgeon), Dr. Valery Vilchez (@valevilchezp), Dr. Sara Swango (@sara\_swango), Dr. Erin Feeney (@ErinVioletMD), and Dr. Jeremy Kauffman (@JerBearMD) to get advice on how to dominate intern year! The tweetchat will take place on Monday June 21st at 8 pm Eastern Time. To participate, follow[ @womensurgeons](https://twitter.com/WomenSurgeons) and moderators, then tag your tweets with the hashtag #AWSChat. Be sure to keep an eye out for Tweets from members of the AWS Communications Committee who helped to organize this TweetChat:[ @MadelineBTorres, @PMartinezMD, @altierim1](https://twitter.com/altierim1), [@niti12](https://twitter.com/niti12), and[ @LenaETrager](https://twitter.com/LenaETrager). If you haven’t participated in a tweetchat with us before, check out this[ tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more! Example Tweetchat Questions: 1. How do you ensure good communication between team members? 2. How do you maintain good communication with patients and family members, especially with visitation restrictions still in place? 3. What can residents do to improve autonomy in and out of the OR? 4. What resources do you recommend for ABSITE studying and longitudinal studying on call? 5. What practices/routines have you found helpful for maintaining wellness? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/Swago-214x300.jpeg)Sara Swango is a rising PGY-2 General Surgery resident at UPMC in Pittsburgh, Pennsylvania. She is originally from Springfield, Missouri. She completed her undergraduate education in Economics at Loyola University in Chicago, IL. She attended medical school at University of Oklahoma. She is a member of AWS and RAS-ACS. You can find her on twitter @sara\_swango. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/Jeremy-287x300.png)Jeremy Kauffman is a PGY-5 General Surgery Resident at UPMC in Pittsburgh, Pennsylvania. He is originally from Lancaster, Pennsylvania. He completed his first three years of residency at UPMC Pinnacle in Harrisburg, Pennsylvania, followed by a pediatric surgery research fellowship at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, and a pediatric surgery critical care fellowship at the University of Michigan in Ann Arbor. He is a member of AWS, RAS-ACS, and currently serves as chair of the RAS-ACS Membership Committee. You can find him on Twitter @JerBearMD. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/Feeney-214x300.png)Erin Feeney is a rising PGY-2 General Surgery resident at UPMC in Pittsburgh, Pennsylvania. She completed her undergraduate studies at Oakland University and went on to receive her medical degree from Wayne State University in Detroit. She is a member of AWS and RAS-ACS. You can find her on Twitter @ErinVioletMD. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat, residency **Tags:** AWS, intern year --- ### [I did it my way!](https://blog.womensurgeons.org/i-did-it-my-way/) **Published:** June 16, 2021 **Author:** mcooke@amrms.com **Content:** By Dr. Sabreen Al Zamil Ever since medical school, plastic surgery was my passion. I was determined to become a plastic surgeon so I shadowed my professor (who later became my mentor). However, in those days (the early 90s) entering into a surgical field was presented as it was considered a ‘man’s domain’. I was even informed by a professor that I may have to give up many aspects of social life including marital life, having children, and having a family to have a shot at becoming a surgeon. And sure I would for my ‘sacred’ dream. However, it was not enough. Opposition by male colleagues was endless. I was once sarcastically told: bake chocolate cakes instead.That was the least I heard! I was subjected to a wide range of untoward behaviour ranging from mere annoyances to vocal discreditation and unnecessary delays when it came time to promotions. During call shifts, unlike my male counterparts, I was never provided an on call room. Instead, I used to briefly nap in the head nurse’s office, or when lucky, find an empty patient’s room. Coffee became my faithful companion and NSAIDS were my rescue during the days of my severe dysmenorrhoea. As a result, I suffer chronic gastritis. As the years progressed, so did the difficulties. However, despite these challenges, I made it. Antagonism continued even after I became a Plastic Surgery consultant and the first female plastic surgeon in Kuwait. My dream was fueled by infinite passion, high morals and ethics, working hard, enriching my knowledge, and ensuring optimal patient management. Support from family, friends and some colleagues helped me hold back tears until I could get home. I worked for approximately 19 years as the only female plastic surgeon in the country. Gradually more female plastic surgeons joined the field and eventually they were treated equally to their male colleagues in all aspects of the surgical specialty, including having designated on call rooms! And , most importantly, they did it without sacrificing important aspects of a woman’s life. This achievement is a conjoined one along with my fellow lady surgeons elsewhere in the country who were exposed to similar harsh journeys and made similar sacrifices. We are indeed pleased to witness the results of perseverance and persistence in chasing our dreams, our way. Not only did we become surgeons and gain the respect of everyone in the medical field, we also paved the way for future generations to come! Today, I am part of decision making in the field of plastic surgery in my country at all levels and at the same rank with my life time opponents. I have gained their full respect and appreciation because of my tough journey and reinforced my ethics and commitment to delivering a flawless kind attitude towards all . My advice to all aspiring surgeons is to chase your dreams and fulfill your aspirations! Your perseverance may pave the way for future generations! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/headshot.png)Dr. Dr. Sabreen Al Zamil *BMS MB, Bch FRCSI FAAAM (Fellow of the American academy of anti aging medicine)* - Consultant Plastic surgeon - THE FIRST KUWAITI FEMALE PLASTIC SURGEON. - SECRETARY GENERAL OF KUWAIT SOCIETY OF PLASTIC SURGEONS (KSPS) - *26* years in plastic surgery practice including training in Canada & Italy. - Founder of the Kuwaiti version breast cancer awareness campaign bradayq8 (2018) - Former head of plastic surgery unit at al Babtain center (2017-2019) - Former vice chairman at al Babtain center plastic surgery center (2012-2019*)* - Former tutor at faculty of medicine Kuwait University (2012-2013) - Introduced & operated the first case of artificial dermal templates in Kuwait (2002) INTEGRA. Official representative of Kuwait : - The Official Kuwaiti medical team accompanying children of Iraq war victims to U.K sponsored by his royal highness the former Prince of Kuwait. August 2003 – U.K - International Forum of Plastic surgeries –November 2016, Fortaleza Brazil. - Local, Regional & International guest speaker in Plastic surgery and cosmetology workshops & congresses Acknowledgements - - Nominated as the woman of the month by neda\_q8 (the first feminist move in the gulf) –October 2016 - Nominated as the woman of substance in science by the British city pages on the occasion of international women’s’ day (March2014) - Also a pianist, speaks three languages (Arabic, English, and Italian), and loves swimming --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, reflection **Tags:** #womeninsugery, AWSBlog, surgery, womeninmedicine --- ### [White Coat](https://blog.womensurgeons.org/white-coat/) **Published:** June 12, 2021 **Author:** Blog Team **Content:** *By Sophia Hernandez, MD* Many leaders in medicine have identified the white coat as a shield of armor—a “visibility cloak”—the very piece of cloth that provides minority physicians with a privilege they have never experienced before. During a residency interview, I was asked to identify my “privilege.” It didn’t take long before I knew my answer: I was born with a “white coat.” I am blonde-haired, blue-eyed, and identify as a Latina. Yet, others do not often recognize me as such. As the daughter of an immigrant, and one who understands the uniqueness of my position, I see the responsibility in this hyphenated perspective to help spread awareness in hopes of promoting societal change and equity. “What do you want to do, doctor?” the nurse questioned me, a medical student, ignoring the Latina physician standing in the room. Though I wore my short coat to signify my position, the louder visual was my skin color. I am certain that this is not the first time skin color has defined a person over their qualifications and seeing this firsthand inspired this post. I know that my privilege was simply due to chance. If my genetics were expressed differently, I may look more like my father who has brown skin, black hair, and brown eyes and I could easily be the one whose title is so frequently dismissed. As a woman, I have experienced this dismissal, but understand that as a non-white appearing woman, the frequency of dismissal is all too familiar. *“You are the perfect applicant. If programs take you, they can check the “diversity” box. However, because you look white, you will not make anyone feel uncomfortable.”* Interactions like this reinforce my privilege and shed light on the racism and inequities riddled throughout medicine. The same inequities that deter women and minorities from pursuing surgery, that hinder their advancement when they get there, and that contribute to the leaky pipeline. While these interactions can be hurtful, they are also a call to action and an opportunity to challenge the status quo. While my intersectionality has made me more attuned to recognizing racism, it has also allowed me to experience the power of representation in medicine. To see the joy, pride, and ease that patients and staff have when they find out I am an *Hernández*. That an *Hernández* is going to be a surgeon and that I am part of their treatment team. These moments fuel my desire to be an ally, to speak out against injustices and microaggressions in the hospital, to advocate for communities of color, to mentor students who identify as underrepresented, and to support inclusive organizations such as LMSA, SNMA, and the AWS. It is our responsibility to develop a more diverse, equitable, and inclusive medical environment for all because diversity matters and improves patient care. Through my personal experiences, I recognize the weight of my privilege and choose to use it to uplift and amplify the voices of others. I challenge you to not only identify your[ privilege](https://urldefense.com/v3/__https:/msw.usc.edu/mswusc-blog/diversity-workshop-guide-to-discussing-identity-power-and-privilege__;!!LQC6Cpwp!_tN6MeauA7GmTw4etyMOaJLzcnEGMwm_Den2Nj9HCo52zUWgRZj0efkbKfZl5gL4rSkhu5w$), but to ask yourself, “How can I use my privilege to support those who do not have the same privileges as me?” This is how we will make change. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/headshot-2020-side-707x1024.jpeg) Sophia Hernandez, MD is an incoming General Surgery resident at the University of California, San Francisco (UCSF) where she completed her Medical Doctorate. and became the first physician in her family. She will be graduating with her Master’s in Clinical Research with a focus in Data Science this summer from the UCSF Department of Epidemiology and Biostatics. She completed her undergraduate studies in Biological Science at the California State University, Fullerton. Her current academic interests include surgical education, outcomes, and disparities research. She is deeply passionate about mentorship, diversity, equity, and inclusion. You can find her on twitter [@SEHernandezz](http://twitter.com/sehernandezz). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion, Underrepresented in medicine **Tags:** #AssociationofWomenSurgeons, #diversityandinclusion, Diversity, ILookLikeASurgeon --- ### [Physicians as Caregivers, A Powerful Position](https://blog.womensurgeons.org/physicians-as-caregivers/) **Published:** June 4, 2021 **Author:** Blog Team **Content:** *By Erin King-Mullins What do you do when you are a physician and your loved one falls ill? It’s a paralyzing feeling to have someone you love hospitalized when you can’t direct their care, especially when the issue falls within your realm of expertise. The phrases ‘well, the way we do it’ and ‘the latest guidelines say’ circle your brain constantly. Sit back, take a breath, and be a caregiver, not a provider. A caregiver has a very important role, so don’t underestimate the impact you can have. The ability to interpret for both sides puts you in a position of great power to influence your loved one’s outcome. Think about it. As a physician, you are responsible for listening to your patient and, hopefully, appropriately absorbing their message and meaning. You then have to synthesize that information to formulate a differential diagnosis, share it with the patient, and create an evaluation and management plan. As a physician-caregiver, you can ensure the messages relayed from patient to physician and vice versa are as accurate as possible. Your family can then make the most informed and educated decision with your guidance, knowing you only have their best interests in mind, and the care team can understand the family’s goals of care. Recently, my sister took my father to the hospital with shortness of breath. He’s 86 years old. He has a longstanding (>10 year) history of hyponatremia for which he takes salt tabs daily. He has a more recent, approximately 6 month, history of idiopathic hypoglycemia for which we make sure he snacks frequently. On admission to the hospital, a pleural effusion was diagnosed which was new compared to a previous scan about 6 months ago. There was a concern for a need for thoracentesis, and the prospect of intubation was even raised. He was admitted to the ICU. Everyone was flustered and chasing the blood glucose and sodium. More than 24 hours passed and he had still not seen a pulmonologist. He still complained of SOB. Meanwhile, no one had consulted the family, and they never talked to the 86 year old patient because what does he know? While my other sister, an OB-GYN, was present, the intensivist made rounds. We were all on video chat. Among other things the intensivist says, “Well, we didn’t know if there was any dementia involved or if he would need a feeding tube….” Have you talked to the patient or family?! My dad is quite sharp and can more than speak to the fact that his sodium and blood sugars run low. We as a family have a great handle on his medications and medical problems. WE ARE HERE FOR HIS BREATHING. We assert that we are here as family first, so as to not offend, but intend to play an active role in appropriately guiding his care. We were fortunate to be able to advocate fiercely for our father given he has two physician daughters. Doctors have immense power in caring for our loved ones despite not being their physician of record. Caregivers have a lot to offer, and we should cherish the ability to do just that. Here is what not to do: – Don’t get ‘paralysis by analysis’. Have those hard talks with your family members about end of life so you can ensure that their wishes and bodies are respected. – Don’t make decisions for them. – Don’t get upset when you feel like they are making the ‘wrong decision’. Physicians must respect patient autonomy, this includes our own family. Equip your loved ones the best that you can with the knowledge you have. At the end of the day, it’s about caring for the patient. Our egos have to be checked at the door, just the same as if we are caring for any patient. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/06/Picture1.png) Dr. Erin King-Mullins graduated summa cum laude from Xavier University in Louisiana. She received her medical degree from Emory University in Atlanta, then completed her internship and residency in general surgery at the Orlando Regional Medical Center in Florida. Dr. King-Mullins went on to complete her fellowship in colorectal surgery at Georgia Colon & Rectal Surgical Associates and subsequently joined the practice, currently serving as faculty/research. She treats all colorectal conditions and has a special interest in minimally invasive robotic surgery and anal cancer prevention in high-risk women. She is a fellow of the American College of Surgeons and the American Society of Colon and Rectal Surgeons, where she serves as the inaugural Chair of the Diversity, Equity, and Inclusion Committee. You can follow her on Twitter [@eking719.](https://twitter.com/EKing719) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life **Tags:** advocacy, doctor-patient relationship, end-of-life, family, patients, women of color, womeninmedicine, womeninsurgery, WomenSurgeons, work-life balance --- ### [Uplifting women surgeons:  BMC Chief Residents’ Voices](https://blog.womensurgeons.org/bmc-chief-residents/) **Published:** May 30, 2021 **Author:** mcooke@amrms.com **Content:** *By Jennifer F. Tseng* Women in surgery are diverse; how can we support them? I have watched with great pride as our graduating Chief Residents at Boston Medical Center and Boston University School of Medicine have navigated their growth and development, as well as that of their partners. I am honored to uplift their voices and share with AWS blog readers my interpretation of their insights. Any errors in judgment are of course, mine. Enjoy! Pearl: **People that aren’t like you can still be important mentors.** Dr. Andrea Madiedo : “Becoming a surgeon is about more than just knowing how to operate and manage patients. Eventually you learn who you want to emulate, how you want to be remembered, get comfortable being yourself, and your skills start to speak for themselves. While having female mentors and visibility of those who look like you in gender, race/ethnicity, and orientation in our field are important, I think it is equally if not more important to find mentors who are dedicated and willing to personally invest in your growth and in building on your strengths. By chance, some of my best mentors as a woman have been male surgeons and colleagues who have been my advocates and cheerleaders along the way. It is so valuable and important to have “he for shes” who understand us and stand by us in our circles!” Pearl: **Define yourself, don’t let others define you.** Dr. Stephanie Talutis: “To the women confused for nurses or other non-physician staff, my advice is to say proudly you are a doctor or surgeon when misidentified. It’s not an insult to be called a nurse, and don’t act like it is; it’s just an error. It’s important to be positive about your real role. Make a point of also identifying your female and male colleagues by their Doctor title as well when performing introductions on rounds to patients. Promoting equality from the top down starts with small actions like this. When my chief resident did this with me as an intern, I felt that my role to patients was acknowledged and now I do this with my juniors too. Empower your team!” Pearl: **Set boundaries.** Dr. Benjamin Nelson: “I am married to a female PMR physician, and career and life balance with two physicians is complicated, but I wouldn’t trade it! My advice for men who support women in medicine is to spend some time thinking about what your life goals really are and clarifying your priorities together. To make that happen I think you really have to disconnect from the hospital when you’re home. As an example, I do not have email or EPIC on my phone. It’s hard, but you have to set up your own boundaries that mutual and family support. That gives me the opportunity to be more present with my family, and we can communicate uninterrupted and build the life that we both want.” Pearl: **In a two-physician household, it’s give, and take, and be grateful. And . . . men should seek out women mentors!** Dr. Praveen Sridhar: “I’m married to a female urologist who just finished residency and now is a fellow. For people who are looking to be supportive of their female surgeon partner I’ve learned two things so far. First, it has been so important for us to be open with each other about our career goals. As a result, we have both learned how helpful it has been to maintain flexibility because we both will sacrifice for each other at different points in our lives. When those times happen we just have to appreciate that support and be ready to do the same when the time comes. Second, as a man, seeking out women who are mentors has helped me understand the pathway that my women colleagues and most importantly (to me!) my wife will have to walk to achieve her career goals in ways that I would not have understood before. Men need to actively seek out women as mentors not just because we can learn how to be a great surgeon or decision-maker, but also so we can recognize the obstacles in this system that we are a part of or can contribute to fixing.” Pearl: **All women are not alike.** Dr. B. Aldana Blanco: “Women are often boxed into categories. This happens in surgery and in any high-performance profession. In reality, some women are more nurturing, some are more assertive, some are better at listening than others. I think we should support and celebrate all women with their differences, strengths and weaknesses and not try to shape women into what we think a surgeon must look like. We should be deliberate about giving women and men equal opportunities to allow them to manifest their true selves and shine in and out of work.” In listening to our BMC Chief residents, I have learned that women in surgery are not uniform; nor for that matter, are the men or partners of any kind who seek to support female surgeons and physicians. Stereotypes of what a surgeon of any gender should or should not be, do, or look like are outdated. I look forward to this new generation of surgeons redefining what our surgical world looks like. Onward! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/05/BCM-residents.png)From Left, Drs. Praveen Sridhar, Dr. Stephanie Talutis, Dr. B. Aldana Blanco, Dr. Andrea Madiedo, and Dr. Benjamin Nelson, BMC/BUSM Surgery Chief Residents, 2020-2021![](https://blog.womensurgeons.org/wp-content/uploads/2021/05/tseng.jpg) Dr. Jennifer F. Tseng was born in Berkeley and grew up in San Jose, California. She attended Stanford University, majoring in English and biological sciences, followed by medical school at the University of California, San Francisco. Dr. Tseng did her surgery residency at Massachusetts General Hospital, where she also served as staff surgeon (super-Chief), followed by a surgical oncology fellowship at the University of Texas MD Anderson Cancer Center. Dr. Tseng began her faculty career at the University of Massachusetts Medical Center in 2005; while there, she completed her master of public health degree at the Harvard T.H. Chan School of Public Health. Dr. Tseng was recruited to Beth Israel Deaconess Medical Center and Harvard Medical School as Chief of Surgical Oncology in 2011, where she rose to the rank of Professor of Surgery at Harvard. In 2017, she was appointed as the James Utley Professor and Chair of Surgery at Boston University and the Surgeon-in-Chief at Boston Medical Center. Dr. Tseng is a surgical oncologist whose practice includes pancreas, hepatobiliary, and gastric surgery. She is also a health services researcher focusing on risk prediction and prevention, disparities in surgical and cancer care, and models to build health equity. Dr. Tseng founded Surgical Outcomes Analysis & Research (SOAR) in 2007. SOAR, now chaired by Dr. Teviah Sachs, with resident leaders Dr. Alaina Geary and Dr. Allan Stolarksi, is now the hub of outcomes research for the Boston University School of Medicine/Boston Medical Center Department of Surgery. Dr. Tseng is the President-Elect of the Society for Surgery of the Alimentary Tract, is a founder and a past President of the Society of Asian Academic Surgeons, is on the executive councils of the Society of Surgical Oncology and the Society of University Surgeons, and is a councilor on the American Board of Surgery (ABS), where she will take over as chair of the ABS Research Committee in June 2021. She serves on a number of editorial boards and is a deputy editor for JAMA Surgery. Dr. Tseng has mentored multiple trainees to great success in national and international meetings, funded grants, and peer-reviewed publications, and their achievements are her source of greatest pride. Dr. Tseng lives with her husband Dr. Marc Sabatine and their two teenagers, Matthew (“Matteo”) and Natalie, in greater Boston. Her twitter handle is [@TsengJennifer](https://twitter.com/TsengJennifer); the department twitter handle is [@BMCSurgery](https://twitter.com/BMCSurgery). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** mentorship, residents, Surgical Education, surgical residency, trainees, training --- ### [A Reflection on My Intern Year](https://blog.womensurgeons.org/reflection-on-intern-year/) **Published:** May 27, 2021 **Author:** Blog Team **Content:** *By Joy Ayemoba* Today I am fewer than six weeks from completing my intern year. Like many of my peers the transition from medical student to physician was a difficult one at best. The excitement to don ‘the long white coat’ was tempered by my realization of the new responsibility and expectations that came with my new apparel. As students pursuing surgery we were told the hours would be long and the work physically demanding. Yet, despite all the lectures on burn-out and sleep deprivation, I wasn’t fully prepared for the mental and emotional toll that comes with this work, especially as a Black woman. Starting residency during a summer in which the whole world felt as though it had been set ablaze, I entered my intern year with heightened sensitivity to the racial and socioeconomic disparity that exists within this country. As more Americans were faced with important conversations regarding race and inequality, I was ushered forward by a wave of optimism. I watched people across the country take a knee and boldly wear pins professing that Black Lives Matter, Trans Lives Matter, and Love is Love. I hoped to see a healthcare system that shifted with the forces of society, but the reality is that [COVID-19 worsened the gap that exists between our most vulnerable and most privileged populations](https://jech.bmj.com/content/74/11/964). Although I did not see the height of the pandemic, I witnessed its wake. I encountered Black and Brown patients who slipped through the cracks of our healthcare system. [Countless elective surgeries were delayed](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272903/). I wonder what future studies might show regarding delays to intervention amongst patients who identify as Black, Indigenous, and People of Color (BIPOC). This year, I have cared for several patients who have been labeled as ‘difficult’ when the reality is far more complex. Some of these patients have been hurt by a healthcare system they feel was not built for them. Others may feel further validated in distrusting the system when faced with [reports of limited access to vaccines within their communities](https://www.scientificamerican.com/article/the-biggest-barriers-to-covid-vaccination-for-black-and-latinx-people1), despite being those most hard hit by this pandemic. As someone who finds strength through their compassion, learning the fine line between empathy and overinvolvement has been a constant challenge. I have felt frustration with a system that moves slowly. The significance of being a Black woman has weighed heavily on my shoulders. My identity has motivated me to work harder but has also carried a weight of expectation that has greatly shaped my intern year. At times, I have felt small and upset with myself and the system, and yet, there have been days in which I have stepped into an operating room full of women and BIPOC and felt a renewed sense of purpose and motivation. I am reminded in the presence of these incredible women how much work I need to put into my training to stand alongside them as harbingers of change. As the clock winds down on my intern year, I’m thankful for the lessons I’ve learned, the friendships I’ve made, and the opportunities for self-improvement. As I prepare myself for next year, I am more hardened, more tired, and more hopeful as I look to the new challenges ahead. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/05/Picture1-1.png) Joy Ayemoba, MD, MSc, is originally from London, United Kingdom. She completed her undergraduate studies at the University of Chicago. After obtaining her BA, she returned to the United Kingdom to complete her graduate degree in Social Epidemiology at the University College London (UCL). She then worked as a research statistician/epidemiologist at UCL before enrolling at Tulane University School of Medicine. At Tulane, she developed an interest in General Surgery and further understanding the relationship between surgical outcomes and health care inequalities. She is a General Surgery resident at New York Presbyterian Brooklyn Methodist Hospital. --- Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons **Categories:** residency **Tags:** education, intern year, residency, residents, Surgical Education, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Half-Chinese and Half-Vegetarian](https://blog.womensurgeons.org/half-chinese-and-half-vegetarian/) **Published:** May 24, 2021 **Author:** Blog Team **Content:** *By* Heather Yeo, MD, MHS, MBA, MS Growing up in a small rural town in Oregon, I was not surrounded by a very diverse community. I don’t think I even understood the words “race,” “ethnicity,” or “cultural heritage” until I was much older. I just knew that I was different from many of the kids growing up around me. My mom used to laugh that when people asked me what my heritage was, I would answer, “I’m half-Chinese and half-vegetarian.” My parents taught me to appreciate my Asian cultural heritage. I grew up visiting Singapore, China, and Thailand, cooking Satay, curry, and dumplings with my grandmother, and looking for red envelopes during Chinese New Year celebrations with my family. I had a large extended family that was important to me, and my grandmother told me about her growing up in Malaysia and Sarawak. But at the same time, I was not raised to speak my father’s native dialect (Teochew), or really any Chinese for that matter. I had an idyllic childhood and really didn’t feel discriminated against. But I always felt different – like I didn’t quite fit in. I was excited for college, where I expected to find more people like me and thought that I could explore my Asian heritage. As I checked the boxes for race, I proudly checked both white and Asian. Arriving at college, I was excited to learn about the Asian American group, because I thought that’s what I was. As an Asian-American, and an Asian Studies minor, I was excited to find a group with shared cultural experiences and interests. I went to that first Asian-American meeting, but what I’ve found out has been called, “A white passing HAPA”, meaning most people don’t know that I am Asian at all. They think I could be Hispanic, Hawaiian, white — basically no one knows. So no one thought I belonged there. Many people asked me the question “What are you?” Some said to me “half doesn’t count”; or “Do you at least speak Chinese?” I wouldn’t say I was devastated, just a little embarrassed that I didn’t even live up to the expectations of half of my culture and disappointed that I wouldn’t have the opportunity to learn more about my heritage. The recent anti-Asian American violence has hurt me, because I imagine my grandmother, my father, who worked so hard to become citizens of this country, now being the target of hate in a country they loved. But it has also hurt me because I am a white passing HAPA. Few people think to ask me about its impact, because many don’t know that it might affect me. And I also feel like maybe they shouldn’t ask me, because how could I possibly understand what it’s like to be the target of Asian hate when I might not look Asian enough to be the target of such hate. More recently, through a friend I have been introduced to a group of “HAPAs” – a term that is used in several contexts in the US, and while not the definitive – half-japanese group that it originated from, the more colloquial “Half Asian PAcific islander” definition is what I’m referring to here. It’s fascinating that in this group I have found people with many shared experiences, people who love their mixed identities, but have also struggled to fit in. Those who grew up with a similarly mixed background to my own and have had similar experiences both not being Asian enough and not being white enough. I am very proud of my mixed background. That my parents saw beyond race and fell in love, that I have two cultures blended together. But this realization has taken me time, a lot of it. Writing this piece makes me feel vulnerable, but I am doing it because for me, finding others with shared experiences, mixed raced people, has made me appreciate that I am not alone in my world experience and has helped me to appreciate my differences. It’s taken me well into adulthood to understand some of the implications of race, gender, ethnicity, community and intersectionality. And while I do research in this area, I still don’t consider myself an expert, there is so much to learn and so much complexity in how these words define us and the way the world reacts to and interacts with us. My experience, I hope, makes me a more understanding physician and surgeon. It has made me more interested in understanding how different cultures and communities shape who we are and how we can celebrate our differences. Societies like AWS, LSS, SBAS, and SAAS are good places to discuss issues of race, gender, and ethnicity, and to find people of varied backgrounds. These societies are inclusive of all races and identities and are full of surgeons who represent the spectrum of our profession and make it stronger. A few other interesting pieces: <https://laist.com/news/essays/spy-in-the-house-of-race-a-daughter-of-black-chinese-and-jewish-parents-on-belonging-everywhere-and-nowhere> <https://www.npr.org/sections/codeswitch/2016/08/08/487821049/who-gets-to-be-hapa> <https://www.refinery29.com/en-us/2019/05/232641/half-asian-biracial-personal-essay> ![](https://blog.womensurgeons.org/wp-content/uploads/2021/05/Yeo.png) Heather Yeo, MD, MHS, MBA, MS is Associate Professor of Surgery and Associate Professor of Health Care Policy and Research at Weill Cornell Medical College and Associate Attending Surgeon at NewYork-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research, and Healthcare Leadership and an MBA and is focused on surgical outcomes, workforce diversity, tech advances in medicine, and quality improvement in Gastrointestinal Cancer Surgery. Dr. Yeo is interested in the psychosocial factors that go into surgical decision making and how they influence outcomes in patients. She is currently funded as a Damon Runyon Clinical Investigator for a randomized trial of an app that Dr. Yeo developed compared to the standard of care. Dr. Yeo believes that new technologies and apps are going to change the future of medicine. Dr. Yeo has studied disparities in surgical training and the impact of race and gender on attrition and training. Dr. Yeo has worked extensively with trainees and medical students. She works with residents and medical students to teach them study design, implementation, and career development. --- Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** diversity and inclusion **Tags:** #diversityandinclusion, #womeninsugery, aapi, DEI, ILookLikeASurgeon, UiM --- ### [The Façade We Keep: Masking Mental Health](https://blog.womensurgeons.org/the-facade-we-keep-masking-mental-health/) **Published:** May 19, 2021 **Author:** mcooke@amrms.com **Content:** *By Alyssa Brown* Trigger Warning: This piece includes details of a suicide attempt, which may be triggering to some readers. If you are thinking of hurting yourself, please contact the [National Suicide Hotline](https://suicidepreventionlifeline.org/) (800-273-8255). This piece was written with the written permission of the friend in the story. Names and locations have been changed to protect her privacy. *Do you feel like killing yourself?* *Yes.* *Do you have a plan of how you would kill yourself?* *Yes.* During my psychiatry clerkship, I spent three of the six weeks in the psychiatric emergency department of University of Louisville Hospital. As a third-year medical student, my job was to screen patients with a brief interview before the team discussed the patient’s case. The general questions stayed the same with minor variations based on their answers. After an introduction with the patient and the regular, “what brings you here today?” question, I always started with these two questions about suicide. The attending always asked, and it was incredibly pertinent information. At first, I felt uncomfortable asking those questions, but eventually, it became second nature. Even after my psychiatry rotation, I asked many other patients questions about suicide and their mental health as part of their general exam. Six month later, I would be asking them to a friend. Graduate school orientation started on my birthday. I had taken Step 2 four days before and moved fourteen hours away from my friends and the life that I had known in medical school. On that first day, I met a classmate, who felt just as out of place as I had. She had moved from abroad to start graduate school. We became fast friends. Graduate school was hard for both of us: full of late nights, new material to learn, missing family and friends, and finding a thesis project. We also had many adventures: concerts, travel, and exploring places around our school. I went home for Thanksgiving, and when I returned that Friday, I noticed that something seemed wrong with her. I asked what she had done, and she said she had just laid on her couch all week. I didn’t think much of it, since we didn’t have class. I couldn’t put my finger on it, but something just seemed off. During the next week, she stopped going to class and started missing time at work. I started coming over after dinner to hang out and make sure she was doing okay. She just seemed sad. I encouraged her to go to the doctor, and she struggled to make the appointment. Thursday night, we were sitting at her place talking and drinking tea, and I finally asked the questions that I asked so many patients before. *Do you feel like killing yourself?* *Yes.* *Do you have a plan of how you would kill yourself?* *Yes.* I knew that it was time to go to the hospital. She did too. She really didn’t know what would happen when we went to the Emergency Department, but from my prior experience, I had a decent idea of the route to come. We sat in a room all night waiting for her to get placed in a psychiatric facility for a few days. In the wee hours of the morning, she was taken to a facility three hours away for treatment. I felt so helpless. I was used to being on the other side of the equation. I was used to helping coordinate the care of the patient, not waving goodbye as she got loaded into the ambulance for transport. She didn’t like being admitted, and her admission was not easy. For the first few months after, she would say that she really didn’t need it. Two years later, she finally will admit that it was what she needed. It is so hard to get help. It is so hard to not fight against it. Even though she knew that she was suicidal, she was worried that she would be in trouble for needing time off for a hospital admission, missing work, missing schoolwork, having to make-up work, affording the hospital bill, and dealing with the stigma that comes along with having to get help for her mental illness. I had felt all those things before. I was happy to advocate for her in those moments. What mattered most was that she was safe. In my third year of medical school, I was diagnosed with generalized anxiety disorder. I never had put a name to my anxiety. I thought it was just a normal part of existence. I had always been anxious, but after a particularly rough stretch and the help of a mentor, I was treated with medication, and eventually, therapy. I had delayed treatment for so long because I thought that medication would change who I was. I thought that maybe I didn’t need it, maybe there was nothing wrong with me. I was wrong. Treatment has helped me so much. I am a better person, friend, and student after getting help. I was so embarrassed that I had to take medication. One day in medical school, I finally told one of my closest friends in a hushed voice that I was going to start taking something for my anxiety, and she matter-of-factly stated, “I take that one!” Over the past three years, I have become more comfortable sharing my story. We shouldn’t have to hide it. In my opinion, it only helps if we share with each other when we struggle with our mental health. Medicine has a long way to go in supporting mental health. A good first step can be bringing it out of the darkness. I am lucky my friend is still here today by my side. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/05/headshot_5x7_0449-731x1024.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, [before finishing her MD](https://blog.womensurgeons.org/medical-students/waiting-your-turn/). She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. Her thesis research is on diaphragm muscle mitochondrial function and morphology. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved [writing pieces](https://blog.womensurgeons.org/medical-students/black-clouds/) for the [blog](https://blog.womensurgeons.org/mentorship/prosciutto/) over the [past](https://blog.womensurgeons.org/medical-students/the-distance-between-two-worlds/) [two years](https://blog.womensurgeons.org/medical-students/confessions-of-an-ill-equipped-third-year-medical-student/). During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram [**@Alyssa\_b\_futuremdphd**](https://www.instagram.com/alyssa_b_futuremdphd/) and on Twitter [@Alyssa\_B\_MDPhD.](https://twitter.com/Alyssa_B_MDPhD) --- Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** self-care **Tags:** #mentalhealth, AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [A ‘Little Extra’](https://blog.womensurgeons.org/a-little-extra/) **Published:** May 13, 2021 **Author:** Blog Team **Content:** *By Charoo Piplani, MBBS* On a Sunday afternoon, while caring for my COVID 19 positive father at home in India, I decided to give him his favorite yet effective substitute for fluids – coconut water. The nearby seller who has served us for years claimed that a single coconut that normally costs ₹40 (Indian rupees; approx. $0.54 US dollars) was priced at ₹80 (approx. $1.09 US dollars). A doubling of the price in a day? To both of our dismay, he wasn’t getting an adequate supply of coconuts from his previous sellers. He also went on to narrate a story about his sons having to travel across three cities to procure the gem in question. It was a plight for everyone. It was, however, a necessity for me. I decided to stop my quarrel or any attempt at logical understanding since time for me meant my father’s health. It wasn’t long after this incident that I noticed a wave traveling through India, where we paid ‘extra’ to live through each minute of our lives. A friend’s father needed an oxygen cylinder that was transported across two states only to be available at fifteen times the original price, classically known to us as a ‘little extra.’ A childhood friend needed to rush to the hospital to find a bed for her mother, who had a declining spO2 of 79%, likely requiring ventilation. These were two ‘little extras’ – an ambulance or a public transport vehicle and a ventilator-enabled bed in the hospital with the hope that they don’t run out of oxygen just yet. Given the state of the city flooded with cases and overcapacity, she scrambled her way through several contacts and paid a ‘little extra’ to be able to transport her mother to another town and hospital. The following day progressed as we expected (given the situation), as opposed to how we would normally hope. Her mother did not survive, for which she ended up paying a ‘little extra’ to be able to bury her with dignity. There are a million stories of people in India paying ‘extra’ to survive. They pay ‘extra’ to be prepared and to maintain their sanity, often with no real hope in sight. More than half their stories do not have a happy ending, for which they end up paying a ‘little extra’ for cremation, burial, and other rituals. Our loved ones, who sadly succumbed to the greatest virus – our system of governance, are merely numbers in data reported in papers. Their lives mattered! Why was there an imbalance between the desired and required resources you ask? Not everything in the market, ranging from travel modalities to trivial needs in the household, was a necessity. In economics, supply and demand are the quantity of a commodity that producers wish to sell at various prices and the quantity consumers wish to buy, respectively. They are the chief drivers of price determination in economic theory. The price of a commodity is further determined by its interaction in the market. The price at which it is set with an agreement between the producer and consumers is known as equilibrium price – this means the quantity produced by the producer matches the demand of a consumer. In any given scenario, if the demand of a commodity increases, the price in that same period invariably increases as well, given that its supply remains constant or is only slightly increased because of storage capacity. This theory, however, exempts all necessities to sustain life. The commodity in question today is the oxygen we breathe packed in cylinders, several life-saving medications, hospital beds in reserved units, and goods and services needed to enable a patient to receive medical care, including but not limited to, transportation, food, and water to name but a few. Why the common man is suffering is the question of the hour. Who exactly is at fault here? Is it the way our healthcare system is formulated or the system at large? Can we collectively not take advantage of the sensitive situation and limit profiting and hoarding? Is it impossible to have tax exemptions on necessities and preparedness of the 13-month-old global pandemic? In my understanding of everyone’s apparent need to charge more than things are worth, I wonder why I was able to get a free consultation from my cardiologist and physician in my prime time of need. I wonder why most healthcare workers, charitable trusts, and non-governmental organizations (NGOs) are charging next to nothing for their services. I wonder! Perhaps, these are questions the answers to which we will never know. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/05/Picture1-730x1024.png) Charoo Piplani, MBBS, is an international medical graduate (2019) from India, currently pursuing a dual degree – diploma in Medico-Legal Systems and Clinical Research, at Symbiosis International University, India. She is also working as a junior doctor in general surgery and is excited to be applying for this year’s general surgery match. Her future interests are in Plastics and Reconstructive Surgery. She is passionate about promoting diversity and equity in medicine and sustainable living. She has spent most of her life in the hills, and, at present, she enjoys her free time with a cup of tea, painting, and in her dog’s company. You can find her on Twitter [@charoo\_piplani](https://twitter.com/charoo_piplani). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** #globalpandemic, access to care, COVID-19, equity, global action, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Honoring Asian American Pacific Islander Women](https://blog.womensurgeons.org/honoring-aapi-women/) **Published:** May 10, 2021 **Author:** mcooke@amrms.com **Content:** *By Susan Tsai, MD, MHS* For many, the month of May is a time of celebration. Many look forward to the end of Ramadan with Eid al-Fitr (May 12) or the beginning of summer with Memorial Day (May 31). For me, the month of May is also important as [Asian American Pacific Islander (AAPI) Heritage month](https://asianpacificheritage.gov/). It seems more important than ever to take advantage of this time to highlight the many amazing AAPI stories of immigration, perseverance, and community. This last year has seen an unprecedented rise in [hate crimes and discrimination against AAPI](https://www.womensurgeons.org/news/557250/Statement-on-Asian-American-and-Pacific-Islander-AAPI-Violence.htm). Less than 2 months ago, a mass shooting claimed the lives of eight individuals, including six Asian women. There is no better time to amplify AAPI experiences and support AAPI communities through allyship and action. I’m excited that the Association of Women Surgeons (AWS) has decided to highlight AAPI members this month in its podcast and blog posts during the month of May and beyond. I hope that in sharing stories, we will learn more about AAPI heritage and culture and begin to see reflections of ourselves in the stories of others. The foundation of a shared humanity is the basis for allyship and future action. This month in the AWS blog you will hear from AAPI residents and medical students who received last year’s inaugural AWS Diversity Equity and Inclusion award. Notable additions will come from [Dr. Jennifer Tseng,](https://twitter.com/tsengjennifer?lang=en) C[hair of the Department of Surgery at the Boston Medical Center](https://www.bumc.bu.edu/surgery/about/chairmans-message/) and[ Dr. Heather Yeo](https://twitter.com/heatheryeomd?lang=en), [Associate Professor of Surgery, Weill Cornell Medical College,](https://weillcornell.org/heatheryeo) Cornell University. [Dr. Taryne Imai](https://bio.cedars-sinai.org/imait/index.html), who is the recipient of the 2021 Society of Asian Academic Surgeons (SAAS)-AWS Visiting Professorship will also join us in celebrating AAPI heritage month by participating in the AWS podcast. Later this year, Dr. Imai will travel to Memphis to be the Helen F. Tsai Visiting Professor at the University of Tennessee. I know the namesake of this Visiting Professorship well, as she is my mom. In the spirit of AAPI heritage month and Mother’s Day (May 9th), I’d like to share a little about my mother. My mother was born in the year of the Tiger, but she is far from a “tiger mom.” She immigrated to the United States from Taiwan in her early 30’s with my brother and sister to join my father who was studying to receive his degree in mechanical engineering. Ultimately to help make ends meet, she opened a grocery store, selling Asian foods in a small college town in the Midwest, where things like short-grain rice and non-La Choy soy sauce were a rarity. To supply her small business, she would drive our family’s green Ford van every week across Michigan to Chicago to pick up produce to sell. As the business began to grow, it became a small nexus of the Asian community. People would come for the groceries, but they would find themselves staying to chat about daily life‒ sharing celebrations and hardships. I was also always amazed that whenever we were out, she would inevitably run into someone she knew. I once joked “Mom! You know everyone- you’re like the mayor!” but she just impishly smiled and said, “I won’t ever be able to do anything bad…I’ll always get caught.” Over three decades, she came to know generations of families, watching babies grow up and go to college and witnessing many old-friends transition on as well. When my time came to go to college too, I knew I was leaving behind a woman who was working from 8 am to 10 pm to put me through school. I learned so many important values from watching my mom run her business: work hard, treat people fairly, do the right thing. My mom retired 10 years ago at the age of 72 and sold the store. Nevertheless, when her customers see her around town, they will stop to update her on products that are missing from the store. I can sense their frustration, I’m sure it’s not quite the same – like a husk of a store now without its soul. This year, with the pandemic, she told me, “I’m afraid to go outside. People are targeting old Asian people.” This made me sad because my mom, who has been a pillar of good will in her community for decades, should not have to feel unsafe and unwelcome in a city where she has lived over 50 years of her life. I also thought about how quickly things change- that this woman, who I once thought was invincible, could feel so vulnerable. And so, on this Mother’s Day, I hope we are able to spend time with our mothers, shower them with love, and cherish them for all that they have done for us. ![Dr. Susan Tsai headshot](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Tsai.png) Susan Tsai, MD, MHS, FACS is an Associate Professor in the Department of Surgery at the Medical College of Wisconsin. She holds a joint appointment at Froedtert & the Medical College of Wisconsin and the Clement J. Zablocki VA hospital and serves as the Director of the LaBahn Pancreatic Cancer Program and the leader of the GI Oncology Disease Team. You can find her on twitter [@isteaus](https://twitter.com/isteaus). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** diversity and inclusion **Tags:** #diversityandinclusion, aapi, DEI, ILookLikeASurgeon, UiM, womeninsurgery --- ### [An Eye for the Overlooked: An Upcoming TweetChat on Rural Surgery](https://blog.womensurgeons.org/rural-surgery-2/) **Published:** May 3, 2021 **Author:** mcooke@amrms.com **Content:** *By Shan S. Lansing, MD* Access to healthcare has been an increasing concern in the United States for the last several decades. Since 2010,[ over 130 US rural hospitals have closed](https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/), most commonly due to financial non-viability. A 2016[ report](https://www.chartis.com/resources/files/INDEX_2016_Rural_Relevance_Study_FINAL_Formatted_02_08_16.pdf) from the National Rural Health Association predicted that one-third of all rural hospitals in America were at risk of closing within 10 years; this represents 673 hospitals in 42 states that serve as the primary access to healthcare for 11.7 million people. The rural hospital closure crisis is driven by a combination of factors, including lower hospital volumes as well as higher percentages of uninsured patients. Ultimately, it is estimated that[ local hospital closure increases the community mortality rate by 5.9%](https://www.nber.org/papers/w26182). In 2009,[ the life expectancy in rural American was close to 3 years shorter than that in metropolitan America](https://www.ajpmonline.org/article/S0749-3797(13)00590-4/pdf). The unfortunate reality at this point is that a person’s zip code can have as much of an effect on their health as their genetic code. Surgeons have a unique role in rural healthcare, both as an integral component of community health systems, as well as an important part of small hospital viability. First, rural general surgeons are important for the health of patients living in rural communities. If we are ever going to alleviate rural health disparities, rural patients must have access to a general surgeon for their undifferentiated and potentially-surgical concerns. Second, in a much bigger picture,[ rural general surgeons are important for the financial stability of small hospitals](https://pubmed.ncbi.nlm.nih.gov/10132999/), which in turn[ plays a significant role in the overall economy of the rural community](https://www.torchnet.org/advocacy--rural-hospital-closure.html). Rural surgeons can provide a number of primary-care services for their communities. Though scope of practice varies depending on training, location, hospital resources, and many other factors – it is suggested by the[ American College of Surgeons Advisory Council for Rural Surgery](https://www.facs.org/about-acs/governance/advisory-councils/374) that[ optimal rural surgery training](https://pubmed.ncbi.nlm.nih.gov/33125284/) includes full-scope general surgery care, upper and lower endoscopies, surgical obstetrics, and even basic thoracic, plastic, and orthopedic surgery. For the average [rural general surgeon](https://www.sciencedirect.com/science/article/abs/pii/S0002961010005404), it is estimated that up to one-eighth of a one’s practice consists of subspecialty procedures in vascular surgery, obstetrics/gynecology, orthopedics, urology, otolaryngology, and thoracic surgery. From a personal perspective, AWS-member Dr. Nikita Machado shares her experience as rural general surgeon in Conneaut, OH: *“Rural surgery faces a number of challenges in the United States. A lot of these hospitals, a significant number of which are designated as critical access, are located in remote areas. As a result, they have less resources and access to other consulting specialties, making it more challenging to provide the multidisciplinary care we are used to at larger centers.* *However, this is offset by the sheer variety of surgical practice. It is not unusual for rural surgeons to perform a variety of different cases every week, including general surgery, endoscopies, thoracic and in some places gynecological cases. Rural surgeons inevitably find creative solutions to help their patients, and the advent of tele-health has made it easier to obtain second opinions and consultations when needed. Patients are extremely grateful to be taken care of in their hometown, avoiding the need for hours of travel for surgical care. It’s not uncommon for them to treat their surgeons and other members of the healthcare team as part of their extended family, which makes this a very rewarding career.* *A combination of broad-based surgical training during residency, along with improved access to more specialized centers for appropriate escalation of care when needed, can result in a successful rural surgical practice.”* Trainees interested in rural surgery can find a list of residency programs with rural tracks in a [recent publication](https://pubmed.ncbi.nlm.nih.gov/29079108/) by Rossi et al. To hear more on access to surgery in rural America, join the AWS Communications Committee in the upcoming Tweetchat on May 17 at 8pm Eastern Time. We will be guided by our moderators Drs. Isolina Rossi, Annie Dunham, Adrian Diaz, and Shan Lansing to discuss the importance of rural surgery, as well as challenges and potential solutions to rural health disparities. To participate, follow[ @womensurgeons](https://twitter.com/WomenSurgeons) and moderators, then tag your tweets with the hashtag #AWSChat. Be sure to keep an eye out for Tweets from members of the AWS Communications Committee who helped to organize this TweetChat:[ @altierim1](https://twitter.com/altierim1),[ @machado\_nikita](https://twitter.com/machado_nikita),[ @niti12](https://twitter.com/niti12), and[ @LenaETrager](https://twitter.com/LenaETrager). If you haven’t participated in a tweetchat with us before, check out this[ tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more! **Tweetchat moderators:** Dr. Annie Dunham ([@adunhamable](https://twitter.com/adunhamable)) – General Surgery chief resident in the University of Wisconsin Rural and Community Surgery track with a passion for teaching and connecting community and academic surgeons through state-wide surgical collaborations. Dr. Adrian Diaz ([@DiazAdrian10](https://twitter.com/DiazAdrian10)) – General Surgery resident at The Ohio State University and fellow at the IHPI Center for Healthcare Outcomes and Policy (CHOP), interested in health policy research, with a focus on optimizing access, quality and value of care health systems deliver to patients. Dr. Isolina Rossi ([@rossi\_isolina](https://twitter.com/rossi_isolina)) – PGY3 general surgery resident at the Carolinas Medical Center in Charlotte, NC. She has published on the details of ACGME rural surgical training while also leading the development of a rural surgery track within her own program. She plans to return to her hometown of Hopedale, IL to practice rural surgery after training. Dr. Shan Lansing ([@ShanSLansing](https://twitter.com/ShanSLansing)) – Incoming general surgery intern at Oregon Health & Science University, interested in advocating for policies and educational programs aimed at increasing rural access to surgical care. **Tweetchat questions:** - How does rural surgery differ from a general surgery practice near a metropolitan center? - What are some ways that rural surgeons can stay connected while caring for (and living in) an isolated community? Are there further training options and/or ways to get second opinions in real time during difficult cases? - Though there are many, what do you think is the greatest challenge that rural surgeons face? - Telehealth is often touted as a solution to physician shortages in rural areas. In what ways is telehealth useful or not useful in rural surgery? - What changes do you anticipate will occur within the field of rural surgery over the next 10-15 years? - What are things trainees should consider if they are interested in rural surgery? What should they look for in a residency or transition-to-practice program? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/Shan-300x263.png) Shan Lansing, MD is a recent graduate from The Ohio State University College of Medicine, and incoming General Surgery intern at Oregon Health & Science University. Originally from a small town in southern Oregon, she attended Oregon State University to earn a dual Bachelors in Chemistry and Biohealth Sciences. She continued at Oregon State University for a Masters of Science in Analytical Chemistry where her thesis focused on optimization of a fluorescent biosensor for detection of microRNA as it relates to cancer diagnostics; though she was able to find the art to micropipetting, she felt a calling to care for underserved populations. Her current academic interests include advocating for policies that mitigate rural health disparities. Ultimately, Shan seeks to pursue a career in rural general surgery, aiming to provide comprehensive surgical care for an underserved community. In her free time she enjoys running, cooking, and cross-stitching. You can find her on twitter at [@ShanSLansing](https://twitter.com/ShanSLansing). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, rural, rural surgery, training, Tweetchat, womeninsurgery --- ### [Adapting to Research Time During COVID](https://blog.womensurgeons.org/adapting-to-research-time-during-covid/) **Published:** April 28, 2021 **Author:** Blog Team **Content:** *By Rachael Essig, MD* May 2019 seems like a world away. I had accepted a research position following my PGY-3 year with a critical care fellowship starting July 2020 in a new city. At the time, it seemed like the start of a beautiful adventure. Yet, fast forwarding to April 2020, while deep into the first wave of the pandemic, I was attempting to view every apartment in my new metro area online. Zillow and a realtor were lifesavers! Another difficulty was the somberness I experienced leaving my surgical family without being able to say goodbye in person. They had raised me from an intern to a capable (hopefully) junior resident. Moving your life is always painful, and combined with global pandemic, it was especially dreadful. Thankfully, the stress was worth it as my fellowship has been an amazing educational experience with truly fabulous attendings and staff. Over the past year, COVID has taken away many things from society. One of the worst losses has been the lack of a social support system; particularly, the importance of talking about your day with your co-residents to help process daily activities. Not only was I separated from my support system from residency, but it was also nearly impossible to foster new relationships while practicing appropriate social distancing. At the beginning of my research experience, I felt overwhelmed by the sudden cessation of this aid. It had been a long time since the thoughts of such inadequacy had occurred. Finding ways to continue to connect with my friends has been critical to overcoming these feelings. One essential tool has been a text thread with co-residents sending links for real estate to brighten each other’s days. Another is zoom game nights with my medical school friends. Even less organized social time, such as chatting on the phone during drives home have been instrumental in healing my mental health. An additional critical part of research is developing a professional network. Unfortunately with social distancing, national surgical meetings have been put on hold which has hampered expanding professional contacts for future career advancement. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/Dog-225x300.jpeg)Research time is often depicted as a fabulous break into “real adulthood” as it often allows for more time for friends, family, and hobbies. With COVID putting a huge damper on travel, this was certainly not my experience. Nonetheless, it is with great anticipation and hope that next year brings the ability to complete great adventures beyond the walls of my apartment. In January, a new adventure began as my significant other and I welcomed a puppy into our lives. Mac is a wonderful addition to our family plus a welcomed distraction. Seeing his wiggly little butt after a long day rejuvenates my soul! Plus, I get to send picture postcard updates to my family of our adorable fur baby! Adaptation has been key during this invaluable time allowing my clinical confidence to blossom and I would not change a thing. For my next year, I’m looking forward to returning to safe social interactions, travel, and puppy cuddles! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/Doc.png) Rachael Essig, MD is originally from West Virginia and is a General Surgery Resident at Georgetown University-Washington Hospital Center in Washington, DC currently completing her research time including a Surgical Critical Care Fellowship at University of Chicago Hospital. You can find her outside of the hospital relaxing on her apartment rooftop with her significant other, fur baby, and a glass of wine. Follow her journey on twitter @RachaelEssig. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, education, reflection, research --- ### [A Practical Guide to Establishing Mentors as a Virtual Medical Student](https://blog.womensurgeons.org/a-practical-guide-to-establishing-mentors-as-a-virtual-medical-student/) **Published:** April 21, 2021 **Author:** Blog Team **Content:** *By Shan S. Lansing* 2020 was the year for virtual medical education. Preclinical students would jest that they were attending *Zoom School of Medicine*, and whole cohorts of new medical students were inducted with virtual white coat ceremonies. Though video platforms made it possible for clubs and interest group meetings to continue, the free pizza and casual networking was replaced with gentle encouragement to go ahead and turn your camera on, if you’re comfortable. Beginning a career in medicine is daunting, and the ongoing COVID-19 pandemic has only served to add new challenges to the already formidable tasks involved with beginning medical school, developing a support network, and creating meaningful relationships with mentors. I have heard from many preclinical medical students that the transition to virtual events has made it challenging to network and connect with surgeons. With that in mind, here are a few practical tips for establishing relationships with mentors: 1. **Be persistent**: I get it. Reaching out to a potential mentor (via email or otherwise) and not receiving a response is discouraging. When this happened to me, I felt like the email I had sent was annoying to the surgeon. The truth is that the lack of response was less a reflection of me, and more likely a reflection of how busy that surgeon happened to be the day I sent the email. When seeking mentors, try not to be discouraged when someone does not have the time to commit to meeting with a student. Continue to reach out to other surgeons until someone replies. 2. **Be specific**: If you find yourself in the position of not receiving a response to the initial email, take a step back and analyze the message. Is it a long email? Make sure the email is brief and easy to read, and that the reason for the email is explicit. I generally avoided long introductions about myself (after all, I wanted to hear their experience and advice, I didn’t want them to listen to my story) – *I am a medical student interested in pursuing a career in surgery*. Then, be specific why you want to meet with them. Rather than asking to “talk about surgery,” explicitly state why you are looking for a mentor. Try asking the Program Director if they would speak with you about how to utilize pre-clinical and clinical years to be prepared for residency. Try asking a female surgeon with children if she would discuss the feasibility of being a mother and having a surgical practice. Surgeons will have an easier time accepting a mentee if they understand what they can offer the student. 3. **Be flexible**: Recognizing that surgeons often have busy schedules with limited time outside of the clinic and the operating room (OR), be flexible when coordinating a time to meet. Sometimes mentors would have designated administrative, research, or office time, which would make it convenient to schedule a meeting. When there are conflicts, it’s okay to be creative. In preclinical years, I would ask if I could shadow an OR or endoscopy day, knowing we would likely talk casually between cases. Bonus points – in addition to talking through problems with a mentor, there’s a great day in the OR! 4. **Utilize membership in professional organizations to connect with surgeons**: When beginning the search for mentors, or trying to initially connect with a surgeon, take a look at professional organization directories for a good starting place. As a student member of the Association of Women Surgeons, you can see which surgeons at your institution are also members. When reaching out to them, include in the email “I am a member of AWS, and I saw on the member directory that you are also a member and was hoping we could connect. I am seeking a mentor that can help me visualize the path to becoming a surgeon-scientist in surgical oncology. Would you have time to meet with me to discuss your path and experience in the field?” If you are not an AWS member, registration can be found [here](https://www.womensurgeons.org/page/Students). 5. **Find multiple mentors for various personal attributes**: Sometimes we begin to feel like we need a mentor that checks all the boxes. *I want someone who can guide me toward a career in colorectal surgery while balancing motherhood, and will help me overcome obstacles related to being from a rural area.* That person might not exist near me – but that’s okay! It’s okay to have a colorectal surgery mentor, and a female surgeon mentor, and a rural/underserved mentor. There is validity to seeking mentors with similar experiences who have faced similar obstacles, but try not to limit the options by thinking a great mentor has to have faced ***all*** the same obstacles. 6. **Appreciate informal mentors**: Mentorship programs such as the [URM Mentorship Program](https://www.womensurgeons.org/page/Students) sponsored by AWS, [LSS](https://www.latinosurgicalsociety.org/), and [SBAS](https://www.sbas.net/) are fantastic, as are formal mentorship pairings made by medical schools. While even asking a surgeon explicitly to be your mentor has advantages, try to appreciate the informal advice that gets passed along. Sometimes on a clinical rotation a resident will give residency application advice, will share which surgeons in the department are known for having active research projects, and will encourage you to take on new challenging patient care tasks. These mentors, while perhaps less obviously mentors, play an important role in the growth toward becoming a physician and surgeon. Much of this advice is applicable beyond the virtual world that COVID-19 has created. While we will go back to having some in-person events where relationships with mentors may casually blossom over small talk, it is unlikely that every mentor relationship will come from a networking event. That said, like anything in life that is worth doing, establishing relationships with mentors is worth working for. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/Shan-300x263.png)Shan Lansing is a fourth-year medical student at The Ohio State University College of Medicine, and she recently matched into the General Surgery program at Oregon Health and Science University. Originally from a small town in southern Oregon, she attended Oregon State University where she earned a dual Bachelors in Chemistry and Biohealth Sciences. She continued at Oregon State University for a Masters in Analytical Chemistry. Her advocacy interests include increasing access to surgical care in rural and isolated communities throughout the United States. Ultimately, Shan seeks to pursue a career in rural general surgery, aiming to provide compressive surgical care for an underserved community. In her free time, she enjoys running, cooking, and cross-stitching. You can find her on Twitter @ShanSLansing. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, medical students, mentorship --- ### [Becoming a Urologist: The Journey from Little Girl to Certified Urologist](https://blog.womensurgeons.org/becoming-a-urologist/) **Published:** April 14, 2021 **Author:** mcooke@amrms.com **Content:** *By Milena Taskovska, MD* Being a surgeons’ daughter, I thought I was prepared for every possible gender discrimination when pursuing a career in urology, but I was wrong. Soon after starting my residency, I realized that it can always be worse. I was entering the field with knowledge of how most male surgeons perceive their female colleagues; about how much female surgeons were undesired and underrated, on other hand how much more effort, time and patience they invested in the process to prove that they can do the job equally successful as their male colleagues. During those six years, I often wondered why we are silently classified into residents and female residents. We did the same job, shared the same responsibilities, and were expected to obtain the same skills and knowledge; on the other hand, we were treated differently during the process. I will never forget the words of one excellent surgeon during my abdominal surgery rotation: “*you would make an ideal surgical resident if you were male. But you are female, so some consider you too aggressive.”* He was/is probably right, and that is the way the majority of our urological/surgical society looks at female surgeon/resident. Some “traditional, conservative” roles are still dominant in our profession. It is considered OK, to have an alpha male surgeon, but it is extremely wrong to have an alpha female surgeon. We all expect professional relations and respect in the OR and outside. We all need 100% dedication of all team members when performing a surgery (no matter if we are male or female). It is about skills and knowledge, not about gender, race, nationality, etc. Through all ups and downs, I did it. Today, I am proud to say that I am a certified urologist (the first female in our department after more than a decade). I love my job. After reaching the top of the resident “circle of life,” here I am again at the bottom of the “urologist circle of life”. And here it starts again the same looks, again the same doubts, is she capable of doing it? Yes, I am! I am against stereotypes. All people do not fit in one mold. Our differences are those that make the world beautiful, diverse, who broaden our views on different topics. Surgery is not about gender. Surgery is about the skills, determination to do your job as best as possible, and be there for your patients. It is passion and lifestyle. My father is a wise man. I always keep in mind his words “*your gender is just a category; never let your gender be an obstacle*”. My mantra since starting my journey in urology is a quote of another wise man “ ***first they ignore you, then they laugh at you, then they fight you, and then, YOU WIN!”*** To everyone considering a career in urology, do not let anyone stop you based on some differences. Be determined, fight for your dream job! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/Capture.png)Dr. Milena Taskovska, MD is a urologist at the Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia. She is also a teaching assistant at the Department of Surgery, Faculty of Medicine, University of Ljubljana, Slovenia. You can follow her on Twitter [@militasko](https://twitter.com/militasko?lang=en) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** womeninsurgery --- ### [Mentorship: How to provide it, how to obtain it](https://blog.womensurgeons.org/mentorship-2/) **Published:** April 12, 2021 **Author:** mcooke@amrms.com **Content:** *By Ashley Meagher, MD, MPH, FACS* Mentorship is one of the most important facets of medicine. We rely on mentors to guide us in medical school, as we choose a specialty. In residency, we are frequently assigned a faculty mentor as well as a “peer” mentor (a more senior resident) to help guide sub-specialty selection, navigate residency issues, or even advise on research projects. Mentorship continues as we exit residency and take on fellowship or faculty positions. Most of us have experiences in which the mentorship relationship can best be described as “non-therapeutic”. Mentorship and menteeship is a relationship that requires effort and commitment from both parties. To maximize the relationship, it is best to start by laying some ground rules. “*What do you/I hope to obtain from this relationship?*” “*What time do you/I have to commit to this relationship?*” It can be helpful to answer these questions during the introductory meeting, or even in an introductory email before meeting. For the mentee, think critically about what you would like from your mentor. It is common to have different mentors for different aspects of your life/career. I have often heard mentoring relationships discussed as more of a “board of directors”, rather than a single mentor to guide every aspect. This allows you to pick mentors according to their strengths. You will learn a lot through diverse mentorship with this technique and find that your various mentors can provide well-balanced guidance on career choice, research efforts, leadership development, or (oddly enough) mentoring. Mentors will push you, and sometimes believe in your abilities more than you do. When agreeing to be a mentor, it is important that you are honest with yourself, and your mentee, about your ability to support them. I find it helpful to schedule meetings, even if it is quarterly, and give goals for the meeting. This keeps both parties accountable and provides a framework for the relationship. While mentorship and sponsorship are different, mentors frequently become sponsors for their mentees. Think critically about ways to boost your mentee along their path. Research ways to help them succeed when they are having difficulties, or research alternatives if something in their path isn’t working. I find that through doing this, I have learned from my mentees nearly as much as I’ve taught them. Interestingly, there is practically no formal curriculum on being a mentee or becoming a mentor. However, these skills are not innate. As junior faculty, I have found that asking for advice and guidance in my own mentoring has been very helpful. Additionally, there are some great leadership development courses that have mentorship/menteeship built into the curriculum. The [Michigan Mentorship Academy](https://medicine.umich.edu/dept/surgery/michigan-promise/our-initiatives/achievement/michigan-mentorship-academy) provides a curriculum and publications for both mentor and mentee success. I rely on senior partners to advise me if I’m struggling with a mentee or specific issue. This type of “tiered mentoring” is helpful and can be formalized into a part of the mentorship relationship. It can be used to train mentors and aid mentees at multiple levels. One of the hardest things to do is terminate a non-functional mentor-mentee relationship. Recognize that not every relationship is destined to last an entire career. Sometimes the goals of the mentor/mentee have changed, sometimes the goal is achieved, and sometimes the relationship just isn’t working. When this happens, it’s ok to acknowledge it and walk away. I would advocate maintaining a civil relationship, if possible. But this is always depending on the circumstances. Some people find that this happens more frequently with “matched” mentor-mentee dyads than with organically developed dyads. When this happens try to remember that, typically, there is no one at “fault”. Being in these relationships can be difficult and require work, just as other professional relationships. I see myself as a product of a long line of amazing mentors, many of whom are members of AWS and AAST. I hope that each of you will find valuable and fulfilling mentors and mentees that enhance your career. **Please join us on Monday, April 19th at 8-9pm Eastern Time for an AWS Tweetchat about mentorship in surgery, in partnership with the AAST**! This chat will focus on how to develop mentorships and sponsorships as a trainee, how to create a mentoring network outside of your home institution, and how to make the most of these mutually beneficial relationships in the surgical world! The chat will be moderated by Drs. Stepheny Berry ([@Dr\_Stepheny](https://twitter.com/Dr_Stepheny)), Jennifer Hartwell ([@traumamom4](https://twitter.com/traumamom4)), Lillian Kao ([@LillianKao1](https://twitter.com/LillianKao1)), Bryce Robinson ([@BryceRobinsonMD](https://twitter.com/BryceRobinsonMD)). Questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtags #AWSchat and \#SurgMentorship. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following questions during our tweetchat: **Q1:** Our first question deals with the practical logistics of establishing surgical mentorships and sponsorships: How should students, residents, etc go about finding a mentor? Any examples from your journey that you would be willing to share? **Q2:** What are key things to look out for when looking for mentors early in one’s career? How do you ensure your mentor has your best interest in mind and goals are aligned or mutual? **Q3:** There has been a lot of interest in developing one’s “mentoring network”. Could you explain what this means to you and how to go about seeking mentorship for various aspects of one’s career, and outside of home institutions? **Q4**: Can you discuss the differences between a mentor and sponsor? How do both play a role in guiding your career? **Q5:** Do you have any suggestions for how to avoid common mentee missteps? Or, how to make the most out of a mentoring relationship as a trainee? **Q6:** What is the best piece of advice you have received or come across during your career about how to successfully navigate mentorships, or a valuable piece of advice from your mentors that has had a huge impact on your journey? Words of wisdom much appreciated, especially for newly matched residents who will embark on intern year very soon! ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/Meagher-1024x1024.jpg) Dr. Ashley Meagher is a Trauma and Acute Care Surgeon at IU Health Methodist Hospital in Indianapolis, Indiana and is affiliated with Indiana University Health Medical Center. She is board certified in General Surgery and Surgical Critical Care. She is also the Director of Research for the Acute Care Surgery Division. She has been honored to have numerous mentors through her career, many of whom are members of AWS and AAST. She’s been passionate about establishing formalized mentorship relationships for medical students and residents pursuing research in trauma and emergency general surgery outcomes. You can find her on twitter @[Dr\_AMeagher](https://twitter.com/Dr_AMeagher) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, mentor, mentoring, mentorship, Tweetchat, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [A year of radical changes](https://blog.womensurgeons.org/a-year-of-radical-changes/) **Published:** April 8, 2021 **Author:** mcooke@amrms.com **Content:** *By Dr. Rocio Carrera* The COVID-19 pandemic disrupted our lives and plans. Almost a year after the world went into quarantine and after countless losses of lives, jobs, and homes, we can finally see a light at the end of the tunnel thanks to the mass[ vaccination programs](https://www.nature.com/articles/s41577-021-00531-0) in many countries. My life, same as many others, changed radically during 2020. I was working as an attending at a general hospital in Mexico City. After finishing residency in both general and thoracoscopic surgery, that was not my initial plan. I wanted to complete my surgical training abroad, but my own indecisiveness, lack of savings, and support, led me to postpone that dream. Not having achieved it right after finishing my fellowship was disappointing, and one of my biggest mistakes was always comparing myself to others. At that time, I felt that all the people I knew, especially my residency peers, were doing important things and I was stuck. In early 2020, I received an email with an offer letter for a senior fellow position at the University of Washington to which I had applied the previous year. I was ecstatic and accepted almost immediately. I started making plans and a few weeks later, the pandemic hit. They were[ difficult months](https://blog.womensurgeons.org/leadership/covid-19-a-mexican-experience/) trying to take all the necessary precautions to protect myself and my family. On top of that, I was concerned that the fellowship start date was fast approaching, and all the paperwork was on hold. With a bit of luck, I got my visa and was finally able to travel. When I arrived, I didn’t know anyone, the city was completely shut down, and all the meetings were virtual. After the initial excitement and keeping busy settling in, the reality is that I started getting depressed. I was living alone for the first time, in another country, away from family, and friends, and worried about their health and safety. Everyone here was kind and welcoming, and I was pushing myself so hard to make a good impression. I felt very lonely and cried constantly. I was wondering, *if this was my dream, why didn’t I feel happy?* In Mexico, I had a good job and had started giving classes to medical students. Now, I was a trainee again, and there were a thousand things that I didn’t know how to do or solve. There were days where I wondered if coming here and leaving everything behind had been a mistake. A few months later, I realized that the situation that we all have gone through with the pandemic has been something unprecedented. I noticed that many were having the same issues and shared my feelings of overwhelm, but we were all really trying to do our best. I learned to appreciate everything I have, to not be so hard on myself, and to manage my own expectations. Some days, I still have problems with my imposter syndrome, and I still miss many things, but I feel very fortunate. Here, I’ve found wonderful people who have treated me as one of their own and taught me more than they can imagine. Now, feeling more adapted, fully vaccinated, with the arrival of the spring and being able to go to more places with less restrictions, I’m improving in all aspects. Success and happiness are not defined by a title, money, or publications, but by knowing that our loved ones are safe and by our side (even at a distance). We all have our own path and timing. Be gentle to yourself. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/headshot.png)*Dr. Rocío E. Carrera Cerón is a general and thoracoscopic surgeon and is currently a Senior Fellow at the Center for Videoendoscopic Surgery (*[*CVES*](https://uwsurgery.org/researchintroduction/labs-and-centers/cves/)*) at the University of Washington in Seattle. She received her medical degree from Universidad Nacional Autónoma de México* [*(UNAM)*](http://www.facmed.unam.mx/) *in 2012 and completed her residency and fellowship at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (*[*INCMNSZ*](http://www.incmnsz.mx/opencms/contenido/cirugia/objetivo.html)*) in 2017 and 2018 respectively. She is engaged in clinical research studies with special interest in surgical outcomes and health disparities. She actively participates in local groups and national associations of* [*women*](https://www.womensurgeons.org/) *and* [*Latino surgeons*](https://www.latinosurgicalsociety.org/) *trying to mentor residents and students interested in the surgical field. A native of Mexico City, she is passionate about sports, cinema, and historical novels. You can follow her on Twitter* [*@ChioCarreraC*](https://twitter.com/ChioCarreraC)*.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, current events **Tags:** #womeninsugery, AWSBlog --- ### [The Journey of a Female Surgeon - How do I Get This Right?](https://blog.womensurgeons.org/journey-of-a-female-surgeon/) **Published:** April 1, 2021 **Author:** Blog Team **Content:** *By Eanas Yassa* Being a female surgeon – how do i get this right? Don’t be too happy, patients think you don’t understand the seriousness of their problem Don’t be too serious, patients think you can’t handle stress and don’t care about making them feel better Don’t provide answers, you seem like a “smarty pants” or “know it all” Don’t admit when you don’t have the answer, you seem too uncertain or unable to do the job Don’t threaten the men with your knowledge, voice or experience; you need them to like you Don’t threaten the women with your knowledge voice or experience; you need them to like you Don’t be pretty, it makes patients not trust you Don’t be ugly, it makes patients not like you Don’t be too well dressed, it gives people the impression you think you are better than them Don’t be poorly dressed, it gives people the impression that you don’t think they are worth getting dressed up for Don’t talk about your family, it makes you seem not focused on the patient and not strong enough for the job Don’t hide that you have a family, it makes you seem like a bad mother and not caring Don’t have a family, it distracts you from patient care Don’t be childless, it makes you cold and unrelatable Don’t admit you have help at home; people will question how you can leave your children at home with a stranger Don’t hide that you have help or people will think you are too “perfect” Don’t… Don’t… Don’t… Don’t forget about the patient experience and likelihood to recommend… But… Don’t believe the critics, the biggest and meanest can be hiding inside you Don’t try and please everyone — be proud of who you are and what you bring Don’t forget you are a powerful person Don’t forget to smile… but not too big ![](https://blog.womensurgeons.org/wp-content/uploads/2021/04/Picture1.png) Dr. Yassa is a vascular surgeon practicing in Grand Rapids, MI, at the Spectrum Health Frederik and Lena Meijer Heart Center. She is the Section Chief of Vascular Surgery and the Associate Program Director for the MSU/Spectrum Health Integrated Vascular Surgery Residency and Fellowship. She has a focus on advanced open and endovascular aortic surgery for thoracoabdominal dissection and aneurysm pathology. She was fortunate to be encouraged to advocate for herself and others from a young age and was mentored by many pioneering women in medicine and surgery in her career. She is an advocate for the intentional development of leadership skills in women and men at all stages of their careers. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** gender differences **Tags:** doctor-patient relationship, family, Gender Disparities, womeninmedicine, womeninsurgery, WomenSurgeons, work-life balance, workplace --- ### [Running from my Problems: How Exercise Kept me Moving through Medical School](https://blog.womensurgeons.org/running-from-my-problems/) **Published:** March 26, 2021 **Author:** Blog Team **Content:** *By Jessa Fogel* People ask me all the time how I manage to run every day in medical school, and I usually answer in the same way: “I just really love it.” But sometimes love alone can’t get you out of bed at 5:30 on a rainy Monday morning, and that’s where the answer gets longer. I started medical school two and a half years ago, leaving my gap-year job in rural Alabama to move to a city I barely knew. While I loved the excitement of starting a new chapter in my life, the change necessitated some form of continuity, something I could carry over from my former home. For me, that continuity came in the form of exercise. I’d been a competitive cross-country skier in college, and when I graduated and moved to the decidedly snow-less Alabama, I satisfied my craving for activity by running every morning before work. When I started medical school, exploring my new hometown on foot every morning before class initially felt like a soothing ritual to help me adjust to the transition. Eventually, however, I realized that I had classmates who shared my love of running—classmates that I hadn’t yet gotten the chance to know beyond a few minutes of small talk at orientation. On an uncharacteristically extroverted whim, I invited a couple fellow students to get together for a run one weekend. That first run was followed by another…and then another…and then another. Within a few months, we started going every morning, meeting at the same time and place before class. Although we all came from different states, went to different colleges, and ranged in age from 22-36, running was what brought us together—that, and a deep love for bagels and coffee. While we ran, we chatted about anything and everything. Family, research, school, history, politics, marine biology, our favorite foods, our preferred running shoe brands—no topic was off-limits. The more miles we ran, the more conversations we shared, the more coffee and bagel shops we discovered around the city, the more we found we had in common. We became a team, tackling local 5Ks and half marathons together, supporting each other through the anxiety of exams, celebrating each other’s birthdays, and gathering together for potluck dinners. We even bought matching “medical-themed” socks to wear to local races adorned with cartoon depictions of various organs and cute phrases like “I heart your guts.” Charming, I know. Maintaining my physical fitness and having a solid group of friends to support me through that first challenging year of medical school was invaluable. Running allowed my body the movement it craved and cleared my mind to focus on studying, while building strong friendships kept me from bearing the most stressful days alone. To those who wonder how we crazy runners do it, my only answer is that it feels like an escape, rather than a chore. Running, especially with others, is no longer something I have to “fit in” to my schedule—it’s something I can’t live without. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/03/2-1.png) Three members of the running group ready to tackle a trail half marathon in the rain!![](https://blog.womensurgeons.org/wp-content/uploads/2021/03/Picture1-1.png) Jessa Fogel is a third-year medical student at Vanderbilt University School of Medicine, hoping to pursue a career in orthopedic surgery. Originally from Bow, NH, she received her B.A. in biology at Dartmouth College, with a minor in international studies. Prior to medical school, she spent a year working for a community health non-profit in Greensboro, AL. Outside of medicine, she enjoys running, biking, drawing, and searching for the best coffee in Nashville. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** education **Tags:** medical school, medical student, mental health, womeninmedicine, womeninsurgery, WomenSurgeons, work-life balance --- ### [“You Matched, Now What?”](https://blog.womensurgeons.org/match-2021/) **Published:** March 22, 2021 **Author:** mcooke@amrms.com **Content:** *By Alicia Greene* Congratulations! This is a moment that you will always remember. Many of you have dreamed about being a physician for several years. Not only are you going to be a physician, but you have the opportunity to train to become a surgeon, one of the most rewarding careers in the world (I’m a little biased but hopefully you agree!). Here is my advice on how to make the most of this valuable time before residency begins. What I am most grateful for during this period was the quality time I was able to spend with friends and family. Vacation and days off are limited once residency begins, so make the most out of this time by visiting the ones who mean the most to you. Some of you may have virtual match days and/or graduations similar to my experience last year. I would recommend setting up a Zoom celebration with your family or celebrating these moments with a small group of your closest friends. Also take this time to enjoy your hobbies. My co-intern, Sareema, had great advice which was to start something that you have always wanted to do such as working out, learning a musical instrument or cooking. Once July 1st (for many programs) arrives, you will need to have these things mastered so you can perform them in autopilot mode during a busy work week. If you will be moving to a new city, take this opportunity to visit and explore housing opportunities. I would recommend living in close proximity to the hospital where you will be spending the most time. Surgical residency involves long hours of work and overnight shifts so a short drive in to work and back home will provide you with more time to do the things you enjoy outside of the hospital. After moving to your new city, take the opportunity to reach out and meet up with some of your new co-residents. This will be your family for the next several years. My biggest concern when thinking about starting residency was, “What should I study? I don’t want to be unprepared.” Looking back, I don’t think I retained much of the information I tried learning prior to starting. However, there was one thing I found extremely helpful, the Behind the Knife podcast sessions that are titled “Medical Student and Intern Survival Guide.” These are 12 podcasts that reveal the common scenarios that you will face every day on the floor as an intern taking care of your surgical patients. You are not expected to know all the details on every disease or all the steps of a surgical operation your first month, but you are expected to know how to evaluate a patient, identify complications, and begin the work-up. Enjoy this moment as well as graduation, and appreciate this time with your family and friends. You are about to embark on one of the hardest yet most rewarding experiences of your life. You will have the opportunity to come to work everyday and change someone’s life. Work hard, be passionate, and learn something new with every experience. Congratulations again on matching! **Please join us on Monday, March 22nd at 8pm Eastern Standard Time for an AWS Tweetchat titled “You Matched, Now What?”.** This Tweetchat will be geared towards medical students who have just matched, providing them with tips for immediate next steps in preparation for intern year, i.e.: reaching out to residents in the program for housing/apt suggestions, licensing, planning out when to take step 3 and books that are helpful to prepare for intern year. We also are planning to have a discussion for medical students who matched into prelim but not categorical spots and what they should be thinking about and aiming to do for the next year’s match. The chat will be moderated by Dr. Bryce Bludevich **(**[@BBludevich](https://twitter.com/BBludevich)), Dr. Jennifer LaFemina ([@JenniferLaFemi1](https://twitter.com/JenniferLaFemi1)), Dr. Micah Brainerd ([@\_BrainyMD\_](https://twitter.com/_BrainyMD_)), and Dr. Hemasat Alkhatib ([@AlkhatibHemasat](https://twitter.com/AlkhatibHemasat)). The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat and #SurgMatch. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more: <http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/>. We will be discussing the following topics during our tweetchat: Q1: Moving to a new place and starting work at a new hospital is a big step. What is your advice for finding a place to live, tackling licensing, and connecting with your new residency program? Q2: What can you do to prepare before intern year i.e. skills, reading, knowledge? Are there any resources/must read books you recommend? #Surgeonswhoread Q3: What advice do you have for students who matched into preliminary surgical positions? Q4: What advice do you have to maintain wellness & practice work/life integration? Q5: What is one thing you wished you knew/did before starting residency? Q6: How do you find a mentor before/during your intern year? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/03/Alicia-Greene-Headshot-1-682x1024.jpg) Dr. Greene is from Jarrettsville, Maryland. She graduated from Stevenson University in 2016 and Campbell University School of Osteopathic Medicine in 2020. She is currently a general surgery categorical intern at Penn State. In her free time she enjoys golfing, playing with her Golden Retriever, and spending time with family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, ILookLikeASurgeon, Match, residency, residents, surgical residency, Tweetchat, womeninsurgery --- ### [The History and Physical](https://blog.womensurgeons.org/the-history-and-physical/) **Published:** March 18, 2021 **Author:** Blog Team **Content:** *By Caitlin Burke* My mother worked full time when I was in elementary school, and when she came home I would recount my entire school day. The level of detail I included was unusual – right down to which classmates I stood behind in the single file lines we traveled in around the school hallways. According to her, I was a child with a “photographic memory.” Twenty years later, as I applied to medical school, I felt my insistence on detail would allow me to know my patients accurately and personally. During my second year of medical school, “Interviewing” was the course everyone talked about. We were finally setting foot on hospital wards, wearing white coats, and feeling like doctors. When it came to patients, some students found a natural place while others struggled to communicate. During 2009, the year of my “Interviewing” course, *Medical Teacher* published an article entitled: “Talking with patients and peers: Medical students’ difficulties with learning communication skills.” This article suggested that patient stories were not being fully captured. My opportunity to capture a story came in the form of a patient suffering from gastroenteritis, let us call him Barry. Barry was a Caucasian man, 65 years old, 190 pounds, with thinning grey hair, glasses, and a smile. I began with the instructed statement, “What brought you to the hospital?” I collected details involving Barry’s abdominal pain, medical history, medications, former smoking habit, and his mother with Alzheimer’s, but I also asked about his favorite color, his wife’s personality, and what he did on Saturdays. I felt relaxed, smiling at many of his remarks. I received feedback from my group: “The interview was smooth, you looked like a natural, it was impressive.” I was thankful that talking to patients was not going to be my figurative mountain to climb. “Interviewing” was paired with a physical exam session later that week with an internist whom fellow physicians referred to as “one of the best educators.” Huddled with our backs to the walls of different patient rooms, our cohort spent an afternoon watching this doctor demonstrate jugular venous distension and the ascites fluid wave. This physical exam was unrushed and thorough. On the eve of my third year, my first clinical year, I was determined to take histories like Barry’s and conduct physicals just like the one the internist had done. The first interview of my third year, on my surgery rotation, was on a young woman (let us call her Sheila) with appendiceal cancer. Given only half the time I’d had with Barry, I focused on pertinent positives. My “Interviewing” course became a distant memory, as there was no time to document subtleties such as Sheila’s double pierced ear, the annoying look she gave her parents, and the number of times she could not make eye contact with me. My physical exam was equally shortened. When I saw the resident’s history: “Abdominal pain x 3 days, weight loss,” and physical exam: “AAO x 3, RRR, CTAB, soft, mildly tender, distended, WWP,” I wondered if the resident felt he knew Sheila at all. During surgical residency, my efficiency increased dramatically. It was not uncommon to complete twenty consults overnight as a PGY-3 working in the emergency department. The volume was exhilarating and I loved the feeling of hitting my groove as the night wore on. If I had spare time, I often talked to patients longer since hearing their stories helped to illuminate the experiences at hand in the emergency department. My habit of wanting to know more carried over to postoperative care units. Once, after participating in a patient’s pulmonary lobectomy, I wheeled him (let us call him Martin) to recovery where I then listened to his feelings about being a retired English teacher. Before I left that day, he knew my favorite author, Gabriel Garcia Marquez. During my chief resident year, I received a copy of Garcia Marquez’s *The Autumn of the Patriarch* in my mailbox with a card: “Dear Dr. Burke, all of the plaques in the hospital honoring women are for the wives of wealthy donors or nuns. I look forward to the day when there is one honoring the career of a female surgeon. It will bear your name.” Martin and I had forged a connection with one another, one that we both valued. I spent my PGY-8 year in cardiothoracic surgery training which, for me, left little room for anything else. It was in this environment where I found that the histories of “Interviewing” and the unrushed physicals that defined medical school were absent from my experience as a fellow. Team rounds felt too brief and conversations too short. I wondered if I had unknowingly allowed a part of myself – the part that insisted on hearing patients’ stories – to be left behind in my decision to become a cardiothoracic surgeon. Now, as a PGY-9 pursuing acute care surgery and critical care medicine, I still wonder how my advancement through surgical training has coincided with the loss of patient stories – illuminated in all of the ways ample time can provide. I feel this loss for myself, since I enjoy knowing my patients beyond their illnesses and for all of the patients who wish to feel more connected to their doctors. I am optimistic about reclaiming patient stories in my daily practice and I am excited to focus part of my career on bringing these stories to light. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/03/AWS-photo-812x1024.jpg) Caitlin Jill Burke, MD, is a critical care medicine fellow in Boston, Massachusetts. She attended Washington University in St. Louis, completing a B.A. in English as well as premedical studies. She received her MD from Tufts University School of Medicine, completed General Surgery training in Albany, New York, and has spent additional time training in both Philadelphia and Chicago. She is excited to be back home in Boston this year with her husband and two-year-old daughter. You can find her on twitter at [@caitlinjburke](https://twitter.com/caitlinjburke). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** career development, clinical practice, doctor-patient relationship, interviews, medical student, patients, time management, womeinmedicine, womeninsurgery, WomenSurgeons --- ### [Palliative Care in the TICU](https://blog.womensurgeons.org/palliative-care-ticu/) **Published:** March 10, 2021 **Author:** Blog Team **Content:** *By Bethany Wood Harvey* I think it’s a fair assumption to say the Trauma ICU is a bit different than anywhere else in the hospital. Our patients are often in our care unexpectedly; they are ‘healthier’, working, and independent just hours before arriving in the TICU. Moreover, they are acutely sicker -their status is often tenuous and can decompensate quickly. In these situations, families are often thrust into the position of being surrogate decision makers, being faced with questions they had never previously considered. These family members look to the team to help guide and support them through this process. Although as surgeons we have 9+ years of medical education, often less than 1 month of that time is dedicated to how to effectively have difficult conversations. While scrubbing for a trauma surgery, you may not know exactly what you will encounter, but at the sink, you rehearse the steps in your head. One needs to treat these conversations as if it were a case and prepare as such: know the history of the patient, the details of their prognosis, their treatment thus far, and anticipate complications that may arise. One way to accomplish this is a pre-meeting discussion with all of the services involved in the patient’s care, as trauma is a multidisciplinary field. Making sure everyone is on the same page with realistic goals, expectations, and treatments that may or may not be indicated helps to present a united picture for the already overwhelmed family. Now, to the nuts and bolts of the family meeting. For some residents and attendings alike, I’m sure just the thought of running a family meeting induces palpitations. Thankfully, there are tools which provide a framework for surgeons to effectively elicit a patient’s goals and values: [The Serious Illness Conversation Guide](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2728430) and the[ REMAP Framework for Difficult Conversations](https://ascopubs.org/doi/10.1200/JOP.2016.018796?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&) being the most frequently used. I encourage you to try both and see which is naturally easier for you! For myself, I tend to use REMAP: R:Reframe E:Expect emotion M:Map out a plan A:Align with patient values P:Propose a plan I could dedicate an entire blog post to each step, but for myself as a surgeon in the TICU, learning to comfortably navigate the “reframe” and “expecting emotion” have been critical. Reframe – In this step, the surgeon assesses the patient/family’s understanding of the patient’s medical course/prognosis and then helps them take a step back to see the big picture. “Unfortunately, we are in a different place than we were X days ago” is one of my go-to phrases. Many TICU patients were healthy, independent individuals and it can be extremely difficult for families to comprehend the new reality. “Although I’m hopeful your loved one may \_\_\_, I’m worried that they may not \_\_\_ (regain their independence, breathe without the help of machines)”. The reframe statement sends a ‘warning shot’ to the family and often elicits an emotional response. Expect emotion – in this step one must recognize that the statement from the patient/family after the reframe is typically an emotion, despite sounding like a factual question: “Are you telling me there’s nothing more you can do?”,“Is my mom dying?” It is critical that the surgeon responds to the emotion first before continuing the conversation. “I can’t imagine how overwhelming this news must be” or “I wish there was a treatment that could fix this, but the team is here to support you”. This step has been the most uncomfortable adjustment for me. Physicians feel safe in numbers, percentages, and factual responses and therefore want to answer the factual question. It feels awkward to respond to a factual question with empathy or naming the emotion rather than an answer, but trust me it works! This allows the patient/family to process the reframe and move forward to collaboratively work on a plan. This framework can be applied to any situation where you are breaking serious news; whether it is your vascular patient who has failed multiple revascularizations now needing to discuss amputation, or your surgical oncology patient with tumor progression despite neoadjuvant chemotherapy. Navigating these conversations requires deliberate practice, and I encourage you to review the referenced articles and begin to integrate them into your discussions. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/03/1-1.png) Bethany Wood Harvey, MD, MHS, is a general surgery resident at the University at Buffalo, currently completing a fellowship in Hospice and Palliative Medicine at the University at Buffalo. She received her MD from Tufts Medical School and her MHS from the Johns Hopkins Bloomberg School of Public Health. She lives with her husband, 3 kids, and 2 dogs in Buffalo NY and plans on pursuing a Surgical Oncology fellowship after graduation. You can find her on twitter at [@bdwood62](https://twitter.com/bdwood62). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice **Tags:** advocacy, communication, end-of-life, palliative care, patients, team, trauma surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Communicating Across Differences](https://blog.womensurgeons.org/communicating-across-differences/) **Published:** March 5, 2021 **Author:** Blog Team **Content:** *By Jaime Lewis and Virginia Shaffer* *This blog entry is the second in a series of six blogs authored by members of the AWS Clinical Practice Committee writing in collaboration with our society liaisons throughout the year.* Throughout our career, we will have heard or been a part of countless conversations – from mundane discourses, to heated debates, bitter diatribes, and cooperative dialogues. Many of us will spend our lives pondering and practicing ways to improve our ability to communicate. In situations where opinions differ, we must approach them with an open mind and acknowledgement that we may not know the entire story. We should recognize stereotypes and biases and try to mitigate their impact. We must have the courage to be uncomfortable,and [we should always observe the platinum rule by treating others as they want to be treated!](https://www.linkedin.com/learning/communicating-about-culturally-sensitive-issues?trk=course_title&upsellOrderOrigin=default_guest_learning) One can often approach a conversation with only our perspective, and we make assumptions about what the other person wants to say or how they want to be treated. We need to take a step back and ask our counterpart to help us see things from their point of view. Once we have created space for the other person, we still may not communicate well because we have different styles. Understanding that different styles exist is the first step in improving our ability to have an effective conversation. [Starting with the basics, there are four common “trip wires” in communication](https://hbr.org/2016/03/having-a-difficult-conversation-with-someone-from-a-different-culture): 1. Getting down to business versus relationship building – cut to the chase or get to know one another 2. Direct versus indirect communication – blunt or vague 3. Low versus high context – words or body language and facial expressions 4. Informality versus formality – casual or ceremonial While there may be obvious and somewhat predictable differences in communication between individuals from different countries, there may be more subtle but still important differences between individuals from the same geographic region. It is important to be aware of how these differences can significantly impact the words that are spoken. [It is then essential to develop your skills as a communicator](https://online.hbs.edu/blog/post/leadership-communication). 1. Understand how to adapt your communication style. Therefore, you must know your communication style and what other styles exist! There are numerous ways to learn your style, including reading and taking quizzes. 2. Learn to actively listen. Stay in the moment. Avoid distractions and the urge to interrupt. This can be very hard. [Practice, practice, practice RASA: ](https://www.ted.com/talks/julian_treasure_5_ways_to_listen_better?language=en)Receive, Appreciate, Summarize, Ask 3. [Engage transparency](https://www.youtube.com/watch?v=oVKaXUB4EFg). 4. [Be clear and specific](https://www.forbes.com/sites/forbescoachescouncil/2016/09/01/five-steps-to-keep-your-communications-crisp/?sh=1795de226d02). 5. Ask open-ended questions using the [TED acronym: ](https://hbr.org/video/3147952548001/the-value-of-asking-openended-questions)“Tell me more.”, “Explain what you mean.”. “Define that term or concept for me.” 6. [Display empathy](https://www.forbes.com/sites/bhaligill/2017/11/17/empathy-is-crucial-to-any-personal-or-professional-relationship-heres-how-to-cultivate-it/?sh=202b3c807961). Regardless of the outcome, acknowledge the other’s feelings and experiences. In communicating across differences, whenever possible, [we must also choose to be an ally](https://www.linkedin.com/learning/communicating-about-culturally-sensitive-issues?trk=course_title&upsellOrderOrigin=default_guest_learning). Being neutral does not make one an ally. An ally is one who learns by avoiding assumptions. An ally is one who listens more than (s)he speaks, even if (s)he disagrees. And an ally is one who acknowledges and yields any privilege (s)he has in the situation. When communicating across differences, it is of utmost importance to understand the other’s point of view. Where are they coming from? What data are they using? What is their interpretation of that data? What is different about the data we are looking at? What is different about our interpretation and implicit rules of the data? We need to shift from [“that’s wrong” to “tell me more”.](https://www.penguinrandomhouse.com/books/313485/thanks-for-the-feedback-by-douglas-stone-and-sheila-heen/) Each conversation we have is an opportunity to communicate across our differences. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/03/2.png) Dr. Virginia Shaffer is an Associate Professor of Surgery at Emory University in Atlanta, GA and specializes in minimally invasive and open surgical treatment of diseases of the colon and rectum. She received her M.D. at the University of Texas Health Sciences Center San Antonio, and completed general surgery residency at Emory University. Dr. Shaffer did a research fellowship in Transplant Immunology and subsequently did a fellowship in Colon and Rectal Surgery at Cleveland Clinic Florida. She is board certified in both General Surgery and Colon and Rectal Surgery. She is a fellow in the American College of Surgeons and the American Society of Colon and Rectal Surgeons. Her research interests include health services research, quality improvement, and clinical research. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/03/1.png) Dr. Jaime D. Lewis is an Associate Professor in the Division of Surgery Oncology and a Career Advisor in Student Affairs at the University of Cincinnati College of Medicine in Cincinnati, Ohio, where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Her practice is dedicated to the care of those with diseases of the breast. Dr. Lewis is also committed to improving wellness and professional development opportunities for those who pursue careers in surgery. Outside of the hospital, she enjoys road and trail (ultra)running and spending time with her family. You can find her on Twitter at [@JaimeDLewisMD](https://twitter.com/jaimedlewismd?lang=en). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** professionalism **Tags:** career development, communication, inclusion, Networking, Professional Development, Social Professional, Teamwork, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [When a Surgery Resident Gets COVID Pneumonia](https://blog.womensurgeons.org/when-a-surgery-resident-gets-covid-pneumonia/) **Published:** February 27, 2021 **Author:** Blog Team **Content:** *By Dr. Sara Parmiter* I awaken fatigued with body aches, not abnormal for a surgery intern. No one would think twice about taking acetaminophen and going to work. That is how I justify it to myself now. Hurrying to the clinic, I force myself to walk faster. I sit and catch my breath feeling the sweat roll down my back. I’m just tired. Walking back to the hospital, I stop and take a break; my legs are filled with sand. By the days end, I struggle to concentrate; it is physically taxing to keep my eyelids open and type. I have a cold, thinking to myself it cannot be COVID. That evening my temperature rose to 101; I reluctantly scheduled an appointment for testing the next morning. I am tough. My entire life I have been the strong girl, the one who can grin and bear it. I pride myself on pushing through uncomfortable situations. A rugby player and weightlifter, I served in the United States Air Force. A single mom attending college, while working two jobs. I can push through anything. I am resilient. COVID didn’t take notice of this. The next morning, barely getting out of bed, I drag myself to the bathroom. Brushing my teeth, I cannot taste the toothpaste. The minty fresh flavor is absent. Later that evening my results are positive. I am finally convinced I have contracted COVID-19. Exhausted like you wouldn’t believe, no amount of sleep could make up for it. Muscle cramps ensure I do not stay asleep long. Headaches guarantee I cannot concentrate on anything meaningful to make my awake hours productive. It is lonely sitting in a bedroom alone, fighting to stay awake and forcing myself to eat tasteless food. This is what I must do, to protect my family and maintain what strength I have left. Every phone call, email, and text asking how I am doing, I feel forced to say, “I’m okay!”. What else do you say in a situation like this? I can barely make it to the bathroom without passing out, but I cannot tell them this. Walking outside to get fresh air is all I crave, yet by week two I cannot make it 50 yards before I need to sit down. My heart races, beating out of my chest; nominal activities such as showering takes my breath away. I cannot return as a surgical resident when my oxygen saturation drops into the 80s walking outside. Convinced to visit the ER, I reluctantly go. Seeing the consolidations scattered about the lungs on CT, MY lungs, was appalling. COVID pneumonia it is. How can this happen to ME? I am young, strong, and healthy, remember? Maintaining oxygen saturation in the 90s while in bed, I go home feeling crushed. Each day I decide to fight. Expanding my lung capacity and building endurance becomes a job, a mission. Using the incentive spirometer, my inspiratory lung capacity is 1/3 a female of my height and age. I practice inhaling until my lungs burn with such intensity, I am forced to take a break. Walking outside slowly and methodically every day, stopping for air when the pulse oximeter announces my heart rate is over 130 or oxygen saturation below 88%. By week four, I can make it around the block with oxygen saturations staying in the 90s, so I return to work in the intensive care unit treating COVID-19 patients, of all places. I experience first-hand what my fate might have been, had I not been so lucky. Code blue, again. I start compressions knowing it is a futile activity we must engage in. This virus devastated this person’s heart, lungs, kidneys, and entire vascular system despite maxing out every medication we have to offer their unrested body. Words cannot describe the heartache and bleakness. Three months later my heart races. I cannot walk upstairs without it pounding as a band of tightness restricts my breathing. A day of operating is twice as taxing as it was prior to this virus sabotaging my body. I am not yet cleared to weight lift or run as I previously enjoyed. I LOOK fine. I go about my daily activities the best I can, knowing my body is not the force it once was. Each night when I lay down coughing, I have a reminder of what this crude virus left me. My tenacity and fortitude will not let me settle. I will continue to fight. COVID did not win. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/02/AWS-pic-239x300.png) Dr. Sara Parmiter is a general surgery resident in Annapolis, Maryland. A non-traditional medical student who was in the United States Air Force. She was also a licensed physical therapy assistant while obtaining pre-med requirements and raising her daughter. She is now married with three dogs and enjoys cooking, hiking, and exercising when she is not at the hospital. You can follow her on Instagram @barbells\_and\_scalpels --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** health, reflection, residency, self-care --- ### [One of these things (is not like the other)](https://blog.womensurgeons.org/one-of-these-things-is-not-like-the-other-2/) **Published:** February 18, 2021 **Author:** Blog Team **Content:** *Patricia Martinez Quinones* Remember joyfully singing to the Sesame Street tune “one of these things is not like the others, \[…\] just doesn’t belong, can you tell which is not like the others \[…\]?” Did you ever play it as a game, trying to guess the answer before the song was finished? What if this song played while you were in medical school, during your rotations, throughout your residency, or even during a committee or faculty meeting? Would you answer: “it’s me!”? For many students, residents, and faculty members in surgery this is likely their answer. According to the [AAMC, underrepresented in medicine](https://www.aamc.org/what-we-do/diversity-inclusion/underrepresented-in-medicine) (UiM) are individuals whose race/ethnicity are underrepresented in the medical profession relative to their numbers in the general population. UiM females in surgery are also a minority in terms of gender. Although women account for over 40% of all surgery residents, according to a recent study by [Aggarwal and colleagues](https://journals.lww.com/annalsofsurgery/Abstract/9000/The_Role_of_Race_and_Gender_in_the_Career.94212.aspx), Hispanic females and Black females only comprised 2.1% and 2.6% of surgical residents, respectively, with similar numbers for Hispanic and Black males. Similarly, [Valenzuela et al](https://www.journalofsurgicalresearch.com/article/S0022-4804(20)30228-6/abstract). found that surgeons from UiM backgrounds account for only 7% of academic surgery faculty in the U.S. UiM surgeons are also less likely than Caucasian surgeons to remain in academia, as revealed [by Abelson and colleagues](https://www.americanjournalofsurgery.com/article/S0002-9610(18)30058-8/abstract), with Black assistant professors having the lowest rates of promotion compared to other racial and ethnic groups. If you’ve ever walked into a room for an academic function and been the only female/UiM/LGBTQ+ in the room, you don’t need the statistics referenced above to know your reality. If you have been mistaken as the OR turnover crew, asked by a Caucasian medical student to pull their gown or gloves assuming you are the assistant, or confused with the only other UiM “X” at your institution, then you certainly have lived the statistics. For the allies, #HeForShe, #WeForShe, mentors, and sponsors, the question remains – knowing that surgery is deficient of UiM residents, faculty, and leaders, what are we (as a surgical community) going to do to increase diversity, promote inclusion, and ultimately reach equity? We must first examine the barriers preventing diversity, equity, and inclusion within surgery, starting with our own training programs, departments, and institutions. We must acknowledge that gender and racial/ethnic discrimination are still experienced by [residents](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2703945) and [faculty members](https://journals.lww.com/annalsofsurgery/Abstract/9000/The_Role_of_Race_and_Gender_in_the_Career.94212.aspx). Discrimination experienced by surgical trainees has been associated with [decreased productivity](https://jamanetwork.com/journals/jamasurgery/article-abstract/2763978) and mental well-being. Social media has served as a tool to emphasize such inequities in surgery, as evidenced by surgical departments that lack diversity being highlighted, manels at conferences being called out on #MedTwitter, and challenges like “Walls Do Talk” and #HerTimeIsNow. There are many existing examples of how each organization, journal, or society can contribute to diminishing disparities, including: Intentional efforts by organizations like [\#EASTForALL](https://www.east.org/), seminars and working groups from [the Resident and Associate Society of the American College of Surgeons (ACS) and ACS](https://www.facsbulletin.com/acsbulletin/january2021/MobilePagedReplica.action?pm=1&folio=Cover#pg1), the creation of liaisons between the various diverse societies (Association of Women Surgeons Association for Academic Surgery, Society of Black Academic Surgeons, Latino Surgical Society, and Society of Asian Academic Surgeons, and Out Surgeons & Allies), and [calls for action by surgery journal editors](https://pubmed.ncbi.nlm.nih.gov/32865554/) to increase diversity within the editorial and peer review process. As a Puerto Rican female, my call to action for you is to examine your program, your department, your institution, and the societies you participate in, and intentionally encourage them to create a safe space for UiMs to thrive. Advocate for your trainees and your colleagues who seek support in establishing programs to recruit and develop URMs in surgery. Lastly, the next time you notice that “one thing does not look like the other” be reminded that it is your call to action and your opportunity to act so it doesn’t keep happening. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/06/Screen-Shot-2020-06-17-at-8.47.59-PM.png) Patricia Martinez Quinones, MD, PhD, is a general surgery resident at the Medical College of Georgia at Augusta University. She plans to continue her career in academic trauma and critical care surgery. Patricia has served as the Chair for the AWS Resident and Fellow Committee and the AWS Blog Committee and currently serves as the Resident and Associate Society (RAS-ACS) Liaison. She is a doggy-mom and wife who is passionate about promoting equity in healthcare, mindfulness, running, and healthy-living. You can find her on Twitter at [**@PMartinezMD**](https://twitter.com/PMartinezMD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, diversity and inclusion, gender differences, Underrepresented in medicine, women --- ### [Diversity and Inclusion in Surgery](https://blog.womensurgeons.org/diversity-inclusion/) **Published:** February 14, 2021 **Author:** mcooke@amrms.com **Content:** *By Yewande Alimi* As we progress through the month of February, the month also dedicated to Black History, I reflect on the notion of diversity and inclusion in the field of surgery. After the gut-wrenching year of 2020 that laid to bear a once in a lifetime pandemic that continues to ravage the world at large and the civil unrest that towered throughout the United States, it’s important that we acknowledge the need for practitioners, allies, administrators, and leaders that look like the composition of the world that we live in. That we are in 2021, and that academic black surgeons only comprise 2.7% of all academic surgeons, and that we have yet to reach parity when we look at[ black academic female surgeons](https://pubmed-ncbi-nlm-nih-gov.laneproxy.stanford.edu/32209893/) in the field of medicine (0.78% vs 1.93%) is disappointing. The United States is comprised of[ 12.8% African Americans, 18.4% Hispanic](https://data.census.gov/cedsci/profile?q=United%20States&g=0100000US), yet they remain substantially underrepresented in the house of surgery ([4.2%, 3.4%;](https://journals.lww.com/annalsofsurgery/Documents/Is%20There%20Color%20or%20Gender%20Behind%20the%20Mask%20and%20Sterile%20Blue.pdf) respectively). When we dive even further and look at these numbers in surgery and surgical subspecialties, we continue to fall short. This isn’t just a numbers game in which one is simply trying to make the numbers match up for the sake of equality. This lack of diversity is important because it impacts the way in which our patients interact with the field of medicine. While data is[ mixed](https://jamanetwork-com.stanford.idm.oclc.org/journals/jamanetworkopen/fullarticle/2772682) regarding[ gender](https://pubmed-ncbi-nlm-nih-gov.laneproxy.stanford.edu/33469761/) and racial concordance and resultant patient satisfaction and outcomes, it has been demonstrated that racial concordance between patient and physician improves outcomes in the domains of[ satisfaction and partnership building](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591056/), which we can all agree can help our patients navigate the confusing world of healthcare better. However, our problem does not lie alone in the fact that the numbers are not reflective of the US population. While efforts are being made to increase the number of under-represented minorities matriculation into medicine and strengthening the medical URM pipeline, our faucets are also leaking. Under-represented Black and[ Hispanic](https://link-springer-com.stanford.idm.oclc.org/article/10.1007/s00268-020-05844-0) physicians and women are [leaving](https://news.weill.cornell.edu/news/2018/03/women-and-minority-surgical-residents-at-high-risk-of-withdrawing-from-training) the field of medicine due to pervasive and structural racism that exist in a system that is reflected by the lack of[ equitable](https://jamanetwork-com.stanford.idm.oclc.org/journals/jama/fullarticle/184622)[ promotion](https://www.statnews.com/2020/01/16/black-doctors-leaving-faculty-positions-academic-medical-centers/) of these physician cohorts and in some from the sense of not belonging and isolation resulting in burnout. The field of medicine, and I dare say the[ house of surgery](https://www.facs.org/-/media/files/about-acs/committees/acs_anti_racism_task_force_report_recommendations.ashx) has work to do to help dismantle this system. These efforts begin in allyship and understanding of the lived experiences of under-represented trainees, faculty, and staff. We cannot dare to fix something that we fail to truly understand. Creating spaces for people to report, share, and document their experiences without retaliation or shame is important. Our efforts must be grounded in evaluation of the state of affairs in our institutions (including within our societies, our[ training institutions](https://www.aamc.org/news-insights/medical-students-use-momentum-anti-racism-movement-advocate-change), and as individuals), creating just and equitable work places, focusing on educating trainees and established faculty to be culturally competent and anti-racist, and by being true champions of diversity supporting research focused on addressing racism and its[ elimination.](https://www.jci.org/articles/view/141675) Finally, these efforts must not be solely undertaken by the very faculty, physicians, and trainees who are at risk of being marginalized. We must ALL embrace this burden and dedicate time and resources to create an impactful change. **Please join us on Monday, Feb. 15th at 8pm Eastern Standard Time for an AWS Tweetchat about diversity and inclusion in surgery, in partnership with the** [**LSS**](https://www.latinosurgicalsociety.org/)**!** This chat will focus on how to increase diversity in surgery, cultivate inclusive environments for all in surgical training, and how to get involved in diversity and inclusion initiatives within surgical societies and institutions. The chat will be moderated by Dr. Yewande Alimi ([@YewandeAlimiMD](https://twitter.com/YewandeAlimiMD)), Dr. Chantal Reyna ([@kprgrl3](https://twitter.com/kprgrl3)), and Dr. Madeline Torres ([@MadelineBTorres](https://twitter.com/MadelineBTorres)). The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweetchat: - Q1: What are current barriers to increasing diversity and inclusion in surgery? - Q2: What are some concrete ways that residencies and medical schools can increase the diversity in their programs and create inclusive, welcoming environments for all? - Q3: What are some ways for trainees from URM backgrounds to build communities within their programs? Are there national organizations, committees, working groups, etc that you recommend? - Q4: How can we all be allies for those who identify as URM? Any specific examples from your programs? - Q5: How can we encourage URM students – from high school through medical school – to pursue medical and surgical careers? Are you involved in any unique volunteer or outreach initiatives? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/02/alimi-1.png) Dr. Alimi is the current MIS & Bariatric surgery fellow at Stanford University. Originally from Nigeria, Yewande obtained her Bachelor’s in biomedical engineering at Washington University in St. Louis, and went on to complete her medical degree in Atlanta at Emory University School of Medicine. Dr. Alimi completed residency in General Surgery at Georgetown University Hospital in Washington DC, where she was an active member in American College of Surgeons, currently serving as the Vice-Chair of the Resident and Associate Society and the Society of Black Academic Surgeons where she currently serves on the informatics and program committee. Her research interests include outcomes in bariatric surgery, healthcare disparities, and diversity and equity in healthcare. You can find her on SoMe [@YewandeAlimiMD](https://twitter.com/YewandeAlimiMD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #diversityandinclusion, AWSChat, Diversity, ILookLikeASurgeon, inclusion, Tweetchat, womeninsurgery, WomenSurgeons --- ### [How COVID-19 has enhanced work-life integration](https://blog.womensurgeons.org/how-covid-19-has-enhanced-work-life-integration/) **Published:** February 13, 2021 **Author:** Blog Team **Content:** *By Mara Antonoff, MD* As the world continues to grapple with the ongoing challenges of a global pandemic, the day-to-day work life for us as surgeons continues to evolve. While some professions enable individuals to convert their previous job duties to complete work-from-home settings, the nature of our job requires a certain extent of live interaction. Nonetheless, there are certain aspects of our jobs—particularly in the areas of research and administration—which readily adapt to a home environment, especially given our recent collective gains in knowledge and experience with remote telecommunication applications. Moreover, for many of us and our patients, there are a large number of visit types which are amenable to telemedicine. As a thoracic oncologic surgeon, a large part of my evaluation of patients relies on our discussion and my review of the imaging—neither of which require face-to-face visit. In recent months, I have heard concerns expressed related to the creep of work into home life. Others have suggested that without a hard stop on the workday or work location, they were finding that work was taking over more and more of their lives. I’d like to argue a different perspective. I believe, as surgeons, we never had hard stops or clear boundaries. We stay scrubbed until the case is done—not after a specified number of hours. We take calls about our patients wherever, whenever. We look at images from kids’ birthday parties, and we text our residents from abroad. As surgeons, we are always thinking about our patients, and the penetrance into our home lives long preceded the pandemic. Given this precedent, I would argue that the pandemic has actually been a huge opportunity to improve our work-life integration, bringing greater balance. Before I’d ever heard of COVID-19, I spent a lot of hours in the hospital, during which I never saw my 4 kids nor my husband. Between both of us traveling for work and our long hours on the job, family meals were a rarity and I often kissed my kids long after they’d been asleep. The initial wave of the pandemic led to much more time together as a family, when the kids were out of school and our ambulatory practice was cut back substantially; we’ve been back to a new normal for several months—with full clinics, normal operative volume, and all 4 kids in live school—yet we continue to benefit from more family time. While I have plenty of work to fill 8 days a week, I now work from home for numerous hours per week—in part due to the persistence of virtual visits that occupy half of each of my clinic days. More substantially, every single meeting that I routinely attend has been converted to a virtual environment—tumor boards, research conferences, M&M, committee meetings, mentoring engagements, multidisciplinary collaborations, and more. In addition, it has become very much professionally acceptable to chart notes, to conduct research, and to work on administrative tasks from home—limiting the unnecessary gathering of groups of people in offices, hallways, and elevators. I have found myself working from home—either on telemedicine or tele-meetings—for several hours every day, with my time in the hospital limited to literally just performing operations, seeing clinic patients, and rounding. With extra time at home, I’m definitely seeing more of my family. This doesn’t mean that I’m playing with my kids instead of working—but it means that I can catch a hug, steal a high-five, or share a snack with family instead of grabbing a coffee alone at work between meetings. I do not take any of this for granted. These changes were not made to improve work-life integration; they were made to enable social distancing and to promote public health. Still, the impact on family has been immense. As we have learned to navigate virtual telecommunications, so have other aspects of our world. I cannot tell you how much easier it is to attend parent-teacher conferences or student-athlete meetings from my phone in the surgeons’ lounge rather than trying to be there in person. Why did it take a world-wide pandemic to make it possible for working parents to be able to participate in their kids’ lives with greater ease? Why did it take such extremes for us to allow our peers to log in to faculty meetings from the clinic across town, or to be able to attend evening journal club from home after asking their kids about their day at school? And why did it take a public health crisis for us to stop thinking it was unprofessional to write a manuscript from one’s home office? Truly, I believe that the silver lining of the pandemic has been improved work-life integration, and I will advocate strongly to keep remote options available for our academic, educational, and administrative meetings. As surgeons, we are incredibly fortunate to make an impact in people’s lives and those of their families every single day. We are rewarded with relative job security, praise, and respect. The most important reality is that we could not do these jobs without the support of partners, family, and friends. So, please, let’s not forget the importance of our own family after we have all been vaccinated and life returns to “more normal.” We have the hardware, the software, the telecommunications experience—and we should continue to use it all! I am overwhelmed with gratitude for these recent opportunities to spend more time with my family—and I hope that we can all maintain this level of work-life integration as we head into a more hopeful future. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/02/Antonoff-201x300-1.png) Dr. Mara Antonoff is a mother of 4 and Associate Professor in Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center. She is the Website Editor and Social Media Director for Women in Thoracic Surgery. At MD Anderson, Dr. Antonoff is also the Program Director for the Thoracic Surgery Training Program. Her twitter handle is [@MaraAntonoff](https://twitter.com/maraantonoff). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, family life **Tags:** covid19, womeninsurgery, WomenSurgeons, work-life balance --- ### [My saggy ovaries: A surgical trainee’s experience with egg freezing](https://blog.womensurgeons.org/my-saggy-ovaries/) **Published:** February 4, 2021 **Author:** mcooke@amrms.com **Content:** *By Tiffany Sinclair, MD* My saggy ovaries – that is what I’ve been calling them since I found out that I have “diminished ovarian reserve,” a term used to describe decreased reproductive potential based on the number of available ovarian follicles. Like many female surgical trainees, I prioritized my education and training over getting married or starting a family. I naively thought that I could get through medical school and residency and then start thinking about those things. During medical school, I still felt so young and not emotionally ready. During general surgery residency, the thought of having and raising a child while working 80 hours per week seemed impossible. But after seeing the steady stream of adorable baby pictures on social media from my friends and colleagues, my own biological clock started ticking and I thought that I should reconsider my baby-making plans. With a significantly reduced clinical load during my 2 years of dedicated research, I finally had time to ponder my fertility goals. Still early in my training and in a new relationship, I was not quite ready for pregnancy. I had heard about ovarian cryopreservation or “egg freezing” in medical school, but did not personally know anyone who pursued it. After over a year of thinking about it, I finally made an appointment with an OB/Gyn specializing in Reproductive Endocrinology and Infertility (REI). At the tender age of 31, I thought I still had plenty of time to have children. “Geriatric pregnancy” does not begin until age 35, after all. At my REI consultation, the physician gave me an overview of fertility preservation therapy, which includes both egg and embryo cryopreservation, and recommended that I have my baseline anti-Müllerian (AMH) hormone levels checked. AMH is a hormone produced by the granulosa cells in ovarian follicles, and it regulates follicle recruitment. It has been correlated with the number of early antral follicles, as well as the clinical degree of [follicle pool](https://pubmed.ncbi.nlm.nih.gov/12571168/) [depletion](https://pubmed.ncbi.nlm.nih.gov/19066296/). Levels of AMH are stable across the menstrual cycle and are used clinically as a marker to estimate [ovarian reserve](https://pubmed.ncbi.nlm.nih.gov/15640257/). [AMH levels peak](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022024) at approximately 24 years of age, then gradually decline to zero at menopause. A typical AMH level for a fertile woman is 1.0–4.0 ng/mL, whereas a level under 1.0 ng/mL is considered low and indicative of diminished ovarian reserve. At 31 years old, I was expected to have a normal AMH level and ovarian reserve. I vividly remember when my physician called to tell me my lab results. I was walking in one of the outside courtyards on the way to resident teaching when she called. She told me my AMH level was “low.” Low enough that if I wanted to have children in 5 years, I would likely not be able to conceive naturally. She said that if I was contemplating having biological children in the future, then I should seriously consider freezing my eggs now. I cried – and I was surprised that I cried! Until that moment, I wasn’t even sure I wanted children, but the instant disappointment that I felt when she told me about my diminished ovarian reserve was enough to convince me that I needed to do this. For reference, my AMH level was 0.46 ng/mL, while the [average level](https://pubmed.ncbi.nlm.nih.gov/20970126/) for a healthy 31 year-old woman is 3.59, and the 5th percentile is 0.6 ng/mL. The egg freezing process is intense. For several weeks before the procedure, I had to inject myself subcutaneously (sometimes multiple times per day) with cycle-stimulating hormones. There were A LOT of doctor’s appointments. The week leading up to the “harvest,” I had to go in for an ultrasound every other day to monitor the maturation of my follicles and determine when the procedure would actually take place (it can vary by a few days based on an individual’s rate of follicle maturation). This required a time commitment and flexibility that I could *only* manage because of my modifiable research schedule. It was also EXPENSIVE. As someone with $300K+ of loan debt, I do not have much money to spare. The entire process ended up costing me over $10,000 out of pocket – $6,000 for clinical care and the procedure and another $4,000 for medications. This is pretty typical as the average cost of egg retrieval is $10-15,000 for most women. My insurance only covered some of the lab work and ultrasounds. Even for those with excellent fertility benefits, insurance companies will rarely cover prophylactic ovarian cryopreservation (i.e. when pursued by someone not actively trying to conceive), except for a few oncologic situations. I actually bought several of the drugs from Europe to save myself a few thousand dollars – not kidding. I was also *very* fortunate to be able to moonlight during my research time to make some extra money and offset my growing credit card debt. Finally, the procedure itself was painful, but tolerably so. I was reminded of this whole ordeal after recently receiving my bill for ongoing egg maintenance – $520 per year to keep my frozen eggs frozen. Today, I have five healthy eggs sitting in a freezer in California. (One of my ovaries was *really* saggy and didn’t produce any eggs – a weighty disappointment for this overachiever). Despite the time and cost, I have absolutely no regrets. As I near the end of my fellowship training, “baby fever” is hitting me harder than ever. I still have to consider how pregnancy could impact my career prospects as a junior attending, but I feel a sense of relief when I think about my little frozen eggs. Egg freezing has given me the option to have children on my own terms, in my own time. It has allowed me to feel empowered, instead of defeated, by my withering, saggy ovaries. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/02/tiffany.png) Tiffany Sinclair, MD is currently completing her fellowship in Endocrine Surgery at the Cleveland Clinic. She obtained her medical degree from the University of Pennsylvania and completed her general surgery residency at Stanford Health Care in 2020. She hopes to pursue a career in academic surgery. Her research interests include pancreatic neuroendocrine tumors, hereditary endocrinopathies, and fertility among women surgeons. She is committed to diversity, equity, and inclusion in medicine and improving surgical culture. You can find her on Twitter and IG: [@thefancysurgeon](https://twitter.com/thefancysurgeon). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** health **Tags:** egg freezing, health, ILookLikeASurgeon, parenting, surgeon mom, womeninsurgery, WomenSurgeons --- ### [Highs and Lows of Surgery: Juice Boxes on my Surgery Rotation](https://blog.womensurgeons.org/highs-and-lows-of-surgery-juice-boxes-on-my-surgery-rotation/) **Published:** January 31, 2021 **Author:** Blog Team **Content:** **By Hannah Case** The first two years of medical school, I found myself fighting with an inexorable desire to be in the operating room. Surgery seemed alluring; addictive almost, yet I fought its appeal. I began convincing myself that what I surely desired was to go into pediatric hospital medicine. It wasn’t the hours, the sore feet, the years of training, the personalities, nor the competitive nature of the field that led me to adamantly deny my love for surgery: it was a subconscious fear that I could not survive the long hours of operating. After all, what is a surgeon to do if their blood sugar plummets, their continuous glucose monitor (CGM) alarms, and their hands begin to tremble as they’re delicately suturing? Surgery was my first clerkship of third year. I recall the week leading up to my first day, during which I met with my endocrinologist and we discussed how to best manage my glucose while in the OR. I could adjust my bolus delivery, which may spike my sugars, but I always found functioning high to be more forgiving than functioning low. I spoke with upper-classmen who were also diabetic, seeking their advice. Not one would explicitly tell me *not* to go into surgery because I was diabetic, though the hesitancy surrounding that decision seemed unanimous. So, on my first day of clerkship, I made a choice. I informed my clerkship director and every surgeon, resident, or fellow that I had the honor of working with that I was diabetic. I taught each team’s circulating nurse how to operate my insulin pump and CGM for me, on the rare occasion it alarmed while I was scrubbed in. I meticulously scrutinized my glucose prior to scrubbing each case, adjusted my basal as needed, and consumed more protein bars (provided by my incredibly supportive clerkship director) than I thought humanly possible. For 8 weeks, I was more regimented in my diabetes care than I had been for the past 14 years of my life. I was so consumed with concern for the “what if’s” that I nearly let it dictate my future career. Most medical students abhor being wrong. We strive for perfection; studying incessantly in order to elude any possible mistake. Yet there I was, scrubbed into a 10-hour-long heart transplant at 1AM, realizing that I had been wrong. Turning my back on surgery simply because I was afraid of managing my diabetes in addition to my OR responsibilities would have been a huge mistake and I am beyond grateful to those who aided me in that discovery. No one bat an eye when I shared my diagnosis. I was able to first assist on colectomies, perform debridements, participate in Whipple procedures, see a transplanted heart-beat for the first time, close laparoscopic ports, help reconstruct a mandible, and substantially more. The craziest part: I only had to scrub out of one case because of my diabetes. In that instance, the circulating nurse notified me that my system was alarming because I was low. I calmly had the scrub tech replace my hand that was retracting and I scrubbed out. I drank juice, waited 15 minutes, scrubbed back into the case, and proceeded doing what I love. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Case_Hannah_F_18JL-250x300.jpg) Hannah Case grew up in Orlando, FL. She attended Tulane University to complete a B.S. in Biological Chemistry and a minor in psychology. She fell in love with surgery while at Tulane as she helped volunteer as a circulator and found herself staring over the operating curtains in awe. She is receiving her MD degree from the Mayo Clinic Alix School of Medicine, Jacksonville, and is currently in her third year. She hopes to match into Otolaryngology (ENT) – a field she found her passion for early on in her surgical clerkship when scrubbing in on a glossectomy with mandibulotomy and flap reconstruction. She has been able to establish an AWS Chapter at Mayo Clinic Jacksonville and looks forward to inspiring and empowering women to pursue their passions. You can find her on Instagram @hannah\_case\_13. --- Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** medical students, self-care **Tags:** #womeninsugery, Diabetes, ILookLikeASurgeon, Medical Student Members --- ### [A Future Female Surgeon and Daughter of Immigrants](https://blog.womensurgeons.org/a-future-female-surgeon-and-daughter-of-immigrants/) **Published:** January 24, 2021 **Author:** Blog Team **Content:** *How a future first-generation surgeon carries her parents’ strength and courage* By Scarlett Tohme I am a native New Yorker, in one of the truest senses of the label—I am a daughter of immigrants. I grew up in Bay Ridge Brooklyn and Staten Island and studied and worked in the “city” (Manhattan). Everyday, I am surrounded by the beautiful language and culture of my parents at home and the vibrant neighborhoods of NYC outside of it-from listening to the angelic voice of Fairouz on the cassette player and eating my favorite Syrian foods like manaeesh and kibbeh bil sanieh, to learning about the lives of New Yorkers from Richmond Town to Washington Heights. I am a first generation Syrian-American, navigating my life with different cultures and learning how to interconnect my parents’ heritage with the heritage that I am creating of my own. There were of course challenges for my family as I moved along my path towards adulthood, common for many first-generation individuals. I have always been passionate about science, and I must give credit to my parents for instilling in me the curiosity and respect for how the universe functions. My parents came from difficult conditions in Syria, where education was not the priority. Despite hardships and obstacles, they were determined to complete their degrees—my mother would hide in the bathroom to study and worked two jobs to help pay for her books and supplies for college; my father, having been pulled from school to work with his father, would stay up all night after working all day at my grandfather’s shop to study to finish his baccalaureate degree. Their determination and strength to reach their goal of receiving an education and to devote their lives to ensuring that their children have better lives than they did has had an incredible impact on my own perseverance and inspiration to achieve my goals. My decision to become a physician came from that energy my parents gave to me to go out into the world and apply my interests, curiosities, and passions in the service of others. They gave me the fuel to push through the challenges that I have faced over the past decade and to never give up so that I can reach my goals. I had never thought that I would be sitting here today, interviewing for general surgery residency programs, and only months away from becoming a doctor. I will be the first surgeon and first physician in my entire family, and I have been able to reach this incredible accomplishment because of my parents, despite their not having experienced first-hand the various institutional systems in the US. Their courage to give up everything they knew in Syria in order to start over in New York is the same courage that I have to step outside my comfort zone to find the resources and opportunities to realize my dreams and support others to reach new potentials. They have also taught me the compassion and empathy that has helped me to go out in my communities in NYC and welcome all backgrounds and philosophies with open arms. As I continue on my path towards becoming an empowered first-generation female surgeon, I hope to take the influence that my parents have imparted on me, as well as the ideas and perspectives on life in every corner of my city, to give back to the communities that have raised me. I have had the privilege to gain knowledge about human disease. Now with the humbleness and appreciation for the life provided to me by my parents, I hope to be the best surgeon I can be where I can use the skills that I gain to provide more effective, efficient, and affordable healthcare to all. I also hope to be a mentor, paying it forward for future first generation and underrepresented surgeons. All of this I give to my parents, and I hope I can show them one day the impact they have had on their communities in NYC and on the future of medicine. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Scarlett.png) Scarlett Tohme is a fourth-year medical student at New York Medical College (NYMC) and is currently a surgery resident applicant, hoping to pursue a cardiothoracic surgery career. She was born on Staten Island and has grown up in Bay Ridge, Brooklyn and on Staten Island, going to high school at Staten Island Technical High School. She completed her BA in biology at Columbia University in the City of New York in 2014 and completed her MS in physiology and biophysics at Georgetown University in Washington DC in 2016. Before medical school, Scarlett spent time as a clinical associate in a private plastic surgery practice in Manhattan, NY, and as a medical assistant in a private orthopedic surgery practice on Staten Island. During medical school, Scarlett has been heavily involved in clinical research particularly in pediatric cardiac surgery, adult cardiac surgery and trauma surgery. She has been a member of NYMC’s SOM Student Senate, of which she is currently the Vice President of the Senate. Along with her classmates and AWS members, Nainisha Chintalapudi and Kendall Post, she has co-founded the NYMC chapter of AWS in 2020. During her free time, Scarlett likes to kickbox, play piano, visit the Metropolitan Museum of Art, and spend quality time with her parents and younger brother, Gil, who is currently a freshman at Boston University School of Engineering. You can find her on Instagram:[ @\_scar.latte ](https://www.instagram.com/_scar.latte/)and Twitter[ @scarlett.tohme](https://twitter.com/scarlett_tohme) ![]()--- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the authors and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** First Generation Surgeon, Medical Student Members, womeninsurgery, WomenSurgeons --- ### [The Significance of Vice-President Elect Kamala Harris](https://blog.womensurgeons.org/significance-of-kamala-harris/) **Published:** January 14, 2021 **Author:** Blog Team **Content:** *By Vaidehi Mujumdar, MD, and Victoria Adewale, MD, MS* **Vaidehi:** Kamala was my paternal grandmother’s name. I never had the opportunity to meet her. The only picture I have ever seen of her is an oil portrait we have in my parents’ home. She died from an aggressive form of breast cancer when my dad was a child. She never saw him grow up, become the first in his family to get a doctorate, move to and struggle in another country, or build the life she could never have imagined in her wildest dreams. In the years after we emigrated to the United States in the early 1990s, we stayed in touch with family in India through aerograms. The lightweight, pale-blue stationery was highly awaited before cell phones existed and when international calls were extremely expensive. **Victoria:** Hattie was my maternal grandmother’s name. I never had the opportunity to meet her. There’s a photograph of her in my parent’s home, still pristine as the day it was taken. She died 6 months after being diagnosed with cervical cancer; she never saw my mother graduate college. She prided herself on making everything from scratch. Premixed shortcuts were never an option for her. She thought that the more she struggled, the less her children would. She loved my grandfather fiercely. Her mission was to support my grandfather and her children with her whole being and her ambition still courses through my veins. When Kamala Harris was nominated to the Democratic ticket as Vice-President she became the first Black and Indian woman on the ticket of a national party in the US. Her entire life, as she describes it, was shaped by her first-generation background and a mother who taught her the skills to survive and succeed in a society that systematically oppresses women of color. In 2018, Senator Harris wrote an Op-Ed in the New York Times about her mother’s battle with colon cancer and the silos and disparities that entrench our healthcare system. As she reminisced, she said, “Though I miss her every day, I carry her with me wherever I go. I think of the battles she fought, the values she taught me, her commitment to improve health care for us all. There is no title or honor on earth I’ll treasure more than to say I am Shyamala Gopalan Harris’s daughter. As I continue the battle for a better health care system, I do so in her name.” Kamala Harris represents America as it could be. When Kamala said: “*Dream with ambition. Lead with conviction, and see yourselves in a way that others will not simply because they haven’t seen it before, but know we will applaud you every step of the way,*” she spoke to the little girls we once were, the women we are today, and the leaders we strive to be. She spoke to the women whose shoulders we stand on – Kamala Mujumdar, Hattie Bell, and the countless others we know by name and those who remain nameless. We are two physicians and surgeons in-training. We are Ivy-league educated women, immigrants and first generation Americans. One of us is the daughter of the African diaspora and the other born in India, raised all over the US. We are both American. Our intersecting and often conflicting identities matter imminently during this time in American history where we sit on the precipice of a country that slowly walks towards greater inclusivity and one that lives in fear of the supposed “other.” When Senator Harris is sworn in as the Vice President of the United States, we know that for many Americans, we are seeing ourselves stand before the very systems of oppression, bigotry, and white privilege that have long been the cornerstones of this country. Our immigrant families believe, in their bones, that moments like the election of Kamala Harris are possible in their chosen country.. To live with such hope in the same space as deep disappointment and fear is the resiliency that we know well. It is the space that women before us have occupied and passed on to their daughters – to us. **Vaidehi:** I am Sunita Deshpande’s daughter. **Victoria:** I am Leslie Joe Smith’s daughter. As obstetrics and gynecology residents, we take care of women from birth to death. We are with them from the first view of that ever so desired yolk sac after a miscarriage to the hard family meeting, nowadays often by Zoom, as the pathology comes back as cancer. We care for these women with compassion and dignity despite how the world tries to strip them of it. As we continue this work – to fight for a more just health care system, an equitable society, and an America where hope outweighs fear – we do so in their names. Our democracy is not guaranteed. Human rights are not guaranteed. Access to health care is not guaranteed. Freedom is not guaranteed. There is so much work to be done. But is the work that has to be done in a country so fraught with division, fear, violence, and loss. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/A.png) ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/B.png) Vaidehi Mujumdar, MD, and Victoria Adewale, MD, MS, and are Obstetrics and Gynecology residents in Philadelphia, PA. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy **Tags:** advocacy, change, Diversity, inclusion, representation, women of color, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [A Day in the Life of Dr. Carter Lebares: Cultivating Resilience through Mindfulness and Cognitive Training in Surgery ](https://blog.womensurgeons.org/mindfulness-cognitive-training/) **Published:** January 11, 2021 **Author:** mcooke@amrms.com **Content:** *By Lena Trager and Dr. Carter Lebares* January’s AWS Tweetchat is focused around creating an inclusive discussion about health, wellbeing, and work-life balance in surgical training and careers. 2020 drastically changed the lives of many in our country due to major public health crises, ongoing racial injustice, and the COVID-19 pandemic. As we enter 2021, we think it’s valuable to reflect on how to prioritize one’s mental and physical wellbeing by creating burnout prevention plans and engaging in health-promoting activities to combat the cumulative stressors of this past year. To introduce this month’s Tweetchat topic, Lena Trager, a member of the AWS National Medical Student Committee, interviewed Dr. Carter Lebares, an expert in the field of mindfulness-based interventions to address surgeon burnout. ***Mindfulness*** The widely-accepted scientific definition of mindfulness is a form of cognitive training that teaches three key abilities: interoception (or moment-to-moment awareness of one’s thoughts, emotions, and sensations), emotional regulation (or non-reactivity to stimuli), and meta-cognition (or the ability to call on these cognitive skills as needed). Another way of saying this is that mindfulness consists of heightened self-awareness, emotional control, and situational awareness. These are central cognitive mechanisms that don’t just apply to well-being. They also influence our ability to problem solve, develop complex motor skills, and communicate – all key capabilities for surgeons. To Dr. Lebares, mindfulness means not taking things personally, being able to filter out my distractive thoughts, and regularly stepping back from situations (especially stressful situations) so I can see them clearly and respond, not just react. ***Mindfulness-Based Cognitive Training and Resilience*** Mindfulness-based cognitive training is the process of learning interoception, emotional regulation, and meta-cognition. This kind of learning is experiential, which means you must learn by doing– not by just reading or through lectures. In this way, it’s like body-building; you don’t get a six-pack from reading about sit-ups, you get a six pack from DOING sit-ups. Dr. Lebares trains this by teaching participants three key skills: The first skill taught is how to recognize our continuous thoughts which often reflect the past or the future, not the reality of the moment. These thoughts can be distracting and not necessarily useful or worth paying attention to, but often still drive our emotions and reactions. This reflexive process is not always in our own best interest. The second skill taught is how to take our awareness of thoughts and link it to the sensations of our bodies. This gives us a ‘red-flag’ for when thoughts and reactions are at work, and gives us the opportunity to build the “six-pack of mindfulness”, which is the ability to pause in our reactions and choose how we want to respond. Third, participants are taught that this awareness and ability is something that, with practice, can be called on whenever needed. It can transform how we experience stress, but also how we problem-solve, how we approach our technical training, and how we sustain long, satisfying careers. Dr. Lebares shared the following during her interview: “I was interested in mindfulness long before I came to surgery, but its place in surgery really hit me when I was doing my intern rotation on Trauma. That was the first time I saw sudden uncontrolled bleeding in the OR and I felt my body push away from that table and freeze. Then, I watched this amazing attending calmly put a finger on the bleeding and go about fixing it. In the midst of all this mayhem, they were so focused and calm. I was like, “What was THAT?!” and I realized it was emotional regulation in action. This is how mindfulness-based cognitive training relates to resilience, because our repertoire of available thoughts and actions expands so marvelously when we’re not just reacting in old, unconscious ways. This affects our personal relationships, how we learn, our ability to collaborate, and how we approach the work we do.” ***The Future of Mindfulness in Surgery*** Dr. Lebares described a few of her “cool” on-going projects. One, is looking at changes needed at the level of systems and culture to support and advance wellbeing in surgery. ESRT (Enhanced Stress Resilience Training) is great, but it’s not the whole story. She believes we can figure out what’s needed on these other levels and align them to really maximize what’s possible. Another project is looking at what wellbeing means in the context of race and gender. This part of the story has been left out for too long. The final big project is a true multi-center, randomized trial of ESRT in surgery residents. She believes that data of this caliber will help our field stop arguing about the benefit of systemic, prioritized, and funded wellbeing initiatives and move us on to national implementation. Her overarching goal is to develop an ‘Internal Curriculum’ in surgery that provides the cognitive skills training to parallel the intellectual and technical training we already do so well. This Internal Curriculum should be longitudinal: starting with ESRT for interns, advancing to things like the evidence-based [Mental Skills Training](https://www.facs.org/education/division-of-education/publications/rise/articles/performace) for operative skills in junior residents, and [Energy Leadership Training](https://www.journalacs.org/article/S1072-7515(17)32180-4/abstract) for senior residents on the cusp of independence. **Please join us on Tuesday, January 19th at 8pm Eastern Standard Time for an AWS Tweetchat about wellness and wellbeing in surgery!** This chat will focus on exploring the principles of work-life balance/integration and create a forum to share tips and tricks on how to navigate the challenges of being a surgeon. The tweetchat will be moderated by Dr. Jamie Coleman, [@JJcolemanMD](https://twitter.com/JJcolemanMD)/ [@denverhealthmed](https://twitter.com/denverhealthmed), Dr. Jennifer Davids, [@jendavidsmd](https://twitter.com/jendavidsmd)/ [@umasscolorectal](https://twitter.com/umasscolorectal), and blog author Dr. Carter Lebares, (no Twitter) / [@UCSFSurgery](https://twitter.com/UCSFSurgery). The questions will be posted directly from the [**@WomenSurgeons**](https://twitter.com/WomenSurgeons) twitter account and you can also find them following the hashtags [**\#AWSchat** and **#SurgicalWellness**](https://twitter.com/search?q=%23AWSChat&src=typd). If you haven’t participated in a tweetchat with us before, check out this [**tutorial**](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([**@heatheryeomd**](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweetchat: **Q1:**How does your definition of health and well-being influence your personal and professional pursuits? **Q2:**What are some changes you’ve made throughout training that have had a significant impact on your health and wellness? Any routines or tips to cultivate daily health/wellbeing practice? **Q3:**Are there any specific programs at your home institutions that support wellbeing of trainees and/or faculty? Any advice for training programs to promote resident/fellow health and wellbeing? **Q4:**What role does the community and one’s personal support system play in maintaining health and wellness as a surgeon? **Q5:**Do you have a burn-out prevention plan? Or a burn-out rescue plan? What do these entail? **Q6**: The ongoing COVID-19 pandemic has had a substantial toll on healthcare workers. Do you have any go-to resources that you have used during this time to maintain mental and physical health? ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Lebares.png) [Dr. Carter Lebares](https://www.ucsfhealth.org/providers/dr-carter-lebares) is a clinically-active emergency and elective general surgeon at University of California San Francisco (UCSF). She received her medical degree from the University of Minnesota and completed her surgical residency at UCSF. She is a Fellow of the American College of Surgeons. Dr. Lebares is Director of the [UCSF Center for Mindfulness in Surgery](https://mindfulsurgeon.ucsf.edu/). She has 20 years of personal practice in mindfulness meditation and scholarly interest in stress, cognition and resilience. She has taken Mindfulness Teacher Training for Physicians through the University of Rochester, is a graduate of the Teaching Scholars Program in Medical Education at UCSF, and is currently pursuing a PhD in Healthcare Education through UCSF and Utrecht University, Netherlands. For more information about her research, please visit: [https://www.carterlebares.org](https://www.carterlebares.org/), [https://mindfulsurgeon.ucsf.edu](https://mindfulsurgeon.ucsf.edu/) ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Trager.png) Lena is a rising third year medical student at the University of Minnesota. She plans to pursue a career as an academic surgeon scientist. At her medical school, she was the founder and first president of a new AWS chapter. After her second year of medical school she embarked on a 2-Year Sarnoff Research Fellowship, investigating the molecular mechanisms regulating cardiovascular aging, exercise, and heart failure. Last year Lena served as a Midwest Regional Representative and now is the Resource Development Coordinator for the AWS Medical Student Committee. She also enjoys organizing monthly Tweetchats with the AWS Twitter team. You can find her on twitter at [@LenaETrager](https://twitter.com/LenaETrager). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, mental health, Tweetchat, womeninsurgery, WomenSurgeons --- ### [Inclusive Mentoring](https://blog.womensurgeons.org/inclusive-mentoring/) **Published:** January 7, 2021 **Author:** mcooke@amrms.com **Content:** *By Christy Chai, MD, FACS and Susan Tsai, MD, MHS, FACS* *This blog entry is the first in a series of six blogs authored by members of the Clinical Practice Committee writing in collaboration with our society liaisons throughout the year.* Mentoring has long been identified as a critical component of professional development. Effective mentorship programs can positively impact career advancement, self-efficacy, confidence, satisfaction, productivity, and retention. More recently, the term “**inclusive**” **mentoring has been introduced to emphasize the need for equity, inclusion, and diversity within mentoring relationships**, thus fostering a safe and collaborative working environment for all. Mentor-mentee relationships are long-term relationships requiring substantial commitment from both individuals and building upon a shared natural affinity. Mentees benefit from practical advice and encouragement as well as guidance in career development. Mentors learn leadership and management skills, and improve communication and interpersonal skills. Traditionally, mentor-mentee partnerships are built on shared interests and experiences. Both the mentor and mentee unconsciously gravitate towards shared commonalities such as gender, race, or background. Unfortunately, this process, although organic and spontaneous, can further concentrate the benefits of mentorship to a select group of individuals and disadvantages both mentors and mentees of underrepresented minorities (gender, race, ethnicity, beliefs and more) since they lack sufficient representation at all levels of professional development. This may exacerbate feelings of isolation and exclusion, narrow networking opportunities, and widen the gap in professional development for individuals of underrepresented minorities. Inclusive mentoring challenges this paradigm and advises mentors and mentees to step out of their comfort zones and actively engage in different styles and types of mentor-mentee relationships. It is important to recognize that a single mentor cannot always meet the diverse needs of an individual mentee, and a group of mentors is often needed. Rather than a traditional one-on-one vertical relationship, **a mentee should consider a “group mentoring” approach with a portfolio or network of mentors who can provide appropriate guidance from shared experiences.** Some mentors may be great at practical guidance on career development and institutional advancement. Others may provide excellent psychosocial and emotional support. The collective strength of the group mentoring approach can provide a more comprehensive and enriching professional development experience. In addition, mentorship does not have to maintain a vertical reporting structure. Peer-mentors with horizontal mentorship can offer mutual support, collaboration, and inspiration – “if she can do it, I can do it too.” Furthermore, mentors do not have to be in the same professional field as mentees depending on the area of expertise needed. A physician mentee seeking a mentor in the area of finance and hospital administration may find a good mentor in the corporate world . It is said that a successful mentoring relationship is based on a “good match.” **A good match can be formed by commitment between mentors and mentees as well as setting clear expectations, documenting goals, establishing boundaries, and communicating effectively** across gender, race, and other differences. A good match can be achieved when we recognize the importance of inclusive mentoring. **Mentees must take the first step to create a network of mentors** as recipients of greater benefits in the relationship. **Mentors should be mindful of equity in support and opportunities** since everyone does not have access to the same information or comfort level in social settings. Finally, both sides must realize that changes occur with different career stages and status levels. Mentees will become mentors over time and pay forward to those who seek encouragement, support, guidance, and opportunities. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Chai.png) Christy Chai, MD, FACS is an assistant professor in the Michael E DeBakey Department of Surgery at Baylor College of Medicine in Houston, TX. She received her medical degree from Loma Linda University School of Medicine in Loma Linda, CA. She completed the general surgery residency at Baylor College of Medicine and the surgical oncology fellowship at Moffitt Cancer Center in Tampa, FL. She is proud to serve our veterans at the Michael E DeBakey VA Medical Center as the chief of General Surgery & Surgical Oncology as a U.S Air Force veteran herself. You can follow her on Twitter [@Chai\_Christy](https://twitter.com/Chai_Christy). ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Tsai.png) Susan Tsai, MD, MHS, FACS is an Associate Professor in the Department of Surgery at the Medical College of Wisconsin. She holds a joint appointment at Froedtert & the Medical College of Wisconsin and the Clement J. Zablocki VA hospital and serves as the Director of the LaBahn Pancreatic Cancer Program and the leader of the GI Oncology Disease Team. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the authors and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** #mentors, ILookLikeASurgeon, mentoring, mentorship, womeninsurgery, WomenSurgeons --- ### [Code Blue](https://blog.womensurgeons.org/code-blue/) **Published:** January 1, 2021 **Author:** Blog Team **Content:** *By Rachel Salinas* The first code blue that I ever witnessed was called on my grandfather during my third year of medical school. He had been in the ICU for seven weeks after there were unexpected complications during his coronary artery bypass surgery. I remember as the world stood still while the code team worked. I held my grandmother’s hand while every last effort was made to save his life, and I was the one who told the team when it was okay to stop. It was a moment that greatly affected me and has changed my entire approach to medicine. At the start of this year’s rotations as a third-year medical student, I was taken aback at the number of code blues that were being called each day. One day in particular, I counted over 15 during my 10 hour shift. I asked my resident if this was normal, and all she could do was shake her head. My small community became a hotspot for COVID-19 in September of this year. Slowly but surely the virus went from being in another country to another state to another city, and then it was here. Plastic walls went up in our hospital to separate those that were sick from the rest of us. Before long, the tension in the air was palpable. Every code that was called would cause our entire team to perk up. We prayed that it wasn’t our patient. Just the word “code” would take me back to my grandfather, and I would feel the anxiety and dread that I did that day, but this was different. These patients did not have loved ones watching on the sidelines. Their families did not watch the code team do everything possible to save their life. Our patients are missing out on spending their last moments with loved ones. Doctors, nurses, and other hospital staff are left to hold hands and watch them take their last breaths. We as physicians are taught to compartmentalize, and to take a breath so that we can stay focused and continue to treat other patients that also need medical assistance. As for me, each code becomes less of a trigger for that painful memory. The callus continues to form, layer by layer, protecting me from my emotions so that I can concentrate. I do my best to hold my patients’ hands, to talk to their families, and get them a video call when I can. My mission is to sit and explain anything that they may be confused about. I take advantage of the time afforded to me by my position as a medical student to try and get my patients through their fear of staying in the hospital during the pandemic. However, the patient lists continue to get longer and the resources become more scarce. The country is currently experiencing a code blue and the healthcare providers work tirelessly to keep it alive. The physicians, residents, nurses, and other hospital staff are pushing forward through grief, through fear and will continue to do so until we are no longer able to. I have never been prouder to belong to a group of people. I admire those around me and how they show up everyday and teach me to be better than I was the day before. I understand that this is not normal, and that everyone is just trying to make it to tomorrow, and yet they take the time to teach. They show patience and understanding while we navigate this pandemic together. I know that I not only speak for myself when I say thank you to every mentor out there who has taken the time to teach a student during this incredibly stressful time. We understand that the pressures and demands of your job are higher than they have ever been, and that your day would go by much faster without having to stop and walk us through a concept, procedure, etc. Because of you, we will survive. ![](https://blog.womensurgeons.org/wp-content/uploads/2021/01/Picture1.png) Rachel Salinas is a third-year medical student at UTRGV School of Medicine in Edinburg, TX. She is a proud Latina and first generation physician and hopes to serve her community and its healthcare needs in any way that she can. She loves to read, enjoys the theatre, and likes spending time with her family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** family, medical school, medical student, patients, Surgical Education, team, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [But what about Christmas?](https://blog.womensurgeons.org/but-what-about-christmas/) **Published:** December 24, 2020 **Author:** Blog Team **Content:** *by Kathleen Romanowski, MD, MAS, FACS* I did not go into medical school planning to be a surgeon. I thought that I was going to be a pediatrician, maybe doing pediatric critical care. That all changed when I did my surgery rotation during third year. I fell in love with the operating room and the impact surgeons can have on the lives of their patients. Despite this, the decision to change paths and choose surgery for a career was not an easy one. I knew that I wanted a family, and one of my biggest concerns was having to miss so many holidays due to the level of commitment that surgery requires. In the end, the allure of surgery was greater than my fear of how it would change my life forever. There have certainly been sacrifices, including missed holidays, special occasions, and school events. However, through the years, I have been able to be present more than I thought I would and have learned ways to lessen the effects of my absences. Here are some of the things that have helped me navigate the holidays while being a surgeon: - **Residency is a challenging time, but it doesn’t last forever.** Obviously, scheduling time off at the holidays as a resident is extremely challenging. Some years I got the holiday off that I wanted, sometimes I didn’t. That was ok. Certainly, at the time, I was disappointed, but in the end, I felt that my residency was fair in the distribution of holidays which made the disappointment easier to handle. If I am completely honest, I now could not tell you which holidays I worked and which ones I spent at home. Additionally, I always knew that residency was temporary, and (I hoped) that I would have more control over my schedule as an attending. - **Choose your partners wisely!** Thankfully, attending life did live up to its promise of giving me more control over my schedule. However, when it comes to holidays, it is critical to compromise with your partners. When choosing your first job, it is important to ask about how holidays are divided and how conflicts will be resolved if two people want the same holiday off. Beyond that, your life will be much happier if you find partners who are supportive and share a mutual respect for each other. In my current group, we do not have a rigid schedule for holidays, but we are generally able to simply discuss our plans/desires and make a plan. I know that if one of us has strong feelings about which holiday we are off, we can usually make it work for that person. - **Determine what events are really important to you.** For most of us in surgery, it is unlikely that we will be able to be at every event or holiday that we would ultimately like to attend. It is important to decide which events are most important to you and try to find ways to be present or to alter the event so you can be part of it. For me, the week of Christmas has always been important. My wedding anniversary, son’s birthday, and Christmas are within eight days of each other. I try every three or four years to take that entire week off as a vacation week so that I get to actively participate in all three events. The other years, I prioritize one of the three celebrations and make sure that I am not on call for that event. I try to predict which event will be most important to my family as well, even though I don’t always get it right. Last year, I assumed my son would prefer to have me home on Christmas, so I volunteered to take call the weekend before Christmas (on his birthday). He was so disappointed! Now that he is getting older, I am learning to ask him which events he really wants me at so that I can try to avoid hurt feelings. - **Be prepared to give more than you get.** If there is an event/holiday that you want off, you may have to give up other things you might want to make it happen. I have taken extra days of call or two days of call in a row in order to have a particular day off. Your colleagues will come to understand and appreciate that you are willing to work for the things you want and this will engender goodwill when you make a request. I also try to be cognizant of events that are important to my colleagues. I know when my partners’ anniversaries and birthdays are (including theirs, their spouses’, and their childrens’) and try to avoid requesting time off on these days so that they can be there for their families. - **Some holidays are more easily moveable.** Valentine’s Day, anniversaries, birthdays (to a certain extent), and Thanksgiving all come to mind as holidays for which the sentiment being celebrated is more important than the actual date they are celebrated. For my family, this means celebrating some time the week before or the week after the actual date. For Thanksgiving, if we are celebrating after the actual day, we will DVR the parade and the dog show so that they can play while we start preparing dinner and then move on to Miracle on 34th Street as is our family tradition. - **Others are not, but you can find work arounds.** Obviously as my son gets older, it is harder to move certain holidays. He knows when his birthday is and that Christmas falls on the 25th of December. Trick or treating is only socially appropriate on October 31st (or whatever day your hometown has deemed appropriate). For these holidays, we have had to get more creative. When I was on call on Halloween, my husband took our son trick or treating and then made a stop at the hospital to do reverse trick or treating in the resident work room. I got a chance to see my son in his costume and he got to show me all of the candy he got. - **Choose alternative dates as a family.** [For Christmas one year, we set up an alternative delivery date with Santa ](https://drive.google.com/file/d/1nUEvYwvsLS7ilq3LyjjtxdJ7bxSrK_co/view?fbclid=IwAR0ECDNiigZqyfoRJW3rXFHHl8JP5yq9EhwaUkDoplu5Yskc_kzTO3QbDDE)for my son so that I could be present on “Christmas” morning. My husband and I picked the date that worked best for us and that became our Christmas that year. As my son is getting older (he turned 10 this year), we are incorporating him into our decisions about when to celebrate holidays and which ones are most important for me to be there on the actual holiday. While I was initially very worried about how much I would miss by choosing a career in surgery, that has not really been the case. I have found ways to make the holidays special both when I am able to be there and when I am not. I hope that these suggestions help you navigate the holidays during your surgical career. Many of them are interrelated and build on each other. I also want to wish you a Merry Christmas and a happy and healthy 2021. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/HI_RES_Final_MG_1238_UCDMC-Kathleen-Romanowski-200x300.jpg) Kathleen Romanowski, MD, FACS, is an Assistant Professor of Surgery at the University of California, Davis and Shriners Hospitals for Children Northern California in the Division of Burn Surgery. She attended the University of Chicago Pritzker School of Medicine and completed her general surgery residency at University of Chicago Medical Center. She did fellowships in Burn Surgery and Surgical Critical Care at University of California, Davis and Shriners Hospitals for Children Northern California. Kathleen is devoted to the care of the burn injured patient and studies disparities in care and predictors of outcomes in elderly burn patients. She is an active member of AWS and is a member of the AWS Communications Committee. You can find her on twitter at [@KSRomanowski](https://twitter.com/KSRomanowski). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life **Tags:** Christmas, holidays, surgeon mom, surgeon parenting --- ### [International Medical Graduates in Surgery: Unknown is Not Bad](https://blog.womensurgeons.org/international-medical-graduates-in-surgery-unknown-is-not-bad/) **Published:** December 17, 2020 **Author:** mcooke@amrms.com **Content:** *By Apoorve Nayyar, MD* International medical graduates (IMGs) form a diverse cohort of the US physician workforce. Historically, IMGs have played a pivotal role in meeting the needs of an ever expanding physician shortage in the United States.[ According to a recent analysis by the Migration Policy Institute](https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states-2018), in 2018, IMGs constituted 28% of the total number of practicing physicians in the United States. In addition to bridging the gap for physician shortage, IMGs also bring diverse perspectives from all parts of the world contributing to the melting pot of cultures that is America. However, given the increasing visa restrictions and limitations on the number of training spots available, the path for IMGs to match into surgical specialties can be challenging and filled with periods of uncertainty. Similarly, for programs previously unfamiliar with matching IMGs, the logistics of hiring and training IMGs can be confusing. In order to be eligible to participate in the Match process, IMGs are required to be certified by the [Educational Commission of Foreign Medical Graduates (ECFMG)](https://www.ecfmg.org/certification/requirements-for-certification.html) which requires successful completion of USMLE Step 1, Step 2 CS and Step 2 CK, in addition to successful graduation from their medical schools. Once ECFMG certified, the IMGs are eligible to participate in ERAS and NRMP to find the right residency position for them, just like any American medical school student/graduate applying for residency. Non-US citizens also require some form of visa sponsorship in order to participate in the training program.[ The most commonly available sponsorship options include either the J1 or the H1B visa,](https://www.ama-assn.org/education/international-medical-education/immigration-information-international-medical-graduates) depending on individual life situations and institutional policy. The J1 visa allows the candidates to participate in their respective training programs for up to a total of 7 years; however this may be extended by 1-2 years under special circumstances and/or further training. The 7 year time limit, however, may preclude some candidates from taking dedicated research/academic time during residency. General surgery has historically been a more difficult specialty for IMGs to secure a position in, with many successful candidates completing a preliminary year before securing a categorical position.[ In the 2020 Match, IMGs accounted for 2.4% of all the categorical surgical positions filled.](https://www.nrmp.org/main-residency-match-data/) Surgery is an extremely competitive field; in addition to candidates being eligible, most programs work hard to identify the “best” candidates for their program, candidates that they believe will thrive and succeed in their training program. In that setting it can indeed be difficult to ascertain the competency and preparedness of IMGs, given the variability of prior educational experiences. A holistic review of the candidates’ application including objective (USMLE scores, medical school academic performance, research experiences/publications) and subjective evidence (letters of recommendation, personal statement, prior clinical experience in the US) can provide programs with critical information for resident selection. While it is of paramount importance to assess the competency of all applicants, it is equally important to not let that turn into bias or discrimination towards IMGs.[ Multiple studies have shed light on the existence of a negative bias towards IMGs](https://pubmed.ncbi.nlm.nih.gov/16093139/),[ despite no evidence of a difference in surgical outcomes](https://pubmed.ncbi.nlm.nih.gov/31850990/) or[ performance during residency between IMGs and US medical graduates](https://pubmed.ncbi.nlm.nih.gov/33038601/). This bias can range from subtle microaggressions during interviews to overt hostility and discrimination. I distinctly remember a conversation with a faculty member during an interview “Apoorve, you know the problem with IMGs is that we don’t really know who you are, where you come from, or whether you will be able to communicate with our patients in English. We tend to prefer candidates that we know will assimilate well culturally”. I remember feeling shocked and shattered coming out of that interview questioning my self-worth. It made me feel like everything I had done in my life up till that moment did not matter, and the only thing that mattered was where I am from. While conversations like these aren’t uncommon, they are definitely not representative of the vast majority of the surgeons that I have come across, who are not only warm and welcoming but genuinely interested in helping you achieve your career goals. You want to be at a place where you are celebrated, not just tolerated. I am so grateful that despite being an outsider to the world of American surgery, I have been fortunate to have found my tribe of mentors and friends who not only inspire me to be an excellent surgeon, but to be a better human being everyday. The kindness that I have experienced from them is unmatched and I only hope I can pay it forward to the next generation of budding surgeons. Given its challenges, the question that’s most often posed to IMGs is why would one want to go through all that? Why not just train and practice in your home country? While everyone has their own reasons, for me it was the ability to learn and practice most cutting-edge evidence based medicine with a hope to make a bigger impact. Most IMGs I have known tend to be driven in pursuit of better opportunities, better futures for themselves and for a better world. It is indeed a big sacrifice, to move away from your family and friends, not knowing when you will get to see them again. This has been exacerbated significantly with the ongoing COVID-19 pandemic with travel restrictions and not being able to be there for your family. So if you know or work with an IMG, show them kindness, it will be much appreciated. My advice for IMG applicants? Work hard, trust your mentors, constantly seek to improve yourself, ask for actionable feedback, be open minded to opportunities and have faith in the process. The road to surgical residency for IMGs is long and hard, but with hard work, grit, and resiliency, nothing is impossible. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/AWS-blog.png)Apoorve Nayyar, MD ([**@apoorvenayyar**](https://twitter.com/apoorvenayyar)) is currently a second-year general surgery resident at the University of Iowa Hospitals and Clinics ([**UIowa\_Surgery**](https://twitter.com/UIowa_Surgery)). He grew up in Amritsar, India and completed his medical school in Mumbai, India before coming to the US for further training. Dr. Nayyar aspires to be a surgical oncologist with a research focus on disparities in cancer care and intersectional equity in healthcare. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** #HeForShe, #IMG, AWSBlog, womeninsurgery --- ### [Tips and Tricks for ABSITE Preparation](https://blog.womensurgeons.org/absite-preparation/) **Published:** December 13, 2020 **Author:** mcooke@amrms.com **Content:** *By Scarlett Hao* A behemoth of a test awaits every surgery resident each January. The dreaded ABSITE (American Board of Surgery In-Training Exam) is a standardized exam with 250 plus multiple choice questions given over five long hours and graded on a percentile curve by year of graduation. More details can be found on the American Board of Surgery[ website](https://www.absurgery.org/default.jsp?certabsite). The details here are to guide you on your journey towards preparing for the test. **It’s a marathon, not a sprint**. No amount of last-minute cramming can replace longitudinal, dedicated study and review, but a few tips and tricks can help you maximize knowledge gained for time spent and set you up for success for when January comes around. **Three-Pronged Attack** There’s three types of mental exercises that your brain needs to jump through. 1. *Knowledge Base*. You need a solid foundation of knowledge. All of the pre-med classes in college, the first two years of medical school, and the information tested on shelf exams and the USMLE Step exams have prepared you. Trust the system. But now you have to add to that the entirety of a surgical textbook (Have you seen the size of *Sabiston’s*?). That takes time and investment of effort. Many programs will either provide you an actual textbook or some way of accessing them (i.e.[ ClinicalKey.com](https://www.clinicalkey.com/#!/)). There is no one best book. Choose one and stick with it. But if you know textbooks do not work for your studying style, find another comprehensive compendium of information such as SCORE or SESAP. 2. *Knowledge Recall*. The test essentially asks you to recall the knowledge you have learned and apply it. Just like any sport or instrument or performative assessment, you need to practice, practice, practice! Find a source of questions, either an online question bank or book. Do as many questions as possible and do them consistently. Even a small quizlet of 10-15 questions every day will help keep your mental muscles well-exercised. There are only so many ways to ask about the same topics. Although preparation in the same atmosphere is ideal (i.e. on a computer in a quiet place), it is not necessary and should not be an excuse to *not* do questions. Any pocket of time is acceptable: walking to your car, waiting for your case to roll back, between lectures, on the toilet, etc. 3. *Impossible Knowledge*. This is the stuff that refuses to stick. A great deal of knowledge and concepts are learned and relearned while being a clinical surgery resident making decisions, taking care of patients, and operating. But some bits of information are so rarely used, yet are easily testable. These include, but are not limited to, cancer staging schema, genetic mutations, and statistical formulas. Although knowledge base and knowledge recall will serve you well, spending a little time getting the impossible knowledge into your head (even if only temporarily) will earn you some easy questions. Review them right before the test! **The Year Before** You finished the ABSITE several weeks ago, had a post-ABSITE celebration, and just got your score back. Good or bad, it’s time to get cracking on next year. Your score report will include a list of topics based on the questions you got wrong. Use this to start making your study plan. Alternatively, if you have never taken the ABSITE before, you can take a practice test and use those missed topics to plan. 1. Your plan should cover all topics, but focus most on your areas of weakness in order to maximize your study efforts. If your program follows a curriculum like SCORE, you can try to arrange your topics of review around the weekly SCORE topics. This is a great and free [resource](http://files.surgicalcore.org/2020-2021_GS_CO_Booklet_v3editsfinal.pdf) even if your program doesn’t use the curriculum. 2. Make a broad plan and be flexible. You may find certain topics are more amenable to different study methods, or find that your preferred study method changes over time. 3. Set reachable and adaptable goals. If you anticipate doing a large number of questions per week and then find your clinical schedule becomes extra busy, studying can become a dreaded additional expenditure of effort when all you want to do is eat and fall asleep. Facing a 10 question block is much easier than facing a 30 page chapter at the end of the day. 4. Include some review. What you learn six months before the test may be forgotten in the two months before the test. Some options include re-testing an older topic closer to the exam, or taking good notes when mastering a KNOWLEDGE BASE and then using the notes for review instead of going back to the source material or textbook. 5. Use your clinical experience. If you know you’re going to be on the surgical oncology rotation in March, arrange to review those topics during that time. When prepping for a case, review not just the case but the related ABSITE material. Take five minutes to teach an ABSITE subtopic (i.e. benign breast disease) to your medical student. You’ll both benefit. In addition, you’ll be surrounded by experts! Use your attendings’ knowledge of their specialty. Ask them what topics are most commonly covered or if they have their own tips/tricks on learning the material. 6. Get a buddy. Share your plan with someone. Hold each other accountable. Run friendly competitions. Quiz each other over lunch. You are not alone. **The Month Before** At this point, most of your time will be spent on KNOWLEDGE RECALL rather than building your KNOWLEDGE BASE. Practice doing larger sets of questions if you have a dedicated space of time to mimic the exam setting. Review wrong questions and learn from them. If you choose to retest yourself with questions that you got wrong previously, be sure you are choosing an answer with a good reasoning of “why I am choosing this answer” rather than the memory of “that was the correct answer.” This is also a good time to work through the IMPOSSIBLE KNOWLEDGE, whether through rote memorization, flashcards, or using related test questions. If you have never taken the ABSITE before, this is also a good time to review the technical details, like where the exam is held, what are the food and drink policies, where the bathroom is located, etc. **The Night Before** Eat. Sleep. This is not the time to study or learn new things. Rest as much as you can. Calm your nerves and trust your brain. You have spent this much effort to make it here. It will be okay. **The Test Day** Eat. Breathe. Trust your knowledge and your gut. Try not to change your answers. Keep a steady pace. You’ve got this! **Do Not’s** 1. Do not procrastinate your studying. It is TRULY impossible to cram the huge breadth of knowledge required for this exam. 2. Do not attempt to use every possible resource. There are endless resources. Choose one or two for KNOWLEDGE BASE and KNOWLEDGE RECALL. What works for one person is not guaranteed to work for you. If you find it didn’t help, choose something else next year. 3. Do not ignore your weak topics. It is painful to face things you don’t like, but they will become less painful when, instead of topics of weakness, they become topics of strength! 4. Do not discount the value or importance of this exam (internal program monitoring, fellowship applications). 5. Do not set your body up for failure by not sleeping or eating well. 6. Do not cheat. **Resources Galore** This is not an exhaustive list of the available resources but hopefully can get you started. *Textbooks* 1. Sabiston’s *Textbook of Surgery*: Extremely comprehensive and dense. Heavy emphasis on basic science and evidence. 2. Cameron’s *Current Surgical Therapy*: Less comprehensive (does not go into subspecialty topics) but some find the writing more straightforward and easier to digest 3. Schwartz’s *Principles of Surgery*: Also very comprehensive. Intended to be accessible by medical students as well. 4. Greenfield’s *Surgery: Scientific Principles and Practice*: A little more clinically practical than conceptual. 5. Fischer’s *Mastery of Surgery*: Two volumes! Organized by pathology and procedure rather than organ site, suitable for upper-level and practicing surgeons. *Review Books* 1. ABSITE Review (FISER) 2. Mont Reid Surgical Handbook 3. Behind the Knife Podcast Companion 4. ABSITE Slayer 5. Clinical Scenarios in Surgery *Question Banks* 1. Surgical CORE ([SCORE](https://surgicalcore.org/)) 2. [TrueLearn](https://www.truelearn.net/) 3. [ABSITE Quest](https://absitequest.com/) 4. [ABSITE Assassin](http://www.absiteassassin.com/) 5. [SESAP](https://sesap17.facs.org/) *Extras* 1. Surgical CORE [modules](https://www.surgicalcore.org/) 2. Behind the Knife [Podcast](https://behindtheknife.org/) 3. SSAT ABSITE Review [Course](https://ssat.com/residents/) 4. Free [Webinars](https://www.sages.org/residents_courses/free_courses/) (SAGES, SSAT) 5. ABSITE Daily Facebook [Group](https://www.facebook.com/groups/1930251443742945/) (free to join, daily question) We look forward to our joint [Association of Women Surgeons](https://www.womensurgeons.org/default.aspx)/Society for Surgery of the Alimentary Tract TweetChat on December 21st at 8PM EST! Join [**@womensurgeons**](https://twitter.com/WomenSurgeons) along with our moderators Dr. Timothy Vreeland (@vreelant), Dr. Scarlett Hao (@ScarlettHaoMD), Dr. Mackenzie Morris (@MackMorrisMD), and Dr. Rebecca Williams-Karnesky (@TheZenOfSurgery). This tweetchat is co-sponsored by the Society for Surgery of the Alimentary Tract (@SSATNews). The questions will be posted directly from the [**@WomenSurgeons**](https://twitter.com/WomenSurgeons) twitter account and you can also find them following the hashtag [**\#AWSchat**](https://twitter.com/search?q=%23AWSChat&src=typd). If you haven’t participated in a tweetchat with us before, check out this [**tutorial**](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([**@heatheryeomd**](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweetchat: 1. What resources did you find the most helpful with preparing for the exam? 2. What are your tips and tricks for studying for the ABSITE? Do you have any advice on developing a study plan? 3. What do you recommend reviewing the day before or day of the exam? 4. What are your go-to mnemonics for ABSITE material? All mnemonics appreciated! 5. How does studying for ABSITE and the boards differ? Any advice on preparation for the written boards exam? ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/Hao.png) Dr. Hao is a PGY-4 general surgery resident at the Brody School of Medicine at East Carolina University. She graduated from the University of Maryland School of Medicine. Her academic interests lie in surgical oncology, health care disparities, and resident and physician wellness. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** ABSITE, AWSChat, surgical residency, Tweetchat, womeninsurgery, WomenSurgeons --- ### [Building Blocks: Progress Over Perfection](https://blog.womensurgeons.org/building-blocks-progress-over-perfection/) **Published:** December 9, 2020 **Author:** Blog Team **Content:** *By Danilea M. Carmona Matos* As I reflect back on the various individuals who have supported my endeavors, I think of mentors and role models – male, female or gender non-conforming, surgeons and non-surgeons, underrepresented minority or not. Some of whom have known me and my family, others my work, and with some I’ve spent a fleeting moment that made a lasting memory. At the end of the day, all of these impressive individuals brought a piece of advice to not only encourage me to succeed, but also to take care of myself in my journey. During this holiday time, I would like to share with you some of the positive messages that I carry close to my heart thanks to these individuals. ***Progress over perfection.*** *From my faculty member who shared that even with what seemed like an imperfect start (7 years to complete a BS in Biology) by persevering and showing commitment you can still reach your dreams.* Perfection is chasing after a unicorn that can lead to frustration. Perfection can be an impossible standard that can let you and others down. Instead, aim for excellence and for the future. Do your best, be your best self and move forward toward your goals. ***You do you.*** *From the surgeon scientist at the mentor-mentee breakfast at a surgical congress who took the time to share his personal struggle with burn out due to always comparing himself to colleagues who had a completely different goal and how liberating it was to cherish his own accomplishments since it helped provide balance at work and at home.* Your journey is unique. If it takes more or less time, if the path is not as linear as you wish, it’s still YOUR story. Persevere, face your challenges head on and make it to the finish line. ***Don’t be afraid to be yourself.*** *From the naval surgeon who I met at a surgical conference after a Q&A. A surgeon who complimented my lively personality and shared the importance of happiness in all we do. Having been told himself by superiors he wasn’t working hard enough because he looked too happy in surgery. He’s still smiling (through good and bad) and growing through the ranks.* Be open and unique. I used to be teased for being “too happy” and social and was told that perhaps my personality was more fit for primary care (which is still awesome if you ask me). ***Breathe.*** *From the amazing endocrine surgeon who has been there taking the time to talk about wellness. A woman who is accomplished in every way: a clinical and medical education researcher, an accomplished surgeon, mentor and mother. Who has taught many (myself included) to close their eyes, think of those they love, breathe slowly and relax.* You’re a human, not a robot. Wind down. Relax. Take moments to take care of your mind and body. Connect with things that bring you joy. Take a moment to get fresh air and sun. Clear your mind. ***Reach out and let yourself be reached.*** *From my mentor who has been there in times when I have struggled. A person who’s always watching me and watching out for me. She challenges me in science and medicine every day and, when I least expected it, she picked me up without me asking her to do so. A mentor who is like family to me and takes the time to ask, “How are you? What are you plans? What can we do to get there?”* There will be times when you will need help. Even if it’s a routine task, a procedure you don’t understand, or something more personal, identify individuals with whom you are comfortable and don’t be afraid of reaching out to them. Even more importantly, don’t be afraid of those who reach out to you. Sometimes, the conversations you may be “evading” can bring the joy of connecting and learning you didn’t know you needed. Whether it may be new perspectives, words of wisdom and support, or help succeeding in your tasks, a moment to connect with someone else may be just what you need in this part of your journey. ***Don’t be afraid to say no.*** *From the amazing woman leader, co-founder of a recently established surgical society, who I met after seeing her as a panelist at a medical student conference. A successful surgeon who continues to make large strides in diversity, equity and inclusion. A great mentor who takes time to remind me to give my best while not forgetting to save time for me too.* Sometimes, the more we do, the more work we get. However, it’s important to prioritize what will get you closer to your goals and identify what you can let go. You may receive twenty learning opportunities, but there’s only one you. Take your time to thank people for considering you for a task but don’t feel pressured to always say yes. Instead, consider if it will be helpful to you, if you will have the time and if it will not conflict with your other responsibilities. Feel free to kindly decline if needed (you can even take that moment to sponsor someone else). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/Picture1.png) Danilea M. Carmona Matos, MS, is an MD candidate at San Juan Bautista School of Medicine in Caguas, Puerto Rico. She is the Latin America Liaison of the AWS National Medical Student Committee as well as the President of the AWS Chapter at San Juan Bautista School of Medicine. She is an avid peer and undergraduate mentor, active member in various interest groups and has led community outreach activities. Danilea has also engaged in both clinical and basic science research in neuroendocrine cancer, surgical education and palliative care. Danilea aspires to become an academic surgeon integrating cancer research, education and clinical care. She hopes to be able to achieve this goal and mentor others in their path to achieve their own. When there’s down time, you can find her with her family, her dog Luna or working on arts and crafts! She can be found on Twitter as [@danileacm](https://twitter.com/danileacm). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** career development, education, medical student, mentor, mentorship, sponsor, womeninmedicine, womeninsurgery, WomenSurgeons, work-life balance --- ### [Becoming a surgeon scientist](https://blog.womensurgeons.org/becoming-surgeon-scientist/) **Published:** December 6, 2020 **Author:** mcooke@amrms.com **Content:** *By Genevieve Boland* Life is full of well-intentioned bad advice. On many occasions, I have been told not to pursue my career as a surgeon scientist, that it is not possible. It is clear that all advice is limited by the life experience of the person giving it, so it’s important to contextualize feedback and appreciate how it may or may not align with your own life and perspectives. The message I hope to share here is that becoming a surgeon scientist is very possible. It requires interest, tenacity, and a community of like-minded academic surgeons (we exist!). When I was a medical student considering surgery as a career, it only took one role model, an amazing surgeon scientist to feed my fire and encourage me to pursue this incredible career path. I am eternally grateful that he took me seriously, listened to my ideas, and showed me that there is room in surgery for serious scientific inquiry. I hope to address some of the themes that came up in the AWS TweetChat held on Monday, November 25th, talking about life as a surgeon scientist: **Mentorship:** You will never find one ideal mentor because you need a mentorship team to align with all the different components of your career and life. You need clinical mentors, scientific mentors, career mentors, and peer mentors. Any of these can come from outside of your department or your institution. Consider building a mentorship committee or team. My mentorship team as junior faculty consisted of a medical oncologist, my chief and chair, colleagues internally and externally, and some amazing female academic surgeons who could help me contextualize all these pieces in parallel with having a life outside of medicine. Realize it’s a team effort and no one person can serve all these roles for you. Build your team to address each need separately. **Collaborations:** Team science is a major component of my career, one that I value immensely. The diversity of perspectives and life experiences greatly enhance our projects, and working together allows our science to move far beyond the limits of each individual. These collaborations can be incredibly productive and lead to life-long friendships. However, collaborations can also be incredibly challenging, deeply political, and in general require early and frequent communication regarding expectations and goals. Not every collaborator will be a friend. Not every collaborator will have your needs in mind during the collaboration. Establish the ground rules early and clearly (get used to these sometimes uncomfortable conversations) and only continue collaborations that are helpful to you and add value to your research program or career. **Funding:** This is the most challenging part. Do not take it personally if most of your grants don’t get funded. This is common to all of us. You must be resilient and move on. Resubmit. Incorporate feedback (if you get any). Learn the process, and continue to try. Start with foundations and/or specialty groups and smaller grants. Build your history of funded research, which helps for each subsequent grant submission. Build up to bigger and more competitive grants. Apply frequently and repeatedly. There is no failure here, that’s the expected outcome. Now and again you’ll get funding. So keep trying and don’t be discouraged! **Negotiating:** When looking at starting your career as a surgeon scientist, look beyond your specific clinical needs and examine the infrastructure of the institution, the track record of supporting people on a similar career pathway, and the culture of the team(s). Negotiate hard for things outside of your salary that will make your life easier and less stressful. Get specific about expected RVUs, clinical expectations, and protected time because time is one of your most valuable commodities. Think about what your needs are in terms of start-up funds and resources. Justify your “asks”, but ask for what you need (not just for today but over the next 3-5 years). The department is investing in you, so make sure you have what you need to succeed. It is in your and their best interests to do this. But avoid being the first of your kind or a new hire to “build a program” unless there is a clear path to success. Overall, a career as a surgeon scientist is incredibly meaningful and fulfilling. For me, as a surgical oncologist, I cure 1/3rd of my patients with surgery, another 1/3rd are potentially cured but also at risk where the evolution in our clinical management is improving prognosis and outcomes, and the 1/3rd of patients I cannot heal with surgery I study in my laboratory with the hopes that what we learn from our clinical “failures” can improve the care of the next patients. I am grateful to my patients who share their stories, their bodies (tissue/blood), and their lives with us in order to help others. I am honored to have the chance to work with them to make a difference in how we care for cancer patients. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/Boland.png) Dr. Boland is a surgical oncologist at the Massachusetts General Hospital. She is Section Head of Melanoma/Sarcoma Surgery, Surgical Director of the Termeer Center for Targeted Therapies, and Director of the MGH Surgical Oncology Research Laboratories. Her clinical practice and research focuses on melanoma and immuno-oncology, and her laboratory is funded by the DoD, the Melanoma Research Foundation, the MGH Innovation Discovery Grant, and various society and industry sources. She previously received the ASA Foundation Fellowship Award, the SSO Clinical Investigator Award, the AWS Grant, and funding from the American Cancer Society. Nationally, she serves on the National Comprehensive Cancer Network (NCCN) Committee for Melanoma, the Executive Council of the SSO, the SSO Melanoma Disease Site Working Group, the SUS Membership Committee, and the Society of Immunotherapy of Cancer Surgery Committee. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** academic development, academic surgery, AWSChat, surgeon scientists, Tweetchat, Women in Surgery, WomenSurgeons --- ### [Nineteen perspectives on COVID-19: How the pandemic impacted women in training for plastic and reconstructive surgery](https://blog.womensurgeons.org/19-perspectives-on-covid-19/) **Published:** December 2, 2020 **Author:** Blog Team **Content:** *By the Johns Hopkins University School of Medicine medical students and Plastic and Reconstructive Surgery residents: Erica Lee, Helen Xun, Sai Pinni, Pooja Yesantharao, Chao Long, Wilmina Landford, Franca Kraenzlin, Amy Quan, Jonlin Chen, Darya Fadavi, Waverley He, Faraah Bekheet, Kristen Broderick, and others.* The glass ceiling found an ally in a virus that arrested the world. Together, these challenges are as detrimental as they are invisible. Although the pandemic’s long-term effects on women in surgery are unclear, COVID-19 has the potential to magnify micro-inequalities that women in surgery already face, as the resulting stay-at-home orders disproportionately burden women with housework and childcare ([Lewis 2020](https://www.theatlantic.com/international/archive/2020/03/feminism-womens-rights-coronavirus-covid19/608302/)). Female trainees navigating the stages necessary to establish successful surgical careers face additional uncertainty due to the loss of networking and mentorship opportunities ([Brubaker 2020](https://jamanetwork.com/journals/jama/fullarticle/2769140)). We interviewed 19 women from the Johns Hopkins School of Medicine in various stages of training in Plastic and Reconstructive Surgery (PRS) on their experiences with COVID-19. This cohort represented diverse personalities, cultures, and motivations; despite these differences, it was clear that each woman held in common an adamant refusal to allow the pandemic to be an obstacle in their career development and training. Together, we share the barriers COVID-19 has created and our concerns for the future. **Seeking opportunity through adversity** *A loss of training in medical school and surgical residency*: As COVID-19 restrictions at institution and state levels evolve, medical education is in a constant state of flux. While pre-clinical courses translated well onto Zoom platforms, trainees in the midst of clinical rotations and surgical residency received a substantial blow to experiences in exploring surgical fields and gaining confidence in a variety of procedures. One PGY2 reported she “did not feel \[she\] was getting a good training experience” due to the low surgical volume and cancelled cases. However, the valued time in the hospital is juxtaposed with fear of COVID-19 exposure and bringing the virus home. *A loss of tradition*: The interview trail is arguably a competitive rite of passage for both medical students and residents applying to fellowship. This brings an opportunity to know the larger PRS community and invites self-discovery as impactful career choices unfold. One medical student was concerned by the lack of “opportunity \[to visit\] programs in person” as in-person interviews allow an opportunity to showcase professional accomplishments and goals, meet future colleagues, and understand the culture of programs. The pandemic converted the already daunting application cycle into an enigma of novelty: an entirely virtual platform. While blanket guidelines from societies provided some comfort in defining the final form, the trainees agreed that “virtual is necessary,” but continued to wonder “is it also sufficient?” *New research opportunities:* Across the board, trainees had to refocus and restructure their research due to non-essential research restrictions and shutdowns. Trainees continued to develop projects that could be completed at home, and one trainee even took the opportunity to repurpose her 3D printing lab to produce COVID-related devices and personal protective equipment. Although limited research funding added additional pressures to trainees, for some residents, the prospect of a difficult research year seemed more appealing than a clinical year with reduced surgical volume. **Rebalancing identity as a surgeon and a mother** While medical students used stay-at-home orders to volunteer and spend time with family, female trainees with children had to balance parenthood with working from home. As daycares closed, resident moms found their free time occupied with childcare while their fellow residents were able to study or complete research during their new found free time. One expecting resident anticipates the effects of COVID-19 on her surgical training will only be compounded by her upcoming maternity leave. Another resident found herself teaching her toddler the alphabet instead of learning to dissect a muscle flap and expressed a loss of confidence in surgical skills, as well as in her identity as a surgeon. **Looking to the future** Although trainees who are in earlier stages of their training believe that there is time to “bounce back” and accomplish their goals, those who are near career milestones are concerned by the impact newfound challenges in visibility and productivity will have on their next career stage. Despite these challenges highlighted by COVID-19, an overwhelming theme expressed by students and trainees is the optimism that they will adapt to the “new normal” and overcome obstacles that arise as the pandemic progresses. Our collective narrative illuminates how the COVID-19 pandemic has impacted aspiring female plastic surgeons’ education and shaped their concerns for the future. We highlight the resilience of women in surgery and their determination to seek opportunity from adversity. While many of the challenges voiced might not necessarily be gender specific, it is critical to recognize that they could disproportionately affect female trainees. We challenge mentors, departments, and institutions to consider these themes in order to provide additional support for women in surgery. As a community, we can work to ensure that as we work to flatten the pandemic curve, we do not also flatten the momentum to close the gender gap in surgery. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/1.png)Pictured Left to Right: Dr. Wilmina Landford PGY4, Helen Xun MS4, Pooja Yesantharao MS4, Erica Lee MS2, Darya Fadavi MS2, Sai Pinni MS0. Photo Credit to Will Kirk of the Johns Hopkins University. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/2.png)Pictured Left to Right: Dr. Wilmina Landford PGY4, Dr. Hillary Jenny PGY3. Photo Credit to Will Kirk of the Johns Hopkins University. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/3-762x1024.png)**Timeline of Women in PRS**: The timeline illustrates the milestones leading up to a career in PRS and the diversity of our respondents in where they fall on that path. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/4.png)**Experiences at a Glance**: The diagram highlights select quotes from respondents across the timeline. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/12/5.png)Pictured Left to Right: Darya Fadavi MS2, Pooja Yesantharao MS4, Helen Xun MS4, Dr. Wilmina Landford PGY4, Sai Pinni MS0. Photo Credit to Will Kirk of the Johns Hopkins University. **About the authors:** Medical students Erica Lee, Helen Xun, and Sai Pinni had the honor of interviewing the women of the Plastic and Reconstructive Surgery residency program at the Johns Hopkins School of Medicine and their fellow medical students interested in pursuing careers in Plastic and Reconstructive Surgery. Under the guidance of Dr. Kristen Broderick, a plastic and reconstructive surgeon and Director of Breast Reconstruction at the Johns Hopkins Bayview Medical Center, they have built combined insights from those interviews into this collective narrative. The 19 women featured in the narrative have a wide range of passions, including painting and yoga, and hold a variety of research interests from engineering to improving diversity in breast reconstruction patient education to optimization of resident aesthetic clinics. The authors are appreciative of the Johns Hopkins School of Medicine’s diverse and enriched environment that emphasizes community building. Collectively, they enjoy yelp’ing through Baltimore’s cuisines and walks along the Chesapeake Bay. The Johns Hopkins University/University of Maryland Plastic Surgery Residency Program can be followed on Instagram @hopkinsplasticsurgery. You can find individual authors on Instagram @elee113, @slpinni27, @hellohelen1958, @heyitschao, @landfordmd, @jonlinchen, and @kpbroderick or via Twitter @helen\_xun and @chaolong. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** covid19, education, medical school, medical students, residency, trainees, training, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [“Finding Your Moment of Moo”: Thanksgiving Traditions (Pandemic Edition)](https://blog.womensurgeons.org/finding-your-moment-of-moo-thanksgiving-traditions-pandemic-edition/) **Published:** November 25, 2020 **Author:** Blog Team **Content:** *By Cheryl Zogg* 2020 has been… a year, and yet, like any other year, as this particular year begins to draw to a close, I find myself reflecting back on the simple moments that have helped shape my memories. It is a simple tradition, one started by my *oma* (grandmother) when she was a child dealing with troubles at home. For many years growing up, I simply dismissed it as a part of my family’s Thanksgiving tradition (a holiday falling on the fourth Thursday of November in the United States for international readers of this blog) when the start of winter holidays came around. “Tell me something that you are thankful for!” my oma would cheer over the din of family and chaos of meal preparation as we all gathered around, summoned by the clanging clapper of a loud Swiss cow bell that she proudly swung as she strutted out onto the front steps of the farm porch. Bedlam ensued as my *opa* (grandfather) and uncles came in from the fields, my aunts and I briefly abandoned the food (fervently hoping that the turkey, ham, and lebkuchen \[think chocolate gingerbread cookies\] did not burn), and someone was sent to round up the kids. Oma would perfectly arrange us into an inevitably lopsided circle (much to my oma’s chagrin) and ask each of us to share something that we were thankful for that year. After a round of responses, ranging from heartfelt and insightful to eye-rolling and silly, she would pause and in German say that what she was thankful for were the simple moments that made up her year, the simple moments that she might otherwise take for granted that enabled us all to be there. As she grew older and eventually passed away in 2018, the tradition largely went with her. That year, the family did not feel like celebrating, and, the following year, in 2019, several of us had other commitments that kept us away. This year, in 2020… well. This year, I decided to do something different. If eight-months of forced virtual meetings and teaching graduate-level biostatistics to masters and PhD students on Zoom have taught me anything, it is that you would be amazed at how creative you can be when you have precious few other options! Therefore, this year, my family received a Zoom invitation, informing them to be present on Thanksgiving at noon. The subject line of the email simply read: “Moo.” From my family to yours during these troubled holiday times, I hope that you can find comfort, friendship, and safety wherever you are. In the midst of a world in chaos with so many of us stranded far away from the people we love, I know that my heart echoes my oma’s words. This year, I am thankful for the friends and colleagues both near and far who have helped me to get through this year and enabled me to still be standing here. I am thankful for the simple moments of creativity and ingenuity that, in the midst of a global pandemic, have enabled the incredible community of an organization like AWS to thrive. As the current Chair of the AWS National Medical Student Committee, I will be the first to say that this year is not what any of us had planned! As an MD-PhD Candidate, I did not intend to complete and defend my PhD locked alone in my room. I did not intend to return to clerkships dressed up like a bad Halloween scuba diver cum astronaut in a face shield, scrubs, goggles, and mask. I did not intend to not be able to walk in the front door of the emergency room with my friend when she was hurt, and I certainly did not intend to celebrate interviews, match day, and graduation with my medical school classmates watching them open their match day letters and receive their MD diplomas over Zoom. Yet for all of the chaos that this year has wrought, they did graduate. They did match. My friend survived her solo journey to the ED. I dressed up like a confused scuba diver cum astronaut and somehow managed to complete a PhD. Not everyone has been so fortunate. Far too many have been forced to live with real loss. It is for that reason that in reflecting back on one… of a year I find myself returning to my oma’s tradition, a tradition born from the experiences of a survivor who lived through too much as a child. I find solace in her words, for it is the simple moments—good and bad, familiar and strange, joyful and earth-shatteringly painful—that have brought us to where we are today and given us the opportunity to look forward to tomorrow. Thus, as 2020 *finally* draws to an end, I wish you all a Happy Thanksgiving and encourage you to (in the words of my mother on seeing the Zoom invitation): “Find your moment of moo.” In saying as much, I am rather certain that my oma would have more than a couple of questions about what we have done to her tradition and am admittedly more than a little scared that the phrase will continue to live on within my family for far longer than this year! Yet for all of the absurdity begotten by my mother and far too many hours on Zoom, I am thankful for the moment to celebrate. I am thankful for my moment of moo. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/11/Picture1-1.png) Cheryl K. Zogg, MSPH, MHS, is an MD-PhD Candidate at Yale School of Medicine where she is currently in the process of completing her PhD in Chronic Disease Epidemiology (Quantitative Health Services Research). She is the 2020-2021 Chair of the AWS National Medical Student Committee and a proud medical student member of the AWS Blog and YouTube Communications Subcommittees. Her clinical and research interests lie in the intersection of health policy and quality as it pertains to outcomes of surgical patients and differential access to care. She anticipates a career in academic surgery. Outside of work, Cheryl is an avid dancer, traveler, bookworm, and (aspiring) biker and runner who loves to mentor and teach. She can be found on Twitter as [@CherylZogg](https://twitter.com/cherylzogg?lang=en). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** covid19, education, family, holidays, womeninmedicine, womeninsurgery, WomenSurgeons, work-life balance --- ### [Picking Between Surgical Specialties as a Medical Student](https://blog.womensurgeons.org/picking-between-surgical-specialties-as-a-medical-student/) **Published:** November 18, 2020 **Author:** mcooke@amrms.com **Content:** *By Alyssa Brown* “What do you want to be when you grow up?” Pediatric geneticist was my answer from high school through the first weeks of medical school. I had shadowed twenty physicians before medical school that ranged from surgical to non-surgical and specialized to primary care. I had stuck to wanting to be a pediatric geneticist. I loved genetics in high school and college. I liked working with pediatric patients, so I thought it would be the perfect field for me. My second week of medical school, my anatomy professor pulled me aside and asked if I was interested in surgery. I responded that I hadn’t thought about it. She said she would email a few surgeons to see if they would mentor me. By the next week, I was in the lobby of the children’s hospital nervously waiting to meet a pediatric surgeon. She floated in, and I was swept into her tornado of a day. Within the first hour, I was learning how to scrub in, and I was watching my first surgical case. I was enraptured. The day ended up finishing at 9pm, but I was sold. Funny, I no longer want to be a pediatric geneticist. I called my mom as I was leaving the hospital to tell her that I wanted to be a pediatric surgeon. I kept shadowing surgeons after that point. I felt so much pressure to see everything I could. I didn’t want to miss any surgical specialty, in case I fell in love with it. I found it so stressful to see everything so that I could make the most informed decision I could about what I wanted to eventually do. During my first two years of medical school, I constantly snuck away to shadow as much as I could. It kept me grounded and made the information I was learning much more real. Halfway through second year, I started to ask around about what order I should try to have for my third year clinical rotations. I wanted to plan, so that I had the best chance of honoring my surgical rotation. It was suggested that I try to take Step 1, start with [internal medicine rotation](https://blog.womensurgeons.org/medical-students/confessions-of-an-ill-equipped-third-year-medical-student/), followed by general surgical rotation third year. Most suggested doing internal medicine rotation first because many of the questions will overlap with the NBME Surgical Shelf Exam. I knew I wanted to honor the rotation. After my [surgery rotation](https://blog.womensurgeons.org/medical-students/black-clouds/), I knew I wanted to be a surgeon. There are so many types of surgery, though: general surgery, orthopedic surgery, otolaryngology, urology, cardiothoracic surgery, vascular surgery, obstetrics/gynecology, etc. I could enter many of these fields through general surgery residency, but others would require me to choose a different subspecialty residency. I wanted to be positive of my choice. I found surgeons in each of these areas during third year. Everyone is always passionate about their field, so it was easy to think you would really like the field when talking to them. I knew I needed to see the operations firsthand. Orthopedic surgery was first. I thought I would like it because I had been a college athlete. I liked musculoskeletal anatomy. I shadowed two pediatric orthopedic surgeons. The day was fun. I really enjoyed spending time with them, but I still did not have a good feel for their everyday routine. I decided to shadow another orthopedic surgeon for a weekend on-call. He had the perfect mix of OR songs and getting to hammer things is always fun. It was a late Saturday night, and we were fixing a tibia. When I was driving home later, I realized if I did orthopedics, I would never get to operate in the abdomen again. I decided to mark orthopedics off my list. Otolaryngology (ENT) was next. I spent most of my summer between sophomore and junior year of college shadowing an ENT in Chattanooga. Also, I had been shadowing ENT during first and second year of medical school, whenever I was home on breaks. I liked the in-office biopsies and scopes. I also thought I would like the mix of pediatric and adult patients. The time in the operating room was fun. I especially liked thyroid surgery. When I came back to it for a short one-week rotation during third year, I realized it wasn’t perfect for me. I just kept coming back to the fact that I missed the abdomen. I completed my obstetrics/gynecology rotation during January of my third year. I wrote about this experience previously in an AWS article, which you can find [here](https://blog.womensurgeons.org/medical-students/the-a-ha-moment/). Choosing between general surgery and OB/Gyn was the hardest decision to tease out. I really liked female patients and the gynecologic surgeries, but at the end of the day, I couldn’t get general surgery out of my head. I still remember the first time I saw peristalsis in the small bowel during an operation. I thought it was the most amazing thing I had ever seen, and I still do think it is amazing. The decision of what kind of surgeon you want to be after medical school is a difficult decision. It can often be clouded by discussions of work/life balance, being a woman, and lifestyle. I knew I wouldn’t be happy doing anything other than general surgery. I remember one general surgery resident saying, “if you can do anything besides surgery, do that.” I do not regret exploring so many different areas and fields – it brought me experience. In particular, I thought it was incredibly helpful to take over-night call in the areas that interested me. . You learn pretty quick which things you are excited to wake up for at [two am on a Saturday](https://blog.womensurgeons.org/medical-students/gimme-shelter/)! Remember, you have enough time to find your path. You will realize eventually what you love, even if you sometimes try to convince yourself out of it. Don’t let anyone scare you out of doing what you love. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/11/headshot_5x7_0449-731x1024.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, [before finishing her MD](https://blog.womensurgeons.org/medical-students/waiting-your-turn/). She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and congenital diaphragmatic hernia. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for two years, and she has loved [writing pieces](https://blog.womensurgeons.org/medical-students/black-clouds/) for the [blog](https://blog.womensurgeons.org/mentorship/prosciutto/) over the [past](https://blog.womensurgeons.org/medical-students/the-distance-between-two-worlds/) [two years](https://blog.womensurgeons.org/medical-students/confessions-of-an-ill-equipped-third-year-medical-student/). During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off” or embroidering. You can find her on Instagram [**@Alyssa\_b\_futuremdphd**](https://www.instagram.com/alyssa_b_futuremdphd/) and on Twitter [@Alyssa\_B\_MDPhD.](https://twitter.com/Alyssa_B_MDPhD) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Keys to Success in Arranging Childcare for Surgeon Parents](https://blog.womensurgeons.org/keys-to-success-in-arranging-childcare-for-surgeon-parents/) **Published:** November 12, 2020 **Author:** mcooke@amrms.com **Content:** By Dr. Lillian Erdahl When I got married at the beginning of my lab years, two years into seven years of General Surgery Residency, I was not sure that I wanted to be a mother. I had been single-mindedly pursuing my career for so many years continuously overcoming the emotional pain of my own mother’s illness and transformation from someone who cared for me into someone who needed care and protection. My surgery resident husband wanted children but was not in a hurry. I hadn’t really thought it possible for us to have a child during residency until I attended a panel at the American College of Surgeons Clinical Congress in 2009. The timing was ideal – being able to breathe and look around me during my non-clinical two years had allowed me to consider what gave meaning to my life. I no longer felt I could wait five or six more years to have a baby, nor did it seem like a good idea based on what I heard about infertility and the pressure to meet productivity targets as an employed surgeon. What was not ideal was the availability of childcare for two parents working 80 hours a week. Family was not an option for the primary daily care of a child. My mother became profoundly disabled when I was sixteen and was living in a nursing home by the time my son was born. My father and step-mother were both working full-time 1000 miles away and traveling to help my step-brothers’ family whenever they could. My in-laws were both working full-time and lived close enough to provide help on weekends or in a pinch. Other women residents, attendings, and friends with children had used a variety of options. Many did not have a spouse who was also a surgery resident. I finally settled on daycare plus a part-time nanny to cover the hours before and after daycare was open. We found one on Care.com who worked well for those first several months. She was experienced enough to give our son nebulizer treatments when he was sick with RSV and taught my mother-in-law how to do so. We paid her an hourly wage for 20 hours/week. Did I mention that was in addition to full-time daycare on the salary of two residents with a large medical school debt burden? When I was still pregnant, we made the decision that my husband would pursue Fellowship 90 minutes away – living there, while I completed my last two years of residency. There did not seem to be a lot of great options for a two-career academic surgeon couple. One of us could work as a general surgeon while the other completed advanced training, but this simply felt like prolonging what is already an intense training process. So, we decided to hire an au pair to live with us and provide the additional childcare beyond the nine hours/day of daycare needed to make our lives possible. The hours that we needed help were early mornings and evenings with occasional weekends. The split shift was difficult for someone who was coming to and from our house. When people in the U.S. talk about an [au pair](https://j1visa.state.gov/programs/au-pair), they usually mean someone who comes from another country on a J-1 visa to provide childcare for 1-2 years while pursuing six hours of post-secondary academic credit. Au pairs are thus regulated by the federal government. Most families hire an au pair with the assistance of a private agency who assists with finding the au pair, processing the paperwork, and providing support to the au pair throughout their time with the host family. How do you hire someone to care for your precious children? It is never completely without fear and yet your ability to continue working depends on it. I was so grateful for the mentorship of Drs Amy Reed, Rena Kass, and Ann Rogers as I embarked on this journey. I learned to write the job description very specifically. Explain what you are looking for and how you expect your child to be cared for while you are away. If you want help with pets, laundry, food prep, or something else make sure that is negotiated in the beginning. Think about the skills you need which will vary depending on the ages of your children and your family life. For instance, I was looking for an au pair who could drive my child to and from daycare since I had to be at work before the place opened. The pandemic has added to the burdens of physician parents while taking away many of the resources we relied on to make our lives work. When it all started in March, I no longer felt comfortable having more people in my home than absolutely necessary. So I put the house cleaners on hold and eventually decided to let them go. I also stopped taking the dog to daycare so that we wouldn’t have to interact with people in the lobby during drop off and pick up. Groomer – no, after school activities -no, school – no. Instead of needing help before and after school, I now needed full-time childcare at home during the day. I was fortunate because I already have a full-time employee. We were able to shift schedules to accommodate this new circumstance but not without significant challenges and the need to spread some of my work into the evening hours. The U.S. government reaction to the pandemic has been a challenge for those who rely on au pairs. However, there is an [exception to the J-1 VISA restrictions](https://travel.state.gov/content/travel/en/News/visas-news/presidential-proclamation-10052-frequently-asked-questions-on-j-visa-processing.html) for au pairs hired to provide care for children whose parents provide medical care to individuals with COVID19 or perform medical research related to COVID19. Even with exceptions, international travel may be challenging during the pandemic. What are the other options? You could hire domestically to fill the gaps. It is important to set expectations from the beginning. Interviews now include a COVID attitude questionnaire and discussions of pandemic prevention expectations. Will you ask your new sitter to wear a mask in your house? What do they do in their off work time and how do you talk about it? My advice is to be clear and consistent in your expectations. You cannot control what someone does in their personal time but you do need to trust that they are considering the needs and safety of your family. The most important lesson that I have learned through my journey through various forms of childcare as a surgeon is to have contingency plans in place. During the pandemic this is more important than ever. We do not know when someone will be ill or quarantined or have an accident. Flexibility must exist on the part of our employers, as well. There may be an option for backup care when your child’s school goes online for a period of time, but what is the option if your child is quarantined? How does your child feel about staying at home? Are they afraid of getting sick or worried about an ill teacher? Do they need their parents for support during that time? Hospitals must take into consideration the need to allow parents to care for their children. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/11/lillian-erhdahl.png)Lillian Erdahl, MD FACS is an Associate Professor of Surgery at the University of Iowa. She serves as Associate Program Director in General Surgery as well as the head of the Iowa City VA Medical Center Breast Clinic. Her research interests include breast cancer prevention, faculty development, and simulation in teaching clinical examination. She is the Communications Director for the University of Iowa Department of Surgery which includes overseeing the department’s social media accounts. Her work for Gender Equity includes serving as the Association of Women Surgeons Communications Committee Co-Chair. Outside of the hospital, she enjoys yoga, cross-country skiing, cooking, and gardening. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life, parenting **Tags:** AWS, AWSBlog --- ### [The Road to FACS](https://blog.womensurgeons.org/road-to-facs/) **Published:** November 6, 2020 **Author:** Blog Team **Content:** *By Erin Garvey, MD, FACS* Last October, I watched as the new 2019 Fellow initiates processed into Convocation at the ACS Clinical Congress in San Francisco. I felt excited as I imagined myself and the friends I trained with being initiated during the 2020 Convocation ceremony. Despite being in my mid-30s, I thought it would be fun to put on another black robe and march proudly into a room of surgeons as Pomp and Circumstance played for yet another time in my life. A few months later, my husband and I were thrilled to announce our first pregnancy. Given that we would have a 5 week old at the time of the 2020 Clinical Congress, we made the decision in December 2019 to not travel to Chicago for the meeting. As it turned out, (due to a global pandemic, never thought I would write that!) no one was able to attend Clinical Congress in person. Thanks to the shift to a virtual meeting, I was able to attend Convocation from the comfort of my home with my husband and newborn daughter present to celebrate with me. 2,125 surgeons were initiated including 1,357 surgeons from the U.S. and Canada with the remaining 768 representing 75 other countries. 585 initiates were women. While I am thrilled to be a part of this group, I was taken back that only 28% of initiates were women. The clinical practice committee and I have been working on ways to help our AWS membership on the road to becoming FACS. Out of more than 900 lifetime, regular and new surgeon members, 64% of AWS members reported being a Fellow of the American College of Surgeons. I imagine the next time I hear the Pomp and Circumstance graduation march, my daughter will be processing into her kindergarten graduation in a construction paper mortarboard hat. Between now and that time, I hope to see 100% of eligible AWS members become Fellows and to see the overall number of women FACS initiates continue to increase as well. See below for more detailed information on how to achieve the FACS credential before the December 1st deadline. **Why become a fellow of the ACS?** The FACS credential exists to foster the professional growth and development of surgeons, promote high standards and best practices in surgical care, and establish and maintain patients’ confidence in the ability and integrity of their surgeon. For more information on FACS benefits and information on how to apply click [here](https://www.facs.org/member-services/join/fellows). **Requirements to become a Fellow:** Be in practice for a minimum of one year Be board-certified **To Do List:** Complete the online application (facs.org, log in and click on My Profile and then My Applications) by December 1st with the below required details: – Medical education – Residency and surgical training beyond residency – Medical liscence – Board certification by the American Surgical Specialty Board (member of the American Board of Medical Specialties or an American Osteopathic Surgical Specialty Board) or an appropriate specialty certification by the Royal College of Surgeons of Canada – Current appointment on the surgical staff of a hospital Give names of Fellows of the ACS to serve as references (two from your speciality and three from your geographic area). Upload a pdf of your current CV. Provide a list of your surgical cases for the most recent 12 months: – Provide a description of each case, date, and the total number of cases – Remove all patient identifying information – Include your name in the saved file name – Click [here](https://www.facs.org/-/media/files/member-services/docs/surgical_case_list.ashx) for more information The $200 application fee is wavied for current Associate Fellows. Participate in an interview with ACS Fellows from your region: – 2020 interviews were conducted via Zoom dur to the COVID-19 pandemic – Full time military applicants are exempt from the interview process Pay the $400 initiate membership fee once approved. Direct any questions to facsapplications@facs.org. **Timeline:** Application deadline December 1, 2020 Interviews typically conducted March-May Applicants approved as initiates in July Initiates may utilize their Fellow status after the Convocation Ceremony at the ACS Clinical Congress in October. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/11/2.png) ![](https://blog.womensurgeons.org/wp-content/uploads/2020/11/1-1.png) Erin Garvey, MD, is a pediatric surgeon at Phoenix Children’s Hospital. Erin was born and raised in Colorado. She earned her Bachelor of Science in molecular biology from the University of Denver and attended medical school at the University of Vermont College of Medicine. Her surgical training was completed in Arizona at the Mayo Clinic for general surgery and at Phoenix Children’s Hospital for pediatric surgery. She previously spent her free time at exercise dance classes, reading and traveling with her husband. Now, however, she and her husband have a new favorite pastime – their daughter! --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** academic practice, career development, clinical practice, Professional Development, WomenSurgeons --- ### [Just Keep Swimming](https://blog.womensurgeons.org/just-keep-swimming/) **Published:** October 29, 2020 **Author:** mcooke@amrms.com **Content:** *By Elysa Margiotta, MD* I could have given up. I could have decided that it was all too much to handle, and just faded away. To say that my path to becoming a physician was eventful is an understatement. I started medical school in Grenada as a fresh-eyed, hopeful 21 year-old, looking forward to the “first day of the rest of my life,” as we so often hear in movies. I had just left my family and friends behind in Canada, and I was starting my new life. Here is the series of tumultuous events that occurred during my medical school journey: – On my second day on the island, I was sexually assaulted by a senior classmate, which led me to develop and experience PTSD over the next few years. – During my second semester, the day before our first exam, I received an email from an attorney’s office back in Canada with documents saying that my father was suing my mother and me. Throughout the rest of the semester, coinciding with my exams, I would continue to receive updated documentation from the attorneys. On my break between the second and third semesters, we finally went to court. – During my fourth semester, despite preparation, I failed one of the exams, and I was told that if I took and failed the final examination that I would be expelled from medical school. – During my final semester, one week before the CBSE examination, an examination that covers the 2 years’ worth of information similar to the USMLE Step 1, I received the news that my grandfather had died. I was unable to attend the funeral. – During core rotations of my third year of medical school, my roommate had an unfortunate experience. After many months of sacrificing my studies to help them, they eventually got the help they needed with inpatient psychiatric hospitalization. Thankfully, this person is now doing much better. – This same year, on my birthday, my partner disappeared for 24 hours, which led to a police search. Thankfully, my partner returned safe and sound. – Three days before the USMLE Step 2 CK examination, my aunt died. I attended her funeral immediately after I completed the exam. Despite all these hurdles and losses, I chose to fight. To me, there was no other option but to just keep going. To keep pushing through these adversities and continue to do my absolute best to reach my ultimate goal of becoming a surgeon. Growing up, I watched my mother working day in and day out to provide for us. As a single mother, she sacrificed years of her life, vacations and other luxuries in life to work so that we would always have food on the table, and so that I could receive the best possible education. I believe that I gained my perseverance and resilience from observing her, and have translated it into my own work ethic. One of the main lessons learned from these experiences is that life goes on, and that there is always a solution. Eventually the dust settles, and it becomes easier to deal with these issues. It takes time, and there are definitely some days that are incredibly harder than others, but with patience, I have learned that it gets better. Despite all of these events, I managed to graduate from medical school on time, have passed all of my exams on the first try, and I have managed to start surgical residency in Brooklyn. I am thankful for everything that I have been through, because it has given me the resilience that I need to be a successful surgical resident. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/Capture.png)**Elysa Margiotta, MD was born and raised in Montreal, Canada. She attended Concordia University for her undergraduate studies, obtaining a Bachelor of Science in Psychology with a Specialization in Neuroscience. She went on to complete medical school at St. George’s University in Grenada. She is currently a first-year surgical resident at Maimonides Medical Center in Brooklyn, New York. In her free time, she enjoys taking dance classes, sleeping, completing jigsaw puzzles, and crossword puzzles.** --- ***Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.*** **Categories:** awareness, self-care, training **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [FOLLOWING IN MY MOTHER’S FOOTSTEPS: AN INTERVIEW WITH DR. TONCRED STYBLO, Part 2](https://blog.womensurgeons.org/following-my-mothers-footsteps-2/) **Published:** October 24, 2020 **Author:** Blog Team **Content:** *By Justine Broecker, MD* **An Interview with Dr. Toncred Styblo, a surgical oncologist within the Department of Surgery at Emory University for over 30 years, with her daughter, Dr. Justine Broecker, a PGY-4 general surgery resident at Mayo Clinic Florida.** **Part 2 of the interview continues below:** **What was your hiring process like at Emory? How did you negotiate, how many women were in the department when you started, and how has your career progressed over the past 30 years?** There was one woman in the general surgery department who left and was no longer in the department when I was hired. Dr. Lawrence had given me some guidelines about how much lab space (sq feet) and how many financial resources to request to start lab work. I would say that my negotiations were fairly simple and I did not demand a lot of resources when I started. In hindsight, I did not have an office for two years. I had a desk in one of my male partners offices. If I had thought I needed to negotiate for that I would have negotiated. I think when you are starting out in a practice, and you’re also trying to establish yourself in a laboratory, you need to understand what are the resources and who your mentors are who can help you initiate your research. In short, you will need to get significant funding and without mentorship it’s not likely for that to be successful. One of the biggest regrets I have of my professional career was I was not able to get funding to do my laboratory research, and part of it was because there weren’t many people doing basic science cancer research when I started and I was expected to build a productive clinical practice given the way my salary was arranged. I was naïve about what establishing a practice and a laboratory would require and making sure I had all the working blocks I needed before I accepted the position. The one complexity of interviewing for a job is that at the time I was engaged to a pediatric urologist (who has been my husband for 32 years) who was also looking for a job in the same city. We had interviewed for 6 months across the county. Trying to find two professional jobs that are challenging and tailored for both of us is exponentially more difficult not twice as hard. If there was a position for me there wasn’t for him and vice versa. We interviewed separately at Emory because people didn’t really interview or hire together at the time. As the only female on the faculty for the department of surgery when I started, they hadn’t really anticipated what my needs were including my fiancé who was a urologist who also was seeking a job. I was initially hired to do a variety of surgical oncology cases(?). I did all of the thyroids, adrenals and breast at Grady Memorial Hospital downtown for about two years. I did some general surgical oncology at Emory but certainly the majority was at Grady. I had the opportunity at Emory to collaborate with Dr. John Bostwick, a world famous plastic surgeon who had developed many reconstruction techniques, and it was a privilege to be able to develop a practice and we pioneered skin sparing and nipple sparing mastectomy during my first decade at Emory. My basic science interest and the focus of my laboratory work was signal transduction and autocrine factors in cancer progression. I developed a breast cancer in vivo and in vitro model with draining lymphocytes which is part of the reason (in addition to fact I was female) why I think my practice became breast specific compared to HPB/colorectal/endocrine. **How did you balance having a family, being a surgeon, and having a lab?** It was extremely challenging, I won’t say that it wasn’t. I don’t know where to start. I was writing DOD grants when I was on maternity leave for 6 weeks. Trying to sort out child care when you have two parents who are full time academic surgeons was a challenge and extremely stressful initially trying to find someone who was reliable and dependable and acceptable for both of us. And, eventually, once the kids got older they started school it was more manageable. But trying to get the operating room and getting kids to school in the morning was a challenge. It almost takes a personal secretary to figure out two surgeons’ call schedules to make sure they didn’t overlap and make sure that someone could be there every night and not called to the hospital. **How did you manage maternity leave and breastfeeding as a surgeon?** When I got pregnant there was no maternity leave. I was taking call at Emory University Hospital. The call schedule came out a year at a time and you covered both surgical oncology and general surgery. I had a due date in early August. The call schedule came out in January and I was supposed to be on call over labor day which was supposed to be during my maternity leave. When I got into my 2nd trimester and realized that I needed to give them notice that I wasn’t going to be able to take call, I was essentially told this was the way it was done, this is the way it was always done, and I was going to need to get coverage (which I couldn’t find). Eventually, the active chair of the department who was the one who could not accommodate my maternity leave and my call schedule was replaced with a chairman who could. Regarding breastfeeding, fortunately I lived close enough to the hospital, I came home most days when I was in clinic, and I could arrange my outpatient surgery schedule so that I would come home between 12-1. If I couldn’t, I had to pump. Some nights when I was on call it would be uncomfortable but I would pump. There were no lactation rooms; I pumped in my office. **What do you think the challenges are for women in surgery and how do you suggest that we address them?** That’s a pretty large question. First and foremost, you want to become a well-trained surgeon who at the end of their residency is capable of taking care of patients to the best possible ability that you are capable of. Which means during surgery residency, it certainly was my priority to become the best surgeon I could and everything else was secondary. That’s part of the reason why I didn’t get married during residency so that I didn’t have to feel that there was a conflict between my family(?) and residency. For instance, I saw a lot of co-residents getting divorced by the end of their residency because of the stresses of trying to work that many hours and to keep a marriage and a family going (which can be a huge challenge). So, you have to be realistic and I don’t think it’s just if you’re female, it’s that the person you share your life with understands that he/she will not be your first priority during residency. Education, patients and becoming a surgeon takes priority because you certainly wouldn’t want to finish residency and have a patient depending on you and not being well trained enough to do the best for that patient. So I don’t think that’s a unique female consideration. I still think that there is not necessarily hidden or overt discrimination, but I worry that female residents do not get the same operative opportunities as male residents. I think that if female residents knew they were falling behind they might have a more aggressive attitude, but right now we don’t have a good way of measuring surgical milestones to measure disparities. Hopefully residency is long enough and there is enough clinical material that those disparities no longer exist by the end of residency, but I think that’s something as faculty within surgery department we need to be aware of and I tell my female residents that they should be talking with their co-residents about what cases, how many cases and what part of the cases they are doing so they know that it is equitable. I think the same thing is true of committee, teaching and research opportunities as you progress from residency to faculty. We need to make things as equitable as possible and be aware of what is actually going on. **How has the culture of surgery changed during your career? How should it continue to evolve?** There are certainly more female surgery residents in training. There are certainly more women faculty now so that female residents have more mentors which I think is important. I have never had a female mentor in my career. It’s not necessary but I think it would have been very helpful to get guidance about being a mother, surgeon, wife and an educator. There are a lot of hats you have to wear, and trying to navigate those positions can be extremely challenging. Sometimes it’s nice to hear someone’s perspective. There are still few women in leadership positions. There are female chairs but it is still a male dominated leadership in surgery. Having women in leadership is extremely important. A mentor is one of the most important things in a mentee’s life to inspire them to choose an area of education and profession. Although they can get it from male mentor, seeing women succeed and having women encourage them to succeed is important as well. **What is your advice to female medical students and surgery residents?** That’s a big question. You are going to get out of it what you put into it. You have to be aware of what your male colleagues are doing and what you need to do to succeed.I think the most important thing is to be objective and not take things personally. It’s easy when you are criticized to take it personally, but it’s important that you adopt an attitude that it’s going to be constructive and that you can move forward. If you think you are not getting the same opportunities as your male colleagues, you need to be able to discuss that in a constructive way. And, if you don’t get a constructive response, you need leadership that can guide you and improve that situation. You need to identify mentors. The role of mentors changes as you progress through your professional career but is equally important. That’s why it’s important to have female faculty in different positions and practices so that you can witness different leadership styles and observe what makes them successful. The saying “a truly great teacher considers the best success when their pupils excel beyond them” is incredibly important and those are the kind of mentors you are looking for. Someone you can stand on his/her shoulders so that you can do not only as well as them but excel and exceed what they are able to accomplish. **What is your advice to students and residents that want a family? Or that have co-physician households?** There is no reason you can’t do it, I did it. You have to have a mate who respects you professionally to be able to do that. You can’t always be the one that’s expected to forego your professional responsibilities to be there for child care. It has to be a partnership. You have to acknowledge it’s not always going to be perfect, it will be frustrating and challenging at times, but you can do it. It’s like Lily Tomlin says, “they say you can have everything, but the part they didn’t tell you, is that you have to do everything too”. And, there are only so many hours in the day. So you need a partner who is willing to work with you and help make all those things happen. **What are you most proud of in your career?** I think all of the patients that I have met and taken care of and have had the privilege of operating on. Also, the collaborations with so many of the people I work with on a daily basis. I feel like I have two families: I have my family at work and my family at home. And I have a great deal of love and affection for both of them **If you had to do it again would you be a surgeon?** Yeah I don’t regret for one minute what I do. I love what I do, I have no regrets. **Did you encourage your daughter to be a surgeon?** I took a lesson from my father. I always encouraged her that there is no reason she can’t do whatever it is she is really passionate about. If she loves it and it brings her joy, then at the end of the day, you spend a lot of hours at work, so you can’t choose something you don’t love to do.” When you find something to do with your life that you have a passion for, absolutely the most fortunate thing in the world is to be able to do that thing. So if you can choose it and you can do that thing, you should absolutely do it. **If you couldn’t be a surgeon what would you be and why?** I would probably be a middle school science teacher. I enjoy teaching and life sciences. I still remember my junior high school teacher. She was one of the reasons I loved science as much as I do. For girls, having a female science teacher is really important. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/photo.png) Justine Broecker, MD, is a PGY-4 general surgery resident at Mayo Clinic in Florida. She is from Atlanta, GA. You can follow her on twitter [@jasb805](https://twitter.com/jasb805). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life **Tags:** career development, family, inspiration, mentor, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Following in my Mother’s Footsteps: An Interview with Dr. Toncred Styblo](https://blog.womensurgeons.org/following-my-mothers-footsteps/) **Published:** October 16, 2020 **Author:** Blog Team **Content:** *By Justine Broecker, MD* **An Interview with Dr. Toncred Styblo, a surgical oncologist within the Department of Surgery at Emory University for over 30 years, with her daughter, Dr. Justine Broecker, a PGY-4 general surgery resident at Mayo Clinic Florida.** **Please introduce yourself.** My name is Toncred Styblo. I have a practice primarily for the treatment of breast disease and breast cancer. I completed my undergraduate and masters in Biology and Biochemistry at Stanford, my medical school and general surgery residency at St. Louis University , and my surgical oncology fellowship at Medical College of Virginia. I’ve been on the faculty at Emory since I finished my fellowship for over 30 years. **Where did you grow up?** I grew up in the Bay Area. I was the oldest of four children. My father was a private general surgeon, my mother was a high school English teacher. I’m the only child that went into medicine in my family. I grew up doing classical ballet through college including summer and Nutcracker performances (I was the sugar plum fairy). I also played the piano and the flute. **What do you remember about your father’s practice?** He was a solo private practitioner in general surgery. He worked long hours, and he was gone in the morning before I woke up and I usually didn’t see him until after dinner when he would come home and read/study for cases the next day. I got to know my father each year when we took a family vacation for a month; we took family car trips across the country seeing the national parks. He was my first mentor. I saw someone who was always challenged and learning about surgery and medicine. He would read and learn on a regular basis even though he was in private practice. He was always intrigued by new medical discoveries and information. That was an inspiration for me about how dynamic the field of medicine can be. **What did you enjoy about ballet and are those skills translatable to surgery**? I think ballet and surgery are similar in that they require physical stamina, the ability to learn choreography or procedures and perform them with a focus on efficiency and elegance of movement. And, always challenging yourself to improve are hallmarks of both a good dancer and an accomplished surgeon. **When did you decide to become a doctor and surgeon?** I always admired my father a great deal and he was the inspiration for me choosing medicine as a career. I was discouraged on more than one occasion by primarily men, male colleagues, and teachers from becoming a physician and then eventually becoming a surgeon because they said that it would be difficult to have a family and to have a personal life if I chose that as a profession. I tried other things—for a while I was a medieval history major—but, I did not have the passion for it that I did for science. I thought about doing other non-surgical subspecialties, but I felt that surgery was my passion, it was what I loved doing and I decided regardless of what personal sacrifices I would need to make to become a surgeon, I could never short-change myself by choosing a profession that I didn’t love in order to have an easier personal life. **When did you first think about doing surgery? What were your influences?** My 3rd year surgery rotation I enjoyed enormously. I still remember a patient I presented—we had to give an oral presentation to the chairman of surgery—I still remember the case and the name of the patient. I remember participating in a medical student surgery course which was the first time I had the opportunity to operate and it was very apparent to me at that point that it was something I absolutely loved. I would be forever sorry if I didn’t decide to become a surgeon because I really loved being able to see the anatomy, perform surgery, and be the person responsible for completing the operation. **What did your father think of your decision to go into surgery?** He never expected me or wished me into surgery. He was very realistic about the challenges in terms of personal challenges, the physical challenges, the family challenges. But at the same time, when I chose to do surgery he was enthusiastic about teaching me what he could and providing his insight and experience. I haven’t had many mentors in my professional career, but he was certainly the first. He taught me simple things such as how to tie knots, how to handle tissue and instruments. He taught me how to approach a case, about the fact that there are points in the operation where you can no longer abort, the point of no return, and what sort of aspects you want to evaluate during an operation before you get to that point, how to take care of patients postoperatively, how to speak to patients, what patients expect, all of those things. I never ever operated with him and that was one of my disappointments. At the time when I was in medical school and residency in Midwest—where he actually did medical school and residency as well—there weren’t any opportunities to operate with him. The medical legal system wasn’t flexible enough. **What was it like applying to surgery as a female medical student? How many women in your class applied to surgery?** Only about 20% of my class was female. There may have been one or two of us who went into surgery. I actually don’t remember any other women at the time, but I have come to learn that at least one went into surgery. I don’t remember interviewing. At the time I was finishing medical school, I initially had anticipated becoming a cardiac surgeon, so I had done a number of externships in cardiac surgery, but after that I had the self-realization that I didn’t want to do cardiac surgery, I wanted to do general surgery. I called the chairman of the department, Dr. Wilman, and told him I wanted to do general surgery and asked if I needed to interview for residency and he said that if I wanted a position it was mine. I interviewed at other programs which were pyramidal programs which I wasn’t interested in going to. SLU was not a pyramidal program which was why I chose to stay there. I didn’t want to feel like I was competing for a position with my classmates. I also remember that there were many programs that never finished a woman, and I made a point of not going there. SLU was a Jesuit program that had graduated many women because they had trained many of the nuns who became missionary surgeons in 3rd world countries. My first chief resident was a woman. They had a track record of graduating women. I was not the first by any means. **What was surgery residency like as a woman? Did you face sexism as a resident and if so how did you navigate that?** I was the only female resident in my class. We had roughly one female resident per class that I recall. I don’t remember having any female surgery faculty. I did have a chief resident when I was an intern who did a fellowship and came back to be on the faculty but not before I finished residency. In retrospect, I think there was a lot of sexual harassment and discrimination. For example, our chief resident dinner was always at an all-male club that didn’t even have a female restroom. I never commented or objected to it. I was aggressive during my residency to make sure that I had the operative experience I needed. It’s hard to judge what your co-residents are actually doing because you don’t actually know. We had a busy clinical residency so there were a great deal of opportunities to get surgical experience. I think because of the volume of practice being a female was not an issue, but I think if the program had less volume and more residents, I think it would have been an issue. I also had an exceptional experience because I became a chief resident as a 3rd year because my chief resident had surgery. I was proactive about taking on autonomy, I didn’t ask, I just did it. There was far less faculty supervision at that time. If you were capable of doing the procedure, it was much easier and more acceptable to do it without asking the faculty for help, and it was much more acceptable for them to let you do the majority of the procedure. **Why did you decide to do surgical oncology?** I wanted to do academics and I realized I needed to do specialty training. I liked general surgery, and I thought surgical oncology gave me the opportunity to do a breadth (GI, HPB, endocrine, head and neck) and I wanted the breadth and diversity of surgical oncology. **Who were your most important mentors in residency and fellowship?** During residency, my father was a mentor to me. The chief of surgery at the city hospital –Raymond Keltner—was a great mentor to me. He had trained as a MASH surgeon and also had done a vascular surgery fellowship and he was one of the most gifted surgeons I have ever known. He had enough personal skill he didn’t do the operation, he guided you and allowed you to learn how to do operations on your own as he was confident enough in his ability to address your shortcomings as a new surgeon to keep the patient safe. When I got to fellowship, Walter Lawrence who was the chair of surgical oncology, was one of my mentors because he was a wonderful teacher. As well as an administrator, he held many national titles within the national cancer community. I was the first female fellow they ever had in the program. I never felt that I was the first female fellow he made the point of being inclusive in every way. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/broecker.jpg) Justine Broecker, MD, is a PGY-4 general surgery resident at Mayo Clinic Florida. She is from Atlanta, GA, and graduated from Emory School of Medicine. She can be found on Twitter [@jasb805](https://twitter.com/jasb805). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** family life **Tags:** career development, family, inspiration, mentor, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Women Neurosurgeons Symposium- A Driver for Change](https://blog.womensurgeons.org/women-neurosurgeons-symposium/) **Published:** October 11, 2020 **Author:** mcooke@amrms.com **Content:** *By Simone Betchen, Jamie Ullman, and Martina Stippler* Women make up a small percentage (7%) of neurosurgeons in the United States according to the [2017 AAMC data](https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017). However, whenever I go to national conferences, if there are women speakers, it is limited to the same few people. Furthermore, women often find it more difficult to travel for a conference given family commitments and don’t have easy access to other means of networking with female surgeons or getting CME. This along with the inability to travel or hold conferences inspired us to start a quarterly virtual symposium entitled **Women Neurosurgeons Symposium.** This is a joint effort between Maimonides Medical Center, Northwell Health, and Women in Neurosurgery. The event will be free to students and residents and $10 for attendings. The event will feature all female speakers and while anyone is welcome to attend, the target audience is female neurosurgeons at any stage of their career or those aiming to join us in support of our endeavors. Our topics will range from talks on spine and brain, to personal branding and surgeons in social media, to resident research night. We are excited to announce the launch on **October 14, 2020 at 7pm.** This quarter our invited speakers are Odette Harris, Professor, Neurosurgery, Vice Chair, Diversity, and Director, Brain Injury at Stanford and Jenniefer Mieres ([@DrJMieres](https://twitter.com/DrJMieres)), Sr. Vice President, Center for Equity of Care, Chief Diversity and Inclusion Officer, Northwell Health, and Associate Dean for Faculty and Professor of Cardiology at Northwell. Dr. Harris will be speaking on the gender effects of polytrauma and Dr. Mieres on the importance of gender diversity and inclusion in healthcare. Question and answer period will follow the talks. We hope that this will be a lasting forum for female speakers to showcase their knowledge and skills for others to learn from in an environment that promotes listening and learning from one another and give all of us the opportunity to hear great speakers from those often missing on a national stage. To register for this fabulous event, please click [here](https://cmetracker.net/NORTHWELL/Publisher?page=pubOpen#/EventID/75721/). To access the program brochure, click [here](https://cmetracker.net/NORTHWELL/Files/Brochures/75721.pdf). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/flyer.png) ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/Betchen.png) Dr. Betchen is a board-certified neurosurgeon. She currently practices at Maimonides Medical Center in Brooklyn and is proud to have served the community there for a decade now. Dr. Betchen received her medical degree from Johns Hopkins Medical School. She did internship and neurosurgery residency at Mt. Sinai Hospital in New York City. After completing a neurosurgical oncology fellowship at Memorial Sloan-Kettering Cancer Center she made the big move south to Brooklyn where she now treats a wide variety of clinical problems in both the brain and spine including tumors, hydrocephalus, chiari malformation, herniated discs, and spinal stenosis. Her research interests are in clinical outcomes and quality of life with neurosurgical treatment. Outside of the hospital she is married with two children. --- ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/Ullman.png) Dr. Jamie S. Ullmann, MD, FACS Professor in the Department of Neurosurgery Donald and Barbara Zucker School of Medicine at Northwell/Hofstra Director of Neurotrauma, Northwell Institute of Neurology and Neurosurgery North Shore University Hospital --- ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/Untitled.png) Martina Stippler, MD, FAANS, FACS Director of Neurotrauma at Beth Israel Deaconess Medical Center Assistant Professor of Neurosurgery, Harvard Medical School Chair, Women in Neurosurgery (WINS) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development **Tags:** ILookLikeASurgeon, neurosurgery, womeninsurgery, WomenSurgeons --- ### [The Important E’s](https://blog.womensurgeons.org/important-es/) **Published:** October 9, 2020 **Author:** mcooke@amrms.com **Content:** *By Chantal Reyna MD, FACS* Lets face it, 2020 has not been kind. Pandemic. Race Riots. Unexpected Deaths. It has been a challenging year on many fronts. Hopefully it will lead to increased awareness of important issues, including but not limited to equity and equality. There has been an increasing cry for diversity, equity, and inclusion. A few months ago, I was awoken to the sound of flash bombs and riots. This was the first time I had witnessed a riot. Windows were smashed; flash bombs exploded; riot police standing in a line moving the protesters along. In the morning after, broken glass and boarded windows were prevalent. Not too long after, Justice Ruth Bader Ginsberg, a champion of equality, died. I spent the weekend after her death watching documentaries, reading biographies as well as reading some of the dissents she so eloquently wrote. Her loss to me (and I am sure to many others) was devastating. She worked for decades striving to lay the groundwork for fundamental change of equality. Equity in every aspect of life should be the end goal. As a result of 2020, I evaluated the role of equity in the workplace. In the beginning of the COVID pandemic, there was so much confusion. Equal access to information during that time may have helped prepare people for the pandemic. Amongst employers, sharing information may have unified the workforce rather than setting up walls between management and the workers. While physicians and staff were putting patient care above their own safety, information sharing from all forms of leadership (governmental, organizational, administrative) would have helped medical care professionals feel valued and included. Hospitals were receiving government funds, but staff were still seeing pay cuts, hours reductions, forced PTO, unpaid leave, and furloughs — many with very short notice and no clear explanation. Equal responsibility and inclusion would help alleviate concerns and create camaraderie. It’s easier to share in the pain if we have a clear understanding of the situation. Recently, I read an [article in the Washington Post](https://www.washingtonpost.com/outlook/2020/09/06/millennial-salary-taboo/), “There’s still a taboo on discussing salaries. But millennials are breaking it” . This brought my introspection to pay equity. The article discusses the Institute of Women’s Policy Research (IWPR) survey which stated about half of employees were forbidden or discouraged to talk about pay. A decade later, despite a few states passing legislation against this, a recent survey by the IWPR found the same results. The beacon of hope was found in the younger generation: Millennials. This group was willing to speak out. In this time, which strives to improve diversity equity and inclusion, breaking the salary taboo and increasing transparency among colleagues and friends is critical. Salary has already been considered a sensitive topic to discuss, but it is the best way to improve transparency. I encourage trainees, colleagues and friends to follow the lead of the young and start to openly discuss the uncomfortable topic of salary. As stated by President Barrack Obama, “Pay secrecy fosters discrimination, and we should not tolerate it.” As we close 2020, I hope that we use this year as a platform on which to continue forward progress. We have faced many challenges and learned many lessons. Let us use these to build a strong unified community and a brighter future where diversity, equity, and inclusion are the norm and not the abstract ideal. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/reyna.png) Dr. Chantal Reyna is an Associate Professor of Surgery in the Division of Surgical Oncology at University of Cincinnati. She is a fellowship trained, board certified surgeon, specializing in diseases of the breast. She received her medical degree from the University of Nevada School of Medicine, and completed general surgery residency at the University of Nevada School of Medicine, University Medical Center and Children’s Hospital of Nevada. Following her passion for breast cancer care, she pursued a fellowship in breast surgical oncology at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. She has been practicing at University of Texas M.D. Cancer Center until her pursuits lead to the University of Cincinnati. Her research interests include minimizing axillary surgery. She has received many honors including, the University of Nevada School of Medicine Surgery Student of the Year, Chairman’s Professional Conduct Award, the University of Nevada Heart of Gold Award and Alpha Omega Alpha. She is a member of the American College of Surgeons, the Society of Surgical Oncology, the American Society of Breast Surgeons and Association of Women Surgeons. She holds committee positions in several of the organizations. She is an avid soccer fan and enjoys reading and traveling internationally. You can find her on twitter [@kprgrl3](https://twitter.com/kprgrl3). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy **Tags:** #diversityandinclusion, covid19, equity, ILookLikeASurgeon, womeninsurgery, WomenSurgeons --- ### [The Theatre](https://blog.womensurgeons.org/the-theatre/) **Published:** October 1, 2020 **Author:** mcooke@amrms.com **Content:** *By Amira Hanis Amir* I was a second year medical student and had a few free weeks of my summer in 2019, so I decided to do a three-week elective in Ireland. The first day started with a four-hour clinic. Just before the clinic ended, the registrar asked if I wanted to join the team in theatre. Going into theatre was such an exciting thought but I knew little of what was waiting for me there. Forty-five minutes were spent as I was running around the hospital like a lunatic, trying to find the changing room. From opening every floor janitor’s room thinking that the scrubs had to be in there and to trying to decode a very securely locked room whilst being watched by three porters thinking it was the door to theatre. I finally found Theatre 7, half an hour late. I should have just given up on finding the theatre when I could but I had embarrassed myself so much in efforts to find that room that I persisted and joined the team anyway despite being late. Better late than never, right? So many things went through my head at once in the empty anaesthetic room; will I be okay? Will I have that postural hypotension that surgeons talk about? Will I faint when seeing the incision or blood? How long will this surgery take? Putting all daunting thoughts aside, I walked into the theatre past the anaesthetic room and ‘AMAZING COOL!’ was the only thing in my head. There was so much going on! I knew from talking to the registrar in clinic earlier that morning that the case was a PCI renal stone removal. There were at least 10 people in that room. I quickly introduced myself to the theatre nurse and blocked everyone out, refusing to make any sort of eye contact with anyone; the surgeons to be specific. Well, if I had actually paid attention, one of them was actually trying to eye signal me to put the lead suit on but since I refused to look at him, he had to call me out and then everyone, I mean everyone, noticed me. Embarrassed, I quickly dashed out for the lead suit. There were two things that I didn’t realise. First, the fact that there are sizes to lead suits, and secondly, I didn’t know how to put them on. THANK GOD, one of the porters who saw me trying to decode the locked room passed by and kindly helped me out. He even pointed out the best door to get into the theatre again without irritating the surgeons. I so needed that! Shout out to Barry! I made a grand entrance of myself once again when the theatre door ‘whoosh’ opened, unperturbed by my stealth attempt at walking in. The consultant (aka attending) quickly realised that there’s a lamb in the room and he went, “Ahh, a medical student.” Here’s how the rest of the conversation went. **Amira:** Dear Mother Earth, swallow me now!- quietly, of course **Consultant:** Give me four types of kidney stones. Two anaesthetists behind the curtains widened their eyes at me whilst giving me that hand-across-neck gesture signalling death. **Amira:** I am not sure, sir (I was a second year medical student, we had not started on Urology then) **Consultant:** Do you know what we are doing? **Amira:** Uhh, yes. You are removing stones from the kidney, sir. **Consultant:** Elaborate please. I was cold and clammy at this point. **Amira:** I don’t know sir. He then proceeded to briefly explain the procedure and continued, “What is the best book for Urology, Amira?” **Amira:** I am not sure. **Consultant:** The Oxford Clinical Medicine Handbook will do you good. You see those pockets on your scrubs? Fill them with the book, a notebook and a pen the next time you come in here so that you can actually learn something and not waste your time standing there. I turned tomato red. **Consultant:** What year are you in ? **Amira:** Second, sir He looked at me sort of apologetically and left me alone then. Ten minutes later, I quietly turned around, walked out and tried not to cry out of humiliation. To have at least 15 people watching me being grilled like that, that Monday was unquestionably the most embarrassing day of my life. However, it is undeniable that learning is best through experience. I decided to not be dispirited by my first day and to take up every piece of advice I got that Monday, (that was only after venting out everything to my mom over dinner) learn from my mistakes and do better in the coming days. I realised very soon that things actually got better and I learnt a lot of things more effectively by just promising myself after each day that I would do better the following day. The things I learnt quickly the first week into my placement include the fact that theatre nurses are God-sent angels if you make the effort to introduce yourself, be nice and humble! From making sure you’ve eaten prior to a case, to fixing your masks when you’ve gowned up, to teaching you something about the next surgical case; they are truly the best! I also gathered that being early gives you time to look up the cases for the day and read them up before entering the theatre. This saves you from being totally clueless of what is going on and will actually have an enjoyable and fruitful theatre experience. Lastly, I have learnt to always be an enthusiastic learner! Yes, 8/10 of the things that you are asked you probably don’t know at the top of your head but hey, you’re a student with a capital ‘S’! You are learning and you have every excuse to not know most of the things- am I right?? Chase not just the doctors for knowledge but find time to chat with the scrub nurse, the theatre technician and the porters and you will be amazed at how much they will be able to tell you. Everyone loves to share their experience and knowledge if you are simply humble and polite enough to give them your best smile, introduce yourself and ask! Dwelling on a bad experience will hinder you from effective learning. It is important to appreciate that learning is a curve and you don’t have to know everything in a day. Simply, keep your chin up and try better tomorrow. Believe me when I say that surgeons do notice your enthusiasm and perseverance. Like myself, after nearly a week full of grilling, the consultant cheerfully side-hugged me and said “You’re still here! You are so good. Now, tell me the risk factors for renal cell carcinoma.” It was a humiliating experience then but when I think about it now, it was truly the best experience I have ever had. One humiliating experience in theatre, I am now an aspiring surgeon! – **in sha allah (God Willing)** ![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/Screen-Shot-2020-09-30-at-10.07.47-PM.png)From left: The amazing theatre nurse Sepna who took care of me most, myself and Katherine who taught me how to scrub in for the first time.![](https://blog.womensurgeons.org/wp-content/uploads/2020/10/Screen-Shot-2020-09-30-at-10.07.59-PM.png)Amira Hanis Amir is a fourth-year medical student at the Royal College of Surgeons in Ireland. She grew up in Johor Bahru, Malaysia and attended INTO, St. George’s University of London where she completed her International Foundation in Medical, Biomedical and Health Sciences. Amira is enthusiastic about a future in surgery following her elective placement in The Mater Hospital in Ireland. She is the second eldest of five girls and has deep passion for fashion, cooking (hence, very skilled at meal prepping) and traveling. You can find her on Instagram at @amiraamir.17 --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** mentorship **Tags:** AWS, ILookLikeASurgeon, womeninmedicine, womeninsurgery --- ### [Being a Woman in AWS](https://blog.womensurgeons.org/being-a-woman-in-aws/) **Published:** September 24, 2020 **Author:** Blog Team **Content:** *By Cheryl Zogg* Since joining AWS in my first year of medical school, running my school’s local chapter as an M2, and spending the last three years as a member of the AWS National Medical Student Committee (first as Research Coordinator and currently Chair… doing an MD-PhD takes a few years), AWS has become an important part of how I define ‘my tribe.’ It is a much loved aspect of how I interact with the broader surgical community and, in general, an amazing organization of women many of whom I have the pleasure of calling my mentors and friends. Since AWS’s creation in 1981 (39 years next month!), it has continued to touch the lives of female surgeons in all stages of their careers. Yet, in AWS’s existence, there comes a divide that we seldom like to address… a lingering concern too often expressed by my non-AWS female peers that in joining an organization like AWS, they risk exposing themselves. They risk drawing attention to the fact that they are female surgeons when what they are looking for is to be seen as good surgeons regardless of gender by their predominantly male peers. I have lost track of how many times I have been sitting alongside a female medical student heading into a surgical residency match, a female resident learning the ropes of a competitive integrated field, or a successful female mentor who has achieved the rare honor of becoming a chief or a chair only to have them look at me and say, “It is great, the work that you do with AWS. I never felt that I could become a part of that organization myself.” It breaks my heart when I hear members of my own AWS National Medical Student Committee talking about how to prep for inevitable questions about their participation in AWS as they head into residency interviews next month knowing that they will be called out for the organization potentially being seen as sexist. We deal with the same issue when working with interested medical schools trying to establish new AWS chapters and justify to their administrations why a women in surgery group needs to exist. It’s frustrating and exhausting and an issue in no way unique to the experience of gender in medicine. By existing, AWS challenges norms. In 39 years, we have come a long way from a sign on a table at a breakfast at a meeting of the American College of Surgeons to a thriving organization with a real impact on the lives of female surgeons around the globe. In many ways, the challenges that we are seeing are a testament to that success—a recognition that the conversation has moved forward enough that deeper issues are coming to light. It is also a harrowing reminder of how far we still have to go and, at present, how many female surgeons AWS fails to reach. In a year dedicated to promoting diversity and inclusion through our[ national conference](https://www.womensurgeons.org/page/AnnualConference); introduction of a[ new trainee award](https://blog.womensurgeons.org/training/new-trainee-award-celebrating-diversity/) in conjunction with SBAS, LSS, SAAS, and AAS; and recent[ kick-off of celebrating Hispanic Heritage Month](https://blog.womensurgeons.org/advocacy/hispanic-heritage-month/) in a coordinated effort as an organization for the first time, I sincerely hope that we can take the opportunity to look within ourselves and begin to challenge what have become our own norms, finding ways to reach out to female surgeons from all walks of life and our male or otherwise non-gender conforming[ \#HeforShe](https://twitter.com/hashtag/heforshe?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Ehashtag) surgical peers to build a better future for all surgeons where everyone feels like she/he/they can belong. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/09/Picture1-2.png) Cheryl K. Zogg, MSPH, MHS, is an MD-PhD Candidate at Yale School of Medicine where she is currently in the process of completing her PhD in Chronic Disease Epidemiology (Quantitative Health Services Research). She is the 2020-2021 Chair of the AWS National Medical Student Committee and a Medical Student Member of the AWS Blog. Her clinical and research interests lie in the intersection of health policy and quality as it pertains to outcomes of surgical patients and differential access to care. She anticipates a career in academic surgery. Outside of work, Cheryl is an avid dancer, traveler, bookworm, and (aspiring) biker and runner who loves to mentor and teach. She can be found on Twitter as[ @CherylZogg](https://twitter.com/cherylzogg?lang=en). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy **Tags:** Diversity, Gender Disparities, Healthcare Disparities, inclusion, leadership, Medical Student Members, medical students, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Zooming Along the Road to Residency: A Tweetchat on Virtual Interviews ](https://blog.womensurgeons.org/virtual-interviews/) **Published:** September 20, 2020 **Author:** mcooke@amrms.com **Content:** By Tishina Tittley and Shan Lansing With residency interviews being held virtually this year due to the COVID-19 pandemic, there have been many speculations among medical professionals at all levels of training about the 2020 residency interview season. As flights and hotel costs will no longer be a factor, virtual interviews will lift a huge financial burden off of applicants, many of whom will already be graduating with 6-figures of student loans. According to [a recent review](https://www-sciencedirect-com.proxy.lib.ohio-state.edu/science/article/pii/S1931720420301537?casa_token=xfGX2xga6YoAAAAA:wJmvuPxxDV4Py489Yh6qRtQM_KHWryg86WUqecwn8dxo5OXp4jDuMb2VyINKaQZTxYW4rKFaiQ) by Dr. Jennifer Tseng, on average, 2020 surgical fellowship applicants saved approximately $6,000 due to virtual interviews. Many students applying to residency travel further and interview at more programs compared to a fellowship applicant, meaning that the cost reduction for medical student applicants will likely be even greater. The financial savings seem to come at minimal cost to the interview itself. In the case of [Complex General Surgical Oncology fellowship interviews](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233675/), over 80% of applicants felt they were able to convey themselves ‘very well’ or ‘well’ during the Zoom video conference interview. While there are undeniable advantages to virtual interviews, many students remain concerned on what this will mean for the residency cycle as a whole. It is unclear if increased applications to each program will overwhelm the selection process. Now that cost and travel will not limit applicants in the number of interviews that they can accept, it is feasible that a portion of applicants could take a majority of the interview invites sent. Meaning that the middle tier applicants that traditionally have a good chance of matching, are likely being encouraged to apply to more programs to increase their interview odds. Additionally, many are concerned with the logistics of virtual interviews, and if backgrounds and poor internet connectivity will reflect poorly on the applicant. This, among other characteristics of virtual interviewing, may have [deleterious effects on underrepresented in medicine applicants](https://www-sciencedirect-com.proxy.lib.ohio-state.edu/science/article/pii/S0027968420301516?casa_token=c2BUeOXitF4AAAAA:xhDjo7Oahq7o4WxhvyAtQ6ID76C7pShOv2MzqmY6C--VRWH7KVI7Dd4B9rnHllNxV67lbJrDNw). Finally, many medical students have voiced concerns that they will be unable to ascertain whether they are a good “fit” for each program without the in-person socials and hospital tours. After all, [89% of applicants](https://www.jgme.org/doi/abs/10.4300/JGME-D-20-00503.1) said the most important factor influencing US medical student applicants’ ranking of residency programs is overall goodness of fit. Now, in addition to determining if they fit into a program’s culture without visiting in person, medical students will need to virtually showcase their personality so that programs can see if the student fits in well. Fortunately for students, [Dr. Sophia McKinley and colleagues](https://journals.lww.com/annalsofsurgery/fulltext/2020/09000/successful_virtual_interviews__perspectives_from.39.aspx?casa_token=EivSFg_MG_IAAAAA:RSLYas83YJPxoJyfxZdEQPN4YlzTbIAhcCx_4D_y_eN009v9qUqzJH_mL8i_0-AcmYEtjhezoz5zgQ0Xg7rmPi0) have published on their experience with virtual fellowship interviews to share lessons learned. While there is a plethora of advice being given out to students applying to residency this year, published and unpublished, many feelings of uncertainty still remain. In response, the Association of Women Surgeons National Medical Student Committee has organized a Tweetchat to answer our medical students’ most pressing questions. Tune in on September 21st at 8pm EST to hear from our expert moderators on virtual residency interviews. We will be guided by Drs. David Spain, Shaneeta Johnson, Thomas Varghese, and Sophia McKinley to discuss what changes can be expected to the interview format this year, and advice on how interviewees can put their best foot forward virtually. To participate, follow [@womensurgeons](https://twitter.com/WomenSurgeons) and moderators, then tag your tweets with the hashtag #AWSChat. The questions will be posted directly from the [@WomenSurgeons](https://twitter.com/WomenSurgeons) twitter account and you can also find them following the hashtag [\#AWSchat](https://twitter.com/search?q=%23AWSChat&src=typd). If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. Be sure to keep an eye out for Tweets from members of the AWS Medical Student Committee and Twitter Subcommittee who helped to organize this TweetChat: Cheryl Zogg ([@CherylZogg](https://twitter.com/CherylZogg)), Shan Lansing ([@ShanSLansing](https://twitter.com/ShanSLansing)), Abra Shen ([@AbraShen](https://twitter.com/AbraShen)), Tishina Tittley ([@TishinaTittley](https://twitter.com/TishinaTittley)), Lena Trager (@[LenaETrager](https://twitter.com/LenaETrager)), and Niti Shahi ([@niti12](https://twitter.com/niti12)). TweetChat Moderators: - Dr. Shaneeta Johnson ([@SMJohnsonMD](https://twitter.com/SMJohnsonMD)) – Associate Professor of Surgery, Director of the Minimally Invasive and Bariatric Surgery Program, and Residency Program Director at Morehouse School of Medicine. - Dr. Sophia McKinley ([@SophiaKMcKinley](https://twitter.com/SophiaKMcKinley)) –General Surgery Chief Resident at Massachusetts General Hospital. She recently completed a virtual fellowship interview cycle in complex general surgical oncology and will begin her fellowship at Memorial Sloan-Kettering Cancer Center in August 2021. - Dr. David Spain ([@DavidASpain](https://twitter.com/DavidASpain)) – Professor and Chief of Acute Care Surgery, and Residency Program Director at Stanford University Medical Center. - Dr. Thomas K. Varghese Jr. ([@TomVargheseJr](https://twitter.com/TomVargheseJr)) – Interim Executive Medical Director and Chief Value Officer at the Huntsman Cancer Institute, Head of the Section of General Thoracic Surgery, Program Director of the Cardiothoracic Surgery Fellowship at the University of Utah. - Abra Shen [(@AbraShen](https://twitter.com/AbraShen)) – MS4 at Harvard Medical School and Chief of Chapter Development of the AWS National Medical Student Committee. Co-author of “Preparing for Plastic Surgery Residency Interviews in a Virtual Era” (Plastic and Reconstructive Surgery Global Open, in press). - Tishina Tittley ([@TishinaTittley](https://twitter.com/TishinaTittley)) – MS4 at Howard University College of Medicine, and Social Media & Marketing Coordinator of the AWS National Medical Student Committee. We will be discussing the following questions during the TweetChat: 1. What is the expected format of virtual interviews? (i.e. number of interviews, duration of interviews, breakout sessions with residents, etc.) 2. What questions should students ask to gain more insight into the culture of a program? 3. What are some essentials students should have on the interview day? (i.e. a glass of water, headphones, etc.) 4. How should students handle technical difficulties during interviews, such as losing internet connection, or audio problems? If their interviews were affected by technical difficulties, how should students respond? 5. How will other parts of the ERAS application be weighed differently this year given the virtual format? ![](https://blog.womensurgeons.org/wp-content/uploads/2020/09/tishina.png) Tishina Tittley is a fourth-year medical student at Howard University College of Medicine (HUCM). She grew up in the suburbs of Washington, DC and attended Columbia University where she majored in Biological Sciences. After graduation, she worked as a clinical research coordinator in the Department of RR&D at the James J. Peters Veterans Affairs Hospital. During medical school, she has served as Co-Vice President of the AMWA Chapter of HUCM and as Vice President of Wellness for her class. When she first decided to pursue a career in medicine, she never thought that surgery would appeal to her. However, that mindset changed when she began her first clerkship on surgery and spent many days in all-female ORs. Her primary research interests include surgical technology and innovation, surgical outcomes and health disparities. Ultimately, Tishina hopes to pursue a career in surgical oncology or trauma. In her free time, she enjoys reading novels, improving her culinary skills, and running outdoors. She can be found on Twitter [@TishinaTittley](https://twitter.com/TishinaTittley). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/09/shan.png) Shan Lansing is a fourth-year medical student at The Ohio State University College of Medicine. Originally from southern Oregon, she attended Oregon State University where she earned a dual Bachelors in Chemistry and Biohealth Sciences. She continued at Oregon State University for a Masters in Analytical Chemistry. Her current research interests include increasing surgical patient communication during the transition from inpatient care to outpatient followup to improve quality outcomes. Ultimately, Shan seeks to pursue a career in rural general surgery, aiming to provide compressive surgical care for an underserved community. Shan has served on the AWS Instagram Subcommittee since 2018 and most recently was the Social Media and Marketing Coordinator for the 2019-2020 AWS National Medical Student Committee. In her free time she enjoys cooking, and cross-stitching, and trying to keep up with AWS Tweetchats. She can be found on Twitter [@ShanSLansing](https://twitter.com/ShanSLansing). --- Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** AWSchat **Tags:** #AWSTweetChat, AWSChat, ILookLikeASurgeon, residency, surgical residency, virtual interviews, womeninsurgery --- ### [AWS Celebrates Hispanic Heritage Month](https://blog.womensurgeons.org/hispanic-heritage-month/) **Published:** September 16, 2020 **Author:** Blog Team **Content:** *By Minerva A. Romero Arenas, MD, MPH* The past 6 months have felt like both a whirlwind and slow-motion. I have been looking for every bit of good news and reasons to celebrate to help keep my mood up during this ridiculously difficult year. So it is partly with that in mind that I am going “all-out” for National Hispanic Heritage Month (HHM). We celebrate the history, culture, and contributions of Americans who immigrated or whose descendants originated from Spain, Mexico, the Caribbean and Central and South America. Each year, HHM is observed from September 15 to October 15. This period was chosen due to the significance of many Independence Day celebrations in those countries occurring in mid-September and *Día de la Raza* (Day of Heritage) being celebrated on October 12th. Although I recognize we have a long way to go in terms of tackling diversity, inclusion, and equity in surgery, I can think of many people and achievements to celebrate when I think about HHM. We have three female and five male Hispanic/Latino Chairs of Surgery in General Surgery Departments across the US, at least one Chair of Neurosurgery, and two in Orthopedic Surgery. We have raised awareness about the urgent need to address the[ lack of diversity in surgery](https://www.sciencedirect.com/science/article/abs/pii/S0022480420302286) and the alarming rate of attrition amongst[ Hispanic surgery residents.](https://jamanetwork.com/journals/jamasurgery/article-abstract/2763024) I have seen the growth of the[ Latino Surgical Society](http://latinosurgicalsociety.org/) (LSS), an organization I helped establish with close friends, to tackle issues affecting Latino patients, communities, and trainees/surgeons. I am thankful to other Societies partnered with LSS to provide guidance, support, and solidarity to tackle the above. One collaboration I am particularly proud of is the establishment of a Liaison position that links the AWS and LSS. Similar Liaison positions are held by members of organizations like SBAS, SAAS, and AAS. This year, I had the opportunity to serve in that role to develop joint programming and efforts aimed at increasing diversity. Some of the notable programming we have collaborated on include the Underrepresented in Medicine (URM) Medical Student Mentorship Program, the Diversity Equity and Inclusion Conference Award, and this month’s feature of notable Hispanic/Latino Surgeons and trainees. As my term in this role comes to an end, I am optimistic about the future of the collaborations we have built with AWS and the other Societies. There is Strength in Diversity and highlighting our colleagues is just one way to celebrate each other and build stronger bonds. Follow our social media posts during Hispanic Heritage Month to learn more about Hispanic/Latino Surgeons and trainees. We will be using the hashtags #HHM #LatinxSurgeons and #AWSLSSCelebrateHHM. You can also follow [LSS](http://instagram.com/latinosurgery) on all social media platforms [@LatinoSurgery](http://twitter.com/latinosurgery). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/09/Picture1-1.png) Dr. Minerva A. Romero Arenas is an Endocrine & General Surgeon. Dr. Romero Arenas completed a fellowship in Surgical Endocrinology at the University of Texas MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She earned her Medical Doctorate and Master of Public Health degrees from The University of Arizona College of Medicine and the Zuckerman College of Public Health. She studied Cell Biology and French at Arizona State University as an undergraduate. Her interests include benign and oncologic endocrine neoplasms, hereditary syndromes, health disparities, quality improvement, global health, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations, such as the Association of Women Surgeons, [Tour for Diversity in Medicine](http://tour4diversity.org/), [Latino Medical Student Association](http://national.lmsa.net/), National Hispanic Medical Association, and Building the Next Generation of Academic Physicians. She is a Founding Member of the [Latino Surgical Society](http://latinosurgicalsociety.org/). She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones. You can find her on [twitter](http://twitter.com/minervies) or [instagram](http://instagram.com/minervies). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy **Tags:** #diversityandinclusion, #Latinosurgicalsociety, #LatinxinMedicine, Diversity, equity, Hispanic Healthcare, Hispanic Heritage Month, inclusion, mentorship, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Black Patients: Enduring Disparities but Ever Resilient](https://blog.womensurgeons.org/enduring-disparities-but-resilient/) **Published:** September 10, 2020 **Author:** Blog Team **Content:** *By Estell Williams, MD and Rachel Issaka, MD, MAS* “When I stand before God at the end of my life, I would hope that I would not have a single bit of ability left and could say, ‘I used everything You gave me’.” – Chadwick Boseman 2020 has been a traumatic year for Black Americans. The COVID-19 pandemic shined a bright light on systemic racism and non-Black Americans are realizing how police violence, redlining, unemployment, environmental injustice, poverty, and more, disproportionately impacts Black communities and contributes to health inequities. Thus, the loss of Chadwick Boseman, the Black Panther, cuts even deeper into an existing wound without signs of rescue or healing on the horizon. Chadwick died at the age of 43 from colorectal cancer after being diagnosed with advanced stage disease at 39. He was a husband, a son, a descendant of slaves, a graduate of a Historically Black College and University, and a beacon to young Black people. He was a superhero on and off the screen and urged us all to press on unapologetically in pride and purpose. Colorectal cancer is the [second leading cause](https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21590) of cancer deaths in the United States. While the overall incidence and mortality from colorectal cancer has decreased by over 30% since 1985, only 67% of eligible Americans are up-to-date with screening and new cases among those under the age of 50 are rising. Between 2008 and 2017, colorectal cancer cases increased by 2% each year for [those under 50](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf). While the absolute numbers are still much lower compared to those over 50, the trend is concerning. Patients under age 55 are also 58% more likely to be diagnosed with late-stage colorectal cancer, which carries a 5-year [survival of 14%](https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21590). The burden of colorectal cancer is not evenly distributed. Black people are 20% more likely to be diagnosed with colorectal cancer, [40% more likely](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf) to die once diagnosed, and more likely to present with [advanced stage disease](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf) compared to non-Hispanic Whites. When diagnosed, Black Americans are less likely to receive [newer chemotherapeutic agents](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665008/) or [receive care](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734396/) in a high-volume facility, where outcomes are best. In every age category, colorectal cancer mortality is highest among Black people, particularly Black men. For those who are under 50, later stage disease and associated mortality is postulated to be due to delays in evaluation of signs and symptoms concerning for colorectal cancer. These include changes in bowel habits or stool caliber, rectal bleeding, abdominal pain, unintentional weight loss or unexplained fatigue. Because these symptoms are not specific to colorectal cancer, patients may delay seeking evaluation and providers without a high-index of suspicion may not immediately refer these patients for endoscopic evaluation. While the United States Preventive Services Task Force (USPSTF) and most gastroenterology societies recommend screening begin for average-risk individuals at age 50, since 2008, the American College of Gastroenterology has recommended that Black people begin screening at 45. In 2018, based on the trends of rising colorectal cancer incidence in those under 50, the American Cancer Society provided a conditional recommendation that all average-risk screenings begin at age 45. For those with an increased risk of colorectal cancer, either due to family history of colorectal cancer, a known inherited genetic syndrome, or inflammatory bowel diseases (Ulcerative Colitis and Crohn’s disease), screening should begin earlier. Therefore, it is critical to have regular conversations about family medical histories, colorectal cancer risk, and the appropriate age to begin screening with patients. Anyone, regardless of age, with signs and symptoms of colorectal cancer should be referred for endoscopic evaluation. The 2010 Affordable Care Act (ACA), mandated that insurers (including Medicaid in expansion states), cover preventative services including colorectal cancer screening. In an analysis comparing pre- and post-ACA colorectal cancer screening, although the ACA led to increased screening for all, disparities by race and ethnicity persisted with the [screening gap](https://pubmed.ncbi.nlm.nih.gov/31525514/) between Black and non-Hispanic Whites actually increasing over time. The National Institutes of Health considers health care disparities one of the most important issues facing the U.S. health system. Therefore, physicians and surgeons must seize every opportunity to address racial health disparities, including addressing the underlying factors that ultimately lead to poor health outcomes. Pertaining specifically to colorectal cancer, here is how you can engage: - Speak with your patients about their family medical history. Black Americans with a family history of colorectal cancer have the lowest likelihood of participation in screening. - Stress to your patients the importance of family medical history knowledge. Black Americans are [less likely](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783613/) than non-Hispanic Whites to know their complete family history of cancer and are also more likely to have inaccurate knowledge of their family history of cancer. Screened family members are less likely to tell their relatives about the finding of colon polyps. This information gap has the potential to incorrectly risk-stratify patients and cause delays in screening initiation and challenges with insurance coverage of colonoscopies. - Educate your patients on the various options for colorectal cancer screening tests. Colorectal cancer screening rates for Black people lag behind non-Hispanic Whites. Mailed stool-based tests, tailored patient education combined with patient navigation services, and enhanced physician-patient communication, can modestly improve adherence to colorectal cancer screening. - Set your patients up for success. Develop a low threshold for gastroenterology referral for evaluation of concerning signs or symptoms. Surgeons should consider if elective operations (unrelated to CRC) can be delayed until patients have completed an initial colorectal cancer screening test. This change in practice can help reinforce the importance of prevention and support primary care and gastroenterology colleagues. General and subspecialty surgeons have unique patient relationships and educating patients on the importance of screening and symptom evaluation, will empower them to take ownership of their health and well-being. While we cannot bring our brother Chadwick back and we do not know the circumstances leading up to his diagnosis, his loss is a rallying cry to amplify our voices to achieve health equity for Black Americans, including improving colorectal cancer outcomes. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/09/Picture2.png) Estell J. Williams, MD, is Assistant Professor of Surgery in the Division of Emergency General Surgery at University of Washington School of Medicine. Dr. Williams grew up in Oakland, CA and studied biology and chemistry double major at Xavier University of Louisiana before being displaced by Hurricane Katrina and completing her undergraduate degree in biology from the University of San Francisco. She earned her Medical Doctorate from the University of Washington, where she also trained in general surgery and was recruited to join the faculty after graduation. She also is the Executive Director of the Doctor For A Day (DFAD) Outreach Program through the University of Washington, School of Medicine. Outside of work, Dr. Williams enjoys spending time with her husband, a critical race theorist who also works at the University of Washington, running a social justice library with her husband named after their 3 year old daughter and raising her young daughter and 15 year-old niece. You can find Dr. Williams on Twitter/Instagram at [@drwooda](https://twitter.com/drwooda). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/09/Picture1.png) Dr. Rachel Issaka is a Gastroenterologist and Assistant Professor at the Fred Hutchinson Cancer Research Center and the University of Washington with expertise in colorectal cancer prevention, quality improvement, and health equity. Dr. Issaka has contributed to national gastroenterology guidelines as a member of the National Comprehensive Cancer Network (NCCN) colorectal cancer guideline committee, and guidance documents on colorectal cancer screening for the National Colorectal Cancer Roundtable (NCCRT) and the Centers for Disease Control (CDC) workgroup on mailed fecal immunochemical test (FIT) outreach. Dr. Issaka’s research focuses on decreasing colorectal cancer mortality through increased screening in medically underserved populations. Her work has been funded by the National Institutes of Health and the Centers for Medicare and Medicaid Services. Dr. Issaka completed her gastroenterology fellowship at the University of California, San Francisco where she also earned a Masters in Advanced Studies in Clinical Research. She completed her internal medicine residency at Northwestern University Feinberg School of Medicine, where she served as chief resident and obtained her medical degree from the University of Michigan Medical School. You can find Dr. Issaka on Twitter/Instagram at [@IssakaMD](https://twitter.com/IssakaMD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy **Tags:** Diversity, Healthcare Disparities, patients, resilience, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Women are not Smaller Men: The Importance of Inclusivity in the Surgical Field](https://blog.womensurgeons.org/inclusivity-surgical-field/) **Published:** September 7, 2020 **Author:** mcooke@amrms.com **Content:** *By Monique Hassan* On August 31st, the [Association of Women Surgeons](https://www.womensurgeons.org/) co-hosted a tweetchat with [@SAGES\_Updates](https://twitter.com/SAGES_Updates) to discuss inclusiveness in the operating room and in the surgical field. The tweetchat was moderated by myself, Dr. Rebecca Snyder ([@RSnyder\_MD](https://twitter.com/RSnyder_MD)), Assistant Professor, Division of Surgical Oncology, Department of Surgery at East Carolina University, Dr. Kellie McFarlin ([@McFarlinKellie](https://twitter.com/McFarlinKellie)), Assistant Professor of Surgery and Senior Staff Surgeon, Wayne State University School of Medicine, and Dr. Jenny M. Shao ([@JennyShaoMD](https://twitter.com/jennyshaomd)), Graduating Advanced GI MIS Fellow, Carolinas Medical Center, incoming Assistant Professor of Clinical Surgery, MIS, University of Pennsylvania. This is an issue that might often frustrate women in surgery but is rarely discussed. Therefore, having the opportunity to offer my unique perspective about this important topic pertaining to women surgeons was a great experience. Surgical disciplines are disproportionately male despite increasing numbers of female medical students. Even though women now comprise more than half of medical school enrollees and 35.2% of all active physicians, they are often scarce in the surgical field. According to [2017 data from the AAMC](https://www.aamc.org/data-reports/workforce/interactive-data/2018-physician-specialty-report-data-highlights), women make up less than one-quarter of 10 surgical specialties and are the least represented in orthopedic surgery, at 5.3%. The inclusion of women in surgery should not be understated. Women surgeons are just as skilled as their male counterparts. A recent [study](https://pubmed.ncbi.nlm.nih.gov/29018008/) revealed that the more women in the operating room, the better it is, not only for patients but for physicians as well. Patients treated by female surgeons were found to have a statistically significant decrease in 30-day mortality when compared with those treated by male surgeons. Female physicians are more likely to follow medical guidelines, collaborate with colleagues, communicate better with their patients, and adopt a patient-centered approach to care which led to improved patient outcomes. Gender inequity in the surgical profession, including disparities in compensation and promotion, is alarming. Hospitals need to focus not only on increasing the number but specifically, retention of female surgeons. Several ways retention within an organization could be improved: - Pay Transparency: open conversations about pay allows for better collaborations and decreases discrimination - Mentorship: providing allyship and mentorship to ensure that women become leaders - Healthy Work Culture: creating a culture so women are not made to feel guilty wanting a healthy work-life balance While changing the culture of the surgery may not be easy, it is essential to retaining excellent surgeons, male or female. As a minimally invasive surgeon, there are several ergonomic challenges that I face on a day to day basis – the design of instrument handles, operating rooms not built to optimize table height, and inadequate monitor placement. The traditional operating room design has favored the taller male surgeon, not women, who on average are shorter and wear a smaller glove size. Laparoscopic surgical instruments have been reported to cause hand and upper extremity discomfort. In a [survey](https://pubmed.ncbi.nlm.nih.gov/15100896/) of 726 laparoscopic surgeons, females found that the scissors and staplers were more difficult to use for the small and medium glove size. Specifically, individuals using glove sizes 6.5 or smaller experience significantly more difficulty using common laparoscopic instruments, and in particular laparoscopic staplers. Compared with surgeons performing open surgery, surgeons performing minimally invasive surgery (MIS) were significantly [more likely](https://pubmed.ncbi.nlm.nih.gov/29511535/) to experience pain in the neck. As women are entering the field of surgery more frequently, an initial step in solving these problems is the recognition that the dimensions of optimal ergonomics may differ widely for male and female surgeons. Manufacturers of surgical hand tools should consider hand size when designing future surgical instruments. Organizations such as AWS and SAGES can help lead the way for changes, so we do not have to make accommodations to the detriment of our bodies. Advocacy for input regarding future changes regarding the design of surgical instruments is critical from hospital leadership. Having women surgeons within hospital leadership can drive operating room changes such as equity in locker room spaces and operating room equipment such as tables and monitors. I think it’s important for female trainees who are interested in surgery to have patience and not give up! Practicing by using simulation or via laparoscopic trainer will allow more familiarity with the instruments and how best to make the environment work for you. In addition, it’s natural to feel frustrated with the instruments and environment of the operating room especially during a long and complicated case, but we must remember that our patients need to get the benefit of our efficiency despite the ill-fitted surroundings. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/09/Hassan.png) Dr. Hassan is a fellowship-trained minimally invasive Bariatric Surgeon. She was an Army surgeon and the Medical Director of the Bariatric Surgery Program at Fort Sill, OK, from 2013-2017. Dr. Hassan holds a Doctor of Medicine degree from The George Washington University School of Medicine and Health Sciences and a Master’s Degree in Biological Sciences from Drexel University. She completed her residency in General Surgery at Madigan Army Medical Center in Tacoma, WA, in 2012 and completed a Minimally Invasive and Bariatric Surgery fellowship at The Cleveland Clinic Foundation. Her clinical areas of expertise are laparoscopic bariatric surgery and revisional bariatric surgery. She specializes in laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy, and she has experience with the management of duodenal switch, upper endoscopy, and intragastric balloon placements surgeries. Dr. Hassan has been published in multiple peer-reviewed surgical journals and has presented her work at national meetings. She is board-certified by the American Board of Surgery and is a Fellow of the American College of Surgeons. Dr. Hassan is married and enjoys spending time with her family traveling the world and participating in CrossFit. You can find her on twitter [@drmoniquehassan](https://twitter.com/drmoniquehassan). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** AWSChat, ergonomics, inclusion, training, Tweetchat, womeninsurgery, WomenSurgeons --- ### [In a World of Social Distancing, Getting Personal in Your Residency (or Fellowship) Application](https://blog.womensurgeons.org/getting-personal-in-your-application/) **Published:** August 26, 2020 **Author:** Blog Team **Content:** *By Jaime Lewis* This year is a curious year, a once in a century, one in a lifetime sort of year. And for some of you reading this blog, the year will coincide with other once in a lifetime events. I sit here tonight thinking of the fourth year medical students I advise who will soon be sending out applications for residency. Many have confirmed their field of interest, identified letter writers, and compiled their resumes. And many are also staring at blank (or nearly blank) pages on their computers, as I did just a few moments ago, trying to figure out how to write a personal statement. They are inevitably concerned that their personal statement will have more importance this year than in others. While I’m not sure if this is true, I do know that this statement is the next page in a story that will follow them through the course of their careers, revised and rewritten with transitions along the way. Many times students believe that they need to be extremely creative, have overcome significant adversity, or have been a national champion in some endeavor in order to write an impactful personal statement. In actuality, none of this is necessary and a strong personal statement is really quite simple once you’ve spent some time gaining insight and perspective on yourself. When I talk to students about getting started on their personal statements, I ask them to think about a few questions: 1. Why do you love medicine and surgery? What is it about this field that wakes you up every day at 4 am, eager to go to the hospital for another long day of work? Oftentimes, I find that students write their entire personal statement about, “why surgery”. They describe patients, cases, and mentors in great detail! But what I really want to know is… 2. Why you? What has helped you to get through high school, college, and medical school? What is it about you that will support your endeavor to become a great surgeon? Then, once I know you have identified the skills that will help you to successfully complete residency, I ask: 3. What do you want out of residency? Where do you believe your residency will lead you? And importantly, do you know what will be required of you over the course of residency and your chosen career? And finally: 4. Are there any issues that need to be addressed? Did you need to repeat a course or exam or take a leave of absence? Once a student can verbalize all of the above, (s)he is ready to write their personal statement! In preparing the statement, students should adhere to the [following guidelines](https://faculty.med.virginia.edu/facultyaffairs/advancement/pandt/pt-resources/personal-statements/): 1. Use active voice – it helps me believe what you’re writing 2. Limit to one page (or less depending on the specialty) – our attention spans aren’t long enough for anything more 3. Don’t forget the audience – we have been through residency and know a decent amount about surgery and the surgical lifestyle, but we don’t know much about you 4. Cover just the high points – make us want to ask more questions during the interview In addition, [students should avoid](https://www.aamc.org/cim/prepare-residency/writing-your-personal-statement): 1. Using a quotation – again, we want to know about you 2. Describing the expected – all of you work hard! 3. Requesting an interview – that’s the point of the application (however, it is okay to personalize a statement and explain why you are interested in a particular program or geographic region) 4. Using a professional service – just don’t 5. Plagiarism! This is absolutely unethical and can lead to investigation and reporting of your application. And while this year is undoubtedly unique, like so many years before, this personal statement will be your introduction to residency. I, like many of my colleagues, look forward to meeting you. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/08/1-2.png) Jaime D. Lewis, MD, FACS, is an Associate Professor in the Division of Surgery Oncology and a Career Advisor in Student Affairs at the University of Cincinnati College of Medicine in Cincinnati, Ohio, where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Dr. Lewis is committed to improving wellness and professional development opportunities for the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys road and trail (ultra)running and spending time with her family. You can find her on Twitter at [@JaimeDLewisMD](https://twitter.com/jaimedlewismd?lang=en). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** covid19, residency, surgical residency, training, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [New AWS Trainee Award Celebrating Diversity, Equity, and Inclusion](https://blog.womensurgeons.org/new-trainee-award-celebrating-diversity/) **Published:** August 20, 2020 **Author:** Blog Team **Content:** Keeping in line with the theme “Strength in Diversity” at the AWS National Conference (virtual meeting being held September 12th and October 3rd,[ register here](https://www.womensurgeons.org/page/ConferenceProgram)), the AWS launched a new trainee Diversity, Equity, and Inclusion Award. This award is intended to celebrate medical students, residents, and fellows of diverse backgrounds; help welcome them into the community of women surgeons; and provide an avenue for leadership development. Preparation for the award has been in the works since 2019 and was built in collaboration with AWS liaisons from the [Society of Asian Academic Surgeons (SAAS)](https://www.asiansurgeon.org/), [The Society of Black Academic Surgeons (SBAS)](https://www.sbas.net/), the [Latino Surgical Society (LSS)](https://www.latinosurgicalsociety.org/), and the [Association for Academic Surgery (AAS)](https://www.aasurg.org/)**.** ![](https://blog.womensurgeons.org/wp-content/uploads/2020/08/Picture1-2.png) [**Applications are due August 21st.**](https://www.womensurgeons.org/page/2020DEIConferenceAward) The new award program will sponsor up to 16 trainees each year to attend the AWS Annual Conference. In conjunction with AWS, each partner society will help co-sponsor up to 4 attendees. Because the conference is virtual this year, each award will cover the cost of registration to attend all of AWS’s 2-day virtual events. We look forward to seeing the winners in September and inviting all readers of this blog to join us on the[ \#RoadtoAWS2020](https://twitter.com/hashtag/RoadtoAWS2020?src=hashtag_click)! For any questions, please contact info@womensurgeons.org. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** Diversity, funding, inclusion, leadership, medical students, residents, surgical residency, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [The Jill of All Trades](https://blog.womensurgeons.org/jill-of-all-trades/) **Published:** August 13, 2020 **Author:** Blog Team **Content:** *By Joy Alvarado* I was once a general surgery enthusiast. I stood steadfast in my belief in the renaissance surgeon, and convinced many others that our nation was in dire need of a general surgery revival. General surgeons, I told the nay-sayers, can do it all. They work on almost every part of the body, and see patients in a variety of settings, including the emergency department. Versatility and portability renders them the swiss army knives of surgery. I felt that the general surgeon’s foundational expertise in a broad variety of cases renders her far from becoming obsolete. However, the general surgeon workforce is declining. A [2018 study](https://pubmed.ncbi.nlm.nih.gov/30098811/) predicts a shortage of 2,525 general surgeons by the year 2030, and a shortage of 25,500 general surgeons by 2050. Some believe that changes in residency funding is the culprit for this decline. A [report](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424235/) published in 1980 by the Graduate Medical Education National Advisory Committee predicted that the US would have a physician surplus of 100,000- 165,000 by the year 2000, including a 11,800 surplus of general surgeons. In response to this, Congress enacted several changes in [medical education](https://pubmed.ncbi.nlm.nih.gov/17888780/), including a[ new cap](https://pubmed.ncbi.nlm.nih.gov/24124658/) on the number of residency positions that qualified for federal support. One [study](https://pubmed.ncbi.nlm.nih.gov/6695342/) recommended specifically to reduce general surgery residency training by 20% to compensate for this surplus. Others believe that the increased enrollment in surgical subspecialties is the reason for declining numbers of general surgeons. In 2012, [80% of general surgery residents](https://pubmed.ncbi.nlm.nih.gov/24022436/) elected to go into fellowship training, up from 55% in 1992*.* The [appeal of subspecialization](https://pubmed.ncbi.nlm.nih.gov/19631340/) has been attributed to the promise of increased income, the ability to control personal schedules, more prestige, and a better variety of cases. As a general surgery resident once told me, “Specialty surgeons are taking all of the interesting cases, anyway. General surgery is just bowels and gallbladders now.” These days, I feel that the decline of general surgeons, while worrisome, may be more indicative of an increase in our nation’s surgical abilities rather than past GME policies or lifestyle preferences. The field of surgery is simply changing with new technologies. Novel surgical methods are being discovered at an unprecedented rate; today more than [25,000 different procedures](https://pubmed.ncbi.nlm.nih.gov/22551130/) are possible, and that number continues to grow. Minimally invasive surgery is pushing our ability to perform multiple surgeries in a short time span, and is ushering [new fields](https://www.facs.org/education/resources/medical-students/faq/specialties#:~:text=The%20American%20College%20of%20Surgeons,surgery%2C%20otorhinolaryngology%2C%20pediatric%20surgery%2C) like fetal surgery. Gaining the “broad spectrum” of knowledge that general surgery requires is becoming a more daunting task as time progresses. It is no wonder that [subspecialty](https://pubmed.ncbi.nlm.nih.gov/25446480/) education is [attempting to](https://link.springer.com/article/10.1007%2Fs00268-008-9658-x) shrink down the hours required in general surgery; there simply isn’t enough time to do it all. Arguably, there is one area of healthcare that still relies on the Jills and Jacks of all Trades, and continues to inspire me to advocate for general surgery: rural medicine. [Small towns ](https://pubmed.ncbi.nlm.nih.gov/19730238/)still heavily rely on the broadened expertise of surgeon generalists for a variety of specialty services, especially trauma care. While specialists are also needed in rural areas, interestingly enough, general surgeons are leaving these communities [more rapidly](https://pubmed.ncbi.nlm.nih.gov/15471767/) than [specialists are](https://pubmed.ncbi.nlm.nih.gov/24124658/). Surgeons continuing to practice in rural areas are [often older](https://pubmed.ncbi.nlm.nih.gov/18427021/) and will soon reach retirement age, leaving even greater deficits behind*.* However, while there is a need for generalists in rural areas, there is still one caveat: If the future of general surgery is in rural medicine, would that not provide support of a new, rural surgery subspecialty? Even though I’m younger than most of the studies I’ve referenced, I feel a nostalgia for general surgery. There is something about going to the clinic, unsure of what you’re going to see, and (perhaps more tantalizing) where you’re going to see it. Despite the many hernias and cholecystectomies, it is true that no two days are exactly alike. When the unexpected occurs, general surgeons have the most gut-wrenching, heart-pounding, seconds-counting, unpredictable last-minute cases I’ve ever witnessed. I love general surgery. However, I concede that changes are coming. Instead of fighting to maintain what worked in the past, I think it’s important for us to embrace the possibilities of the future. These days, I am no longer an enthusiast for general surgery as it once was, rather I’m an enthusiast for what it will become, whatever that may be. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/08/Picture1.png) Joy Alvarado is a Captain in the US Army and a family medicine resident. She is a graduate of the University of Texas Rio Grande Valley School of Medicine. She enjoys writing and oil painting. See her artwork at <https://drjoyartstudio.com/>. Twitter handle: [@thejoyalvarado](https://twitter.com/thejoyalvarado). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** residency, rural surgery, surgery, time management, training, Women in Surgery, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [A new program brings change for women in surgery](https://blog.womensurgeons.org/new-program-brings-change/) **Published:** August 6, 2020 **Author:** mcooke@amrms.com **Content:** *By the General Surgery Residents of Tower Health* While female General Surgery residents still number [less than their male counterparts](https://bulletin.facs.org/2019/09/2018-acs-governors-survey-gender-inequality-and-harassment-remain-a-challenge-in-surgery/), that is not the case at the Tower Health General Surgery residency program in West Reading, PA. The program, which began in 2019, is currently comprised of 100% female residents, after having matched an entirely female intern class in 2020. It has been interesting to observe various people’s reactions to the news of a completely female General Surgery residency, from the look of shock to the slow smile to the comments such as “well at least you won’t have any smelly boys to stink up your call room!” Although the Tower Health program may be lacking in male residents at the moment, there is still a great deal of diversity, as each of the current residents have a very different background and path to General Surgery. There are also opportunities for mentorship via the female surgical attendings, two of whom had children during their surgical residencies and maintain an excellent balance between outside life and a busy surgical practice. During the rigors of surgical training, it is important for all residents to have support and mentorship and this especially applies to female surgeons, who often face more challenges than men when it comes to academic careers and leadership positions. The AAMC and ACGME have found that there are [significantly less women faculty in surgery departments](https://americansurgical.org/files/2018/Equity.pdf) and women have not had as many opportunities to pursue academic surgery. As of 2017, there were [15,667 women surgical faculty but only 12.8% were tenured](https://pubmed.ncbi.nlm.nih.gov/30048312/). There have been advances in the recent years as the number of women chairs of US Departments of Surgery has now reached over 20 and continues to grow. Recently the American Surgical Association (ASA) created a [Task Force](https://americansurgical.org/equity/) to focus on equity, diversity and inclusion in academic surgery. In this aim the Task Force created a handbook and emphasized that “academic surgery has a duty to catalyze change in the broader community; to expect diversity and demand inclusion.” As we navigate the growth of women in leadership and academic positions in surgery, it is essential to have good institutional support, equal treatment and mentorship as well as opportunities for involvement in societies such as the Association of Women Surgeons (AWS). Recently the Tower Health program residents and two female residents from Philadelphia College of Osteopathic Medicine had a meet and greet lunch to discuss women in surgery and the benefits of membership in AWS. The surgical department and faculty at Reading Hospital, home of the Tower Health program, have been supportive of academic and leadership endeavors by providing educational funds to be used for conferences and membership in professional societies as well as encouraging involvement in research, involvement in quality improvement projects, implementation of protocols and presentations at local and national conferences. In a country where women still make up only about 20% of practicing general surgeons, are paid less than male surgeons, hold less academic and leadership positions and [face more obstacles such as burnout, harassment](https://www.nejm.org/doi/full/10.1056/NEJMsa1903759) and unique obstacles relating to pregnancy and parenthood, an all-female General Surgery residency program represents perhaps a glimpse of changes to come. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** Gender Disparities, residency, Surgical Education, training, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Residents on the Front Lines in NYC](https://blog.womensurgeons.org/residents-front-lines-nyc/) **Published:** August 2, 2020 **Author:** Blog Team **Content:** *By Tamar Nobel, MD* *“In any given moment we have two options:* *to step forward into growth or step back into safety.”* – Abraham Maslow The darker sides of the COVID-19 pandemic have been well documented in the media by our colleagues. Although the pandemic rages on elsewhere, as New York City enters a recovery phase my objective here is to focus on the ways in which we have grown and the future impact of this experience, from my perspective as a general surgery resident-turned-COVID provider in New York City. **Compassion, collegiality and community** The suffering and loss experienced during the COVID-19 pandemic carried a heavy emotional toll. As providers, one of the most challenging aspects of this experience was the way hospital policies changed our ability to support and guide families through making the most difficult of decisions surrounding end-of-life care. Bans on visitation resulted in [virtual solutions](https://www.nejm.org/doi/full/10.1056/NEJMp2007781?query=RP&fbclid=IwAR2P7G7dRJI1hFxl9MCPZYLkEC29MBs-it40IBrSnBMXi6TkSZBO7-CfcNU) to try to ease the pain of family members needing to say goodbye via remote mechanisms, sometimes with little warning prior to changes in clinical status. These heavy moments were juxtaposed with acts of kindness and new palpable collegiality between employees and across specialties within the hospital as clinicians and staff across all departments continued their routine jobs with new hazards to their own health or stepped into new roles. I am hopeful that as we move forward we will maintain this newfound collegiality. **Flexibility to adapt to evolving scheduling and environment** Surgical training is a regimented series of long days in the operating room interspersed with floor, consult, and trauma calls. As our hospitals began to saturate with COVID-19 patients, the sudden upheaval of normal operating procedures required the flexibility to deviate from our sense of normal regulated lives and accommodate near-daily changes to scheduling structures and staffing assignments. More details on our specific program rescheduling can be accessed [here](https://www.surgjournal.com/article/S0039-6060(20)30248-8/pdf). The deployments were also in conjunction with required time off for preservation of the workforce, which challenged our innate desire to help our city at its time of greatest need. I am proud of my colleagues for the way they handled the daily uncertainty and supported one another during this time. **Resourcefulness** With the need for judicious use of PPE early on during the pandemic, we adjusted the ways in which we both used available resources and distributed those resources among providers. As teams deployed across our hospital system, PPE was provided to our deployment team leaders to distribute to ensure we were protected. As the pandemic progressed, PPE stations were established throughout each floor, and as we enter recovery, we have maintained an organized and structured approach to distribution of PPE. Furthermore, we have adjusted some of the ways in which we approach surgery, including mandatory COVID-19 testing for all elective patients, and configuration of systems to evacuate laparoscopic insufflation. Through interdisciplinary collaboration, we have been able to proceed with elective cases starting Mid May. **Moving forward** Our experience during the COVID-19 pandemic took us out of our narrow field of training and expanded our horizons. As residents, we do not have as much experience as some of our attendings navigating uncertain situations. The experiences of the past few months have provided us with the toolset, and most importantly, confidence, to face the next unknown. Although training as we know it was completely upended for the last three months, I believe that as residents we will emerge from this experience stronger, more compassionate, more collaborative, and prepared to take on any challenges. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/08/Picture1-1.png) Tamar Nobel, MD, is a general surgery resident at The Mount Sinai Hospital in New York, NY. She is in her final year of residency and will begin thoracic surgery fellowship at Memorial Sloan Kettering Cancer Center next summer. Tamar grew up outside of New York City and attended Case Western Reserve University School of Medicine. You can follow her on twitter [@TamarNobel](https://twitter.com/TamarNobel). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** covid19, residency, stress, Surgical Education, Teamwork, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Leadership in Surgery](https://blog.womensurgeons.org/leadership-surgery/) **Published:** July 29, 2020 **Author:** Blog Team **Content:** *By Lilah Morris-Wiseman, MD* This is a story about leadership in surgery. I was in my third year of post-training, independent private practice and had been dealing with a disastrous complication. We know that the first two years post-training are those in which we are more cautious and we may defer more challenging cases. Then our confidence grows with positive outcomes. I had taken on a complex elective case in a younger patient. The case went well but the second day out it was clear the patient was having a known but serious operative complication. I called a senior partner to help me and we took the patient back to the operating room (OR) together and repaired the problem. Several days later, it was clear the repair didn’t work; the complication had recurred. The situation went from controlled to uncontrolled. I was in a state of mixed dread and fear – I worried I had harmed this patient and had run out of options to fix the problem – but I knew I had to do something different, and quickly. I called a colleague at a local academic center who I had met before but did not know well. She is in a position of leadership in academic surgery and had much more experience and expertise in this area than I did. After listening to the story, her first question was “how can I help you?” She offered me every option – from accepting the patient that day for transfer to her ICU and her service at the university hospital, to coming with me to see the patient and give advice, to trying to obtain emergency privileges at my hospital and coming with me to the OR. Training in large academic medical centers, I didn’t realize that one could obtain emergency privileges if a hospital did not have a specialist in that area. Ultimately, we decided on the latter. That afternoon, she came to a hospital she’d never entered – one to which she needed directions – and scrubbed in with me. She came with me to talk to the family. In the OR, she lent her vast experience in a calm, reasoned, empathetic manner, withholding any criticism. *“This happens,”* she told me, *“It will heal.”* Everything changed that day for the patient and for me. We didn’t solve the problem, but we took the first steps necessary to achieve success. She was in contact with me daily to discuss ongoing management and give suggestions that were helpful and unassuming. By coming to my hospital and giving of herself in this way, she allowed me to continue to care for the patient, to fix the problem, to see this through and learn the most from this. Fortunately, the patient made a full recovery. I’ve seen many different types of leaders in surgery. In training I was on both sides of this picture, with an attending surgeon asking for help and with those being asked to give it. From this experience I learned that true surgical leadership is less about the number of papers you publish and the awards on your wall than how you react and behave in a situation in which you are called to help. It is about your willingness to support your colleagues (even those with whom you have no professional ties), and, most important, it is about doing whatever it takes to achieve the best outcome for the patient. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/Picture1.png) Lilah Morris-Wiseman, MD, FACS, is an Assistant Professor of Endocrine and General Surgery at the University of Arizona, Tucson where she is the Associate Program Director for the General Surgery residency. After graduating from Tulane University School of Medicine, she completed General Surgery Residency at University of California, Los Angeles and fellowship in Surgical Endocrinology at MD Anderson Cancer Center in Houston, Texas. She worked in private practice in the Tucson community before returning to academics. You can find her on twitter at [@lilahfran](https://twitter.com/lilahfran). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** leadership **Tags:** leadership, mentorship, teaching, Teamwork, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Reflecting and Progressing Forward: A Chat with Two Incoming Interns](https://blog.womensurgeons.org/reflecting-and-progressing-incoming-interns/) **Published:** July 27, 2020 **Author:** Blog Team **Content:** *By Elisa Atamian, MD, MS, and Joy Ayemoba, MD, MSc* When I (Elisa) volunteered to write for the AWS blog over 7 months ago, I assumed I would submit a piece that reflected on my experience as an Integrated Plastic Surgery residency applicant. Over the course of the past month, with the uprising of the Black Lives Matter Movement, I realized that this space could and should be used differently. In recent days I’ve seen the trending hashtag on our beloved Med Twitter, [\#ShareTheMicNowMed](https://twitter.com/hashtag/ShareTheMicNowMed?src=hashtag_click). I was inspired by this movement that was amplifying the voices of Black Women in medicine. I was also struck by the realization that we (White women) should not just be “sharing” the microphone on our own social media channels… Black men and women have been sharing their successes, joys, and hardships for years, and it is our duty to seek out their stories. The voices have always been there. With that being said, I was honored to have my former classmate and now surgical colleague, Joy Ayemoba, join me in contributing to this blog post. We are both incoming surgical interns. Dr. Ayemoba will be starting her surgical career as a General Surgery Resident at the New York Presbyterian Brooklyn Methodist Hospital. I (Elisa) am heading to Zucker School of Medicine Hofstra/Northwell as an Integrated Plastic Surgery Resident. We discussed our paths to this point, and what our roles are as physicians in the midst of a historic movement and dismantling of systemic racism. ***Reflecting on Our Paths*** **Elisa:** When asked about my interest in Plastic Surgery, I will always bring up my mentors. The moment I established a successful mentor relationship was the moment I felt comfortable and supported in pursuing my dream. So much of my path has been shaped by my mentors, including my interests, research endeavors, away rotations, and clinical experiences. Something that I have taken for granted is the opportunity to see myself in many of my mentors. We often shared the same hometowns, the same passions, and, the same skin color. Drawing attention to my privilege, and the privilege other white medical students and residents share, is vital in dismantling the systems that prevent my Black colleagues from finding mentors and role models that look like them. **Joy:** My decision to pursue a career in General Surgery took much self-reflection in addition to trial and error. Like many individuals identifying as Black, Indigenous and/or People of Color (BIPOC), I stand as the first physician within my family. Finding mentorship has been a challenge I’ve endured long before entering medical school. Once I decided on a career in medicine, I remember being disappointed by the lack of Black physicians within my community. Although I had hoped to see improvement in medical school, the truth is I had more or less the same experience. In 2018 the [AAMC](https://www.aamc.org/data-reports/workforce/interactive-data/acknowledgments) reported that 5% of all active physicians self-identified as Black or African-American. Within surgery, these numbers were dismaying when focusing on Black women. A [recent study](https://pubmed.ncbi.nlm.nih.gov/32209893/) found that less than 1% of all current academic surgical faculty are Black women. Furthermore, Black women are [less likely to receive NIH grants, tenure](https://pubmed.ncbi.nlm.nih.gov/32209893/), and less likely to be made department chair. Understanding that pursuing a career in surgery as a Black woman meant becoming a minority within a minority, I realized that I had to readjust my expectations and try and find mentors who reflected some other characteristic or interest I possessed. Although I navigate within this country as a Black woman, I could not and did not expect to find a mentor within my medical school who could completely understand the challenges I experienced. This is not to say that I had ‘bad mentors’. I have a wonderful support system, and I remain so immensely grateful and fortunate to have found a group of mentors who advocated for me and advised me to the best of their capabilities. What I mean is that as a Black woman interested in surgery, finding a Black female surgeon within my institution felt like an impossible task. As students, we long to see some future version of ourselves within our mentors. It gives us hope that we too can accomplish our goals. But what does it mean when you struggle to see yourself within the present structure of leadership? How does lack of diversity AND inclusion affect the goals that underrepresented students set for themselves? ***Acknowledging the Landscape*** As we enter a new chapter of our lives, we have an important role in bringing to light the practices that perpetuate health inequities based on race. At the most basic level, countless [diagnostic algorithms and practice guidelines](https://www.nejm.org/doi/full/10.1056/NEJMms2004740) used in the medical field raise racial equity concerns. In Louisiana, [76.9% of patients hospitalized with Covid-19 and 70.6% of those who died were black](https://www.nejm.org/doi/full/10.1056/NEJMsa2011686), though Blacks comprise only 31% of the population of the largest health system in the state. In two of our nation’s largest cities—Chicago and NYC—a [recent study](https://jamanetwork.com/journals/jama/fullarticle/2766098) found that Black and Latino residents had significantly increased odds of infection and death from COVID-19 compared to white residents. The [AAMC](https://www.aamc.org/news-insights/how-we-fail-black-patients-pain) found that 40% of first- and second-year medical students believed that Black skin is thicker than white skin. But these wrongly held beliefs don’t end in medical school. One [study](https://www.pnas.org/content/113/16/4296) found that 50% of medical students and residents it surveyed held some false beliefs regarding biological differences in Black patients. These beliefs translate into continued poor practice, as we see that Black patients are less likely to receive [analgesics](https://pubmed.ncbi.nlm.nih.gov/27044069/) in the ED ([57% v 73% for whites](https://pubmed.ncbi.nlm.nih.gov/10613935/)).7 Moreover, even [when dealing with children](https://pubmed.ncbi.nlm.nih.gov/26366984/) the disparity remains apparent. Understanding the current landscape and the racial biases that are deep-rooted in medical culture is crucial in ensuring patients receive the best possible care. By increasing diversity within our medical schools and residency programs, our cycle of health inequity can be broken. Trainees today become the attendings of tomorrow. ***Where do we go from here?*** We want to shift the focus to actionable items: required historical readings, implicit bias training, diversification of leadership, mentorship programs for underrepresented minorities in medicine. Together we can create change and transformation in the world, especially in the medical field, but we must all put the work in! We must listen to our patients, educate our colleagues, study the history, understand the statistics, and have the difficult conversations that are necessary. We must support our Black colleagues and not only “share the microphone,” but also give them the entire stage. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/1.png) **Elisa K. Atamian, MD, MS,** is originally from New York, NY. After receiving her undergraduate and graduate degrees in Human Physiology at Boston University, she spent a year in NYC completing a research thesis at NYU which discussed DNA damage leading to infertility. She recently graduated from Tulane University School of Medicine, where she developed her interest in Plastic Surgery. She is currently a first year Integrated Plastic Surgery Resident at Northwell Health. Elisa is also a former member of the AWS National Medical Student Committee, where she served as the South Regional Representative for two consecutive years. Follow her on Twitter at [**@elisaatamian**](https://twitter.com/elisaatamian) and Instagram at @drelisaatamian. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/2.png) **Joy Ayemoba, MD, MSc,** is originally from London, United Kingdom. She completed her undergraduate studies at the University of Chicago. After obtaining her BA, she returned to the United Kingdom to complete her graduate degree in Social Epidemiology at the University College London (UCL). She then worked as a research statistician/epidemiologist at UCL before enrolling at Tulane University School of Medicine. At Tulane, she developed an interest in General Surgery and further understanding the relationship between surgical outcomes and health care inequalities. She is a first year General Surgery resident at New York Presbyterian Brooklyn Methodist Hospital. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** residency **Tags:** #diversityandinclusion, intern year, leadership, social media, surgical residency, Women in Surgery, women of color, womeninmedicine, WomenSurgeons --- ### [A Call for Rural Surgery Training Opportunities](https://blog.womensurgeons.org/rural-surgery-training/) **Published:** July 23, 2020 **Author:** Blog Team **Content:** *By Riann B Robbins, MD* Imagine practicing rural surgery in the dense mountains of western Montana. For nearly a year, I immersed myself in subspecialty and rural surgery training through the Kalispell Regional Medical Center Rural General Surgery Fellowship. During this time, I worked at a regional medical center and multiple critical access hospitals, defined as centers with 25 beds or less. Here I share some of the lessons learned through this unique experience. Unfortunately, we currently do not meet the critical surgical workforce needs of this country. Twenty-five percent of the US population live in rural locations while [only 15% of physicians practice in these areas](https://pubmed.ncbi.nlm.nih.gov/22500672/). Despite a 27% increase in rural population size between 1980 and 2000, the [general surgery workforce increased by only 2%](https://pubmed.ncbi.nlm.nih.gov/15219476/). Consequently, a significant maldistribution of surgeons exists between urban and rural areas and only two thirds of critical access hospitals have an available general surgeon on staff. [Rural surgeons](https://jamanetwork.com/journals/jamasurgery/fullarticle/508241) are more likely to be over age 50, graduates of international medical programs, and nearing retirement. One [national study](https://pubmed.ncbi.nlm.nih.gov/18436007/) of 233 rural hospitals reported 34% had a surgeon who planned to leave within the year, 36% were actively recruiting, and 12% would be forced to close if they lost their surgery program. This surgical workforce crisis is not addressed by current training models, leaving a large segment of society without adequate access to surgical care. Graduating general surgery residents increasingly pursue fellowship training. In 2004, [70% of graduating residents pursued fellowship](https://pubmed.ncbi.nlm.nih.gov/16310697/) compared to 55% in 1992. [When asked about the decision to pursue fellowships](https://pubmed.ncbi.nlm.nih.gov/19773565/), residents cite lack of confidence to perform procedures independently, the belief that fellowship training is necessary to remain competitive in current job markets, [the lack of exposure to rural and subspecialty training experiences,](https://pubmed.ncbi.nlm.nih.gov/25939206/) and the [misconception that current training inadequately prepares them to enter practice independently](https://pubmed.ncbi.nlm.nih.gov/22500672/). Furthermore, [one third of procedures performed by rural surgeons are not required by ACGME for graduation](https://pubmed.ncbi.nlm.nih.gov/14972321/) and are typically not taught to general surgery residents at large academic training institutions. Dedicated rural surgery tracts may increase trainee confidence to pursue independent general surgery practice after graduation and combat these previously held misunderstandings in critical ways. Operating in rural hospitals provided me with exposure to the basic procedures of surgical subspecialties including urology, OBGYN, orthopedics, otolaryngology, and even interventional radiology. Without this unique opportunity, I would not have been exposed to these types of procedures at my urban, academic training institution. Through this experience, I gained more operative independence in the OR, enhanced my surgical decision-making in a resource-limited environment, and gained insight into a viable but often overlooked career path. Now I strongly value the contribution our rural surgery colleagues make to our collective surgical community. Our current surgical training model can be modified in ways that support the goal to prepare, recruit and retain more residents to meet the general surgery workforce needs of America. I encourage training institutions to evaluate how they can incorporate experiences that facilitate exposure to rural surgery as we collectively strive to meet the surgical workforce needs in our country. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/Picture1-3.png) Riann B Robbins, MD is a fourth-year General Surgery resident at the University of Utah. In lieu of a dedicated research year, she recently completed the Rural General Surgery Fellowship through Kalispell Regional Medical Center in Kalispell, Montana under the guidance of Randall Zuckerman, MD and David Sheldon, MD. Her professional interests include trauma and emergency general surgery, surgical critical care, and surgical education. She is currently completing the Surgical Education Research Fellowship through the Association of Surgical Education. Her non-academic interests include yoga, exploring national and state parks, and spending time with her growing family. You can find her on Twitter [@riann\_robbins](https://twitter.com/riann_robbins). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** training **Tags:** ILookLikeASurgeon, rural surgery, Surgical Education, surgical residency, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Building a family in surgery, and finding one too](https://blog.womensurgeons.org/building-family-surgery/) **Published:** July 15, 2020 **Author:** mcooke@amrms.com **Content:** *By Colette Inaba, MD* You can’t be both a surgeon and a mom. At least, that was my understanding throughout my early years of medical school. Let me clarify that nobody explicitly told me that I should not go into surgery if I also wanted kids. However, I had heard that surgery is a particularly time-intensive specialty in which it would be challenging to have and raise children, whereas other medical specialties allow more time and flexibility to integrate work with family. As a medical student who loved surgery but also wanted to have a family, I found it discouraging to have to choose between personal and professional fulfillment. Ultimately, I decided to be a surgeon and ended up having two children during my residency. After years of working with surgeon moms and becoming one myself, I know it’s misguided to presume that being a surgeon and a mother are mutually exclusive aspirations. But I can still recall the distress of feeling I had to choose between personal and professional goals that seemed, at least superficially, to be incompatible. But becoming a surgeon mom, even as a resident, was not as challenging as I had feared thanks to three tiers of support: family, role models, and surgical community. **1. Family** The importance of having family support as a new mother is obvious, and I will spend little time on this point. My spouse’s help was invaluable. He was fortunate to have a job that allowed paternity leave after both of my deliveries, as well as the flexibility to stay home when the kids were sick. Whenever I was on call, he was also on call for taking care of the kids solo; he never once made me feel guilty about it. My mother and mother-in-law also stayed with us for a week at a time when the kids were newborns and assisted us with childcare when needed. Knowing our kids were safe and cared for at all times allowed me to focus on my training, be at the hospital when needed, and while there, be mentally and emotionally present for my patients. **2. Role Models** By the end of my third year of residency, two of my chief residents had become moms. Over the course of my residency, the number of female surgical faculty at my university hospital increased from three to ten in various sub-specialties, and the majority were already moms or became moms during my training. These women were a valuable resource on how best to plan for a baby, the logistics of pumping at work, coordinating child care, and various other helpful tips for a new surgeon mom. I wish I had met these amazing women sooner. If I had been exposed to more surgeon role models and the work they do in my premedical or early medical training, I do think I would have more readily considered becoming a surgeon. However, I had not even considered a career in surgery until my clerkship, and as such, I had never sought mentorship from a surgeon. Prior to my surgical clerkship, I had only met one female surgeon in my entire life. In contrast, I had worked with a number of primary care physicians who eventually became mentors and encouraged a career in primary care. I did not have to seek out these mentors; they were plentiful, approachable, and readily available through a variety of early coursework, extracurricular activities, and social events. So robust was the mentorship for pursuing a primary care specialty that I might have ended up in primary care despite my interest in surgery, if I had not met a surgeon mom who inspired and encouraged me during my surgical clerkship. As a prominent academic cardiothoracic surgeon who had become a mother of two children during her residency, she was a manifest counterexample to all I had heard about the inability of a female surgeon to also raise a family. I was fortunate to meet such an exemplary role model at a career crossroads, but it is distressing to think how many other female students who could have thrived in surgery went down a different path merely due to a lack of exposure to role models and mentors. **3. Surgical Community** It has been said that it takes a village to raise a child, but I never understood the proverb as acutely as I did when our second child was born six weeks before her due date. I worried about inconveniencing my colleagues, who unexpectedly had to adjust their schedules and cover my clinical responsibilities in addition to their own. But no one hesitated to help or complained at all. My faculty encouraged and supported my maternity leave, our administrative chief resident promptly restructured the rotation schedules, and our research residents jumped in to help cover my remaining trauma shifts. They all worked together so that I could focus on my recovery and on caring for my newborn. When I did return to work, I was on a modified rotation that minimized overnight call. My co-residents graciously covered my trauma pager whenever I needed to pump. I even had an attending come to the OR unprompted while I was in a long case just to scrub me out so that I could pump. In short, members of my residency program became my extended family, my community support. We hear a lot of talk about “resident wellness” these days, but it’s usually in the form of a free lunch or a taxi voucher to use if we’re too tired to drive ourselves home after a long call shift. While these gestures are appreciated, they can feel perfunctory at times, a mere checkmark on a list of accreditation requirements. In contrast, I cannot recall anything in my medical training that did more for my personal well-being than having the institutional support to integrate my personal and professional lives. Having a supportive family at home and role models at work were fundamental to becoming a surgeon mom, but the essential contributions of my surgical community cannot be overstated. My co-residents, faculty, and administrative staff demonstrated in word and deed that they cared, not just about me and my health, but also about the health and well-being of my family. All the free lunches and taxi vouchers in the world could not have made me feel more valued and more thankful to be part of the surgical family I found in residency while building a family of my own. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/Inaba.png) Colette Inaba is a minimally invasive surgery fellow at the University of Washington. She earned her Medical Doctorate at the University of Washington and completed her general surgery residency at the University of California, Irvine. She enjoys spending time with her husband and two children, as well as other family and friends in the great Pacific Northwest. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** parenting **Tags:** ILookLikeASurgeon, parenting, womeninsurgery --- ### [Fellowship Interviews: COVID-19 Edition](https://blog.womensurgeons.org/fellowship-interviews-covid-19-edition/) **Published:** July 8, 2020 **Author:** mcooke@amrms.com **Content:** *By Megan Delisle* I never imagined fellowship interviews unfolding as they did this season. As efforts to “flatten the curve” escalated, emails regarding intentions to conduct all interviews virtually flooded my inbox. This came as a relief as the feared alternative was that interviews would be canceled altogether. Many of my mentors were eager to help me prepare for interviews, but virtual interviews were a new territory. There are several key insights and lessons I learned along the way specific to virtual interviews that may be helpful for future candidates. **Lesson #1: Research the city and program** In-person interviews offer an opportunity to visit the city and facilities. While many programs still provide a “virtual tour”, this is often abbreviated compared to what would be available in person. Spending some time understanding the local context can help tailor your questions and answers during the interview to maximize the opportunity. **Lesson #2: Prepare for a marathon, not a sprint** Many programs offer several opportunities to virtually meet with faculty and fellows. I initially thought I would have more energy given that I would not be traveling and moving around as much for the meeting. It proved to be challenging to maintain an engaging and enthusiastic demeanor while interacting with a computer screen for up to eight hours. Most programs sent the schedule ahead of time. Planning bathroom and snack breaks throughout the day was essential to maintaining good energy levels. **Lesson #3: Familiarize yourself with the technology** While the majority of programs used Zoom, there were some that used other platforms such as Cisco, Webex, and Microsoft Teams. Logging in up to 30 minutes prior to the first meeting allows time to download any necessary plugins and additional software. **Lesson #4: Strategize your environment** Interviewers will notice your surroundings. Make sure all distracting noises and objects are removed. You can consider placing a few purposeful objects that serve to stimulate the discussion and to provide a more personalized experience. Play around with the angle of the camera to optimize eye contact and allow for some natural body language to be visible. A camera that is too close or too far can reduce the effectiveness of nonverbal communication. Consider doing some practice runs to ensure the lighting, sound, and internet connection are functioning smoothly. These lessons are a few of the key takeaways from my experience. Several excellent [resources](https://journals.lww.com/annalsofsurgery/Documents/Successful%20Virtual%20Interviews.pdf) are now available to help candidates prepare for virtual surgical fellowship interviews. There is still a lot of uncertainty about what traveling will look like in the future and it is possible interviews may need to continue virtually for the foreseeable future. Even after COVID, there are many other reasons interviews should continue virtually. After visiting 15 cities and traveling 16,425 Km for residency interviews, [Dr. Kevin Liang estimated his CO2 emissions](https://twitter.com/kevlian_/status/1227098226899087361) during the process were equivalent to 62% of the average yearly Canadian household emissions per capita. The financial and administrative burden of organizing coverage for fellowship interviews is well recognized. [Watson et al](https://pubmed.ncbi.nlm.nih.gov/27425434/). conducted a survey of U.S. General Surgery residents and found over half of candidates spent more than $4000 and missed at least 7 days of work during the process. Personally, coming from the Midwest, virtual fellowship interviews allowed me to save over $10,000 and greatly reduced the number of days I was away from clinical duties. It is likely the virtual process was cost and time-saving for programs as well. While there are a lot of benefits to conducting interviews virtually, there is still a lot to learn about how the process may affect selection and ranking for both candidates and programs. It may be that virtual interviews become a part of a multi-step process used to determine a shorter list for in-person interviews. Ultimately, the pandemic created an opportunity for us to examine the way we do things. While there is still a lot to learn about the optimal way to change the process and how it will influence outcomes, I think virtual interviews offer an opportunity to change the status quo. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/Screen-Shot-2020-07-08-at-4.04.57-PM.png)**Megan Delisle**, **MD MPH MSc** is a final year General Surgery resident at the University of Manitoba, Canada. She obtained her medical degree from McGill University. During her residency, she obtained an MPH in epidemiology from the Harvard T.H. Chan School of Public Health and a MSc in Surgery from the University of Manitoba. She is the incoming complex general surgical oncology fellow at the University of Ottawa. In her free time, she enjoys spending time with her dog Charlie and doing yoga and biking. You can follow her on Twitter[@MeganDelisleMD](https://twitter.com/megandelislemd). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, residency **Tags:** #womennsurgery, AWS --- ### [Tips for medical students, residents/fellows, and junior attendings looking to network in the surgical community through social media](https://blog.womensurgeons.org/networking-in-the-surgical-community-through-social-media/) **Published:** July 2, 2020 **Author:** mcooke@amrms.com **Content:** *By Jaina Lane & Tishina Tittley* Networking is an important aspect of professional development. In a typical application season, medical students work hard to form connections with attendings, residency program directors, and other medical students in order to find their ideal residency home. Similar skills are needed for residents applying to fellowship, fellows looking for their first jobs, and current attendings looking to move into different and/or more advanced leadership roles. Unfortunately, due to the unforeseen circumstances that COVID-19 has presented to all of us, medical students through junior attendings now struggle with establishing the same professional relationships. Unable to interact directly with potential colleagues (*e.g.* current residents/fellows, potential coworkers), they may find it more difficult to assess their proper “fit.” This issue is confounded for many medical students applying this year as they also can’t do away rotations at programs they are most interested in and are missing out on seeing the culture of the program. To help surgeons at all levels of practice and training, we have come up with a few unique ways that trainees and junior attendings can use social media to network with people who share their professional interests, find opportunities to explore their institutions of interest, and ease their journey through the application season and job application cycle. *Best platforms to use* There are a few platforms that are especially helpful to use for networking in medicine. Twitter is extremely popular among physicians in general, but especially among surgeons. They use it to highlight personal and professional accomplishments, share their opinions on hot topics, and educate their followers on a variety of issues. Facebook and Instagram are also good platforms to use to follow residency and fellowship programs, and lately, have been the best place to receive updates on upcoming webinars geared toward medical students in addition to information on virtual grand rounds and potentially virtual subinternship opportunities. *Choosing a handle* So, how are you going to set up your profile? It all starts with a good handle. Keep it simple and as similar to your name as possible, to make you easily recognizable. Avoid anything unprofessional or too complicated to type on a phone. Be conscious that length can matter in a professional tweet, so keep your Twitter handle descriptive but short. *Creating a bio* The next step is creating a bio. Indicate what level of training you are at. Include your current institution and past institutions attended for medical school and residency/fellowship training. If you took year(s) off for research, say where you did it. If you serve in any leadership positions on national committees or organizations, make sure to include it and tag the organization. Finally, you can list areas you’re particularly passionate about as part of your present and future career (diversity, nutrition, public health, global surgery, etc.). Don’t be afraid to get creative with emojis here and there, as long as they are used appropriately (especially on Instagram)–your bio is also a great place to showcase your personality. A great example: “MS3 @OhioStateMed \| MPH @HarvardChanSPH \| Dog mom \| Caffeine Connoisseur \| Interests are #vascularsurgery #trauma #ballet \| She/Her \| Opinions are my own.” Keep in mind you have a 160 character limit! *Picking a profile picture* A good profile pic is a must. The best photo to use for Twitter would be a professional headshot. You could also use a casual photo that is preferably not a selfie. On Instagram, professional photos are less common, but you always want to make sure your pic is appropriate and doesn’t present you in a questionable light. *Who to follow* The big question, who should you follow? An easy way to start is with your classmates and other colleagues at your level. Look for trainees and faculty at your institution you’ve worked with. Another easy way to find people in your specialty of interest is to look at who your mentors and colleagues follow. For people you meet at conferences or on rotations, Twitter could be a good way to stay connected. You may have role models in the field that you don’t know personally but whom you really look up to. Following them could be a great way to establish a connection! Many people are open to receiving DMs or may even privately message you their contact information if you politely ask for their mentorship. Finally, it’s good etiquette to follow people back, using discretion of course. *What to post* While in the professional world, your CV/resume represents who you are, social media can add another dimension. So post things that highlight you! This can include major milestones, like graduating, publishing research, or going to a conference. This can also include hobbies you’re really into, fun activities, and trips. It’s a chance for people to see a fuller picture of who you are, so take advantage of that freedom. Don’t be afraid to share things you feel passionately about, that could include politics, art, music, travel, etc, While some people may fear that posting about political issues could be polarizing and turn off some programs or potential employers, don’t forget that you want to be at a program/institution that is a good fit for you and shares your same values. If a program/institution cannot appreciate your opinions and the person that you are, then that program/institution might not be for you and you won’t have missed out on anything. At the same time, always remember to be respectful and professional on your feed. Your opinions on your feed are your responsibility. *What to share/retweet* Your shares and retweets reflect on others perceptions of you, so share things related to areas you’re passionate about or interested in. On Twitter, your likes and shares are accessible on your profile page, so it’s something to be conscious of. Try to avoid posting or commenting on threads that you’re not that knowledgeable about because you don’t want to be held accountable to defend someone else’s opinions. *How to network* Networking on social media is largely about finding ways to engage with others! Tweetchats are a great way to do this. A Tweetchat is where a group of Twitter users meet at a predetermined time on an account to discuss a certain topic, using a designated hashtag (#). AWS has a monthly Tweetchat ([\#AWSChat](https://twitter.com/hashtag/awschat?lang=en)) that you can participate in, on Mondays at 8pm EST. [\#FollowFriday](https://twitter.com/search?q=%23followfriday&src=typed_query) is another pretty popular Twitter thread among medical students ([\#MedStudentTwitter](https://twitter.com/search?q=%23MedStudentTwitter&src=typeahead_click)). People introduce themselves, share a hobby or recent event, tag others, and retweet and follow others on a chain! It’s a great way to develop camaraderie and find interesting people to follow. Other great Twitter threads to follow for surgery are: [\#SurgTwitter](https://twitter.com/search?q=%23surgtwitter&src=typed_query) [\#SurgEd](https://twitter.com/search?q=%23surged&src=typed_query) [\#ILookLikeASurgeon](https://twitter.com/search?q=%23ilooklikeasurgeon&src=typed_query) [\#MedTwitter](https://twitter.com/hashtag/medtwitter?lang=en). Another way to network is to reach out directly through DMs. After you have followed someone on Twitter, a little envelope icon should appear above their bio on their Twitter page. Clicking on that allows you to send them a message directly. Be professional and succinct in your introduction — state your name, level of training, and the reason you are reaching out to them. Then, ask if the best way to contact them is through Twitter, or if they would prefer email. Now you have the ball rolling on a conversion, and can proceed from there! On Instagram, you can reach out to potential mentors with specific questions by DM’ing them as well. On both Twitter and Instagram people may or may not respond, but many residents and faculty are particularly sensitive to the need for mentors among medical students right now because of the disruptions due to COVID-19. Definitely don’t message people daily if you don’t hear back, but try two or three times and if you don’t hear back, there are plenty of other people to reach out to. While DMing a resident or attending can seem daunting as a medical student, there have been some great mentor-mentee relationships built this way, so don’t be afraid to give it a try! *What not to do* We’d be remiss to not share some not-to-do’s. Please don’t post or share anything inappropriate or with profanity. Make sure you don’t subtweet, which is commenting or criticizing a fellow Twitter user without mentioning them with the @ sign–this is absolutely not the place to burn bridges and people will notice. Do not harass people by messaging or tagging them excessively. If you’re wondering whether you should post something, ask someone or play it safe and don’t post it. Remember, anything that you post publicly can be seen by anyone and is fair game during your interviews for residency, fellowship or a future job. You don’t want your social media engagement to come back and haunt you, so use it wisely but remember to have fun with it as well! We hope that this guide to networking for student surgeons on social media was helpful to you. Given the disruptions to COVID-19, this might be a great opportunity for you to expand your professional network using the tips we’ve offered, and put yourself in the best positions for the future you’re pursuing. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/Screen-Shot-2020-07-02-at-9.48.30-AM.png)Jaina Lane is a medical student at the University of Virginia pursuing a career in plastic and reconstructive surgery. As a Bill Gates Millennium Scholar, she attended Harvard University where she studied biochemistry and global health. Her clinical & research interests lie in craniofacial surgery and medical education, and she is committed to promoting diversity inthe field of surgery through mentorship and advocacy. She is the current Diversity & Inclusion Coordinator of the AWS National Medical Student Committee. In her free time, she enjoys her faith community, music, comedy and playing spades. She can be found on Twitter @[jainaclane](https://twitter.com/jainaclane) and [Instagram @jayclane.](https://www.instagram.com/jayclane/) ![](https://blog.womensurgeons.org/wp-content/uploads/2020/07/Screen-Shot-2020-07-02-at-9.48.39-AM.png)Tishina Tittley is a rising fourth-year medical student at Howard University College of Medicine (HUCM) pursuing a general surgery residency this year. She grew up in the suburbs of Washington, DC and attended Columbia University where she majored in biological sciences. She currently serves as Social Media & Marketing Coordinator of the AWS National Medical Student Committee. Her primary research interests include surgical technology and innovation, surgical outcomes and health disparities. Ultimately, Tishina hopes to pursue a career in surgical oncology or acute critical care. In her free time, she enjoys reading novels, improving her culinary skills, and running outdoors. She can be found on Twitter [@TishinaTittley](https://twitter.com/TishinaTittley). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, medical students, networking, professionalism **Tags:** AWSBlog, womeninmedicine --- ### [To My Colleagues: A Call to Individual Change in a Surgery Residency Program](https://blog.womensurgeons.org/to-my-colleagues-a-call-to-individual-change-in-a-surgery-residency-program/) **Published:** June 30, 2020 **Author:** mcooke@amrms.com **Content:** *By Danielle Walsh* *Written June 1, 2020* Dear Colleagues, Unprecedented times. It’s been said so often that the phrase starts to ring hollow, but there aren’t better words. Across our nation and in our own backyard, we have a problem. Centuries of discrimination created by the systematic bias ingrained into our society has led our brothers and sisters of color to stand up and make it clear that enough is enough. It is not OK for Ahmaud Arbery to be shot when walking or running in Georgia. It is impossible to understand how another human being thought it was OK to crush the life out of George Floyd laying on the ground in handcuffs. It is unacceptable for a woman in NY, breaking the law herself, to wield power over Christian Cooper by both gross exaggeration of the circumstances and full knowledge that calling the police would likely settle the matter in her favor. It is not OK. As a woman entering surgery more than 20 years ago, discrimination was just making the turn from overt to covert. Almost all progress in this past 20 years came about by 2 changes: 1 – Men stepping up to publicly call out discrimination with active advocation for women to have a voice in our profession and 2 – My brothers and sisters in healthcare at all levels calling out injustice against women right on the spot. With these efforts, women have found their footing and blossomed such that our numbers are rising rapidly to on par with our male colleagues. **The need to do the same for our brother and sisters of color in our personal and professional lives is critical.** Without the courage of people in power (and all doctors are people of power) making changes in society, we can not move ahead. That is the message of this movement. It is incumbent on all of us to hear it and take action. Watching the news earlier this month, my first response was likely the same as many of you. Surely, I am not the one discriminating… But as I continued watching people angry to the point of destruction, my thoughts shifted to one of judging them for their actions. And then it hit me. I’m guilty. In judging others, without having taken enough action in the past to root out the causes of such anger in our community, without having lead others to do the same, I am complicit in discrimination. By using my own lens of justice to say I have no sympathy for your cause because you damaged a structure is to fail to see the bigger picture of the destruction of the human spirit in a large segment of our society. It is to fail your fellow man by closing your eyes to their pain and hurt with an arrogance of being better. This is not to say I understand the pain and anger of living as a Black person or person of color. I don’t. I can’t. I can only know that I have failed to hold myself accountable to calling it out around me and failed to help fix an ugly part of society because of any number of excuses. And I have failed to hold my colleagues accountable as well. If we can successfully slow a pandemic to a crawl, surely we can do the same for discrimination in society. We just need the same level of concern for life, allocation of resources, and commitment to safety. Let it start with each of us now. So where can we go from here? Each day, I ask each of you to use all the skills that all doctors were trained to use for the society around you. - **Listen** to the anger and upset and stories both on the news and in our workplace. Do so without judgment. Hear and try to understand just a little bit better than you did yesterday. - **Look** at the people working around you. Don’t just walk past anyone, whether they have a stethoscope or a broom, who is contributing to the care of YOUR patients without acknowledging them as a VALUED member of the team. - **Ask** your co-workers of color if they are getting the support they need from you. In fact, if you don’t know their names, ask who they are, and thank them for what they do. Many are hurting and could be helped by someone sharing the burden they carry. - **Learn** – If you want to help your fellow man, start with yourself. Understand the voice of others. Start with a book by Robin Diangelo called “[White Fragility. Why it’s so hard for white people to talk about racism](https://robindiangelo.com/publications/).” Then keep reading – try these [recommended books.](https://time.com/5846732/books-to-read-about-anti-racism/) After that, keep educating yourself – here are some [suggested films and podcasts](https://www.npr.org/sections/codeswitch/2020/06/06/871023438/this-list-of-books-films-and-podcasts-about-racism-is-a-start-not-a-panacea). - **Advocate** - Inside the hospital. When a VIP patient is in the hospital, people bend over backward to make sure they are comfortable, and we constantly ask what we can do to make their stay better. Do this for EVERY patient. Make every patient, especially those of color and disadvantage, feel they are a VIP in our care. Make every colleague and patient and family member trust that you will do whatever is necessary for them to succeed and live well. - Outside the hospital- Support activism. Organize White Coats for Black Lives demonstrations. Join local discussions. Be part of the conversation. Be part of the solution. Don’t wait for another harm to fellow black men and women to stoke the flames further. I look forward to learning, hearing, and helping right along with you. We are all in this together. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/06/Screen-Shot-2020-06-30-at-8.12.34-AM.png)*Dr. Danielle Walsh is an Associate Professor of Surgery at East Carolina University in the Division of Pediatric Surgery. After obtaining her undergraduate degree at Columbia College and her medical degree from the University of South Florida College of Medicine, she trained in general surgery at Massachusetts General Hospital in Boston. She also completed a fellowship in fetal surgery and research at Children’s Hospital of Philadelphia and a fellowship in pediatric surgery at Children’s National Medical Center in Washington, D.C. She is the General Surgery Residency Program Director and Vice Chair of Diversity and Inclusion at East Carolina University. She is the 2013-14 President of the Association of Women Surgeons and mother of 2 children.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, training **Tags:** womeninsurgery --- ### [Overcoming Bias](https://blog.womensurgeons.org/overcoming-bias/) **Published:** June 25, 2020 **Author:** mcooke@amrms.com **Content:** *By Joyce Majure, MD, FACS* The [Association of Women Surgeons](https://www.womensurgeons.org/page/History) (AWS) has come a long way since its founding in 1981. Looking back, it is amazing to see not only how our organization has grown, but also to see the progress we have made in our profession. Only 10% of my medical school classmates and co-residents were women. Constant comments about our looks, sexist jokes, demeaning remarks, and outright hostility were the norm. But I loved surgery from the minute I stepped into the operating room. I was warned about how bad it could be, how it was too difficult for a woman, how I would never have a family. However, I believed in myself and was not about to let a bunch of obstructionist men ruin my dreams. [Women now comprise 40% of general surgery residents](http://aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019), and the subspecialties are making progress towards gender equity as well. The statistics for underrepresented minorities however are quite discouraging. Only 10.8% of practicing physicians in the US are Black or Hispanic, with less than eight percent of medical school faculty. Only 13% of medical students come from these two groups, despite making up more than thirty percent of the US population. There are multiple other smaller ethnic groups that are also grossly underrepresented in medicine. [Figure 18. Percentage of all active physicians by race/ethnicity, 2018](https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018) While our focus has been dealing with gender bias and creating opportunities for women, we have failed to address the many other biases in medicine and surgery. We make judgments automatically about people based on their accent, their skin color, their clothing, their gender identity, their religion, and even their hairstyle. We need to start treating all our trainees as our future colleagues. We also need to identify ways to promote those who don’t look or act just like the majority of current surgical faculty. . People need to be judged by their accomplishments, their attitude, their work ethic, their creativity, and teamwork. We must learn to respect those who look different from ourselves, whether it be a patient or another surgeon, whether it is a nurse or a tech. Surgery is a difficult but ultimately rewarding career. People in authority are loath to cede their place to anyone, particularly those they see as “lesser than,” essentially anyone who does not look or think like them. Despite many studies that demonstrate increased productivity, creativity, and success in corporations with a more diverse culture, change is difficult. While gender bias is real there are multiple other biases at work. We in AWS have had much success in the battle of gender, but now we are faced with undeniable inequalities in healthcare delivery and surgical career paths based on race and ethnicity. What can we do to actively support women and persons from underrepresented backgrounds in our profession? We need to look at the lessons on gender bias and adapt them to overcoming these other biases. Some strategies that have proven worthwhile: - Mentoring students, residents, and junior faculty - Coaching people to identify their goals and find strategies and solutions - Suggesting underrepresented minorities for increasing roles and responsibilities who may have been overlooked. - Make certain they are included in complex cases in the OR, rather than assigning them scut work. - Welcome them by their proper name and title. Learn to pronounce names (and find out what each person prefers to be called). - Show by your speech and actions that they are your true colleagues and that you respect their contributions to the team and patient care - Speak up and challenge surgeons or others who may tell racist jokes. Let them know that is not acceptable behavior. Report them if they persist. - Support our juniors when they are subjected to hostile or demeaning remarks. Speak up if you can, or at least offer moral support later on. - Set specific goals for retention, promotion, and recruitment based.. - Explore ways to evaluate applicants and residents that can be blinded if possible. (The only way that orchestras began to include women and minorities was when they started doing auditions behind a screen!) - Engage our underrepresented minority colleagues to help identify solutions to navigate over and around the obstructions. - Educate and inform ourselves on the experiences and unique needs of our underrepresented colleagues. It is not enough to just restate the problem: it has been there in full sight for too many years. Marching and carrying signs may assuage our guilt and outrage, but we need to promote specific actions within ourselves and our institutions that codify and reinforce the necessary changes. There must be consequences for those who continue to hurt and disrespect others. There is plenty of surgical work to go around. Our actions speak louder than words, and we must find ways to actively “inspire, encourage, and enable” those who are struggling for acceptance in our profession. The strategies that helped us infiltrate the top echelons of surgery as women can be applied to minorities as well. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/06/Screen-Shot-2020-06-24-at-8.17.56-PM.png)Dr. Joyce Majure was one of the founding members of the AWS, authored and edited the first edition of the AWS Pocket Mentor, and started the first AWS newsletter. She has served as President of AWS, Treasurer for the AWS Foundation, and continues to serve as a Trustee of the Foundation. She was a private practice general surgeon from 1982-2012. She then became Chief Medical Information Officer at her hospital after retiring from active surgical practice. She has served as a preceptor for medical students, and served five years on the Advisory Council for General Surgery for the American College of Surgeons. She is now retired to a small mountain town in Idaho with her husband Christopher Moreno, MD, FACS, They have three children, and four grandchildren. She continues her interests in technology, healthcare, and women’s issues. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, gender differences, leadership **Tags:** #womeninedicine, womeninsurgery --- ### [Working Towards Equity in Surgery](https://blog.womensurgeons.org/working-towards-equity-in-surgery/) **Published:** June 18, 2020 **Author:** mcooke@amrms.com **Content:** By Patricia Martinez Quiñones As a nation, we are facing the reality that systematic racism exists at all levels, affecting the communities we live in, the institutions we train in, and the patient populations we serve. The recent events, from the start of the COVID-19 pandemic and culminating with the tragic deaths of George Floyd, Breonna Taylor, Ahmaud Amery, to name a few, have highlighted how a lack of diversity can lead to situations such as these. Unfortunately, this is no different in the medical community, both for its practitioners and its patients. As we process our emotions and overwhelming frustration, we must acknowledge the marginalization endured by physicians who are underrepresented in medicine (URiM), the challenges of discrimination and exclusion that they face, and the obtacles overcomed by many URiM to become a physician, a surgeon, and a leader. In a nation with a diverse population, it has become an urgent priority that our physician workforce represent the patient population we serve. Encouraging diversity and inclusion, and striving for equity, in medicine and surgery begins by educating ourselves and our peers. In United States medical schools, [women have reached parity with men](https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019); however, these gains of gender diversity among matriculating students have not been afforded to racial and ethnic minorities, especially Black and African Americans. Similarly, most surgical faculty are predominantly White and male. As of 2018, Black or African American and Latino or Hispanic surgeons only accounted for [7% of academic surgeons in the US](https://www.sciencedirect.com/science/article/pii/S0022480420302286?dgcid=coauthor). Diversity and inclusion is not limited to gender and race/ethnicity. Socioeconomic background, sexual orientation, cultural background, and religious beliefs must also be taken into consideration. Encouraging diversity and inclusion in these areas leads to diversity of thought and innovation and growth of departments, institutions, and organizations. While organizations like the Association of Women Surgeons (AWS), Association for Academic Surgery (AAS), Society of Black Academic Surgeons (SBAS), Latino Surgical Society (LSS), and Society of Asian Academic Surgeons (SAAS) are working to expand URiM in surgery, the question remains: *As individuals and as a surgical community, how can we make surgery and surgical training equitable for all?* Listen intently and keep an open mind. Reach out to your colleagues, trainees, and friends. Ask them about the challenges and difficulties that they may be facing. Inquire how you can help eliminate or lessen them. To become an ally and advocate, provide them with an opportunity to talk and express their emotions. Respect their right to share and *not* to share. Reflect on your conscious and unconscious biases. Everyone has them. Confront your biases and prejudices. Awareness of our own biases is the first step toward eradicating them. The [Implicit Association Test](https://implicit.harvard.edu/implicit/education.html) is a great tool to measure your attitudes and beliefs, some of which you might not even be aware. When reviewing candidates for awards, promotions, and leadership positions, ensure URiM colleagues are not overlooked and nominate them or encourage them to apply. To increase inclusion and retention of URiM and, ultimately, reach equity, we must advocate and become allies for our peers and promote their advancement. If asked for speaker recommendations, panel discussants, candidates for awards, or leadership positions, consider your URiM colleagues and trainees. Volunteer to serve as their mentor and/or sponsor for that award application, grant submission, or letter of recommendation. Lastly, I encourage you to become a catalyst for change. Although we have made some progress in increasing awareness and developing initiatives to promote diversity and inclusion in surgery, we must strive for equity. Achieving equity is a collective endeavor. As the AWS motto–“Engage, Empower, Excel”–goes, we must Engage with those who possess a diversity of culture and thought and Empower URiM around us to achieve their goals, providing them with the necessary skills to Excel and flourish in their environment. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/06/Screen-Shot-2020-06-17-at-8.47.59-PM.png)Patricia Martinez Quinones, MD, PhD, is a general surgery resident at the Medical College of Georgia at Augusta University. She plans to continue her career in academic trauma and critical care surgery. Patricia has served as the Chair for the AWS Resident and Fellow Committee and the AWS Blog Committee. She is a doggy-mom and wife who is passionate about promoting equity in healthcare, self-care, running, and healthy-living. You can find her on Twitter at [@PMartinezMD](https://twitter.com/PMartinezMD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** gender differences, leadership **Tags:** #medicine, AWS, AWSBlog, womeninmedicine --- ### [Video conferencing: Virtual interviews to virtual social hours](https://blog.womensurgeons.org/video-conferencing-virtual-interviews-to-virtual-social-hours/) **Published:** June 10, 2020 **Author:** mcooke@amrms.com **Content:** *By Chantal Reyna* A year ago, when I thought about technology in my career and medicine, the first thing I thought about was the electronic medical record: EPIC/Cerner/etc. Not all of these thoughts were pleasant. Since that time, my concept of technology in medicine has changed drastically. Now, I fully embrace it. The pandemic essentially forced unconventional means of communication and socializing: videoconferencing, virtual interviews, and virtual happy hours. I knew that there was a rise of online social networking, social media, and online apps, but the instantaneous utilization of videoconferencing, as a result of social distancing, left many heads spinning. Video calls have paved the way from telephone calls to video calls to now video conferencing. We keep saying video conferencing is new, but it has been around for almost two decades, being used in other aspects of life and business. LifeSize, a video conferencing app, was established in 2003, with Blue Jeans, Zoom, WebEx, Google Meet, Microsoft Teams, and many others being created over the next decade. Social distancing has also increased my awareness of cloud storage and programs (OneDrive, Google Drive, iCloud, Box) which allow people across the globe to access and work on documents, presentations, etc with ease and often simultaneously. From brief discussions with my colleagues, they tolerate the videoconferencing, but they cannot wait for the return of face-to-face conferences. While I agree to some extent, I believe we have an opportunity to learn new ways to encourage cooperation and expand horizons. Telephone conferences were used previously, but we know that the mute button is our friend as we multitask. In fact, while on a videoconference, we discussed that people are more engaged when there is video present rather than just audio. *Does the virtual face to face increase engagement? Does it minimize multitasking? Should video rather than audio be encouraged?* Regardless, the ubiquitous use of videoconferencing seems to have increased the number of meetings leading to what many have termed “Video Fatigue.” With the ability with meetings to take place every hour, more meetings appear to take place with fewer breaks in between. This can be exhausting as there is less time to stand up, stretch, get a beverage, or have a mental break. Personal well-being and mindfulness need to be encouraged during these times. Another use for videoconferencing has arisen out of necessity. Virtual interviews for medical school, residency, fellowship, and even employment are being performed. I overhear stories that the virtual interviews have gone very well. They included scheduled breaks and more relaxed settings. Perhaps this allows interviewees to shine and have better interactions. Although there are some concerns about minimal face to face interactions, gut reactions, and discerning “a good fit”, this may give way to structured or semi-structured interviews, which have designated themes or characteristics. While some institutions have already implemented structured or semi-structured interviews, it is not uniform. Virtual interviews for all levels of training pose challenges, which warrant consideration and forethought. For me, the most pleasant use of videoconferencing is the virtual social hour. I am a true extrovert. I gain energy from external sources, such as, talking to friends, family, and colleagues. During these times with limited contact, the ability to interact with people has been extremely difficult for me. I find myself longing to go outside anywhere just to talk to people. Fortunately, videoconferencing has provided a platform for such a purpose. In fact, I have had more virtual social hours with friends who live farther away whom I wouldn’t normally have seen.Videoconferencing provides new platforms for networking. I take this as a new opportunity. Videoconferencing has become more routine. As our comfort with it increases, we should embrace it and expand our horizons. We should use technology to collaborate beyond the usual borders, offer additional educational opportunities, and connect with family and friends. We are better together. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/06/Screen-Shot-2020-06-10-at-1.15.54-PM.png)Dr. Chantal Reyna is an Assistant Professor of Breast Surgical Oncology at University of Cincinnati College of Medicine. She is a fellowship trained, board certified surgeon, specializing in diseases of the breast. She received her medical degree from the University of Nevada School of Medicine, and completed general surgery residency at the University of Nevada School of Medicine, University Medical Center and Children’s Hospital of Nevada. Following her passion for breast cancer care, she pursued a fellowship in breast surgical oncology at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. Her research interests include minimizing axillary surgery. She has received many honors including, the University of Nevada School of Medicine Surgery Student of the Year, Chairman’s Professional Conduct Award, the University of Nevada Heart of Gold Award and Alpha Omega Alpha. She is a member of the American College of Surgeons, the Society of Surgical Oncology and the American Society of Breast Surgeons. You can find her on twitter [@kprgrl3](https://twitter.com/kprgrl3) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** AWSBlog --- ### [Pandemic Thoughts from a Surgeon and a Mom](https://blog.womensurgeons.org/pandemic-thoughts-from-a-surgeon-and-a-mom/) **Published:** June 4, 2020 **Author:** mcooke@amrms.com **Content:** *By Jennifer M. Weiss* We are a few weeks into our pandemic lifestyle. Physicians have been on the front line of this pandemic crisis. I am in a unique role as an orthopaedic surgeon. At the beginning of our preparations in March, one of my friends said, “if anyone thinks that orthopaedic surgeons are going to be caring for patients with Coronavirus, they are sadly mistaken.” As correct as he was, our duty to lead from where we stand is immense. When the CDC and the Surgeon General have recommended that we postpone elective surgery, we acted quickly to transition. We did not want to expose our patients to COVID-19. We did not want to use materials that were in short supply, like masks and protective gowns. We understood that the children of doctors, nurses, physician assistants, medical assistants, x-ray technicians, and orthopaedic technicians were home and in need of care. Our resources were and are short. We had to be ready to use these resources for the anticipated waves of sick patients. Our elective surgeries, like joint replacements, ACL reconstructions, shoulder arthroscopy, and carpal tunnel releases were postponed. We converted as many patients as possible to virtual visits, whenever safe. Social distancing is crucial to flatten the curve of spread. We quickly understood that it was necessary to avoid patients and healthcare professionals coming into mass contact to address issues that were neither urgent or emergent. Most patients received this information with grace and gratitude. People want to stay safe and to keep those on the front lines safe. Some true colors are shining through during this time. Support from so many. People were grateful that we worked long hours to do the right thing. Keeping public health and the greater good in mind, many have risen up, leaned in, and are supporting one another. And some are not. This has not landed for some of us. I had a patient’s mother yell at me in the early days of “stay safe at home” for the 2-day wait to see her child with a non-emergent problem. I received this without the compassion and empathy that I usually conjure. I am sure this woman was scared and frustrated, perhaps short on toilet paper, and daunted by the lines around the block at the grocery stores. She was likely overwhelmed with the mixed messaging coming from the press and our government. She was absolutely trying to advocate for her child, and she was certainly not able to see that we were far from business as usual in the orthopaedic clinic. I cannot blame her, but I did not have the ability to offer her what she needed‒ patience and understanding. Before the clear directive for lockdown was ordered, my 13-year-old daughter had a sleepover planned with a new friend. I do not know the friend’s parents. I should have canceled, but I felt bad for the girls and wanted to let them have one last hurrah before lockdown. In the middle of the night, my 10-year-old daughter woke up with a fever. I did not call the friend’s mother. I made the call to keep my sick daughter in our room away from the friend. This was not the right call. The friend’s family was correctly upset. All I could do was apologize, and this was received with much-appreciated forgiveness. That same weekend I went to my favorite Sunday yoga class, usually filled to the brim. There were five students, and a teacher dealing out everything I needed‒ hard work, deep breath, sweat, and focus. I was sure even this outlet would shut down within the week, and of course, it did. We continue to be so raw. As parents. As doctors. As people. Our leaders cannot get it right when there is no precedent in contemporary times. A partner texted me, “our leaders are waiting for word from other leaders, and it all feels like trying to do a U-turn in a big rig on a cul-de-sac.” I shifted to asking for forgiveness instead of permission. I did what seemed right. This is not the time for rule following, as there are no rules. I am going back to my Hippocratic Oath. Just trying to do no harm. To all of my tribe in medicine, let’s be patient with ourselves. Let’s support one another, and let’s remember that we have exited a world of patient-led care and “customer” service in medicine. As we do what we believe is right, we may not have consensus. The moral and ethical barometer that comes with the art and practice of medicine cannot be dictated or scripted in these times. Let it be said that we tried to do what was right with courage and even ferocity. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/06/Screen-Shot-2020-06-03-at-8.22.32-PM.png)**Jennifer Weiss** is an **Orthopaedic Surgeon** specializing in **Pediatric Orthopaedic Surgery and Sports Medicine**. Growing up as the daughter of an orthopaedic surgeon, Jennifer saw first-hand how male-dominated the world of medicine is. Throughout medical school, she encountered few female students and fewer women that were aspiring to become orthopaedic surgeons. From the start, it has always been her goal to help aspiring women to become successful surgeons — and to inspire women to enter the field of surgery and not be intimidated by this largely male profession. Dr. Weiss actively writes and speaks on the topic of women in medicine. She has served on the American Academy of Orthopaedic Surgeons Board of Directors, and is currently the Communications Committee Chair. She teaches communication skills to physicians, surgeons, and other health care clinicians both within her large integrated health care system in Southern California and within the Orthopaedic surgery societies. Her research is widely published, and she is an active leader and speaker within the medical community nationally and internationally. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events **Tags:** #COVIDsurgery, AWS, AWSBlog, WomenSurgeons --- ### [Covid-19: A Mexican experience](https://blog.womensurgeons.org/covid-19-a-mexican-experience/) **Published:** May 31, 2020 **Author:** mcooke@amrms.com **Content:** *By Dr. Rocío Carrera* In México, the Health Department has reported over[ 65,000 cases and more than 7,000 deaths (as of May 24th).](https://www.reuters.com/article/us-health-coronavirus-mexico/mexico-reports-65856-coronavirus-cases-7179-deaths-idUSKBN23000P) and 111 of these deaths have been[ healthcare workers](https://www.eluniversal.com.mx/english/mexican-healthcare-workers-are-dying-covid-19). It is known that my country’s health system has always had deficiencies; we fight against the lack of resources and physicians and nurses do not receive an adequate salary or benefits. The greatest challenge that national hospitals, administrators, and doctors have faced is to adapt the existing healthcare facilities for the pandemic. When positive cases of coronavirus began to appear in our country, some hospitals were designated as COVID-19 centers; at the beginning, my hospital was just a triage center, but as the cases increased, many places became saturated with little to no availability of ICU beds and ventilators, and it was when most of the public and private hospitals in the country had to be reconditioned in order to receive and attend to these patients. With the increase in the number of infections and deaths, doubts and fear also rose. Healthcare workers[ protested across the country due to lack of PPE](https://www.aljazeera.com/indepth/features/mexico-medical-workers-beg-ppe-200430115012143.html), students were withdrawn from their clinical rotations, massive staff resignations occurred, physicians requested unjustified medical leave,[ reports of attacks on hospital workers by communities fearing spread of the virus](https://www.nytimes.com/2020/04/27/world/americas/coronavirus-health-workers-attacked.html?searchResultPosition=30), and many people on the streets were not following the recommendations (stay at home if not an essential worker, avoid public gatherings, use of face masks, frequent hand hygiene). All of this created an atmosphere of uncertainty. The government was forced to hire doctors and nurses in a very short time to cover the demand for staff and the workload. Fortunately, in my hospital, we had the opportunity to prepare in advance and to have equipment available for all the staff. After several administrative adjustments, I was named chief of general surgery in March. I was happy because I thought it was a recognition of my work and effort, but soon, I felt overwhelmed by all the things that I had to coordinate and supervise. I also faced the doubt and apprehension of the older and more experienced surgeons in the department that took many of my decisions with mistrust. In addition to fighting their prejudices, I had to deal with my imposter syndrome. *Can I really do this? Did they name me chief because I’m the best or because they had no other choice?* Many questions like this have hung around my head these days. Overcoming this has been challenging but I have learned to accept that self-doubt is normal and even if I have many flaws I’m also very capable, hard-working, and willing to listen and learn from others. I have set realistic goals for my career and tried to take all this one day at a time. Also, I have mentoring from wonderful and amazing women surgeons who have shown me that it’s possible to be successful and an example for younger female trainees. Fortunately, my family, close friends, and, very importantly, the hospital managers and administrators have been very supportive and understanding. These have been very hard weeks, with a[ full hospital since early April](https://www.reuters.com/article/us-health-coronavirus-mexico-hospitals/hospitals-treating-covid-19-in-mexican-capital-quickly-filling-up-idUSKBN22L0WF), we are tired and overwhelmed after seeing patients, many of them relatively young and healthy, dying every day. The first time I had to enter a COVID-19 area was to place a central line, and as I put on the full PPE, I felt really scared for the first time in my career. Some colleagues left their homes and many of us took other measures of isolation in our own houses because of the fear of infecting ourselves or our families. All that stress and worry are affecting many healthcare workers emotionally. There have also been good days. Many people and some institutions have organized to donate money, equipment, and food to healthcare personnel. Some senior physicians came out from retirement, and many general practitioners and students volunteered to help. This type of support from society and the commitment of healthcare workers has buoyed our spirits on the hardest days. In addition to the great camaraderie and solidarity that has developed among all hospital staff are what often urges us to continue working, despite the limitations that have always existed in our country. My most sincere appreciation and admiration goes out not only to the doctors, but also to all the nurses, administrative staff, and laboratory and sanitation personnel, who have made it possible for the entire health system to continue to function, despite the danger and fear. Although it is likely that we can never return to ‘normality’ and that healthcare and the way that hospitals work will change significantly all around the world, we hope that the COVID-19 pandemic will pass soon but that the environment of solidarity and cooperation remain as an example of one of the best lessons learned. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-31-at-4.14.21-PM.png)*Dr. Rocío E. Carrera Cerón is a general and thoracoscopic surgeon and the current chief of surgery at* [*Hospital General Ajusco Medio*](http://data.salud.cdmx.gob.mx/portal/index.php/um-sedesa/99-hospital-general-ajusco-medio) *in Mexico City, Mexico. She received her medical degree from Universidad Nacional Autónoma de México* [*(UNAM)*](http://www.facmed.unam.mx/) *in 2012 and completed her residency and fellowship at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (*[*INCMNSZ*](http://www.incmnsz.mx/opencms/contenido/cirugia/objetivo.html)*) in 2017 and 2018 respectively. She has been accepted in the Esophageal Research Fellowship Program, at the University of Washington School of Medicine starting this summer. She is engaged in clinical research studies and actively participates in local associations of women surgeons trying to establish mentorship and sponsorship programs for young residents. A native of Mexico City, she is passionate about sports, cinema and historical novels. You can follow her on Twitter* [*@ChioCarreraC*](https://twitter.com/ChioCarreraC)*.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, leadership **Tags:** AWS, AWSBlog, womeninmedicine --- ### [Making the Leap from Trainee to Staff Surgeon](https://blog.womensurgeons.org/making-the-leap-from-trainee-to-staff-surgeon/) **Published:** May 27, 2020 **Author:** mcooke@amrms.com **Content:** *By Lakho Sandhu* *‘The more I read, the more I acquire, the more certain I am that I know nothing.’ –Voltaire* The moment you’ve dreamt about for years finally arrives. You pack up your belongings and move across the country or perhaps just down the hall, to start a new journey as a staff surgeon. Without a doubt, it’s an exciting moment *–* the culmination of years of dedication, hard work and sacrifice. It’s also a significant transition into a new role that can stir feelings of doubt and anxiety. A sense of imposter syndrome can make even the most confident among us start to second guess themselves. During my first 18 months of practice, I received many pearls of wisdom from colleagues and mentors that have eased my transition from trainee to staff surgeon. What follows is by no means an exhaustive list but just a few lessons that I hope will help you on your journey. **Set yourself up for clinical success by being selective about your early case-mix** A colorectal surgeon I admire did not tackle recurrent rectal cancer referrals during her first six months of practice. She knew how important it was to have good clinical outcomes to build her own confidence and to gain the respect of her colleagues. This was especially true given she was working at an institution where she had not previously trained. By taking a graduated approach, she wanted to have a few “wins” under her belt before tackling the tougher cases that inevitably would come her way. I acknowledge that not everyone can be this selective when starting out, but if you can, avail yourself of the opportunity. **Be prepared to come across the weird and wonderful** There will be moments when you encounter disease processes and presentations that you have never heard of let alone cared for before. This is not only to be expected, but this appears to be a rite of passage. **Reach out to others who are also starting out** Several of my closest friends are also early career surgeons, and we are an unofficial support group for one another. We run cases and complications by each other, discuss billing strategies, and share plenty of laughs along the way. Hearing my friends confirm that they share many of my concerns has made me feel far less alone. **Negotiate for leeway in hiring administrative assistants** You will spend a significant amount of time working with your administrative assistant. Patients and other clinicians will often interact with this person before they have ever met you. Hiring someone you can see yourself getting along with can make all the difference. **Find a financial planner, accountant, and insurance specialist** Many of us have accumulated a fair amount of debt throughout the course of our training, so we become focused on debt reduction when earning a staff salary. This is an opportunity to tackle this as well other financial goals.If possible, find experts who do not receive a commission from specific financial institutions for selling their products. **Setting expectations with trainees** Before every case, I take a moment to ask the senior and junior residents what part of the case they are especially excited to perform. I let them know that if we are failing to progress, I’ll particularly give them extra time when working on these portions of the case. I will also openly acknowledge that as a newer staff, my threshold for taking over may be different than others, but this too will evolve with time. **Find yourself different mentors for the various aspects of your career** A recent [population-based study](https://www.cmaj.ca/content/192/15/E385) found that increasing surgeon age was associated with decreasing rates of postoperative death, readmission, and complications in almost a linear fashion. Finding a senior colleague who is both approachable and highly skilled provides you an opportunity to benefit from the breadth of their experience. Your clinical mentor, however, may not be the person you turn to for advice regarding grant writing. Identify those who can help you and don’t be shy about reaching out. **Set realistic goals** A few years ago, I saw an early career surgeon leave his first job in academia for private practice after he was asked to take on an unrealistic number of educational and research projects. While some of these goals he cared about deeply, others simply did not provide him with meaning. Only you know what matters most to you, so protect yourself and set realistic goals whenever possible to ensure your success. **Cut yourself some slack** Remember that you are a well-trained surgeon who has spent years refining your judgement and technical skills. Take the opportunity to be kind and reward yourself for your hard work. Hire a cleaning service, get a meal delivery plan, or work with a personal trainer if these changes add to your quality of life. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-27-at-10.48.03-AM.png)**Lakhbir “Lakho” Sandhu**, **MD PhD FRCSC** is a surgical oncologist and general surgeon in Hamilton, Canada. After obtaining her medical degree from McGill University, Lakho completed a general surgery residency at the University of Toronto. During her residency, she obtained a PhD in clinical epidemiology from the Institute of Health Policy, Management and Evaluation at the University of Toronto. She completed her training in surgical oncology at MD Anderson Cancer Centre in Houston, Texas. In her free time, she enjoys traveling and biking. You can follow her on Twitter [@Lakho\_Sandhu](https://twitter.com/Lakho_Sandhu). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice, reflection, training **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Navigating The Red Tide: Menstruation and Myths in the OR](https://blog.womensurgeons.org/navigating-the-red-tide-menstruation-in-the-or/) **Published:** May 20, 2020 **Author:** mcooke@amrms.com **Content:** *By Joy Alvarado* Although there have been major advances in the field of surgery toward gender parity, some circumstances that are unique to women still remain poorly addressed. One such circumstance, colloquially known as The Red Tide, Aunt Flo, The Monthlies, The Cycle, or Shark Week (for those National Geographic fans; *i.e.* dealing with menstruation), still seems to challenge our expectations of what a surgeon should look like. At a minimum, it still induces fear of mythical proportions in young women who are considering the field. I know this to be true, because as a young woman entering surgery I heard many horror stories during medical school. They always starred a 4th year student or surgical resident who suddenly experienced The Red Tide oozing down her leg during an operation. Our protagonist would not be able to scrub out to change her clothes and would have to suffer with a growing, unconcealable red stain garnering the attention of everyone in the room. I remember hearing similar stories in middle school, except instead of being in an OR, the hard-working and well-meaning girl would be in a classroom. What makes these stories truly horrific is not the scarlet stain (although it is a pain to wash out) but the reactions from those who witness it. In grade school, having an accident would not only evoke laughter from other students but also, and perhaps more fearsome, genuine concern. The student who was bleeding would have to go to the nurses’ office. She would have to be removed from the classroom activity. She would have to change clothes or wear a jacket around her waist, heightening her growing self-consciousness with a new fear that any wrong movement could reveal her plight. When she came back to the classroom, for a few moments she would have to face the concerning looks from her peers, asking “What happened?” and “Are you OK?” Finally, she would be faced with the teacher’s inevitable question: “Do you want to rest for a little while?” This concern is not a bad thing on its own. Those of us who have experienced cramps or moodiness, and especially those of us who did not like Physical Education, can attest to the glorious option of resting and the kindness of nurses. However, there are times when this concern becomes limiting, for example, when other children assume you aren’t capable of playing sports well or when you come back from the nurses’ office and find out that you missed a key part of the lesson. Worse is when the concern turns into suspicion, when students start to think that maybe you left the activity on purpose or maybe you like the attention from the nurse and you don’t want to participate in class activities like everyone else. Perhaps other students become resentful of the fact that they had to work harder while you were gone. Although embarrassing, the greatest fear is not that you are having blood stains on your pants. For ambitious girls, the greatest fear is that you are considered a weaker team member than everyone else, that, no matter how hard you work, if you have an accident you will not be able to fully participate, and any special accommodations made for you will slow everyone down. In the OR, this fear is heightened as “participation” is more than classroom activities or dodge ball. It’s your career. In the minds of young women considering surgery, the embarrassment of having blood show through their scrubs is minuscule compared to the fear of what happens afterward. They must either stand there with blood running down their legs or ask that the team pause the operation, allow them to scrub out, and have a fellow resident take their place while they go to the bathroom. Even after this request is granted, while frantically changing into new scrubs, it doesn’t stop the fear in their minds: *Am I now considered the weakest team member?* Perhaps these fears are unfounded and many of the The Red Tide horror stories are mythical, but myths are often seeded in historical truths. Menstruation was once thought to be a curse, even providing proof (in some sects of Christianity) of God’s anger at Eve for the fall of man. In ancient Greece, the term [‘hysteria’](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480686/#R18) was used to describe a condition in which a uterus full of blood wanders around in a woman’s body, causing psychiatric disturbances. In the 1900s, the term ‘hysteria’ was still being used by physicians to describe the [mood swings](https://www.nytimes.com/1982/03/07/magazine/dispelling-menstrual-myths.html) associated with menstruation. In the past, menstruation and its related symptoms were used as a way to deem women unfit for certain careers. Today, there is still a fight for “menstruation equality,” with the [tampon tax controversy](https://aeon.co/essays/throughout-history-and-still-today-women-are-shamed-for-menstruating) taking center stage. It is no wonder that myths continue to propagate in fields dominated by men. In fact, I am in the military, and the myths I’ve heard about bleeding in uniform during outdoor drills are just as harrowing as the ones I’ve heard in the OR. However, due to the increased presence of women in the military, for every myth I’ve heard, I’ve also heard a good piece of advice. For example, using particular uniform pockets for storing tampons so that they stay dry, or taking strategically timed bathroom breaks during boot camp. The good thing is that drill sergeants and military leaders are now encouraged to excuse women when possible to change their pads or tampons, and the military at-large has been educated on the damaging effects of sexist commentary on attrition, training, and performance. The message is clear: when we make gender discrimination a thing of the past, everyone benefits. Despite these gains in gender equality, circumstances unique to womanhood are still causing fear in those pursuing male-dominated careers. The fact is, women are a new presence in surgery. Even as recently as the 1980s, women were estimated to only comprise up to [2% of surgical residents](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724816/). In the past, our periods were not regarded as a normal part of life, but as something that caused us to become ill and less than. There is a greater moral here, and as we continue to fight toward gender parity, it is important for us to contemplate the reasons why these tales continue to exist. Where is this fear coming from? Perhaps we can push toward gender parity faster by dispelling the myths, and ensuring that our response to menstruation doesn’t inadvertently limit our fellow female surgeons. I wish that for every horror story I heard about menstruation in the OR, I heard some great piece of advice from a woman surgeon. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-20-at-6.47.35-PM.png)Joy Alvarado holds a Bachelors of Arts in English from the University of Texas at Austin, a Masters of Health Science from Johns Hopkins Bloomberg School of Public Health, and a medical degree from the University of Texas Rio Grande Valley School of Medicine. She is also a Captain in the US Army. She is passionate about alleviating health disparities, and enjoys oil and acrylic painting. She maintains a blog with her artwork [here](https://drjoyartstudio.com/). Follow her on Twitter [@thejoyalvarado](https://twitter.com/thejoyalvarado) --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** self-care, training, women **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [COVID has obliterated Work-Life Balance and exposed Gender Inequalities](https://blog.womensurgeons.org/covid-has-obliterated-work-life-balance-and-exposed-gender-inequalities/) **Published:** May 13, 2020 **Author:** mcooke@amrms.com **Content:** *By Pam Choi* The COVID era has brought forth unprecedented times. Schools are closed, and clinics/elective cases are canceled. As a result, many of our schedules have changed. We were still taking the same amount of call, but we were not coming into the hospital as frequently. “My workout schedule is great.” My male surgery colleague exclaimed. I looked at him blankly. We were the same level. He was a father with 2 young children. But his wife was still home from maternity leave, and his mother-in-law and au pair were also still with them. I, on the hand, had put on some weight during this time. At baseline, [professional women still do more household work](https://academic.oup.com/sf/article/91/1/55/2235879) than professional men. But COVID has skewed the entire work-life balance and destroyed the childcare equilibrium we had had in place before, making the gender inequalities even more apparent. To be fair, my husband, who is a software engineer and works from home, has taken the brunt of home-schooling activities. When I am at work in the hospital, which is still most of the time, he is the one who is struggling to figure out how to work and teach/entertain our son at the same time. As such, we had generally agreed that when I was “working from home”, I would try to help out and take care of our son. But ultimately, even when I am at home, I also still have work to do. This is how I work from home. I still get up at 0500 because that is the only time I have to myself to work until 0700. In the last few days, I’ve submitted an abstract, finished a case report, a Grand Rounds presentation, and worked on some surgical Committee tasks. But I am also trying to teach 2-digit addition subtraction, the difference between noun and verb, and keep our 6-year old from climbing the walls. Even at this very moment, I am “working from home.” But I’m also doing laundry, trying to finish a manuscript, trying to finish this AWS blog essay, and also trying to get my son to sit down and finish his math problems. Frankly, I feel like I’m doing a terrible job at everything (except for the laundry- at least I know how to do that). The quality of my work has suffered. And my son and I have had more arguments now than we’ve ever had before. I’ve literally just sent him to his room because he was trying to draw on the table. Overall, it’s not a great feeling. “Self care” is easy to say, harder to do. But why does it seem all that much easier for my male colleagues to do? As I had said before, these times are unprecedented. The situation is unique- such that we haven’t outsourced some of the household work or childcare/teaching as we would typically do if not for the Pandemic. It’s not really anybody’s fault, per se. It’s just exposing the gender inequalities that were there all along. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-13-at-12.37.35-PM.png)Pam Choi ([@pmcho](https://twitter.com/pmchoi)i) graduated medical school at the University of Rochester and completed general surgery residency at Washington University in St Louis. While in St Louis, she met her awesome husband, Nick, and had their son, Calvin. After residency, she was the ship surgeon for an aircraft carrier as an active duty Navy officer. She is presently the senior pediatric surgery fellow at Children’s Mercy Hospital in Kansas City. In her free time, she enjoys eating, conquering Escape Rooms, and visiting National Parks with her family. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized **Tags:** AWS, AWSBlog, womeninsurgery --- ### [Trauma in the Time of COVID](https://blog.womensurgeons.org/trauma-in-the-time-of-covid/) **Published:** May 10, 2020 **Author:** mcooke@amrms.com **Content:** *By Jeff Claridge and Lillian Kao* As trauma surgeons and acute care surgeons, we are available 24/7 for all types of emergencies and crises. We often find ourselves at the epicenter of disasters, such as mass casualty incidents. As part of disaster preparedness training, we are instructed in utilizing and running an incident command center, working locally and regionally to coordinate care between services and institutions, managing units and multiple patients, triaging patients to those centers with the right resources, and dealing with extraordinary life and death decisions. However, few if any disasters have tested trauma surgeons and health care professionals to the scale of the COVID-19 pandemic. Rarely, outside of war, have we had to simultaneously manage a disaster of such large magnitude across the country and the world. Now, health care professionals are soldiers and are among those who are putting their lives on the line. In trauma care, there are tried and true algorithms for the recognition and diagnosis of injuries, and there are proven management strategies. We are classic “doers and fixers”, but our instruments are often most effective in the operating room and involve surgically tackling catastrophic injuries. This is different! We are very limited in our treatment options, and surgical solutions are not apparent and may carry extra complications to the patients and risks to the surgical team. In this pandemic, much is unknown. We continue to struggle with COVID testing and with assessing the prevalence of asymptomatic carriers. Defined treatment strategies are unproven and fraught with controversy. Furthermore, most mass casualty incidents are short-lived and affect only a segment of the population at one time. Despite multiple models for predicting COVID spread, it is unknown when life will return to some sort of “normalcy”. **There is also a tremendous amount of uncertainty as we go to work every day and as we move forward in our profession.** Amidst the uncertainty, however, we find comfort and solace where we can. We are still an integral part of healthcare today. Our ability to continue to maintain our routines and contribute helps to lessen our feelings of helplessness incurred by the pandemic. Despite stay at home orders and social distancing, people are still being injured in motor vehicle collisions and by other mechanisms; there is still a need for trauma care! There is something oddly soothing about going through the A-B-Cs of trauma resuscitation. Nonetheless, even trauma care has been affected by the pandemic, from the types of injuries being seen to the way that trauma patients are being evaluated to the kinds of specialists now caring for trauma patients. As everyone is being asked to play an important role in this fight, there are countless stories of sacrifice, ingenuity, and resilience. Perhaps, most importantly, we have seen how despite “social distancing”, the pandemic has also united us in a fight against a common enemy. Thus, we would like to use this forum and to encourage the use of the term “physical distancing” instead of “social distancing”. In the words of Gabriel Garcia Marquez, author of Love in the Time of Cholera: *“The heart’s memory eliminates the bad and magnifies the good, and that thanks to this artifice we manage to endure the burden of the past.”* Although it is hard to see the light at the end of the tunnel, this too shall pass. We will get through this together. We may even come out of this stronger and more resilient! #StrongerTogether In keeping with the motto that we are “stronger together”, we hope that the upcoming combined [AWS](https://www.womensurgeons.org/)/[AAST](https://www.aast.org/Default.aspx) Tweetchat will bring together our collective experiences and help us to weather this pandemic. **Many of us wonder if we are doing enough.** **The feelings and emotions this current pandemic evokes in our hearts and minds are difficult to put into words and worthy of talking about for years.** We will be discussing the following topics during the tweetchat that may help us get stronger together: 1. Has your trauma center seen a difference in the number and types of injuries since stay-at-home and physical distancing mandates have been put into place (i.e. more intimate partner violence or child abuse)? 2. What has your role been during the pandemic? Do you worry that you have not been able to do enough? 3. What has your hospital done to ensure capacity for COVID positive patients? What has your trauma center done to ensure its ability to continue to care for both injured and COVID positive patients? 4. How can we ensure learners are educated safely and effectively during physical distancing? If you are a learner, do you feel education is safe and/or effective? How we can do better)? 5. How have you addressed your personal wellness in this time of uncertainty? 6. Do you have concerns about future job opportunities, job security, or salary as a result of the pandemic? Join the [Association of Women Surgeons](https://www.womensurgeons.org/) in a tweetchat to discuss trauma in the time of COVID-19. This #AWSchat will be hosted on Monday May 18th, 8pm Eastern Time. To participate, follow [**@womensurgeons**](https://twitter.com/WomenSurgeons) along with our blog authors Dr. Lillian Kao ([@LillianKao1](https://twitter.com/LillianKao1)) and Dr. Jeffrey Claridge ([@ClaridgeJeffrey](https://twitter.com/ClaridgeJeffrey)), as well as moderators Dr. Stepheny Berry ([@Dr\_Stepheny](https://twitter.com/Dr_Stepheny)) and Dr. Bryce Robinson ([@traumabryce](https://twitter.com/traumabryce)). The questions will be posted directly from the [**@WomenSurgeons**](https://twitter.com/WomenSurgeons) twitter account and you can also find them following the hashtag [**\#AWSchat**](https://twitter.com/search?q=%23AWSChat&src=typd). If you haven’t participated in a tweetchat with us before, check out this [**tutorial**](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([**@heatheryeomd**](https://twitter.com/heatheryeomd)) to know more. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Claridge.png) Jeffrey A Claridge, MD, MS is the Service Line and Division Director of Trauma, Burns, Critical Care and Acute Care Surgery at MetroHealth Medical Center in Cleveland, OH. He is a Professor at Case Western Reserve University School of Medicine. He is the current state chair of the Committee of Trauma for Ohio and is the President Elect for both the Surgical Infection Society (SIS) and the Eastern Association for the Surgery of Trauma (EAST). He went to medical school at the University of Rochester and did his surgical residency at the University of Virginia. Dr. Claridge did his critical care and trauma fellowship at University of Tennessee in Memphis and moved to his current location in Cleveland in 2005. His twitter handle is [@ClaridgeJeffrey](https://twitter.com/ClaridgeJeffrey). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Kao.png) Lillian S. Kao, MD, MS is Professor and Division Chief of Acute Care Surgery at McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth). The division staffs the Red Duke Trauma Institute at Memorial Hermann Hospital-Texas Medical Center which admits over 5,000 adult trauma patients per year. She is also Vice Chair of Research and Faculty Development and one of two Vice Chairs of Quality in the Department of Surgery. She is the co-founder and co-director of the Center for Surgical Trials and Evidence-based Practice (C-STEP). She is a past president of the Association for Academic Surgery. Her twitter handle is [@LillianKao1](https://twitter.com/LillianKao1). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the authors and are not necessarily the opinions of the Association of Women Surgeons or the American Association for the Surgery of Trauma.* **Categories:** AWSchat **Tags:** AAST, AWSChat, covid19, surgery, trauma, trauma surgery, Tweetchat --- ### [Announcing the 2020-2021 AWS National Medical Student Committee](https://blog.womensurgeons.org/announcing-the-2020-2021-aws-national-medical-student-committee/) **Published:** May 7, 2020 **Author:** mcooke@amrms.com **Content:** *By Cheryl Zogg* From a simple sign at a national conference to a thriving organization with thousands of members around the globe and key collaborations with many of the world’s leading surgical societies, the Association of Women Surgeons has grown into an influential organization that continues to touch the lives of women surgeons throughout their careers. In few places is AWS’s influence more evident than in what the organization has come to mean to its medical student members, the women surgeons of tomorrow. Following the most competitive application cycle in the Association of Women Surgeons National Medical Student Committee’s history with more than 140 applications for 22 roles, it is my extreme pleasure as the incoming Committee Chair to introduce the 2020-2021 National Medical Student Committee: ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-07-at-1.27.28-PM-1024x607.png)![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-07-at-1.27.49-PM-1024x507.png)Hailing from 7 countries, 17 US states, and 7 different AWS regions (not counting the Regional Representatives, who themselves come from 11 of 12 different AWS regions around the world with medical student chapters), this group of passionate, talented, and inspiring surgeons-to-be blew us away! I am thrilled to get to work with them this year and to continue to build on the incredible accomplishments that last year’s Committee set as an example. It is moments like these that make it clear in my mind why I am a part of AWS and why I will continue to be throughout my career. In writing this blog to celebrate the start of their terms as a part of the National Medical Student Committee, I want to share with you what it is that AWS has come to mean to us as the medical students whose lives this organization continues to touch in deeply meaningful ways. **Shan Lansing, Vice Chair (2020-2021):** Being involved with AWS has been an instrumental part of my journey to a career in surgery. I joined the AWS National Medical Student Committee in 2019 to give back to the organization that gave me a multitude of opportunities. As a member of AWS, I served as a reviewer for *The American Journal of Surgery*, presented research at the AWS [Annual Conference](https://www.womensurgeons.org/page/AnnualConference), and connected with strong surgeon mentors. Serving as Social Media & Marketing Coordinator (2019-2020) was a unique opportunity to contribute to all of our major committee-wide initiatives and utilize AWS platforms to share the opportunities and resources with medical students across the globe. Among many projects, we used social media to recruit mentors and mentees for the inaugural URM Mentorship Program, share our [subspecialty resource guides](https://www.womensurgeons.org/general/custom.asp?page=SpecialtyResourcesGuides), and request input from Underrepresented in Medicine (UiM) surgeons for a qualitative study on the impact of intersectionality. I am so looking forward to overseeing the continuation of these programs as Vice Chair and supporting new initiatives that our incredible incoming Committee will pilot. **Abra Shen, Chief of Chapter Development (2020-2021):** I have truly loved working with an international group of passionate aspiring women surgeons! As the New England Representative (2019-2020), I had the opportunity to organize and lead a regional conference that brought together almost 50 medical students and 20 residents and attendings in workshops, panels, speed networking, and talks (including a keynote by my mentor Dr. Susan Pories)! I also contributed to committee-wide initiatives such as developing specialty resource guides and assisting with research projects focused on sharing the stories of women in surgery. It was a joy to work with AWS chapters within my region last year, and I’m thrilled to be working with all Regional Representatives this coming year as the Chief of Chapter Development. AWS has provided me with life-long mentorships and friendships which I will always be grateful for. I’m so excited to welcome the incoming Committee to this family and work with them on strengthening the community of AWS members all over the globe! The lasting friendships, life-changing opportunities, career advancements, impressive accomplishments, and amazing group of women surgeons we get to interact with on a daily basis are powerful and lasting gifts felt by us all. This is why we are a part of AWS, and it is certainly [\#WhyIAWS](https://twitter.com/search?q=%23WhyIAWS&src=typed_query). To borrow a line from our outgoing Committee Chair [Ashley Choi](https://blog.womensurgeons.org/medical-students/whyiaws-calling-on-all-medical-students-md-do-mbbs-pursuing-surgery/): this is my tribe and my home. To the outgoing Committee and AWS as a whole, thank you for all you do! ![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-07-at-1.32.05-PM.png)![](https://blog.womensurgeons.org/wp-content/uploads/2020/05/Screen-Shot-2020-05-07-at-1.32.46-PM.png) Cheryl Zogg, MSPH, MHS, is an MD-PhD Candidate at Yale School of Medicine where she is currently in the process of completing her PhD in Chronic Disease Epidemiology (Quantitative Health Services Research). She is the incoming 2020-2021 Chair of the AWS National Medical Student Committee and a Medical Student Member of the AWS Blog. Her clinical and research interests lie in the intersection of health policy and quality as it pertains to outcomes of surgical patients and differential access to care. She is funded by an F30 from the National Institute on Aging. Outside of work, Cheryl is an avid dancer, traveler, bookworm, and (aspiring) runner who loves to mentor and teach. She anticipates a career in academic surgery with an intention to combine cutting-edge clinical research and clinical practice. Cheryl is excited to return to her third year on the AWS National Medical Student Committee and to work with an amazing group of women rising to leadership this year! She can be found on Twitter [@CherylZogg](https://twitter.com/cherylzogg?lang=en). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWS --- ### [The Distance Between Two Worlds](https://blog.womensurgeons.org/the-distance-between-two-worlds/) **Published:** April 29, 2020 **Author:** mcooke@amrms.com **Content:** *By Alyssa Brown* I want you to think of your first love. Close your eyes, and think of them. Mine was a blonde-haired nerdy linebacker on my college’s football team. I remember the heartbreak of him moving 14 hours away. We broke up when he moved—a common story for many of us. I was starting my senior year of college and applying to medical school, and he was getting his Master’s in Physics. Whenever I was sad about the breakup and listening to “our song” ([Rollercoaster by Blink 182](https://www.youtube.com/watch?v=WEtYP25JO8k)), my best friend Marlee always said, “Absence makes the heart grow fonder.” While our paths diverged and we never reunited, I’ve always liked the sentiment of the phrase. If you are wondering why you are reading about first loves on a [surgical blog](https://blog.womensurgeons.org/medical-students/black-clouds/), I get it. I didn’t think the sentiment would apply to medicine. I think many of us have thought of the first time we entered the operating room or scrubbed in. I sure do. I remember the patient, which scrub I used, and even the pattern on the surgeon’s scrub hat. This was five years ago now, and if I close my eyes, I still smell the bovie and hear the whine of Mick Jagger singing Honky Tonk Women, and yes, [Mick Jagger](https://blog.womensurgeons.org/medical-students/gimme-shelter/) seems to follow me to the operating room. From the first day in the operating room, I tried to spend as much time as I could with my [mentor](https://blog.womensurgeons.org/mentorship/prosciutto/) in the [operating room](https://blog.womensurgeons.org/medical-students/the-a-ha-moment/). I was enchanted. During third year, I would even sneak back for her [call nights](https://blog.womensurgeons.org/medical-students/the-a-ha-moment/) and weekends, like a lunatic. I don’t get to scrub in as much as I used to. I paused medical school after third year, in 2018, and I moved to Rochester, MN to start a PhD in Biomedical Engineering and Physiology. Once I started my PhD, I quickly realized that I would not get as much OR time. Research work with cells and animals took up most of my time. Every time I travelled back to visit my medical school friends, I would inevitably end up in the operating room with my mentor. I know it’s weird. I just missed it. After a year and a half in my PhD, I get to sneak away sometimes. I schedule half-days to shadow with my mentor here. I round with the pediatric surgery teams on two weekends a month. I didn’t realize how much I would miss medicine until it was gone. It was no longer part of my daily life. I walk past patient rooms on the way to my laboratory in the mornings. I try not to think about their possible medical problems or why they are admitted. If I think about it too much, I get lost missing medicine. When I talk to my friends who are [now interns](https://blog.womensurgeons.org/medical-students/waiting-your-turn/), I live vicariously through their stories and patients. I realize how much I am missing. This March, I travelled back to medical school to complete three weeks of outpatient pediatrics. I had not finished the clinical hours required before I moved for my PhD. In the fall, we made a plan. I would finish this time in March. I only had to complete the hours: no shelf, no quizzes, no assignments. I was going to get back to medicine. I had my [white coat](https://blog.womensurgeons.org/medical-students/confessions-of-an-ill-equipped-third-year-medical-student/) ready to go. I was so nervous. Questions kept running through my mind. *Would I still know how to be a good student? Would I have forgotten everything? Do I still know how to write a “good note”? Would I screw up?* Here are the questions I got instead: “*Are you a visiting student? Have you taken Step 1? What year are you in? Why aren’t you taking the quizzes? Are you an intern?*” The answers were no, yes, somewhere in purgatory between third and fourth, I have completed them before, and no, but all my friends are. The first morning back, I woke up two hours early to get ready. The walk to the hospital felt like walking to a first date. I had butterflies in my stomach, and I was grinning from ear to ear. I took a deep breath and buzzed into the newborn nursery. To my surprise, the first thing I saw was a familiar face. My classmate and friend from medical school was the pediatrics intern. The other third year medical student assigned to the newborn nursery was also a classmate and friend from medical school. We confused the attending when we said we all started medical school in the 2015 incoming class. We were all supposed to graduate in 2019, and only the intern did. We all had our different reasons of course, and we had different paths. It was nice to have familiar faces around me. It was like riding a bike. I fell back into the rhythm of medicine, like I never left. I was happy to be back, and I was happy to feel useful. I felt like I was home again. I wasn’t in the operating room, but it still felt so good. It was like taking a deep breath after being underwater. I had forgotten plenty of things like the HEADSS score and well-child exam questions. I also quickly realized I forgot my stethoscope. I did remember how much I loved patients. I had missed reading through the charts and missed hearing the patients’ stories. I missed results. In research, I get results, but this is often after spending days to weeks to months troubleshooting and validating the experiment. I forgot how satisfying it was to order a rapid influenza or strep test and getting the answer within the hour. Don’t get me wrong, it is satisfying to get those research results after playing the long game and solving a problem. It is incredibly satisfying, but I missed the immediate effect of medicine. Absence makes the heart grow fonder. Being gone from medicine made me realize how much it meant to me. My rotation was cancelled after a week and a handful of days because of Covid-19. After lunch, they just told us to go home. Home was 14 hours away. The initial shock wore off, and I started crying like I had just been dumped. I hate to admit I did. I was sad. I was sad I had to leave and go back to my PhD. I had just gotten back to my happy place, medicine, and I already had to leave. It felt like I was leaving part of myself behind. Absence makes the heart grow fonder. I am sure I will miss research when I go back to medical school. I know I will be back in medicine, and it will be soon. It is something I can look forward to on the horizon. I appreciate the strange path I am on, and I am happy for the perspective it has given me. Just like I am still happy I met my first love. I am happy I have both medicine and research. I still can’t wait to be scrubbing in again with the orange soap and the 7.5 green gloves. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/04/VSAS_0449.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and congenital diaphragmatic hernia. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for two years, and she has loved writing pieces for the blog over the past two years. When she is not buried in lab work, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram [@Alyssa\_b\_futuremdphd](https://www.instagram.com/alyssa_b_futuremdphd/) and on Twitter [@Alyssa\_B\_MDPhD. ](https://twitter.com/Alyssa_B_MDPhD)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, research **Tags:** AWSBlog --- ### [Tips and Tricks for Surviving COVID-19 as a Medical Student](https://blog.womensurgeons.org/tips-and-tricks-for-surviving-covid-19-as-a-medical-student/) **Published:** April 22, 2020 **Author:** mcooke@amrms.com **Content:** *By Camila R. Guetter* During the COVID-19 pandemic, medical students are facing many changes in their education and schedules. Lectures turning into a virtual format, cancellation of clinical rotations, and closure of exam centers, to name a few. We understand how all these changes can make students feel anxious and stressed. Although as healthcare workers we all recognize and support the need for social distancing and other measures to flatten the curve, it is completely valid to feel frustrated and anxious as your plans constantly change. These are definitely unprecedented times. As a result, we are all facing the need to reinvent ourselves and adapt our habits, goals, and expectations to the situation. In this article, I want to discuss how this is especially true regarding medical education, and how medical students across the United States and around the globe are having to adjust their daily study routine and figure out how to stay well (mentally and physically) and productive while social distancing. Here are some thoughts and suggestions on how to do so. Everyone has their own studying strategy, so not all suggestions will apply to everyone, but hopefully you will find some of them useful to you! **1. Stick to a pre-set schedule**: it is easy to fall behind on your to-do list when you suddenly find yourself with lectures that turn into an online-only format or when you have to study from home all day long when that was not the environment in which you better concentrate. In order to achieve your goals, a good idea is to make a list every night of what you would like to accomplish the next day (or every Sunday for what you want to accomplish the following week). Be realistic, and set times to tick each of the boxes. Wake up at a predetermined time. Include periods of time in your schedule for exercising and relaxing too. Having a schedule to stick to can be very helpful in order to keep track of what you are doing and what still needs to be done. In addition, ticking off a task from your to-do list gives immediate positive feedback and contributes to your wellbeing as you realize you are getting things done! **2. Find the best spot in your home to study**: somewhere comfortable, but maybe not too comfortable… quiet or maybe with some background music (you choose the genre!). We all know what our best environment to learn and concentrate in is. Although some people might not be used to studying for long periods of time in their homes (some may prefer to study at coffee houses with some background noise), try to adapt your space so that it feels more like your usual study place. Make your own latte, turn on background lounge music, the same you usually hear while studying at your favorite coffee house – maybe that will feel a little bit more familiar and will allow you to be more productive! **3. Prevent eye straining**: we are all probably finding ourselves joining in a lot more conference calls than usual (school daily/weekly update calls, lectures, group/research meetings, talking to friends and family). On top of that, a lot of our studying (question banks, videos, lecture notes) is usually based on a laptop or tablet screen. This is definitely something that can make us tired and can lead to eye straining. Here are some good recommendations to avoid eye strain (which are also simple to add to your routine): - Blink more often. Use eye drops to keep your eyes lubricated if needed (consult your doctor to check which one is best for you). In general, eye lubricants without preservatives are safe to use frequently. - Practice the “20-20-20 rule.” If you haven’t heard about it before, here is the opportunity to learn something easy that can help you rest your eyes. While studying, look away from your laptop every 20 minutes and focus on an object 20 feet away from you for a period of 20 seconds. You can then go back to studying! - Take breaks away from your phone, tablet, computer, laptop. In your free time, do something that does not involve a screen. You can still binge watch your favorite TV series, but it is a good idea to alternate with something different such as reading a book, meditating, or cooking. It might also be a good time to pick up an old hobby like knitting, baking, drawing, playing an instrument, etc. - There are also lots of other pieces of advice regarding the ideal angle and distance from your eyes to the screen, best lighting options, etc. You can easily find this information online! **4. Practice your knot tying skills**: here is another great option for taking time away from your laptop and acquiring surgical skills at the same time! A shoelace and a couple of Youtube videos is all that is needed! Also make sure to check the [ACS/ASE Medical Student Core Curriculum](https://www.facs.org/education/program/core-curriculum) for some great resources to prepare for your surgical clerkships when they resume. **5. Check out the AWS resources for medical students:** the AWS National Medical Student Committee has put together great resources for students, such as specialty specific resource guides. Click [here](https://www.womensurgeons.org/page/Students) to access them! **6. Don’t forget to exercise**: exercising keeps both your body and mind healthy. If you were used to an exercise routine prior to the social distancing measures and suddenly stop it completely, it won’t be long until you are feeling tired and unable to concentrate properly. There are many apps and content online for indoor exercises, many of which are adapted to objects you can easily find in your house. In addition, if you are located in a region where outdoor exercising is allowed, going for a walk or a run is a great option for burning some calories and clearing your mind. Make sure to follow regulations/recommendations on outdoor activities in the region where you live. **7. Eat well**: be conscious of what and how much you are eating. No need to say how easy it is to start eating differently from your normal when you find yourself at home all day long. Make sure you are getting all the nutrients that you need in order to keep your body healthy! **8. Meditate and practice mindfulness**: if you were used to doing this already, keep it up! If not, what a great time to try some mindfulness and meditation! It can be a great alternative to help reduce your anxiety levels. There are many apps and websites for beginners (many of them made their content free of charge during the COVID-19 pandemic). You may find that this is something that you enjoy and want to continue doing even after the pandemic to relax after your busy days as a medical student! Another great option for de-stressing is to join the Resident and Associate Society of the American College of Surgeons (RAS-ACS) in their “Take a Breath and Decompress” hangout series. Click [here](https://www.facs.org/member-services/ras/hangout) to check the date and time for the next calls. **9. Last but not least, know that it is ok not to be productive all of the time**: things are constantly changing, and we are all having to adapt. Focus on the positive things of your day, and make sure to take some time off to relax as well. Talk to your friends, family, and significant other. Sharing your day with them can always help relieve the pressure and anxiety all this uncertainty can bring. The Association of Women Surgeons has also put together a list of [resources](https://www.womensurgeons.org/page/COVID-19) for members on the website. Make sure to check those out too. Together, we will get through this, and we will come out even stronger! Stay safe, everyone! ![](https://blog.womensurgeons.org/wp-content/uploads/2020/04/Screen-Shot-2020-04-22-at-1.59.23-PM.png) **Camila R. Guetter, MD,** is originally from Curitiba, Brazil, and graduated medical school from the Federal University of Paraná. Camila is passionate about pursuing a career in academic surgery and is very active in AWS. She currently serves as the Medical Student Chair for the AWS Blog Committee and the Vice Chair for the AWS National Medical Student Committee. She is also a member of the AWS Publications Committee. You can find her on twitter at [**@camila\_guetter**](http://twitter.com/camila_guetter). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** current events, medical students **Tags:** AWSBlog --- ### [Maintaining Wellbeing Amidst the Fear and Uncertainty of COVID-19](https://blog.womensurgeons.org/wellbeing-amidst-covid-19/) **Published:** April 19, 2020 **Author:** mcooke@amrms.com **Content:** *By Taylor S. Riall* With the COVID crisis upon us, we are being called upon to be our best as we navigate this uncharted territory. To be our best, we must take care of ourselves, which is challenging under normal circumstances. Now, in addition, we are all afraid and grieving simultaneously…as are our colleagues, family, and friends across the world. As healthcare providers we are afraid of becoming seriously ill, of our colleagues and friends being seriously ill, of infecting others, of being “redeployed” to somewhere where we may not feel comfortable working, of not having access to PPE, of being alone or unsupported, of watching people suffer or die alone without their families by their sides, and so many other things. And, at the same time, we mourn the loss of our “normal”. Whatever “normal” was to each of us, it has changed. I fluctuate between intense, irrational fear, and thinking that maybe I am overreacting to the whole thing. I used to be able to sleep (my superpower), but now, ironically, when I have the time, I no longer can. I worry that any one member of my team will get really sick. I struggle every day wondering if we are making the right decisions about which patients can be offered necessary operations and which can’t. My mom is 75. She lives in NJ – I worry every day that she will get sick and if she does, I worry about not being able to go see and care for her. I fluctuate between compassion for and frustration with people around me. I know that everyone around me is scared. They are grieving the loss of their normal and many are hurting financially. But sometimes, my container is not big enough to hold all of it. I struggle with the irony of having time with Charlie (my husband) and Winston (my Goldendoodle), yet being consumed by my own fear and worry and wasting that precious time. And I feel bad grieving over the temporary loss of what seem to be insignificant things… eating out, running marathons, having people walk by me and not be afraid to come near me. And then I worry about tomorrow…what will our world, and, selfishly, my world look like after this. Ask yourself who you want to be during this crisis (I actually ask myself that question all the time). Take the time to do things that help you maintain your sanity so you can show up the way you want. Then inspire others to do the same. In this unusual time of social distancing, connect with each other. It is essential to our wellbeing. Communicate. Listen. Acknowledge fear, grief, and uncertainty. There is no playbook for this situation; say “I don’t know but I am here to listen.” Inspire and empower those you care about to care for themselves and to support others when they need it the most. Joke with each other, laugh together, cry together, ask for help when you need it. Recognize that you are human – that all of the emotions you are experiencing are normal. And know that you are not alone. Join the [Association of Women Surgeons](https://www.womensurgeons.org/) in a tweetchat to discuss wellness during the COVID-19 pandemic. This #AWSchat will be hosted on Monday April 20th, 8pm Eastern Time. To participate, follow [**@womensurgeons**](https://twitter.com/WomenSurgeons) along with our moderators Dr. Taylor Riall ([@TaylorRiall](https://twitter.com/TaylorRiall)) and Dr. Minerva Romero Arenas ([@minervies](https://twitter.com/minervies)). The questions will be posted directly from the [**@WomenSurgeons**](https://twitter.com/WomenSurgeons) twitter account and you can also find them following the hashtag [**\#AWSchat**](https://twitter.com/search?q=%23AWSChat&src=typd). If you haven’t participated in a tweetchat with us before, check out this [**tutorial**](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([**@heatheryeomd**](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweetchat: 1. How has the COVID-19 pandemic affected your work-life balance? 2. How have your interactions with patients changed during this pandemic? 3. In what ways have you seen healthcare workers positively support one another during this time? 4. What types of wellness measures have you personally found helpful during this time of uncertainty? 5. In what ways do you think healthcare workers can support one another and feel more supported? ![](https://blog.womensurgeons.org/wp-content/uploads/2020/04/Riall.jpg) **Taylor S. Riall, MD, PhD, FACS,** is Professor and Interim Chair of the Department of Surgery at the University of Arizona, College of Medicine – Tucson. Her clinical expertise is in general and pancreaticobiliary surgery, including pancreatic and periampullary cancer, acute and chronic pancreatitis, gallstone disease, gastrointestinal cancer, and general surgery. She has extensive expertise in comparative effectiveness and health services research. Dr. Riall is also an executive leadership coach, trained at the Institute for Professional Excellence in Coaching. She applies her leadership training as a developmental tool to help surgeons and residents reach their full potential by raising self-awareness, developing emotional intelligence, clarify their goals, identifying and addressing personal challenges, and consciously improve and integrate the many facets of their lives. In her free time she loves to run and enjoys time with her husband and 2 year old goldendoodle, both of whom are essential to her wellbeing. --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #globalpandemic, AWSChat, covid19, surgery, Tweetchat, Wellness, womeninsurgery --- ### [The Taming of the Amygdala](https://blog.womensurgeons.org/the-taming-of-the-amygdala/) **Published:** April 16, 2020 **Author:** mcooke@amrms.com **Content:** *By Jaime D. Lewis* The last few weeks have been trying at best. Unprecedented, as they say. Feeling the anxiety of significant uncertainty, I find myself frequently stopping to slow my breathing and note the calming effect it brings despite a worldwide pandemic. I am quite aware that much of the danger that my body is sensing is not due to immediate threat. It is secondary to the [“freeze flight fight” response](https://www.ncbi.nlm.nih.gov/pubmed/30800852) triggered by a sometimes overwhelming flood of concerns about our current situation. This emotional process triggers my amygdala to send out a distress signal leading to a cascade that stimulates my hypothalamus and then my adrenals which send out epinephrine activating my sympathetic nervous system. You can see this reflected in the dilated pupils in my pale blue eyes, the spike in my heart rate recorded by my running watch, and my disinterest in eating due to inhibited GI motility. The above cascade of events is extremely useful in energizing a fight when crossing paths with a black bear on a hiking trail or flight if suddenly trapped in a burning car. However, they can be quite detrimental when one is perfectly safe and socially isolated in their own home in a state that is unlikely to see a truly overwhelming surge in Covid-19 cases and deaths. Persistent surges of epinephrine in chronic stress contribute to increased blood pressure and other cardiovascular effects. A second component of the stress response is secretion of cortisol. In the acute phase, cortisol helps the body restore energy stores once the threat is gone. However, chronic stress and elevated cortisol levels can lead to excessive appetite and weight gain among other various and sundry negative impacts. I know that I have an overactive amygdala and am susceptible to the impact of chronic activation of this system. As a medical student I took up rock climbing in an effort to try to tame it, assuming that it would become less active if I scared it enough. I was wrong. Apparently, I am not Alex Honnold. For those who don’t know Honnold, he is the climber who free soloed (meaning he climbed with no partner, no gear, no safety net) the Freerider route on El Capitan in Yosemite in 2017. His epic climb was chronicled in the film Free Solo. One of the reasons he is able to achieve such feats is because [his amygdala barely reacts](https://web.musc.edu/about/news-center/2019/03/18/how-a-neuroscientist-and-professional-climber-learned-from-one-another). His lack of fear is counterbalanced by a high level of conscientiousness and obsessive preparation. He spent years preparing to free solo El Capitan. He practiced routes and moves over and over with protection until he was sure he would not fall. Because I will never be Alex Honnold and my amygdala refuses to be tamed, I have had to learn other methods of calming my “freeze flight fight” response when unnecessary. One of the simplest methods is breathing. [Breathing is hypothesized](https://www.ncbi.nlm.nih.gov/pubmed/23538082) to stimulate vagal activation of GABA pathways from the prefrontal cortex and insula which then inhibits the amygdala. Breathing techniques have been shown to reduce symptoms of stress, anxiety, insomnia, post-traumatic stress disorder, obsessive compulsive disorder, depression, attention deficit disorder, and schizophrenia. There are many ways to practice breathing including: - Paced breathing – controlled rate and length of breath cycles - Coherent (resonance) breathing – equal inhalation and exhalation with a slight pause between - Resistant breathing – breathing through a partial obstruction (i.e. pursed lips) - Alternate nostril breathing - Moving the breath – visualizing the breath moving through all of the parts of the body - Breathing with movement – pacing the breath with physical movement When I notice the effects of a spike in epinephrine, I stop and take 3 deep paced breaths. Sometimes I add a component of resistant breathing. If you, like me, are not a thrill seeker, have an overactive amygdala, and are experiencing some serious activation of your sympathetic nervous system in the uncertainty of the current days, I encourage you to breathe. I have done these exercises alone, with my children, with my patients, and with my operating room team. While the exercises may be short, sometimes the moment of respite is all that is needed to initiate a long-lived response. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/04/Dr.-Lewis.jpg)Jaime D. Lewis, MD, FACS, practices breast surgery at the University of Cincinnati College of Medicine in Cincinnati, Ohio, where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Dr. Lewis is committed to improving wellness and professional development opportunities for the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys running and spending time with her family. You can find her on twitter at[ **@JaimeDLewisMD**](https://twitter.com/JaimeDLewisMD). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Thank You Without Ceremony](https://blog.womensurgeons.org/thank-you-without-ceremony/) **Published:** April 8, 2020 **Author:** mcooke@amrms.com **Content:** *By Francesca Voza* Just a few weeks ago, I was preparing for the biggest event of my life: celebrating my medical school graduation at 42 years old. Moreover, I am about to embark on the exciting adventure of becoming a surgeon. I wanted this to be a firework of joy, shared with whoever would be happy for me. When obtaining my high school diploma in 1997, I departed from my hometown of Fort-de-France, Martinique, a small dot located in the Caribbean Archipelago. My plan was straightforward: - Join my sister studying in the capital city of Paris, France - Work hard to pursue medical studies - Become a physician - Care for patients Little did I know that severe mental illness would suddenly hit both my little brother and my father back home. Despite the query and the feelings of worry, fear and guilt, I remained focused on my studies. Nevertheless, my selecting exam rank as 135/635 met closed doors to medical school in France. With a cutoff at 112/635 as the sole means to pursue medical/dental studies in France, I was “EXCLUDED FROM MEDICAL STUDIES” as mentioned in all caps on my transcripts. My dream crushed, my family perturbed, I climbed my way back up, studying biological sciences to finally earn a master’s degree in pharmacology. Having completed my graduate studies, I crossed the ocean again for research opportunities in vibrant New York City. My plan was once again straightforward: - Work in a research lab for two-three years - Apply to a PhD program - Become a teaching scientist Or, maybe, an MD-PhD program? An MD program? My interest in medicine quickly revived as I learned more about the possibility of integrating into a medical school in the United States. No obstacles were going to stop me this time. No GPA, no credit history, not a dime to my name, it did not matter. Three years as a research technician in a lab became six, then twelve, while going back to undergraduate school in the US, to finally earn a spot in my top choice medical school and discover the place I belong: the Operating Room. Following a successful match into my first-choice residency program, I reflect on the journey. I was of course determined but contrary to the teenager in 1997, I did not seclude myself. Today, being kept distanced from one another because of a dreadful pandemic, I value even more those every single person who came along. The professors who encouraged, the colleagues who understood, the bosses who trusted, the mentors who guided, the peers who taught, the role models who inspired, the friends who listened, the patients who shared, the believers who prayed, and the family who loved… Thank you! Thank you for taking me to where I am today. None of us knows what the future holds, but what we do know is that together we’ll continue the journey. Together, we’ll continue to navigate through the storm and become stronger. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/04/Screen-Shot-2020-04-08-at-5.41.45-PM.png)Francesca A Voza, MS, is receiving her MD degree and Global Health Certificate from the Weill Cornell Medical College in New York this spring. She is honored to join the University of Miami/Jackson Memorial Health System for a categorical position in general surgery. Born and raised as a dual French/American citizen in Martinique, Francesca obtained the equivalent of a BS in Biology & Biochemistry from the University of Paris-Est Creteil (UPEC)/Paris XII and an MS in Pharmacology from the University of René Descartes/Paris V. She worked as a research technician at the Erlangen-Nuremberg University in Erlangen, Germany, at the Mount Sinai Medical Center in New York City, and at the Memorial Sloan Kettering Cancer Center in New York City. During this time, she co-authored 12 peer-reviewed scientific articles and pursued post-baccalaureate classes at the CUNY-Hunter College with a major in psychology. A lover of outdoor activities and live music performances, Francesca used to sing in the chorus of the New York Grand Opera (NYGO) and celebrates her Afro-Caribbean heritage when playing Haitian drums with mentors from [La Troupe Makandal](https://makandal.org/). As a [Student National Medical Association](https://snma.org/?)[ (SNMA)](https://snma.org/) leader in her Cornell chapter and member of the [Susan Smith McKinney Steward Medical Society (SSMS)](http://www.nyesma.org/local-affiliates/), Francesca advocates for equity in the medical field and empowerment of underrepresented minority students at all levels. She’s interested in pursuing a career in academic surgery, as a pediatric or thoracic surgeon. She can be found on Twitter [@fravoza](https://twitter.com/fravoza?lang=en) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Cura te ipsum -- Surgeon heal thyself](https://blog.womensurgeons.org/cura-te-ipsum-surgeon-heal-thyself/) **Published:** April 1, 2020 **Author:** mcooke@amrms.com **Content:** *By Lilah Morris-Wiseman, MD, FACS* “Stepping into the operating room to perform heart surgery on a sick patient, being fully in control of the large team of people who are required to do the procedure, and feeling totally prepared to perform the task at hand is an unbelievable feeling that can barely be described.” –Renee Hartrz, MD, FACS, Cardiothoracic Surgeon, FACS website [“Why do surgeons become surgeons?”](https://www.facs.org/education/resources/medical-students/faq/why) I received a call from my program director after the second time I didn’t show up to work. “We need to meet,” he told me. I was a fourth-year general surgery resident on our night trauma surgery team. I didn’t wake up for my shift and I wasn’t answering my phone or pager. I woke up to let the paramedics in, but only became truly aware when there was a needle in my vein infusing dextrose. I had not adjusted my insulin pump schedule to reflect that my days and nights were now flipped, which caused hypoglycemia when my typical higher daytime insulin needs were delivered while I was asleep. We sat in the hospital cafeteria before my scheduled shift. My program director was kind and supportive. “Do you want me to switch your schedule? I can take you off nights,” he offered. “No, thank you,” I replied, “I’m fine.” *I did not need help*, I thought. It never crossed my mind that I could have died had no one figured out what was going on or been persistent enough to call 911. “I will fix this,” I assured him. Surgeons are supposed to be invincible and strong, I thought, and that’s certainly how I thought of myself. Years before, after ending up in the hospital in diabetic ketoacidosis and a new diagnosis of Type 1 diabetes, I still ran 4 marathons and decided to go to medical school. In line with choosing the most difficult route, surgery became a perfect fit. Truthfully, I’m not sure I had ever considered diabetes as a limitation, or even an influence, in my path. At that moment, sitting with my program director, I realized that I needed to figure out how I could live as a healthy surgeon, wife, and eventually mother, with a chronic disease requiring constant management. I chose a specific surgical career path that fit with my health needs. Because I have more difficulty managing blood sugar in cases longer than four hours or when my schedule is erratic, I pursued a specialty with shorter, non-emergent cases (Endocrine Surgery). I am able to take general surgery emergency call on a defined schedule. I learned how to live safely with my disease. I have a continuous glucose sensor with feedback to an insulin pump. If my blood sugar is low in the operating room, my sensor alarms. I have set a backup “auto off” mode so if I have not touched the pump in 8 hours, it will alarm and turn off. I eat a higher protein, low carbohydrate diet that helps me avoid many of the blood glucose swings, and I exercise daily. Finally, I share my experience. I talk about my diabetes in an attempt to normalize chronic disease in a surgeon. Much of the medical perception of chronic disease relates to disability. In truth, I know several surgeons with Type 1 diabetes. I have surgeon colleagues with neuromuscular diseases who receive monthly treatment infusions. We also hike, swim, and run outside of the OR. A life in surgery is challenging, but for those who can live safely with a chronic disease, it is not a limitation. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/04/Screen-Shot-2020-04-01-at-9.27.05-AM.png)Lilah Morris-Wiseman, MD, FACS, is an Assistant Professor of Endocrine and General Surgery at the University of Arizona, Tucson where she is the Associate Program Director for the General Surgery residency. She was diagnosed with Type 1 diabetes at age 22, which prompted her to attend medical school. After graduating from Tulane University School of Medicine, she completed General Surgery Residency at University of California, Los Angeles and fellowship in Surgical Endocrinology at MD Anderson Cancer Center in Houston, Texas. She is grateful to be able to work with her surgeon husband; at home they enjoy hiking and spending time outdoors with their three daughters, ages 16, 8, and 6. She is currently training for her first ultra-marathon. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection, self-care **Tags:** #womensurgery, AWS, AWSBlog, womeninsurgery, WomenSurgeons --- ### [#WhyIAWS: Calling on all medical students (MD/DO/MBBS) pursuing surgery](https://blog.womensurgeons.org/whyiaws-calling-on-all-medical-students-md-do-mbbs-pursuing-surgery/) **Published:** March 30, 2020 **Author:** mcooke@amrms.com **Content:** *By Ashley Choi* As I reflect on the past three years of being a part of the AWS National Medical Student Committee, I am blown away by how much I have grown personally and professionally. One thing is clear: AWS has given me much more than I can give back. It has gifted me with my tribe. **Who we are:** The “[Med Student Committee](https://www.womensurgeons.org/news/467810/Welcoming-the-2019-2020-AWS-National-Medical-Student-Committee.htm)” is a 20 person committee with every position grounded in leadership and service. We have specialized roles to ensure that tasks are completed in a short period of time, including Research Coordinator, Resource Development Coordinator, Diversity and Inclusion Coordinator, Social Media Coordinator, Mentorship Coordinator, and 11 Regional Representatives who together manage 80+ AWS [chapters](https://www.womensurgeons.org/page/Chapters) worldwide. At the end of the day, we all work together to be a resource to our colleagues in need. **What we do:** I want to share some of the work that we have done this past year as well as our efforts to respond to COVID-19. It is becoming more evident that COVID-19 is affecting every part of the healthcare system and will continue to do so in the coming months. With most institutions suspending clinical service for medical students, there are many uncertainties as to how these policies will impact away rotations, residency interviews, and USMLE exams. Just two weeks ago, we hosted a [\#tweetchat](https://twitter.com/WomenSurgeons/status/1239703997440802819) on the topic of away rotations in the midst of a pandemic. We also celebrated our graduating fourth years through a [\#virtualmatch](https://twitter.com/WomenSurgeons/status/1241148466216284163) ceremony on Twitter. This past year, our committee has had one of its most productive years in history: - 14 surgical subspecialty career guides for medical students were published[ online](https://www.womensurgeons.org/page/Students), - The [Starr Research Forum](https://www.womensurgeons.org/general/custom.asp?page=Starr) 2019 had a record number of abstracts (170+), - High-impact research led by the committee is currently underway to investigate the impact of intersectionality on the female surgeon experience, - And we launched a new mentorship program dedicated to under-represented minority students in collaboration with the[ Society of Black Academic Surgeons](https://www.sbas.net/) and[ Latino Surgical Society](https://latinosurgicalsociety.org/). **Join us:** Our work to promote gender equity in all levels of training is far from done. We still need to understand how to better support our LGBTQ colleagues, students aspiring to become military and rural surgeons, and women from all walks of life interested in surgery and looking for a community where they feel welcomed and like they belong. We welcome anyone who is up for the challenge of working in a fast-paced environment with emphasis on collaboration and professional communication. Whether you are someone who was not offered a position last year, someone just learning about the committee, or someone who is unsure if you are qualified to apply,[ please **APPLY**](https://forms.gle/TDWm7P6vF95sTGuYA)! We pay attention to the unique experiences that you bring to the table to represent others like you. We love to see ideas that we have not considered before. In addition, there are countless advantages to joining a professional society early in your career. Beyond amazing networking opportunities, AWS is home to all women surgeons. Be a part of the solution and apply today:[ https://forms.gle/TDWm7P6vF95sTGuYA](https://forms.gle/TDWm7P6vF95sTGuYA). **\#WhyIAWS:** If you are still not sold on the idea of joining, I want to tell you #WhyIAWS. My family is from South Korea. As with many parts of the world, it remains a conservative community with slow progress towards gender equity. I was raised by a single mother who did not have the same opportunities that I did. Despite a series of unfavorable turns in life, she never gave up finding a way. She always told me to look past today and find my tribe. Whether you are status post (s/p) a rough day in the OR, s/p breakup in the middle of rotations, s/p getting destroyed by reviewer #2 on your manuscript, or s/p hurtful criticism by someone who made it all about your gender, your tribe just gets you without having to explain a single thing. I found my tribe. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Screen-Shot-2020-03-29-at-7.43.24-PM-1024x619.png)The AWS National Medical Student Committee is my tribe:![](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Screen-Shot-2020-03-29-at-7.43.45-PM.png) We’ve laughed and cried together:![](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Screen-Shot-2020-03-29-at-7.43.56-PM-1024x492.png) We’ve also all shown up to a 6am committee meeting at the AWS national conference in San Francisco smiling, excited to see each other in person:I come back to this tribe whenever I feel like I’m alone in my journey because let’s face it, sometimes it really feels like we walk alone. AWS gives me the community and support that inspires me to continue this journey towards the #FutureIsFemale. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Screen-Shot-2020-03-29-at-7.44.07-PM.png)Ashley Choi is the outgoing Chair of the AWS National Medical Student Committee and a rising fourth-year medical student at Duke University School of Medicine. She hails from Southern California and grew up playing tetherball. As an undergraduate at Johns Hopkins University, she studied International Relations. She plans to train as an academic cardiothoracic surgeon and improve the care of patients with end-stage heart and lung disease. In her free time, you can find her playing volleyball or tweeting away on Twitter [@AshleyYJChoi](https://twitter.com/AshleyYJChoi). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students, reflection **Tags:** #WhyIAWS, AWS, WomenSurgeons --- ### [Leveraging technology to improve rural public health](https://blog.womensurgeons.org/leveraging-technology-to-improve-rural-public-health/) **Published:** March 26, 2020 **Author:** mcooke@amrms.com **Content:** *By Allison Martin* At my first general surgery residency interview in the fall of 2012, I sat across from a senior faculty member at a prestigious surgical residency program as he leveled a tough question at me: “Why does a surgeon need a degree in public health?” I had taken time between my third and fourth years of medical school to obtain an MPH from the Harvard T.H. Chan School of Public Health. I was fortunate that many of my mentors in medical and graduate school had regularly incorporated community health principles into their research and clinical endeavors, so my response was easy. This article summarizes some of the reasons that an understanding of public health has proven important to me. In the past, there was less emphasis on surgeons’ role in outreach policy and prevention, risk reduction, and quality improvement. In recent years, more surgeons are stepping into the roles of advocate, policy adviser, and thought leader regarding how surgical knowledge is shared with providers who have variable access to resources around the world. Examples exist throughout academic surgery. A great example that highlights the use of mobile technology to improve outcomes for post-surgical patients is Assessing Surgical Site Infection Surveillance Technologies (ASSIST). This project was spearheaded by Dr. Heather Evans, a surgeon, surgical infectious disease specialist, and innovator in mobile health (mHealth) technology at the Medical University of South Carolina. Evans and her collaborators created a [novel platform](https://assisthta.wixsite.com/project) for remote assessment of postoperative wounds that may provide earlier detection of infections through electronic information sharing between patients and practitioners. There are specific barriers to the dissemination of surgical knowledge and access to resources in geographically isolated areas in both the United States and abroad. Surgeons in rural communities cannot easily share information and often do not have the same resources as surgeons in more resource-rich environments. Developing programs that facilitate information exchange for practitioners in isolated domestic and international communities should be prioritized. One example of this practice is the creation of health information exchange (HIE) entities such as the [Nebraska Health Information Initiative (NeHII)](https://nehii.org/), which was created as an electronic system to facilitate the compilation and organization of clinical information at the point of care. This type of system improves health outcomes and quality of care delivery to rural patients by allowing for any provider within the NeHII system to electronically access patient medical records. This system allows providers in rural areas to track patients when they visit larger referral health systems for specialty care. There are national resources to better understand how HIEs work at [HealthIT.gov](https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/what-hie). Surgeons at academic medical centers are in a unique position to advocate for better collaboration with surgeons operating at community hospitals and [critical access hospitals](https://www.ruralhealthinfo.org/topics/critical-access-hospitals) (CAHs). CAHs are small hospitals with 25 or fewer acute care beds, located greater than 35 miles from another hospital that provide 24/7 access to emergency services. Links must be created between highly-resourced systems and low resource systems. This could be accomplished by, for example,converting underperforming rural hospitals to CAHs and linking them to the nearest academic medical centers via telemedicine or other electronic means. The [Rural Health Information Hub (RHIH)](https://www.ruralhealthinfo.org/) is an example of a program that fills this need. It is a valuable online resource supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services for rural hospitals and providers. Advances in [telemedicine](https://www.ruralhealthinfo.org/toolkits/telehealth/2/care-delivery/specialty-care) technology over the last decade have provided money-saving and life-saving links between rural hospitals, like CAHs, and larger urban or teaching hospitals through increased contact with medical specialists. In an age where pandemics are the new reality, using virtual web platforms and telemedicine to engage with rural practitioners will become even more critical. Issues like maintaining proper personal protective strategies while transferring rural patients to higher levels of care are just one of the novel challenges rural health providers will face in the coming days. Utilizing existing technologies to lessen the burden on rural America will become more imperative as the world gets smaller and rates of chronic and infectious diseases continue to rise. Current programs like the NeHII, RHIH, and ASSIST have shown how surgeons can utilize public health principles and technology to improve health care and outcomes in rural and underserved areas. Moving forward, we surgeons should continue to innovate and apply technology to ensure that quality of healthcare is not limited by a patient’s geographic location. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Screen-Shot-2020-03-25-at-9.50.36-PM.png)Allison Martin, MD, MPH, is a general surgery chief resident at the University of Virginia. She completed her MD at Vanderbilt School of Medicine and an MPH at the Harvard T.H. Chan School of Public Health. During residency, she completed a two-year research fellowship in surgical oncology, including a year-long Fogarty fellowship in Rwanda, and will begin a fellowship in Complex General Surgical Oncology at the MD Anderson Cancer Center in August 2020. She currently serves as the AWS Facebook Subcommittee Co-Chair and can be found on Twitter[ @globalsurgallie](https://twitter.com/globalsurgallie). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, residency, training **Tags:** #womensurgery --- ### [Coronavirus Pandemic and the U.S. Surgeon: A Dilemma with many Facets](https://blog.womensurgeons.org/coronaviruspandemic-surg/) **Published:** March 18, 2020 **Author:** mcooke@amrms.com **Excerpt:** It goes without saying that we are in a unique time in world history. We are facing a public health crisis unlike anything seen in our lifetimes. We can look to prior pandemics in history such as the Spanish Flu of 1918 **Content:** By Estell J. Williams, MD\* It goes without saying that we are in a unique time in world history. We are facing a public health crisis unlike anything seen in our lifetimes. We can look to prior pandemics in history such as the Spanish Flu of 1918 to give us some context about response and expectations. However, we now face these public health challenges amidst healthcare advances that have resulted in a larger portion of our population enjoying life over the age of 60, with chronic medical illnesses, and in immunosuppressed states– variables which were not factors in prior pandemics. This is also true within surgery. We operate on patients at more advanced ages and with complex medical histories that have expanded the boundaries of medicine. As an acute care surgeon in Seattle, WA, a routine acute care week may include operations on patients with intra-aortic balloon pumps (IABP), ventricular-assist devices (VADS, used to extend life in heart failure), immunosuppression after chemotherapy for a cadre of malignancies, and a problem list consisting of at least 5 medical diagnoses. As I reflect on current times and the bombardment of media and social media “experts” on our current public health crisis, I find myself grappling with three major perspectives: as a layperson, as a physician, and as a surgeon. As a layperson, I hear the comments of young healthy able-bodied individuals who feel this pandemic is all propagated by the media and just “don’t understand the hype.” However, as a physician, I have the advanced medical knowledge to understand the real risk this pandemic poses as a public health emergency. I carry the fear of being a mother, daughter to elderly parents who live in another state, and a relative to individuals who fit the description of the “high risk” population. As a surgeon in an epicenter of COVID-19 disease in the United States, I am in awe of my colleagues– anesthesia, emergency medicine, internal medicine, intensivists, nurses, ancillary support teams, and administrators –who have rallied, worked longer and harder to care for the most vulnerable and keep daily communication with employees. Within the medical community lies an intersection of these perspectives unique to the surgical community, minimizing the spread of COVID by delaying non-urgent operations. Additionally, efforts to maximize resource allocation such as personal protective equipment, has led to recommendations form the American College of Surgeons to restrict surgical case volume as the numbers of infected continue to grow across the U.S. The University of Washington has been a leader in addressing COVID-19 and was one of the first institutions to develop its own test, develop disaster teams with COVID-19 units for rule-out and confirmed patients and COVID-19 teams to streamline information and minimize exposure to staff. *But what does all this have to do with surgery?* Well, surgery does not exist in a vacuum. Although we cannot operate on someone to save them from COVID-19, we can minimize the risk of our surgical patient contracting the illness. And while the number of cases continue to expand in Washington, prior to the ACS recommendations, our elective operations were cancelled except for urgent operations such as cancer operations. And within days of cancelling elective operations we are now anticipating the needs to minimize cancer operations as the number of COVID positive hospitalized patients continue to grow, to limit exposure and spread. As things rapidly change we have now encountered cases of COVID-19 positive patients, likely from community spread, becoming symptomatic within the postoperative period, one requiring ICU admission. As a result of the real impact of provider interaction with these patients while asymptomatic and the conversion to severe symptoms while under surgical care, we as surgeons must consider the direct impact we have in the fight to contain this pandemic. So when we hear the [ACS recommendations](https://www.facs.org/about-acs/covid-19/information-for-surgeons/elective-surgery) and consider, *Is there a more effective way to ensure we continue to deliver care to surgical patients without increasing their exposure to COVID-19? Without cancelling operations?* As a physician on the frontlines I personally believe the answer is a resounding NO. Our only job as layperson, physician and surgeon is to do our part to contain this pandemic. We must be proactive and not retroactive in our efforts to contain the spread of COVID-19. We are in this with our colleagues across the nation and must continue to be surgeon leaders, advocating for resource allocation as PPE shortages begin, patients who were asymptomatic when we brought them to the operating room with no consideration of testing needing converting to a positive case with symptoms requiring escalated care. If we fail as a profession to act in unison with our emergency department and medicine colleagues to minimize spread, It is not a matter of if it will happen in your practice, but more a question of when. In response to this we have now reorganized our general surgery services. Here in the front lines of the disease outbreak in Seattle, we must also consider the impact on our surgical workforce. While none of the below questions have concrete answers, and protocols will continue to change as we learn more, these are all important to discuss and keep in consideration. *If our surgeons become infected, who will maintain the workflow for the emergent operations?* *Are we going to be flexible as an academic institution in ensuring our residents receive the necessary training during this interruption in their education?* The preliminary answer to this question was developed within the last day as we completely reorganized our general surgery service structure to ensure we preserve our workforce. This is a model we have developed at UW but each institution must find whatever work best for their institutions. We have developed alpha, bravo and charlie teams to manage all general surgery inpatient, OR and clinic, respectively. With the idea that the clinic team will function as a “cold” team and take home-call to minimize exposure and only return to the hospital if needed. The inpatient team will round and manage all general surgery inpatients. The OR team is staffing all cancer and urgent operations. Our acute care surgeon is on day call for 5 days with a back-up attending if they are needed to operate on a COVID positive patient, as that will render them unavailable after that case for decontamination. While I recognize the need to control the pandemic and act quickly, I also would be doing a disservice to the core value that was my driving factor for entering the field of medicine. We must consider the lasting effects of this pandemic on our most marginalized and medically at-risk populations.The crushing economic implications of this pandemic will leave our metropolitan city Seattle, and many cities across the U.S., which already struggled with crippling rates of homelessness, economic insecurity, wealth gaps, and inequities in shambles. One cannot dismiss the impact that this will continue to hold in the months to come for so many communities who have suffered unemployment and no longer have access to health insurance as businesses have either shuttered or are unclear if they can weather this storm. For all those I cannot help but consider, *how many will suffer further health crises?* As a surgeon, what concerns you the most? Join the [American College of Surgeons](http://www.facs.org) and the [Association of Women Surgeons](http://womensurgeons.org) as we discuss the COVID-19 global pandemic from the surgeon’s perspective. This special Tweetchat will be hosted on Thursday March 19th at 8pm Eastern Time. We will be guided by our moderators Drs. Estell Williams ([@drwooda](https://twitter.com/drwooda)), Patricia Turner ([@pturnermd](https://twitter.com/pturnermd)), and Sharon Stein ([@slsteinmd1](https://twitter.com/slsteinmd1)). To participate, follow [@womensurgeons](https://twitter.com/womensurgeons) and moderators, then tag your tweets with the hashtag #AWSChat. Be sure to keep an eye out for Tweets from members of the AWS Communications Committee Leadership who helped to organize this TweetChat: [@minervies](https://twitter.com/minervies), [@LillianErdahlMD](https://twitter.com/LillianErdahlMD), [@ainhoac63](https://twitter.com/ainhoac63), and [@kpmcguiremd](https://twitter.com/kpmcguiremd). If you haven’t participated in a tweetchat with us before, check out this tutorial written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more! We’ll be discussing the following questions: 1. How has the COVID-19 pandemic affected your surgical sphere? 2. What distinguishes an elective case that can be postponed? How should surgeons select which patients they should push through? 3. Will this pandemic impact the education of surgical trainees? What accommodations should be made to avoid compromising their education without unfair consequences? 4. Should medical students be allowed to continue clinical rotations? What meaningful lessons can they gain from continuing on the front with us? 5. How are we protecting our workforce? Who will continue to care for patients when our first responders, nurses, and doctors get sick? 6. What impact will this have on our patients and communities beyond an operation? *\*The views expressed in this blog are those of my own and do not reflect my institution.* ![Dr. Estell Williams](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Professional-Headshot-199x300.png)Estell J. Williams, MD (s*he/her/hers*) is anAssistant Professor of Surgery in the Division of Emergency General Surgery at University of Washington School of Medicine. Dr. Williams grew up in Oakland, CA and studied biology and chemistry double major at Xavier University of Louisiana before being displaced by Hurricane Katrina and completing her undergraduate degree in biology from the University of San Francisco. She earned her Medical Doctorate from the University of Washington, where she also trained in general surgery and was recruited to join the faculty after graduation. She also is the Executive Director of the Doctor for a Day Outreach Program through the University of Washington School of Medicine. Outside of work, Dr. Williams enjoys spending time with her husband, a critical race theorist who also works at the University of Washington, running a social justice library with her husband named after their 2 year old daughter and raising her young daughter and 14 year-old niece. You can find her on [**twitter**](https://twitter.com/drwooda). ![Dr. Patricia Turner](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Turner-Patricia-2019s_Resized-214x300.jpg)Patricia L. Turner, MD, FACS is the director of the Division of Member Services at the American College of Surgeons and a clinical associate professor at The University of Chicago Medicine. Prior to joining the American College of Surgeons, Dr. Turner spent eight years in full-time academic practice on the faculty of the University of Maryland School of Medicine, where she was the surgery residency program director. Roles in national professional organizations include her recent appointment to the Board of Directors of the Council on Medical Specialty Societies, chair of the American College of Surgeons’ Delegation to the AMA House of Delegates, past chair of the AMA Council on Medical Education, past chair of the Surgical Section of the NMA, and past president of the Society of Black Academic Surgeons. A graduate of the University of Pennsylvania and the Bowman Gray School of Medicine at Wake Forest University, Dr. Turner continued her training as an intern and resident in surgery at Howard University Hospital in Washington, DC. Her fellowship training in minimally invasive and laparoscopic surgery was completed at the Mount Sinai School of Medicine, Weill-Cornell University School of Medicine, and Columbia University School of Medicine in New York City. Dr. Turner is board-certified in surgery, and is a Fellow of the American College of Surgeons. You can find her on [**twitter**](https://twitter.com/pturnermd). ![Dr. Sharon Stein](https://blog.womensurgeons.org/wp-content/uploads/2019/10/Stein-200x300.png)Sharon L. Stein, MD, FACS, FASCRS, is a colorectal surgeon at University Cleveland Medical Center (UH) and Associate Professor, Surgery at Case Western Reserve University (CWRU) School of Medicine. She is also the Director of UH RISES: Research in Surgical Outcomes and Effectiveness Center. She was recently appointed at the Murdough Master Clinician in Colorectal Surgery for outstanding contributions to her patients and University. She is the President elect of the Association of Women Surgeons. You can find her on [**twitter**](https://twitter.com/slsteinmd1). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** #diversityandinclusion, #globalpandemic, #medstudenttwitter, #surgeryresidency, AWSChat, Food4Thought --- ### [Not What I Planned, More than I Expected](https://blog.womensurgeons.org/not-what-i-planned-more-than-i-expected/) **Published:** March 12, 2020 **Author:** mcooke@amrms.com **Content:** It was approaching 3:30 pm in the afternoon as I sat finishing up progress notes for the day. As I looked at my watch, I felt the feeling of dread start to creep in. At any moment I would be getting a text message from my husband about how our son’s day at school had gone. Lately, the reports had been pretty grim with lots of refusing to do his schoolwork, hitting and swearing. I had little confidence that today would be any different. The stress of raising a child with special needs and being a surgeon was starting to wear on me, and I wasn’t sure how much longer I could carry on worrying as intensely about my son’s behavior as I did about the critically ill patients I cared for in the burn ICU. It would have been so easy to give up hope and believe that my son couldn’t succeed at school, but history told me that betting against him was a poor plan. Nothing about being a mom and a surgeon had gone as I had planned. I had planned to have a baby while I was spending two years in the lab, but life had other plans. Instead, I returned to my third clinical year 12 weeks pregnant. I had planned to take call the night before I was going to be induced at 39 weeks, but, instead, I developed pre-eclampsia and was induced at 36 6/7 weeks, leaving my administrative chief scrambling to find coverage for my last two calls. I had planned on having a healthy baby and spending my eight weeks of maternity leave at home bonding with my new little boy. Instead, I had a baby with [CHARGE Syndrome](https://www.chargesyndrome.org/about-charge/overview/) who spent six weeks in the NICU, came home with a g-tube, had eight therapy sessions a week, and eventually underwent nine operations in his first two years of life. While it would be easy to be disappointed at how things did not go as planned (and trust me there are times that I was very angry with the world), I have gained more than I could have possibly expected as a mother through our struggles. I have learned tenacity from watching a little boy take his first steps after 29 months of grueling therapy. I have learned patience from the six years it took my son to learn to eat by mouth and finally get his g-tube removed. I learned pure joy from hearing him call me Mommy for the first time after his cochlear implant and years of speech therapy. I have taken these lessons (tenacity, patience, and joy) from my role as a special needs mom and applied them to my role as a surgeon. They have made a world of difference not only in how I practice medicine but also my happiness and satisfaction doing so. I have learned to fight not only for my patients but for myself too. I know that there are very few things worth having that are not worth the work it takes to achieve them. I try to instill this tenacity in my patients and their families as they start their journey through a burn injury. I have learned to be patient not only with myself (which was perhaps the hardest lesson) but also with my patients as they come to terms with their injury. Finally, I have learned to find joy in the small wins. Being a surgeon in the current healthcare climate can be disheartening, but there are small joys to be found every day if you look for them. My life as both a mother and a surgeon has not gone as planned, but in the end, I have gained far more than I have lost. If you are the mother of a special needs child consider joining the Physician Mothers of Children With Special Needs Facebook group. This group along with my son’s syndrome specific Facebook group have been helpful to support my son and me through our journey. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Screen-Shot-2020-03-12-at-6.03.06-PM.png)Kathleen Romanowski, MD, FACS, is an Assistant Professor of Surgery at the University of California, Davis and Shriners Hospitals for Children – Northern California in the Division of Burn Surgery. She attended the University of Chicago Pritzker School of Medicine and completed her general surgery residency at University of Chicago Medical Center. She did fellowships in Burn Surgery and Surgical Critical Care at University of California, Davis and Shriners Hospitals for Children – Northern California. Kathleen is devoted to the care of the burn-injured patient and studies disparities in care and predictors of outcomes in elderly burn patients. She is an active member of AWS and is a member of the AWS Communications Committee. Two of her greatest accomplishments are her husband and her son. You can find her on twitter at [**@KSRomanowski**](https://twitter.com/ksromanowski?lang=en). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** awareness, parenting, reflection, resources, self-care **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [The Ins and Outs of Away Rotations](https://blog.womensurgeons.org/away-rotations/) **Published:** March 8, 2020 **Author:** mcooke@amrms.com **Content:** By Shan Lansing Let’s talk about away rotations. [*Visiting Student Learning Opportunities*](https://students-residents.aamc.org/attending-medical-school/article/visiting-student-learning-opportunities/), are short-term electives traditionally for fourth-year medical students to experience rotations at an institution other than their home school. Students do away rotations for a number of reasons. In some specialties such as [orthopedic surgery](https://link-springer-com.proxy.lib.ohio-state.edu/article/10.1007/s11999-009-0920-9) and [plastic surgery](https://journals.lww.com/plasreconsurg/Abstract/2016/04000/Away_Rotations_and_Matching_in_Integrated_Plastic.41.aspx), away rotations seem to be an important part of matching into residency programs. On the other hand, students applying to specialties in which away electives are known to be optional, may do the rotation to explore how the specialty is run at other institutions. When considering the risks and benefits, away rotations are somewhat controversial. It can be expensive to submit the application through the VSLO site, travel, and find temporary housing in a new city. Furthermore, students are often advised that it is as easy to make a bad impression at another institution as it is to make a good impression. Even the best students can have a bad day during a 4-week rotation, and it’s possible that would be their lasting impression. That said, it is clear that in many cases, away rotations can strengthen a student’s residency application, and serve as an opportunity for the student to determine if the program and city are a good fit for their future. To hear more on how to succeed on an away rotations, join the AWS National Medical Student Committee in the upcoming Tweetchat on March 16th at 8pm Eastern Time. We will be guided by our moderators Drs. Thomas Varghese, Melissa Erickson, Haripriya Ayyala, and Faith Robertson to discuss applying to and preparing for away rotations, and advice for success on away rotations. To participate, follow [@womensurgeons](https://twitter.com/WomenSurgeons) and moderators, then tag your tweets with the hashtag #AWSChat. Be sure to keep an eye out for Tweets from members of the AWS Medical Student Committee who helped to organize this TweetChat: [@AshleyYJChoi](https://twitter.com/AshleyYJChoi), [@camila\_guetter](https://twitter.com/camila_guetter), [@ShanSLansing](https://twitter.com/ShanSLansing), [@ElisaAtamian](https://twitter.com/ElisaAtamian), and [@AbraShen](https://twitter.com/AbraShen). If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more! Tweetchat Moderators: – Dr. Thomas K. Varghese Jr. ([@TomVargheseJr](https://twitter.com/TomVargheseJr)) – Interim Executive Medical Director and Chief Value Officer at the Huntsman Cancer Institute, Head of the Section of General Thoracic Surgery, Program Director of the Cardiothoracic Surgery Fellowship at the University of Utah. – Dr. Melissa Erickson ([@drericksonspine](https://twitter.com/drericksonspine)) – Assistant Professor of Orthopaedics at Duke University Hospital, specializing in Spine Surgery. – Dr. Haripriya Ayyala ([@ayyalahsMD](https://twitter.com/ayyalahsMD)) – Plastic Surgery Resident at Rutgers in New Jersey, PGY5. – Dr. Faith Robertson ([@FaithCRobertson](https://twitter.com/FaithCRobertson)) – Neurosurgery Resident at Massachusetts General Hospital, PGY1. 2018-2019 Chair of the AWS National Medical Student Committee. Questions for the Tweetchat: 1. What are some things students should take into consideration when deciding to apply for away rotations? 2. As for the match, do residency programs favor students who have done an externship at their institution or in the same geographic region? 3. What are your thoughts on seeking a letter of recommendation from a professor at an away rotation? Is it expected or an added bonus? 4. What are the impacts of COVID-19 in pursuing away rotations and how should students plan around it? How will cancelation of away rotations affect students applying to specialties that traditionally expect multiple aways? 5. We know that away rotations can be expensive, both from application and housing costs. Any financial advice for students applying to away rotations? 6. Parting thoughts: We often hear the best advice is to “be yourself.” What other advice do you have for students once they’re at an away rotation? ![](https://blog.womensurgeons.org/wp-content/uploads/2020/01/Unknown-300x263.jpeg) Shan Lansing is a third-year medical student at The Ohio State University College of Medicine. Originally from southern Oregon, she attended Oregon State University where she earned a dual Bachelors in Chemistry and Biohealth Sciences. She continued at Oregon State University for a Masters in Analytical Chemistry. Her current research interests include increasing surgical patient communication during the transition from inpatient care to outpatient followup to improve quality outcomes. Ultimately, Shan seeks to pursue a career in rural general surgery, aiming to provide compressive surgical care for an underserved community. In her free time, she enjoys running, cooking, and cross-stitching. You can find her on Twitter [@ShanSLansing](https://twitter.com/ShanSLansing). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** away rotations, AWSChat, medical school, medical student, training, Tweetchat, womeninmedicine, womeninsurgery --- ### [Match Day: Reflections of a First-Generation Medical Student](https://blog.womensurgeons.org/match-day-reflections-of-a-first-generation-medical-student/) **Published:** March 5, 2020 **Author:** mcooke@amrms.com **Content:** *By Nancy Lopez* As a fourth-year medical student, I am anxiously awaiting the third Friday of March: Match Day. Match Day is an iconic moment for medical students in which the last decade of both successes and failures consummate into a single envelope… an envelope that contains the program at which we will be training as residents. For some, this envelope is simply a job opportunity, but for others it is the manifestation of generations of sacrifice and perseverance. As the first individual in my family to be born in the United States, I was the first to have many opportunities, including the opportunity to obtain a medical education. My success story began a little under one hundred years ago with my grandmother. My grandmother did not have the resources to pursue a career in her country, however, when she heard the news of my imminent birth in a country full of opportunities, she knew that I would surmount to greatness. By being a product of humble beginnings, she told me I would understand who is in need and because of my desire to heal, I will heal those similar to me, those similar to her. As a woman of Latino descent, I have been faced with a variety of obstacles to overcome: cultural, linguistic, and financial to name a few. The day that I started to hear “no” is the day that I became adamant about proving to the world that I was capable of achieving greatness, regardless of my ethnic or gender background. My determination to prove my capabilities to the nay-sayers drew from my desire to make my family proud. I wanted to make my family proud of the fact that their perseverance and sacrifices amounted to a better future for their children. They could not be more proud of my success in becoming the first woman in my Latino family to become a surgeon. Why is Match Day momentous for a first-generation medical student? As Markowitz eloquently [described](https://www.forbes.com/sites/troymarkowitz/2017/08/08/the-barriers-to-success-and-upward-mobility-for-first-generation-students-and-how-to-fix-the-problem/#17adc6a21cb3), consider a child who is learning how to ride a bicycle. Who is teaching this child? The parent, aunt, uncle, or grandmother? What if this particular adult does not know how to ride a bicycle? *“Do you expect the child just to pick up the bicycle and hope for the best?”* In my case, I was determined to learn how to ride a bicycle. I wanted to learn in order to teach others whose parents might also not know how to ride a bicycle. My family endured similar moments of joy, stress, and anxiety having been intertwined with my education through all of its intricate steps. My success is as much their accomplishment as my own. They will be there by my side the day I begin to remove the training wheels. On Match Day, when you see medical students opening their envelopes, consider looking at the friends and family, particularly those of first-generation women entering the surgical field. The pride radiating from their eyes is the very essence by which I, as a first-generation medical student, will continue to succeed and why I will continue to teach others like me how to ride a bicycle. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/03/Screen-Shot-2020-03-04-at-6.17.31-PM.png)Nancy Lopez was raised in Los Angeles, CA. She attended the University of California, Irvine and obtained a B.S. in biological sciences with a minor in medical anthropology. She then pursued a Masters of Science in global medicine at the University of Southern California. Having developed an interest in health disparities, she became a clinical study coordinator at the University of California, Irvine School of Medicine where she investigated malnutrition, diet, and racial disparities in ESRD. She is receiving her Medical Doctorate degree from the University of Arizona College of Medicine, Phoenix. She is involved with policy and advocacy as Vice President of Policy for the Latino Medical Student Association (LMSA) West Region. She is interested in addressing racial and gender disparities in surgical education and is part of the AWS Outreach Task Force as well as the Latino Surgical Society. She is interested in pediatric surgery and global surgery. In her spare time, Nancy is an avid hiker, snowboarder, and Latin dancer. You can find her on Twitter @Nancy\_Lopez5. ——————————————————————————————————————– *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, medical students **Tags:** AWS, AWSBlog, womeninsurgery --- ### [The Token Foreigner](https://blog.womensurgeons.org/the-token-foreigner/) **Published:** February 26, 2020 **Author:** mcooke@amrms.com **Content:** *By Patricia Martinez Quinones* “Do not go where the path may lead, go instead where there is no path and leave a trail” – Ralph Waldo Emerson Imagine receiving an email that you have been selected to present as an invited speaker at one of the largest surgical meetings. That feeling of excitement, a sense of pride, knowing all your hard work is paying off. You are wandering the hallways of your hospital and run into a senior male member of your department. Unable to contain your emotions, you share the good news, only to be met with a response of “well, looks like you’re the token foreigner.” Certainly not the response you were hoping for, not a “congratulations” or “job well done.” Your excitement, happiness and pride are now replaced by feelings of self-doubt and you sense the imposter syndrome creep back in. As a Latina in surgery my life has been one of many firsts. First in my family to obtain a professional degree, first physician, first to move from the island (Puerto Rico) to the mainland, first Latina to match into my general surgery program and first to decide to pursue a doctorate during residency. In a world of firsts, how do we find the support and encouragement to thrive when we are traveling an unknown path? 1. Find your tribe: Would you believe me if I told you I found my tribe through Twitter? Several years ago, I found the[ Association of Women Surgeons](https://www.womensurgeons.org/) through social media. Becoming involved in AWS has led to life-long friendships, leadership opportunities, research presentations at the [annual conference](https://www.womensurgeons.org/page/AnnualConference) and even publications with other AWS members. With data demonstrating an[ increase in attrition for women and Hispanics](https://jamanetwork.com/journals/jamasurgery/fullarticle/2673189) in general surgery training, it is ever more important to go “[find your tribe, engage, and thrive](https://blog.womensurgeons.org/networking/finding-your-tribe/)” as[ Dr. Feibi Zheng](https://twitter.com/FeibiZheng?s=20) recently wrote on the [AWS Blog](http://blog.womensurgeons.org/). 2. Mentorship and Sponsorship are key: According to the[ Association of American Medical Colleges](https://www.aamc.org/data-reports/workforce/interactive-data/figure-15-percentage-full-time-us-medical-school-faculty-race/ethnicity-2018), Hispanics comprise only three percent of faculty positions in US medical schools. A[ lack of mentorship and role models](https://www.annalsthoracicsurgery.org/action/showPdf?pii=S0003-4975%2819%2931362-1) is a challenge for underrepresented minorities. Support from my PhD advisor, surgery faculty and chairperson were instrumental in my success of pursuing an advanced degree in the middle of my surgery training. Find support within your institution, through AWS, the [American College of Surgeons](https://www.facs.org) or through organizations such as the [Latino Surgical Society](https://latinosurgicalsociety.org), [Society for Black Academic Surgeons](https://www.sbas.net), [Association for Academic Surgery](https://www.aasurg.org) and others which provide mentorship programs and opportunities for students and trainees. How did the presentation go, you may be wondering. Well, after the panel session ended a medical student walked up to me and introduced herself. A Latina medical student, a DREAMER. Her comment was “I never thought I would come to this meeting and see someone that looks like me on stage. You are the first Latina surgeon I have seen present.” Goosebumps, and a lump in my throat, quickly followed. I was left speechless, because a few years ago I was that medical student who didn’t see herself represented. I will cherish our brief interaction and hope that the next time we meet I can call her my colleague and introduce her to the next medical student who will soon follow our footsteps (or create her own). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/02/Screen-Shot-2020-02-26-at-3.58.47-PM.png)Patricia Martinez Quinones is a general surgery resident at the Medical College of Georgia at Augusta University. She completed a PhD in Biomedical Sciences (Physiology) during her residency research years. She hopes to continue her career path in academic trauma and critical care surgery. Patricia is the chair of the AWS Resident and Fellow Committee. She is a wife, doggy-mom, proud Puerto Rican and you can find her on Twitter at [**@PMartinezMD**](https://twitter.com/PMartinezMD). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, mentorship, reflection, resources, training **Tags:** AWSBlog, womeninmedicine, womeninsurgery --- ### [Being Non-Traditional in a Historically Traditional Field](https://blog.womensurgeons.org/being-non-traditional-in-a-historically-traditional-field/) **Published:** February 19, 2020 **Author:** mcooke@amrms.com **Content:** *By Jackelyn Moya* My first memory of being in a space where I was treated in a “traditional” manner was during my senior year in high school. My counselor was creating my schedule for my final year and deciding whether he should place me in statistics or physics. I remember his words, “I doubt you’ll ever need physics in your life, so I’m placing you in statistics for your fourth class.” Without having any input from my 17 year-old self of what I planned on pursuing after high school, I accepted his statement as truth and thought, “hmm, When will I need physics?” I suppose that for my high school counselor, my traditional path would not require taking physics, so he placed me in what he assumed would be a more traditional class for me. I always knew that I loved science and wanted to be a doctor, but the path toward reaching that goal was so foreign to me. I had no idea where or how to begin. Upon graduating high school, I enrolled myself into community college and began my path of being a non-traditional pre-medical student in a place where I would take physics for the first time. Navigating my way through community college until transferring to the University of California, Davis would not be possible if I didn’t have the support of other students in my classes who shared similar stories of being “non-traditional” students. Fast forward to my third year in medical school, I remembered a familiar feeling of being “non-traditional” during my surgery rotation. Initially, I came into medical school set on going into pediatrics because I was inspired by my own pediatrician as a child and wanted to emulate the same feelings of security and trust with my patients. I purposefully scheduled surgery to be my last rotation given that I knew it was not something that I would pursue based on what I thought surgery would be like in my mind. However, after the first week on my general surgery service, that all changed. There was an indescribable feeling that I felt when I was in the operating room and even more so with the interactions with patients pre- and post-op. I would go home at night and try to reflect on what I was feeling and on how different I felt in comparison to my pediatric rotation. I decided to give this newly developed attraction towards surgery more time, as I had eleven more weeks of my surgical rotation. Soon, the twelfth week approached, and this pull towards surgery did not subside, I felt lost and confused, but I knew that this meant that I would have to feel “non-traditional” once again. I couldn’t help thinking, “Do I even belong in surgery? It’s so late in my third-year to make this change” among many other thoughts of doubt. As fate would have it, I just so happened to be a part of an all Latinx team on my vascular surgery service. I remember the first moment we all were speaking in Spanglish in the OR. I experienced a sense of belonging as I felt as if I was in a room full of unicorns. As a Latina in medicine, it was an indescribable feeling to be on this team and feel supported with this newly found interest in surgery. On my last day on the team, I had a conversation with the resident and told him that although I would love to pursue surgery, I have never met a Latina surgeon while being a student at UCLA. He then introduced me to one of his colleagues who is a Latina surgeon. Speaking with her and explaining not only my excitement about this new change in career choice that I had made but listening to her story choosing surgery as her career choice made me feel less “non-traditional” and more reassured that I belonged in surgery as well. Knowing that there was someone out there with a similar experience and story to my own thriving in surgery made all the difference with my confidence in moving forward with my decision. To this point, it is no wonder that I felt non-traditional with the mere thought of enjoying a field such as surgery let alone medicine as a career choice in general. A [study](https://www.ncbi.nlm.nih.gov/pubmed/25629948) conducted by the Center for the Study of Latino Health and Culture at UCLA reported that between the years 1980 and 2010, there was a 22% decrease in the number of Latino physicians. In 1980 there were 135 Latino physicians per 100,000 Latinos in the U.S. In 2010, this number decreased to 105 per 100,000. This is not only a statistic but a fact that is felt by many Latinx students while pursuing a career in medicine. Upon reflection, I realized that this lack of representation of Latinx surgeons played a larger role in my own hesitancy to pursue this field. The intersectionality of being both a woman and a Latina in surgery will undoubtedly come with many feelings of being “non-traditional”. However, knowing that there are others that have also lived these experiences brings hope of one day future medical students envisioning themselves as a woman in surgery because they have seen themselves represented and leaving their thoughts of doubt behind them. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/02/Screen-Shot-2020-02-19-at-2.57.12-PM.png)Jackelyn Moya, MS, is currently completing her MPH degree before returning to her 4th year this summer. Jackelyn is a first-generation student and the first in her family to pursue medicine. She is currently completing her MPH degree at the Fielding School of Public Health at UCLA with an emphasis in health policy and management. She completed her undergraduate studies at the University of California, Davis where she majored in nutritional sciences and continued to pursue a master’s degree in nutritional biology. She is currently part of the UCLA-Prime program and plans to practice surgery in underserved communities. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, awareness, medical students, reflection **Tags:** #LatinxinMedicine, AWS, AWSBlog, womeninsurgery --- ### [Confessions of an Ill-Equipped Third-Year Medical Student](https://blog.womensurgeons.org/confessions-of-an-ill-equipped-third-year-medical-student/) **Published:** February 13, 2020 **Author:** mcooke@amrms.com **Content:** *By Alyssa Brown* “Wrong, Wrong, Wrong, Wrong”, called the attending from his swivel chair. It was my first day of third year. I had been placed at the Veterans Association hospital (VA) for a cardiology rotation. It was the last week of June, so our residents were well prepared for anything that came their way. Looking at it from their point of view, they went from having almost fully fourth-year medical students, who were prepared, knew what to do and what not to do, to two fresh out of Step1 third-years, who had no idea at all. I remember googling the night before, what to put in the pockets of my white coat. I scrolled through reddit and student doctor network looking for a sign or post to assuage my nerves. I found no salvation there. I had shadowed/precepted plenty during first and second year, probably to an absurd degree, but this was different. I was being graded. Plus, I usually was shadowing in the operating room—give me a gown and gloves, and I would have been 100000x more comfortable than I was in that tiny workroom at the VA. We had texted our upper level resident the day before, and she told us to find the workroom on the fourth floor in the cardiology workroom at 7am. No other real instructions. We showed up with our brand new white coats—pockets bulging with papers, pens, snacks, reflex hammers, penlights, eye charts, Pocket Medicine, Maxwell’s Quick Medical Reference, small clipboard, extra hair ties, bobby pins, Band-Aids, and gum. My coat probably weighed ten pounds. Did I need any of this? The short answer was no, but I’ll get back to the story. I met my classmate early to try to find the workroom. We circled the fourth floor for thirty minutes trying to find the workroom before we gave up and called the resident. We could hear the phone ring, so we followed it to an unmarked broom closet. We were welcomed with a “rounds are in thirty minutes, look up these patients that you’ll be presenting.” First off, I had not practiced presenting in any formal sense, so what was I supposed to say? Also, we still had not figured out how to log onto the computer. Instead of the patient I was supposed to present, I found a different patient of the same name in Arizona. It was going well, clearly. Seven thirty came in the blink of an eye. The attending, an older physician, and his fellow appeared in the room. I had no idea how they were even going to fit in the room honestly. They looked at our two fresh faces, and they must have smelled blood in the water. The attending decided to start with me. “Please present your patient.” I had about two things written down because of the confusion over finding his record on the medical records system. I started, and I barely got a sentence in before he said, “wrong, wrong, wrong, wrong.” The resident tried to come to my aid, and she stated that we were brand new third year medical students. That did not faze him. I started again, and I got the same result. One of the residents rolled her eyes, and she began the presentation. I was embarrassed to say the least. I was so excited to start third year and see patients, and I was not expecting to be berated the first day. I was expecting the residents to help us and gently nudge us in the right direction. This did not happen, and I do not blame them. I should have been more prepared, and I did learn eventually. Don’t worry, you will learn too. The first few times are hard, but don’t beat yourself up too much. Here’s some of my advice to avoid a hard transition. 1\. White Coat Pockets: By the end of third year, my white coat was down to the essentials. I had my favorite pens, granola bar, stethoscope, lube (we could never find it), sterile gloves, and usually the patient list plus some small scratch paper. If I was on surgery, I also kept ten dollars and my credit card with me. These are my essentials, everyone’s pockets are different. Some items were rotation dependent, like the reflex hammer. By the end of third year, I wanted to have everything I needed but nothing I didn’t. I highly recommend ordering the coat to not be fitted. They do not stretch much, and they do sometimes shrink in the wash. I wish mine had been larger, so I felt more comfortable. Also, having lots of stuff in the pockets makes it smaller (FYI). 2\. Shoes: Okay ladies, some of y’all impress me by trotting around in heels all day. You’re amazing. I will be honest though, I am not one of those women I admire. I wore comfortable loafers or clogs. Did it look fashionable? No. Was I comfortable? Yes. Also, don’t make the same mistake I made. If you are going to go to the OR, don’t forget to bring comfortable clogs or sneakers. I had to wear my ballet flats (covered in shoe covers) through a Whipple, which was not ideal. On that note, compression socks were my best friends during surgery rotation. I did not buy the expensive ones. I got the cheap five-pack, but they do really help. 3\. Be self-sufficient and efficient: “Show me a student from the “best medical school” who only triples my work and I will kiss his feet.” This is a popular quote from *House of God*, and I always tried to remember it during my third year. My goal was to avoid slowing down the team. From calling to get records from another hospital, answering pages, or getting the ultrasound for the team, sometimes the work isn’t the most glamorous, but you are helping the team and the patient. I learned a lot from doing these seemingly smaller jobs, and the residents would give me more responsibilities because they trusted me to get things done. Also, the team is there to take care of the patient. Yes, your education and rotation is important for you, but at the end of the day, the patient comes first. I feel like sometimes students forget that. On that note, don’t be afraid to ask questions, but be aware if someone is working on something and wait until it is a good time for them. It is a balancing act sometimes, but it is worth it, and you’ll get the hang of it. 4\. Enjoy third year: Everyone has bad days. This includes your residents, fellows, attendings, and fellow medical students. There will be bad days. There will be days that will never seem to end. There will be days where you get done early and get to see the sun. There will also be days that you aren’t sure if you can do medicine anymore. There are patients that will die, and these will hurt. The days are long, and sleep is a premium. This is also what you sat in class for two years to do. Remember that when you’re bleary eyed driving home from a call shift wondering why you do this. You will find what makes you tick and what makes you love medicine. There are so many highs and lows, but you will meet so many people and so many patients. This is what filled me up. We all make mistakes and look dumb sometimes, and that is okay. If you ever start feeling sorry for yourself, remember we’ve all been there, and keep close to your friends. I could fill pages (or [AWS Blog posts](https://blog.womensurgeons.org/medical-students/waiting-your-turn/)) with [advice](https://blog.womensurgeons.org/mentorship/prosciutto/) and things I wished I had done better. [Third year](https://www.womensurgeons.org/page/Publications) will be full of [happy](https://blog.womensurgeons.org/medical-students/the-a-ha-moment/) and [sad](https://blog.womensurgeons.org/medical-students/gimme-shelter/) [memories](https://blog.womensurgeons.org/medical-students/black-clouds/), but there is one thing to always remember. Every hospital has a room full of crackers and peanut butter. Always find that room. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/02/5x7_0449-1-731x1024.jpg)Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. When she is not buried in lab work, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Twitter [@Alyssa\_B\_MDPhD](https://twitter.com/Alyssa_B_MDPhD) and on Instagram at [@Alyssa\_B\_FutureMDPhD](https://www.instagram.com/alyssa_b_futuremdphd/) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** medical students **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Mentorship: Vital to Women on Both Sides of the Relationship](https://blog.womensurgeons.org/mentorship-vital-to-women-on-both-sides/) **Published:** February 10, 2020 **Author:** mcooke@amrms.com **Content:** *By Erin M. Corsini, MD and Mara B. Antonoff, MD* As surgical trainees, we have a tendency to think of mentorship as a one-way street, a gift that is bestowed down from those with great experience to those seeking to climb to such ranks in the future. However, successful mentor-mentee relationships should be rewarding for both parties, and can be especially meaningful between women navigating specialties in which they are underrepresented. As excitement builds leading up to the next AWS chat on mentorship, we’d like to share perspectives from both sides of the relationship and some fodder for contemplation. “*In the months prior to beginning my first year as a clinical research fellow at a new institution, I was in my second trimester of my first pregnancy – a reality that had not previously been evident when I interviewed for the position. This was how I would begin my 2-year research fellowship at a prestigious institution amidst an entirely new set of faculty who I greatly desired to impress. To say I was worried is an understatement. I was starting my new job already requiring a significant amount of time off in the coming months, and no one yet had a clue. Having absolutely no idea who to tell, when to tell, or what to say, I requested a meeting with my future mentor, Dr. Antonoff, and she was kind enough to find time in her schedule.* *I told her I was pregnant, but was exceedingly worried about how this would be perceived, as I’d be starting my job already needing to take a significant leave in a few months’ time (I had already calculated that my 8-week leave would be 8% of my total fellowship, which felt exceedingly indulgent). I said I was worried the Department would think I was taking advantage of their time and money to have my baby. I accidentally cried – not really the first impression I was hoping to make. Dr. Antonoff reassured me that this would not be the disaster I had worked up in my head. Everyone would be supportive and happy for me. ‘I will support you’ and ‘Please let me know how I can help you,’ she reiterated several times. She explained to me how to inform the necessary parties, and she offered to help me figure out the best approach to succeed in my new position while maintaining a healthy pregnancy.”* *“I was wrapping up my first day back to work as a surgeon mother-of-four. I didn’t have any cases that day, but, despite my attempts to keep up with clinical and administrative tasks during my maternity leave, my first day back was jam-packed with meetings that had been put off for weeks. A seasoned mom, I had my day figured out perfectly with pumping breaks between my meetings, and I’d prepared exactly the right number of bottles at home for my day at work. I knew that my last meeting was with Dr. Corsini, our future research resident whom I was so excited to mentor. In our previous meeting, she had been so poised, so smart, so conscientious, and I was thrilled that she was interested in our specialty. But that day, Erin seemed especially nervous. She told me that she was expecting! I could not have been more thrilled for her. Not only was this amazing, talented young doctor going to enter my beloved surgical specialty, she was going to do it as a surgeon-mom! She was worried, and she didn’t need to be. Whatever challenges I’d endured during my pregnancies, I was going to do my best to try to make things better for her. I knew then that she would be a phenomenal researcher and prolific investigator, and, as she has exceeded all of our expectations, I could not be more proud. I firmly believe that she will be a leader in our field, and I will be so grateful to have played a role in her training.* *That day, as we discussed Erin’s path, I kept checking my watch, as 4:40, 4:45, 4:50 ticked by. I prayed that she wouldn’t notice, as I wanted in every way to ensure that Erin knew how much I supported her. Eventually, I explained that I had not left a 5PM bottle at home, and I needed to get back to nurse my baby. Erin dried her tears, helped me pack up my stuff, and rushed me out the door. Our conversation continued via text that night, and via numerous other avenues ever since then. Still, as I reflect on that day, we bonded over shared needs, shared emotions, and a shared understanding of being women in surgery. The relationship that day was absolutely reciprocal, and it always will be.”* Previous work in the areas of surgical education and mentorship has demonstrated the important networking role that women surgeons play for one another. Specifically, despite a relative lack of females in surgical specialties, as compared to males, female trainees consistently [wish to foster](https://www.ncbi.nlm.nih.gov/pubmed/29478827) [same-sex mentorship relationships](http://awspodcasts.libsyn.com/aws-and-east-joint-mentoring-podcast-marie-crandall-and-cassandra-white) but often are unable to fulfill this need. This is especially true in cardiothoracic surgery, a specialty in which the overall [proportion of women pales in comparison to men](https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017) (93% male), and [female trainees find themselves without these meaningful relationships](https://www.ncbi.nlm.nih.gov/pubmed/30063967). This is likely also a prevalent issue in other [heavily male-dominated surgical subspecialties](https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017), such as orthopedic surgery (95%), neurosurgery (92%), urology (91%), and vascular surgery (91%). The issue of underrepresentation is further compounded by the existence of “[sticky floors and glass ceilings](https://www.ncbi.nlm.nih.gov/pubmed/29078918).” The reality is that there are very [few women](https://blog.womensurgeons.org/training/leadership-gap/) within these fields who can serve as the exemplar of “having it all” – a booming practice, active research interests, global volunteerism, [award recipients from medical specialty societies](https://www.ncbi.nlm.nih.gov/pubmed/28606837), [full professorship](https://store.aamc.org/downloadable/download/sample/sample_id/228/), or [leadership](https://www.ncbi.nlm.nih.gov/pubmed/?term=Understanding+the+Barriers+to+Hiring+and+Promoting+Women+in+Surgical+Subspecialties.) within the department or at the national level, all while maintaining interesting hobbies, balanced family life, and a meaningful life outside of work. These role models are the women that many trainees seek, but their existence becomes more elusive in such exclusive echelons. But how important is identifying a same-sex mentor? What if there are no true options within your institution or city? Are there other ways to foster this type of relationship? What topics are off-limits in discussion with your mentor? We look forward to delving into all of these questions and sharing our dual perspective as a mentor-mentee team during our joint [Association of Women Surgeons](https://www.womensurgeons.org/default.aspx)/[Women in Thoracic Surgery](https://wtsnet.org/) TweetChat on February 17th at 8PM EST! Join [@womensurgeons](https://twitter.com/WomenSurgeons) along with our moderators Dr. Mara Antonoff ([@maraantonoff](https://twitter.com/maraantonoff)), Dr. Virginia Litle ([@vlitlemd](https://twitter.com/vlitlemd)) and Dr. Erin Corsini ([@ErinMCorsiniMD](https://twitter.com/ErinMCorsiniMD)). This tweetchat is co-sponsored by Women in Thoracic Surgery ([@WomenInThoracic](https://twitter.com/WomenInThoracic)). The questions will be posted directly from the [@WomenSurgeons](https://twitter.com/WomenSurgeons) twitter account and you can also find them following the hashtag [\#AWSchat](https://twitter.com/search?q=%23AWSChat&src=typd). If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweetchat: 1\. How should I identify a mentor who is a good fit for me? 2\. a) Should a female trainee have a female mentor?b) What if I cannot find a female mentor within my institution or city? Are there other avenues to foster this type of relationship, or am I simply out of luck? b) How many mentors do I need? 3\. Is it okay to have different mentors for different aspects of training or different time periods of training/professional development? 4\. Does a mentor-mentee relationship need to be formalized? Do I need to ask someone to be your mentor? 5\. What are the expectations for a mentor? What are the expectations for a mentee? 6\. Is it okay to talk to a mentor about non-medical topics, such as family/home life, pregnancy, work-life balance? What about venting about a really terrible day – does that cross boundaries? ![](https://blog.womensurgeons.org/wp-content/uploads/2020/02/Corsini.png) Dr. Erin Corsini is a general surgery resident at Baylor College of Medicine in Houston, TX. She is completing a two-year clinical research fellowship and Master of Science in Clinical Research with the Department of Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center before returning to clinical residency this summer. Dr. Corsini grew up outside of Boston, MA and attended Albany Medical College. She is a mother of 1 and is an aspiring thoracic surgeon. You may follow her on twitter [@ErinMCorsiniMD](https://twitter.com/ErinMCorsiniMD). ![](https://blog.womensurgeons.org/wp-content/uploads/2020/02/Antonoff.png) Dr. Mara Antonoff is a mother of 4 and Assistant Professor in Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center. She is the Website Editor and Social Media Director for Women in Thoracic Surgery. At MD Anderson, Dr. Antonoff is also the Associate Program Director for the Thoracic Surgery Training Program. Her twitter handle is [@MaraAntonoff](https://twitter.com/maraantonoff). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat, mentorship **Tags:** AWSChat, ILookLikeASurgeon, mentorship, training, Tweetchat, womeninsurgery, WomenSurgeons --- ### [Finding Our Way Back to Translational Research](https://blog.womensurgeons.org/finding-our-way-back-to-translational-research/) **Published:** February 8, 2020 **Author:** mcooke@amrms.com **Content:** *By Anna Garcia Whitlock, MD* Banting – Metabolism, Huggins – Oncology, Murray – Immunology. These are three of the nine surgeons who’ve won the [Nobel Prize in Physiology or Medicine](https://jamanetwork.com/journals/jamasurgery/article-abstract/398315). To me, it seems only natural that surgeons would carry research from the bedside to the bench and back again. Not only are surgeons required to have an extraordinary command of human physiology, but they are among the few individuals who bear witness to function and pathology in action. Surgeons actually see, hold, and experience science in the operating room, providing the unique opportunity to evaluate mechanism and foster discovery in real time. Unfortunately, [surgeons also experience some of the most profound barriers in the pursuit of research, in particular, basic science](https://www.facs.org/media/press-releases/2018/nih030518) – a phenomenon that must be stopped. Research support for surgeons is fading. A [report from the Society of University Surgeons](https://www.ncbi.nlm.nih.gov/pubmed/27643928) found that the proportion of NIH funding allocated toward departments of surgery fell from the already low 3% in 2006 to 2.3% in 2014. Another study found that [fewer surgeons are applying for NIH grants](https://www.ncbi.nlm.nih.gov/pubmed/29482999) and those who do are less likely to be funded compared to their non-surgical colleagues. For example, NIH funding for surgeons has declined from $314 million in 2007 to $292 million in 2016, while funding for Internal Medicine and its subspecialties has held steady at $3.2 billion. This outlook grows more ominous for women surgeons given another report on the state of the NIH funded workforce from the Federation of American Societies for Experimental Biology that found [women are less likely to be funded](https://www.ncbi.nlm.nih.gov/pubmed/29920223) compared to their male colleagues as a whole. While the study did not explicitly examine trends among physicians or surgeons explicitly, the funding climate can seem daunting for an aspiring surgeon-scientist like me. So, where do we go from here? Last year, the Basic Science Committee of the Society of University Surgeons published a [“roadmap” for aspiring surgeon-scientists](https://www.ncbi.nlm.nih.gov/pubmed/29958227) in which the authors highlight many of the barriers experienced by young faculty and offer advice on how to address them. Specifically, they cite four elements that they feel are key to succeeding as a surgeon scientist: financial support, supportive environment, social support, and committed mentors. While I am still a trainee, I can already vouch for the importance of these ingredients as a trainee. During medical school, I participated in a [formal program ](https://www.niddk.nih.gov/research-funding/process/apply/funding-mechanisms/t32/medical-student-research-training-supplement)that provided not only funding and protected time for a year dedicated to research but also educational sessions on topics beyond the bench such as grant writing. This experience was truly formative, and now that I am in residency, I am grateful for a program that has allowed me to continue to develop my scientific skill set by pursuing a PhD. Most importantly, both institutions connected me with mentors who exemplify not only the type of scientist or surgeon I hope to become but also the caliber of innovation that is possible when you combine the two. Roadmaps, programs, and mentors like these are just the start of helping the next generation excel in both surgery and translational research. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/02/Screen-Shot-2020-02-08-at-12.50.12-PM.png)Anna Garcia Whitlock, MD is a General Surgery Resident at the Hospital of the University of Pennsylvania where she is using her academic development time in residency to pursue a PhD in Cell Biology, Physiology, and Metabolism through Penn’s [Surgeon Scientist Training Program](http://www.uphs.upenn.edu/surgery/Research/phd_program.html). She attended Vanderbilt University for medical school and the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill for her undergraduate degree in Nutrition and Public Health. Her research interests center on metabolic derangements in the critically ill while her non-academic interests include exploring the Philadelphia music and food scenes with her husband and two dogs. She can be reached on Twitter [@annagar33.](https://twitter.com/annagar33?lang=en) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** research **Tags:** AWSBlog, womeninsurgery --- ### [A big difference in a small pond](https://blog.womensurgeons.org/a-big-difference-in-a-small-pond/) **Published:** January 29, 2020 **Author:** mcooke@amrms.com **Content:** *By Danielle Hashmi* When I was applying for medical school and residency, I was certain that I would never have children during my training. Despite this original conviction, by the time that I was getting my residency out of the gloomy pit of intern year, I was realizing that I was ready to start a family. I am currently a fifth-year resident at a fairly large general surgery program based in Philadelphia. Prior to residency, I completed a five-year undergraduate program and worked for three years as an engineer. I then did a dual degree program obtaining an MS in Forensic Medicine, adding an additional year to my medical school training. I say all of this to explain that I am a few years older than my classmates and that while delaying child-rearing until graduation seemed logical to a twenty-something-year old, at 32 I was no longer as certain. I had my daughter during my third year of residency. She is the light of my life, and I would not change that for the world. The process of taking leave for the delivery of my baby was less than ideal. I found a lack of support and at times flat out resentment from some of my fellow residents. However, the reason that I wanted to focus on this topic for this article is not to reminisce in nightmares; it is to highlight the positive change and culture shift that occurred in my program between my third and fifth years and to encourage those reading this to push to make those changes as well. We did not have a defined maternity leave policy at the time of my planned cesarean section. Our medical leave policy included filing for leave through the Family Medical and Leave Act and using all of our vacation. Any leave taken in addition to the four-week vacation period needed to be made up at the end of your residency. You could not transfer vacation time from year to year, so essentially any leave over four weeks for any resident, from family medicine to neurosurgery, required an extension of your training. In my mind, this policy almost ensured any resident mother would either not pursue fellowship training or would not have adequate time to recover and bond with her newborn. After hearing about my experience, two fellow residents approached me and brought up the idea of changing our policy. While this was something that I knew needed to happen, it was not something that I was able or willing to do alone, especially after the judgment I felt during my pregnancy. I had personally argued for a leave that mirrored the American Board of Surgery (ABS) time requirements, but it had fallen on deaf ears. I learned an important lesson after this: three voices are louder than one. We wrote a draft policy and presented this to our Graduate Medical Education (GME) director. After several meetings and revisions, this policy became congruent with the ABS policy. Our policy was expanded to include the same for all specialties- a leave policy which included the maximum time allotted by their governing board. Our leave was designated “family leave” that included maternity and paternity leave and leave for family emergencies. Our GME director and our new general surgery program director were very supportive during this process. The most rewarding part for me has been the mental shift in what it means to be a resident parent. It is no longer a shameful secret that you want to have a child during your training. Our residents have pulled together for baby shower gifts, and we routinely share pictures of our children. I am so proud of the change that my program has made, and I know we will continue to see improvements as long as people do not abuse the policy. Since I had my daughter two years ago, our program has welcomed three new additions into the world. A mother and a father have taken family leave, and that is a wonderful feeling. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/01/AWS-Pic.png)Danielle Hashmi (LaSalle) grew up in Philadelphia. She attended Drexel University for Biomedical Engineering before working for Augusts Aerospace Engineering. She attended medical school at the Philadelphia College of Osteopathic Medicine, where she also completed her general surgery residency. She has an MS in Forensic Medicine. She will do her Surgical Critical Care fellowship at Lehigh Valley Hospital and hopes to pursue a career in acute care surgery, trauma, and burn. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons* **Categories:** residency **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Electronic Health Record fails the test of physician usability: What can we do?](https://blog.womensurgeons.org/electronic-health-record-fails-test-of-usability/) **Published:** January 23, 2020 **Author:** mcooke@amrms.com **Content:** *By Lillian Erdahl* Today I achieved what has been a challenging goal for me, zero tasks in my electronic health record (EHR) inbox. It is unlikely to last for very long, but it feels good to accomplish it even briefly. Much has been done with information technology in the interest of improving the delivery of health care. Not surprisingly, there are positives and negatives to the digitalization of health care delivery.[ Emerging literature](https://www.ncbi.nlm.nih.gov/pubmed/29295278) shows that U. S. physicians find the burdens and poor usability of the current systems to be a major source of stress and dissatisfaction. We are spending “pajama time” trying to keep up with the seemingly endless list of tasks generated in our EHR inbox. Positive aspects of the current EHRs include electronic preservation of clinical data and accessibility of these data, the ability to share data in a timely fashion from one hospital to another when a patient is transferred or referred to another location, and the potential to reduce errors. Negative aspects of current EHRs include that mechanisms for capturing data that are focused on billing rather than clinical care leading to poor usability for clinicians, redundant processes increasing the work of care, and separation of clinical care from the bedside. There is a crisis of physician burnout and the EHR is a major contributing factor. For example, a recent study published in the[ Mayo Clinic Proceedings](https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/fulltext) found that physicians overall graded EHR usability at an “F”. In addition, individual EHR usability ratings correlated with reporting of burnout. Not only are rates of burnout high,[ the physician suicide rate](https://www.npr.org/sections/health-shots/2018/07/31/634217947/to-prevent-doctor-suicides-medical-industry-rethinks-how-doctors-work) in the United States is more than double that of the general population. Yet, the health care industry fails to provide user-centered delivery of healthcare including EHR systems that physicians find difficult to use. We must not accept this status quo. Yes, there are ways to improve individual efficiency, but this is often left to the physician to seek out on her own. [Systemic changes](https://www.washingtonpost.com/health/2019/10/23/broken-health-care-system-is-causing-rampant-burnout-among-doctors-nurses/) to the electronic delivery of healthcare are desperately needed. The onus should be on manufacturers, hospital administration, and health care systems to provide tools tailored to clinician needs not just hospital billing. We would never accept F level performance from a surgeon. We must work with hospitals, EHR companies, and legislators to demand better from the systems we use to deliver care. In the meantime, physicians must control what they can in the moment and give feedback to those who can improve the systems. What can you do? First, make sure that you are taking the necessary measures to avoid or treat burnout. Seek out opportunities to gain knowledge and skills. Ask for resources such as dictation software, scribes, or templates for common documentation types. Join a hospital committee focused on EHR or Information Technology to give feedback on what works well and what could be improved. Take a course on billing and coding to familiarize yourself with how it works. Subscribe to [blogs](https://blog.srs-health.com/), [podcasts](https://www.adsc.com/blog/healthcare-podcasts-you-need-to-listen-to), or [other publications](https://en.wikipedia.org/wiki/List_of_medical_and_health_informatics_journals) that teach physicians about how to interact effectively with the EHR and other digital healthcare delivery tools. EHR and Health IT Learning Resources: [University of Minnesota Interprofessional Healthcare Informatics Online Course](https://www.coursera.org/lecture/health-informatics-professional/electronic-health-records-nItrS) [AMA Health Systems Science Textbook](https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2780003) [AMIA Clinical Informatics Certification](https://www.amia.org/applications-informatics/clinical-informatics) ![](https://blog.womensurgeons.org/wp-content/uploads/2019/02/Erhdal-1.png)Lillian Erdahl, MD FACS is an Assistant Professor of Surgery at the University of Iowa. She serves as Associate Program Director in General Surgery as well as the head of the Iowa City VA Medical Center Breast Clinic. Her research interests include breast cancer prevention, faculty development, and simulation in teaching clinical examination. She is the Communications Director for the University of Iowa Department of Surgery which includes overseeing the department’s social media accounts. Her work for Gender Equity includes serving as the Association of Women Surgeons Communications Committee Co-Chair. Outside of the hospital, she enjoys yoga, cross-country skiing, cooking, and gardening. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery, WomenSurgeons --- ### [Splendor: The Art of Compassion in Surgical Training](https://blog.womensurgeons.org/splendor-the-art-of-compassion-in-surgical-training/) **Published:** January 16, 2020 **Author:** mcooke@amrms.com **Content:** Deciding on a career in surgery was very difficult for me. I went into medical school believing I would become a family medicine physician or a pediatrician. I wanted that patient-physician relationship, and that was one of the hardest aspects of falling in love with surgery: I thought I would never develop those relationships. How wrong I was. Even as a resident, where patient continuity doesn’t exist as you rotate to new hospitals or services every 4 – 8 weeks, there are several patients I will never forget. The first was a young man who came to the ED with symptoms of a large bowel obstruction. He had undiagnosed Stage IV colon cancer with tumors throughout his liver. As the third-year surgical resident on call, I had to tell this patient and his lovely wife that he had metastatic cancer, and that was causing the blockage in his colon. We took him for a laparoscopic transverse colostomy and port placement the next morning. In the recovery time, he spent a few extra days in the hospital learning colostomy care, consulting with oncology, and working with our social workers. I lingered longer in their room every day than I really had time for, counseled him about possible genetic syndromes and that his family needed early colon cancer screening. But we didn’t just talk about medicine; we discussed our favorite graphic novels and board games. He told me about a board game, where you acquire gems to buy cards with different points. It was near Christmas, so I bought the game for my husband as a gift. We still play it regularly; and every time we do, I think of this patient and his family. As a chief on our Acute Care Surgery team, I admitted an elderly previously healthy woman who swam regularly who also presented with an obstructing colon cancer. She didn’t want any surgery, but I educated her that since she did not appear to have any metastases this was a very curable process. I convinced her to have surgery. Given the obstruction, we did an open left hemicolectomy. The surgery went well and only took 2.5 hours. However, in recovery her blood pressure dropped and with fluid resuscitation she went into right heart failure. She was transferred to the ICU and required pressors. Her heart never recovered and she died 2 days later. I had never cried in front of a family before, but I sobbed with them as they hugged me and they said goodbye to their wife, mother, and sister. I was devastated and lost confidence in my abilities. However, about 3 weeks later, I received a letter from her husband explaining how in his opinion she died with dignity and that he couldn’t have asked for any better care than what I provided. I was shocked that was his perspective. That letter still sits on my desk to remind me that how we handle complications and loss is just as important as how we handle success. Patients truly respond to compassion. As a current surgical fellow, I have had similar encounters with families. I have learned the names of their children, joked with them as they recover, and delivered new devastating diagnoses. I have finally gotten a glimpse of patient care continuity, and it is so rewarding. In the age of EMR overload and burnout, never forget what brought us to medicine in the first place: to care for our patients. *One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.- Dr. Francis W. Peabody* ![](https://blog.womensurgeons.org/wp-content/uploads/2020/01/Screen-Shot-2020-01-16-at-9.35.25-AM.png)Sabrina Drexel, MD, is a minimally invasive surgery and flexible endoscopy fellow at University Hospitals Case Western Reserve in Cleveland, OH. She attended the University of Rochester for medical school, and completed her surgical residency at Oregon Health & Science University in Portland, OR. She will be returning to Portland after completion of her fellowship in Minimally Invasive Surgery to surgeon in private practice. She can be reached on Twitter [@SabrinaDrexelMD](https://twitter.com/SabrinaDrexelMD). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** reflection **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Sculpting a Civil Work Environment: Managing Microaggressions](https://blog.womensurgeons.org/managing-microaggressions/) **Published:** January 12, 2020 **Author:** mcooke@amrms.com **Content:** *By Jaime D. Lewis* Many of us can come up with a list of ways that we and our colleagues have been reminded that we do not fit the expectations of a surgeon. For [women in medicine](https://www.nytimes.com/2019/10/31/well/live/a-gender-divide-on-microaggressions-in-medicine.html) these incidents often center on similar themes: sexism, sexually inappropriate discussions, pregnancy and child care concerns, limitations placed on perceived ability, relegation to tasks unlikely to advance their career, and exclusion and marginalization. Those who are underrepresented minorities (URM) in medicine often face additional scrutiny based on their race or ethnicity. Not only do these events, or microaggressions, interrupt our daily lives, they also impact the advancement of women and URM in medicine and other fields. In 2019, [more women](https://www.aamc.org/system/files/reports/1/factsdatachart3.pdf) than men entered medical school for the first time in the US. However, gender representation in [many fields](https://www.aamc.org/system/files/reports/1/18table14.pdf) of medicine and the proportions of individuals of increasing [ranks in academics](https://www.aamc.org/system/files/reports/1/18table9.pdf) do not reflect this shift. Similarly, [improvement of URM](https://www.aamc.org/data-reports/faculty-institutions/interactive-data/us-medical-school-faculty-trends-percentages) is occurring at a nearly glacial pace. Not only can they impact our career trajectories, [microaggressions](https://jamanetwork.com/journals/jamasurgery/article-abstract/2738043) can also exact a high toll on physical and mental health leading to decreases in self-esteem and increases in blood pressure, anxiety, alcohol use, and even suicidal ideation. At the 2019 annual Association of Women Surgeons meeting, many of us participated in a session on managing microaggressions which opened the channels for further discussion on the topic. Having terminology to describe the offenses and a cadre of responses and retorts will help us to pave the way forward. Macroaggressions*:* systemic, overt discrimination towards a group based on race, gender, etc. Microaggressions: [term coined initially in 1970](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2611929/?page=1) to describe racial insults, but [now expanded to include “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative…slights and insults”](https://psycnet.apa.org/record/2007-07130-001) directed at a personal level towards individuals of a particular group. [Microaggressions](https://jamanetwork.com/journals/jamasurgery/article-abstract/2738043) include: - Microassaults: “old-fashioned”, blatant acts of discrimination - Microinsults: more subtle actions or statements that are insensitive and/or demeaning towards the recipient’s gender, race, heritage, or identity - Microinvalidations: negate or dismiss an individual’s thoughts and experiences - Environmental microaggressions: culture and climate reflect the microassaults, microinsults, and microinvalidations experiences by the individuals who share the workplace Sometimes it’s tough to know if an offence has even occurred. In addition, the offence may be obvious to a spectator or witness but unrealized by the offender. A number of methods for clarifying and responding have been proposed, including: [**O**pen **T**he **F**ront **D**oor](http://www.pamelaroy.net/uploads/5/0/8/2/50825751/pod15dcwhitepaper.pdf) Observe: describe what you saw Think: explain what you are trying to accomplish Feel: clarify your/their emotions Desire: specify how you hope to proceed [**ACTION**](https://www.facultyfocus.com/articles/effective-classroom-management/responding-to-microaggressions-in-the-classroom/) Ask: clarify with questions Come: approach the situation with curiosity Tell: describe what you saw as concerning Impact: explore what the event meant to others Own: understand how the event affected you Next: encourage action [**GRIT**](https://www.ncbi.nlm.nih.gov/pubmed/31774484) Gather: pause and collect thoughts Restate: ask speaker to or personally restate the comment of concern Inquire: seek clarification Talk it out: discuss impact, intended or unintended To discuss further, join [@womensurgeons](https://twitter.com/WomenSurgeons) along with our moderators Dr. Jaime D. Lewis ([@jaimedlewismd](https://twitter.com/JaimeDLewisMD)), Dr. Elizabeth Acquista ([@AcquistaE](https://twitter.com/AcquistaE)), and Dr. Elizabeth Shaughnessy ([@DrBethS1](https://twitter.com/DrBethS1)) for a tweetchat on Monday January 20th at 8pm Eastern Time. The questions will be posted directly from the [@WomenSurgeons](https://twitter.com/WomenSurgeons) twitter account and you can also find them following the hashtag [\#AWSchat](https://twitter.com/search?q=%23AWSChat&src=typd). If you haven’t participated in a tweetchat with us before, check out this [tutorial](http://blog.womensurgeons.org/medical-students/beyond-the-basics-of-tweeting/) written by Dr. Heather Yeo ([@heatheryeomd](https://twitter.com/heatheryeomd)) to know more. We will be discussing the following topics during our tweetchat: 1\. Are you aware when microaggressions occur? 2\. How have microaggressions impacted your career and/or your health? 3\. What evidence have you seen of environmental microaggressions in the workplace? Have you noticed any efforts to address? 4\. Do you have a systematic way of addressing microaggressions such as Open The Front Door, ACTION, or GRIT? How has this worked for you? Have you had any challenges? 5\. Do you have allies who will help you to address microaggressions when they occur? Who are these allies and how do they help? ![](https://lh4.googleusercontent.com/b5kSZ7Alen66_iJOXL9UKmNh6KRIew9YHr1TiOsXAZeHkFsyItmGl24vMYyODabzmJ1wBXyb6MyCjwm-iHY0bODggyNznEv9EZwWCn7NugMeyFO-aA_jvVkXuZJm1fDdefhZ66zQ) Jaime D. Lewis, MD, FACS, practices breast surgery at the University of Cincinnati College of Medicine in Cincinnati, Ohio, where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Dr. Lewis is committed to improving wellness and professional development opportunities of the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys running and spending time with her family. You can find her on twitter at[ **@JaimeDLewisMD**](https://twitter.com/JaimeDLewisMD). --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** AWSchat **Tags:** Awareness, ILookLikeASurgeon, microaggressions, Tweetchat --- ### [Supporting Women in 2020](https://blog.womensurgeons.org/supporting-women-in-2020/) **Published:** January 8, 2020 **Author:** mcooke@amrms.com **Content:** *By Shan Lansing* Queen Bee Syndrome is a social theory that describes how women in leadership roles sometimes expect more from female trainees than their male counterparts. I have heard this phenomenon alluded to a number of times during medical school, generally to sympathize with why a rotation may be particularly hard for female students. Most recently Queen Bee Syndrome came up in the midst of a completely awe-inspiring keynote address from Dr. Julie Freischlag on the importance of #HeForShe and #SheForShe. Each time it gets casually dropped into a conversation I leave feeling a bit stung that a woman who has been through the same conditions might pass them onto other female trainees. After Dr. Freischlag’s talk, I had a mix of those same feelings – though overshadowed with a heaping dose of inspiration. Though my instinct was to pity how this might affect my growth, it occurred to me that one day I will (hopefully) be in a leadership position overseeing the next generation of female students. I wondered what I need to do to prevent myself from falling into this same phenomenon, and what I can do now to ensure I’ll be prepared to support women in the future. Unfortunately, I currently have very little influence or standing to sponsor women in the big career-advancing ways I hope to in the future. That said, I’ve been brainstorming and the following is a short list of achievable ways I hope to support women as a modest medical student in 2020: 1. **Read books published by** [**She Writes Press**](https://shewritespress.com/): This holiday season I enjoyed reading *After Kilimanjaro*, a novel by surgeon and author, Gayle Woodson. Dr. Woodson effortlessly describes a surgical resident on a quest to evade burnout who finds purpose in studying maternal mortality in Tanzania. I highly recommend it to anyone looking for a captivating read. A visit to shewritespress.com or a quick search on Google yields a plethora of similar works published by female authors. During this coming year, I look forward to supporting these authors by buying and reading their work. 2. **Recommend female classmates for opportunities**: One of the things I am working on is “to learn to say no” if an opportunity presents itself but I am already overcommitted. I can’t say I am very good at it, but I can attest I successfully said no at least one time last year. A few weeks ago, I was giving advice to a first-year medical student about the summer after M1; she said she was interested in Infectious Disease and I encouraged her to contact one of the ID attendings I had rotated with who was empowering, knowledgeable, and would make a great mentor. Two days later, the same attending emailed me and asked if I would be interested in starting a research project with him. Already overwhelmed with third-year rotations and other projects, I had a sinking feeling in my stomach as I wanted to say yes, but knew it would be a bad idea. Coincidentally, an hour later I ran into the first-year student and the little light bulb above my head blinked on. Instead of saying ‘no’, I had the opportunity to recommend another female student for a project in the field she’s interested in, with a mentor she would undoubtedly benefit from. Managing time efficiently and turning down opportunities will become significantly easier moving forward if I use it as an opportunity to sponsor another student. 3. **Be cognizant of my language when discussing specialties with third-year students**: MS3 is a time to consider all specialties and envision committing to a residency tract. A natural conversation is to discuss what we’ve liked and where we’re thinking of applying. I’ve noticed that sometimes these conversations, while well-meaning, can lend themselves to making students feel like they do not belong in their hopeful specialty. For example, I often hear “I think you would be great in psychiatry/family medicine/etc.” and then the student awkwardly explains she’s interested in surgery. And I have even caught myself saying “You look like ortho” as an attempted encouraging response to a classmate who said he was interested in orthopedic surgery, without considering how someone else might feel overhearing that. This year, to avoid stereotyping or suggesting non-surgical fields to female classmates interested in surgery, I will practice asking *Do you have a specialty in mind?* and following it with *I think you’d be really good at that.* Because the specialty they belong in is the one they want to pursue, regardless of what they look like or what I think they would be good at. 4. **Continue to share the benefits of an** [**AWS student membership**](https://www.womensurgeons.org/page/Students): Being involved with AWS has been one of the most fun, inspiring, and empowering experiences of medical school. For $25 a year I became part of a global network of female surgeons. AWS members have access to [surgical subspecialty resource guides](https://www.womensurgeons.org/general/custom.asp?page=SpecialtyResourcesGuides) that include a list of annual conferences, abstract submission deadlines, available scholarships, relevant journals, and more. The [*American Journal of Surgery*](https://www.womensurgeons.org/news/477531/Get-Involved-with-the-2020-AWS-Issue-of-AJS.htm) reviews submissions from AWS authors and invites AWS members to serve as reviewers. The annual AWS Conference is an incredible opportunity to network with fellow students, surgical residents, and national leaders in surgery. These are a few of the things I hope to share with students this coming year so that they can benefit from an AWS membership as well. As I progress in medicine, so too will the magnitude of opportunities I have to promote others; but for now, these are a few small (and achievable) things I can do to lift up the women around me. Queen Bee Syndrome, like many forms of bias, is likely implicit. This means that my intention to avoid falling into it must be conscious and decisive. I will start making mindful decisions to support women today, even in the form of small acts like reading their books and sharing the opportunities offered by AWS. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/01/Unknown-2.jpeg) Shan Lansing is a third-year medical student at The Ohio State University College of Medicine. Originally from southern Oregon, she attended Oregon State University where she earned a dual Bachelors in Chemistry and Biohealth Sciences. She continued at Oregon State University for a Masters in Analytical Chemistry. Her current research interests include increasing surgical patient engagement in care and communication after discharge to improve quality outcomes. Ultimately, she seeks to pursue a career in rural general surgery, aiming to provide compressive surgical care for an underserved community. In her free time, Shan enjoys running, cooking, and cross-stitching. She is always looking for new ideas to empower other women; you can share yours with her on Twitter [@ShanSLansing](https://twitter.com/ShanSLansing). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** leadership **Tags:** AWS, AWSBlog, womeninmedicine, womeninsurgery --- ### [Surgeons and OR ergonomics: When Doing What We Love Hurts Us](https://blog.womensurgeons.org/surgeons-and-or-ergonomics/) **Published:** January 1, 2020 **Author:** mcooke@amrms.com **Content:** *By Geeta Lal* Almost 3 years ago, I woke up with a familiar throbbing pain in my left jaw and face. My first brush with it was four years prior, while caregiving for my mother with cancer. “Stress and teeth grinding…” said the well-meaning oral surgeon I saw, and proceeded to advise soft foods, muscle relaxants and NSAIDS for what was diagnosed as myofascial temporomandibular dysfunction (TMJD). That episode resolved and aside from some intermittent discomfort, I had done reasonably well. This time, however, things were different. The usual measures weren’t helping, and as the days and weeks wore on, the pain extended to my head, neck, shoulder, and upper back – and it refused to go away. My journey to feeling better has involved many imaging studies, specialist consults, and treatment modalities. But what I didn’t know was that a [major contributor for TMJD was the exaggerated head-down posture](https://www.practicalpainmanagement.com/pain/maxillofacial/tmj/tmd-facial-pain-forward-head-posture) I had held for many hours during the previous 12 years of my career as an endocrine surgeon. In fact, each 15 degrees of [forward flexion of the neck increases the load on the C-spine ](http://cdn.bancodasaude.com/attachment/spineee.pdf)by several kilograms. In addition, using surgical loupes for magnification causes more pronounced neck hyperflexion. The net result is an activation of the proprioceptive reflexes that then engages other muscles (of the jaw) to keep the head aligned on the spine. Antagonistic co-contraction of these muscles thus leads to symptoms that fall under TMJD. It became pretty easy to see why I was having pain and how adding a headlight (which I had long abandoned) to this could only aggravate the situation further. My struggles spurred a deeper dive into the injuries faced by surgeons during their careers. I was appalled to discover that musculoskeletal (MSK) problems have been reported in surgeons of almost every specialty – with minimally invasive procedures carrying the highest risk . Not surprisingly, only a small proportion of surgeons report their symptoms or seek treatment for them. However, this doesn’t diminish their impact as MSK pain has been shown to [correlate with both professional satisfaction and burnou](https://www.sciencedirect.com/science/article/pii/S0741521419300552?via%3Dihub)t and the reason many surgeons choose to retire early. This not only has significant financial and workforce implications, but also affects the [quality of patient care](https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S2049080118300049?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2049080118300049%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F29511535.) as 30% of surgeons report taking their own physical symptoms into account when recommending a particular surgical approach. There are additional sobering statistics. Kokosis et al. recently demonstrated that 52% of plastic surgery residents reported developing [MSK symptoms within the first 2 years of training but only 22% had received some type of ergonomics training](https://insights.ovid.com/crossref?an=00000637-900000000-96802). More worrisome is that almost 75% of medical students surveyed in a multi-institutional study endorsed MSK pain during their surgical rotation. Furthermore, their [interest in entering surgery decreased](https://www.sciencedirect.com/science/article/pii/S002248041830831X?via%3Dihub) significantly when made aware of the literature regarding the incidence of MSK injuries in surgeons. So, what do we do? The first step would be to increase awareness among all surgeons, but especially for our trainees. Surgeons need to be involved in instrument design from product inception. Early research in a multicenter randomized-control study has demonstrated the positive impact of a [preventative program](https://insights.ovid.com/pubmed?pmid=30672801) (using ergonomic principles in the OR and exercises supervised by physical therapists) in improving back pain and overall quality of life. [Microbreaks and targeted exercises](https://www.sciencedirect.com/science/article/pii/S0003687016302666?via%3Dihub) appear to decrease shoulder discomfort without disrupting focus and OR flow. Such behavioral interventions are crucial but preserving the health of the current surgeon workforce and safeguarding future generations also needs systematic organizational support and commitment. We should be teaching our residents not only how to operate but also how to do so without compromising their physical health and wellbeing. ![](https://blog.womensurgeons.org/wp-content/uploads/2020/01/drlal.png) Geeta Lal MD MSc FRCS(C) FACS is Associate Professor of Surgery at the University of Iowa and a fellowship-trained endocrine surgeon with extensive experience in thyroid and parathyroid surgery, including re-operative surgery and pediatric thyroid cancer. She serves as Co-Leader of the Endocrine Multi-disciplinary Oncology Group at the Holden Comprehensive Cancer Center and also headed and NIH-funded basic science lab focused on the role of ECM1 in thyroid, breast and other malignancies for many years. She has since transitioned to an administrative role as the Associate Chief Quality Officer for Adult Inpatient services at her institution. She chairs the AWS Grants and Fellowship Committee and the American Association of Endocrine Surgeons’ Information Technology committee. In addition, she has authored or co-authored numerous peer-reviewed articles and book chapters related to her areas of interest. She is committed to increasing awareness and developing solutions to counteract the impact of poor ergonomics on surgeons’ professional and personal lives. Follow her on Twitter [@GeetaLalMD](https://twitter.com/geetalalmd?lang=en) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** practice, self-care **Tags:** AWS, AWSBlog, womeninmedicine, WomenSurgeons --- ### [The Semmelweis Reflex: Consideration of a Gap in Theory, Practice, and Ethics](https://blog.womensurgeons.org/handwashing_gap/) **Published:** December 29, 2017 **Author:** mcooke@amrms.com **Content:** Surgical site infections (SSIs) continue to ail today’s physicians, despite centuries of advancement in aseptic technique. Patients are constantly cautioned about the risks of hospital-acquired infections, while it seems every effort has been made to reduce them. The rigorous focus on foaming in and out to patient rooms has been all too familiar to the medical student sporting a recent paper cut. Straying from the sterile field is met with a quick warning and a heightened sense of vigilance throughout the operating room. And yet, as of 2014, SSIs continue to plague 2-5% of patients undergoing [inpatient surgery](https://www.ncbi.nlm.nih.gov/pubmed/?term=25376070). In the 1840s, a young obstetrician named Ignaz Semmelweis felt that there was a connection between physician contact with cadavers, regardless of the lack of visibly transferred matter, and the risk of infection. At the time, the leading cause of death within obstetrics was puerperal fever. He introduced a chlorinated lime solution to the hospital and mandated frequent hand washing. With hand washing, the rate of puerperal fever dropped from one in ten to [one in one hundred](https://www.ncbi.nlm.nih.gov/pubmed/?term=21117357). While the outcomes improved, the lack of a strong theoretical explanation resulted in a backlash. Louis Pasteur’s germ theory of disease would not be discovered until the 1860s. At the time, his work was severely criticized. Danish physician Carl Edvard Marius Levy wrote a passionate letter against Semmelweis’ work, pointing out that the decrease in mortality was merely part of a continual ebb and flow that was natural to the fluctuations of healthcare, similar to current interpretations on [climate change](https://townhall.com/columnists/johnhawkins/2014/02/18/5-scientific-reasons-that-global-warming-isnt-happening-n1796423). He argued the improbability of anything small enough to be invisible having the capacity to kill someone and questioned the methods of this study. Despite Semmelweis’ seminal work, people continued their practices, resulting in the continued deaths of [thousands of people](https://www.bestthinking.com/articles/science/biology_and_nature/bacteriology/expert-skeptics-suckered-again-incredibly-the-famous-semmelweis-story-is-another-supermyth). The backlash can be understood as a critique against the threat of the practice, as the honorable name of medicine would be tarnished were it true that physicians were the ones [causing disease](https://www.ncbi.nlm.nih.gov/pubmed/?term=10.5923%2Fj.ajmms.20140406.11). This tendency to reject new evidence or knowledge because it contradicts established beliefs has been referred to as the Semmelweis reflex. In psychology, this is referred to as belief perseverance, a [phenomenon](https://www.researchgate.net/publication/256309187_Shortcomings_in_the_attribution_process_On_the_origins_and_maintenance_of_erroneous_social_assessments) described as “beliefs \[that\] are remarkably resilient in the face of empirical challenges that seem logically devastating”. While it is known that handwashing causes a significant reduction in the carriage of [potential pathogens](https://www.ncbi.nlm.nih.gov/pubmed/?term=1200507), as well as patient morbidity and mortality from [nosocomial infection](https://www.ncbi.nlm.nih.gov/pubmed/?term=7503437), compliance remains low. A study found that while self-reported a handwashing rate of 73%, the actual [measured rate was 9%](https://www.ncbi.nlm.nih.gov/pubmed/?term=8609848). The theory-practice gap is often cited as a lack of integration of environmental factors that are responsible for the difference between the idealistic and the realistic. However, athethird dimension of ethics can be added to this bridge, the moral duty and obligation to integrate theory and practice, not allowing for external factors to continue dictating unacceptable outcomes within [healthcare practice](https://www.ncbi.nlm.nih.gov/pubmed/?term=24174860). The beneficence of a physician’s care is not limited to pharmacological prescription or surgical decisions – every aspect of care is an opportunity to create a better health outcome for patients, and every aspect must be considered with outcomes are not at the ideal complication rate of 0%. When quantifying hand hygiene through direct observation, self reporting, and indirect calculation from product usage, compliance at baseline has been found in one study to be 26% for intensive care units (ICUs) and 36% for non-ICUs. With monitoring and feedback, compliance increased to 37% for ICUs and 51% for [non-ICUs](https://www.ncbi.nlm.nih.gov/pubmed/?term=19332864). There is opportunity to create systems that bridge the gap between theory, practice, and ethics. From the reception of Semmelweis’ findings, it seems prudent to remain mindful of the biases that can persist regarding the physician’s role in patient’s healthcare, being aware that physicians can harbor pathogens as well. Handwashing at the time was a novel concept to prevent complications, but has now been accepted as fact – unfortunately, it has yet to be put into universal practice. Just as every surgeon must scrub into a surgery, there is an ethical imperative to bridge the gap between practice and theory by maintaining the self-direction to protect the patients’ well-being with every facet of care, handwashing not excluded. ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/connie-150x150.jpg) *Connie Shao is a fourth year medical student at the University of Chicago Pritzker School of Medicine. She is originally from Michigan and enjoys swimming, reading, biking, and painting. She is applying to general surgery residency and has been meeting incredible applicants and inspirations along the way.* **Categories:** advocacy, resources --- ### [Clean Hands Deserve Two Thumbs Up](https://blog.womensurgeons.org/clean-hands/) **Published:** December 7, 2017 **Author:** mcooke@amrms.com **Content:** 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](http://graphics8.nytimes.com/images/blogs/freakonomics/pdf/the%20etiology,%20concept%20and%20prophylaxis%20of%20childbed%20fever.pdf): mortality rates of mothers seen on those wards covered by students and junior physicians plunged. Despite the evidence, Semmelweis’s conclusions were not as readily accepted, and would not be so for years to come. Hand hygiene is one of the most important methods of preventing transmission of healthcare-associated infections. The Centers for Disease Control and Prevention asserts that hand washing [prevents](https://www.cdc.gov/handwashing/why-handwashing.html) diarrheal illnesses by 30% and respiratory infections by 20%, for which antibiotics are, consequentially, overprescribed and overused, lending to a rise of antibiotic resistance. Rubbing alcohol-based solutions and washing with soap and water are the most popular and widely used techniques for hand hygiene. Newer hospital wards are especially equipped with sinks and sanitizer dispensers inside and outside patient rooms, while older wards, especially emergency departments (ED) and intensive care units (ICU), are being similarly retrofitted. Still, low hand hygiene compliance plagues healthcare workers. Surprisingly, the World Health Organization (WHO) 2009 Guidelines on Hand Hygiene in Health Care lists [physician status](https://www.ncbi.nlm.nih.gov/books/NBK144026/) as a leading risk factor for poor adherence. The same set of WHO guidelines studied predictive factors for good adherence to hand hygiene, and cited peer pressure and the awareness of being watched as leading determinants. Another positive determinant for good adherence: being a woman. Few of us can objectively contest anything less than 100% compliance, especially when Infectious Control personnel are making their rounds, but consistent efforts to wash in, wash out, and wash in between encounters (for the double-occupancy rooms) can be more difficult to achieve. The five critical moments of a patient encounter during which hand sanitation must be attained are: 1. Before touching a patient (e.g., prior to examination, or assisting patients to move or walk) 2. Before a clean/antiseptic/sterile procedure 3. After body fluid exposure risk (e.g., handling Foley bag, IV sites) 4. After touching a patient 5. After touching a patient’s surroundings (e.g., bed rails) The above measures not only prevent exogenous germs on your hands from colonizing the patient or their room, but prevents us from carrying infectious particles to other patients or healthcare professionals. Cold weather and large crowds makes the holiday season an especially vulnerable time for germ spread, even just by walking through a hospital lobby, cafeteria, or the ED; pocket-sized sanitizer bottle come in handy when no wall mounts are available or should we become the unsuspecting victim of a wet sneeze, ours or someone else’s. The busyness of a surgeon’s day is on par with the delicate state of our patients’ health. The sense of criticality with which we adopt sterile techniques in the operating room should be translated just as readily in the clinics, inpatient wards, ED, and the ICUs, and beyond the weeks of Infection Control monitoring our movements. We do not think twice about it in the OR, we should not think twice about it outside it. This National Handwashing Awareness Week (December 3-9), spread the word, not the germs. Alert those who walk in without washing into a patient’s room. --- ![](http://blog.womensurgeons.org/wp-content/uploads/2017/12/fatima-150x150.jpg)*Fatima S. Elgammal is a fourth-year medical student from St. George’s University School of Medicine. She developed an interest in critical care and trauma/acute care surgery following four years of studying neuronal changes in traumatic brain injury models of epilepsy and her time at Hackensack University medical Center as an emergency physician scribe then later as student completing clerkship. An alumna of New Jersey Institute of Technology, she enjoys illustrating, baking, reading, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education, professionalism, resources, self-care **Tags:** Handwashing --- ### [ASSOCIATION OF WOMEN SURGEONS "TWEETCHAT" ON THE #IDEALTEAMPLAYER](https://blog.womensurgeons.org/tweetchat-idealteamplayer/) **Published:** November 30, 2017 **Author:** mcooke@amrms.com **Content:** This past Monday, November 27th, the Association of Women Surgeons (AWS) Clinical Practice Committee carried out a very insightful Tweetchat discussing The Ideal Team Player, a book by Patrick Lencioni ([@patricklencioni](https://twitter.com/patricklencioni)). The Tweetchat was moderated by Dr. Sasha Adams ([@SashaTrauma](https://twitter.com/SashaTrauma)), current AWS CPC Chair, and Dr. Jean Miner ([@Jfminermd](https://twitter.com/Jfminermd)), past CPC Co-Chair. For those who were not present or missed any parts during the chat, you can find some of the highlights of the discussion in the Tweetchat [storify](https://storify.com/MadelineBTorres/aws-tweetchat-on-the-idealteamplayer). Thank you for everyone who participated and look out for the next AWS Tweetchat taking place in December! **Categories:** leadership, professionalism, residency, training **Tags:** humble, hunger, smart, team, Teamwork --- ### [Hurricane Season: A Family Affair](https://blog.womensurgeons.org/hurricane-season-a-family-affair/) **Published:** November 26, 2017 **Author:** mcooke@amrms.com **Content:** News of hurricane Irma came on the heels of witnessing the heroism and devastation of [hurricane Harvey in Texas](https://www.womensurgeons.org/when-disaster-strikes/). Yes heroism. Natural disasters do not discriminate and we have witnessed people of all walks of life coming together to help one another in the face of tragedy. 2017 has certainly had its share of devastation. Even though I wasn’t in [Houston](https://www.womensurgeons.org/lessons-healing-after-harvey/%3E), I lived it through my family and social media who live just outside of Houston. I watched people, like my own nephew, rescuing stranded men and women in areas of flooding and delivering food & water to those unable to get out of their houses. ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/IMG_2934-300x225.jpg)My nephew helping rescue people from floods caused by Hurricane Harvey. So when word came from the hurricane center that Irma was headed to Florida, Floridians prepared. Food, water, and supplies disappeared from grocery store shelves days before the storm hit. Gas lines became long as people filled up everything they could for car travel and backup generators. College students were evacuated and sent home two days before the storm arrived and were told not to return for a week. Schools and offices closed to make ready. The government sprung into action and orchestrated the largest evacuation plan in the state’s history. Now Floridians are used to hurricanes. We have Miami Dade grade windows, hurricane shutters, back-up generators, and sandbags galore. This time was different. Floridians found themselves in an arcade pinball machine. The eye of the hurricane and where it would hit landfall kept moving. People would evacuate from one area only to learn that new area was now in the path of the hurricane. Some managed to get out of the state via jam-packed highways or airplanes until roads and airports closed. Shelters opened at a fierce pace for those fearful to stay home alone whilst other joined forces and supplies in the safest house in the neighborhood. Mine was one of those houses with Miami Dade grade windows, extra hurricane curtains, a household generator running off the public gas line, and a walk in closet that was emptied to convert to a safe room. Outpouring of texts and emails from concerned friends and colleagues across the nation keeping me connected with the outside world. Newscasters kept us abreast moment by moment of the storm’s progress. The entire state of Florida was hit by hurricane Irma without exception. Some lost their houses, many lost power for days (some for over a week), and many had no drinking water or usable water as their house supply comes from a well. Grocery store shelves lacked refrigerated products and water for days after the storm. Gas stations remained closed as the ports took days to re-open to receive tankers of gas. The government and public servants worked tirelessly to get the state up and running. Like hurricane Harvey and the other tragedies, Floridians banded together. Households with water and power opened their doors to those without (Florida this time of year is still hot and humid). Cleanup and repairs are still under way. As for me, eventually I will unpack my house and take down the hurricane curtains. In the grand scheme of things, it is just not a priority. What is a [priority ](https://www.womensurgeons.org/when-the-storm-clears-a-new-perspective/%3E)are efforts to help our [Puerto Rican](https://www.womensurgeons.org/handties-heartbreak-pr/) neighbors (many of which have family members in Florida). Our schools are taking on their students. Our hospitals are taking their sick. I am proud of how we all put our differences aside, rose to the occasion, and are helping one another. We have seen such resolve time and again this year for other tragedies. *A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.* *![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/CLaronga-150x150.jpg)* *Christine Laronga is a Senior Member at Moffitt Cancer Center and a Professor of Surgery at the University of South Florida and specializes in disease of the breast. She joined the Association of Women Surgeons as a resident and has been an active member for over a decade. She is also the Immediate Past President. Follow her on Twitter [@clarongamd](http://twitter.com/@clarongamd).* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, family life, leadership **Tags:** Awareness, AWSFood4Thought, National News, safety, Wellness --- ### [Prioritizing Palliative Care in Surgical Management](https://blog.womensurgeons.org/prioritizing-palliative-care/) **Published:** November 22, 2017 **Author:** mcooke@amrms.com **Content:** 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 know him, his family, and how painful treatment could be. Our discussions with palliative care, his family, and himself helped me understand medicine beyond the naive understanding of a medical student, freshly emerged from board exam studying. Oncologic care has been the subject of national discussion, as the cost of treatments become a financial burden to the survivor and/or their family. Treatment can be continued to the detriment of the quality of the patient’s few remaining days of life. Without sufficient conversation about goals of care, treatment options become oriented to flowchart algorithm for a much different patient with very different goals. Palliative care focuses on management of symptoms and psychosocial support, providing patients with options to achieve their personal goals for their remaining days of life. In the 1950s, Dr. Cicely Saunders first articulated the concept that would eventually become modern hospice care. From careful observation of dying patients, she advocated that the ‘total pain’ of dying could be relieved by an interdisciplinary team in the context of the patient’s family ([1](https://www.ncbi.nlm.nih.gov/pubmed/19074127)). This concept of teamwork is very much alive today in palliative care, where teams consist of nurses, social workers, pharmacists, chaplains, physicians, and most importantly, the patient and their family. Unfortunately, this can be mistakenly perceived as ‘giving up’ instead of an opportunity to have informed discussions between patients and providers. It has also been traditionally delivered late in the course of care when hospitalized patients have uncontrolled symptoms. In those cases, it is often too late for palliative care to alter the quality and delivery of care provided to patients. Pancreatic and lung cancer are diseases that have a high burden of symptoms and poor quality of life. The prognosis for metastatic non-small-cell lung cancer is less than 1 year after diagnosis ([2](https://www.ncbi.nlm.nih.gov/pubmed/11441624)). Early introduction of palliative care has been found to improve both quality of life and mood, as well as leading to less aggressive care at the end of life with longer survival ([3](https://www.ncbi.nlm.nih.gov/pubmed/20818875)). In a retrospective study done in 2016, McGreevy et al found that for the 205 adult, nontrauma patients who had gastrostomy tubes placed, there was an 8% in-hospital mortality rate and a 19% 1-year mortality rate. Of the patients who survived to discharge, 69% were not able to live independently. Of the patients who suffered acute brain injury or respiratory failure, 90% died in the hospital or were severely disabled at discharge. For the 205 patients who had gastrostomy tubes placed, only 12% of patients received a documented palliative care assessment preprocedure ([4](https://www.ncbi.nlm.nih.gov/pubmed/27919451)). Gastrostomy tubes are just one example of a ‘trigger’ that can be used for a palliative care assessment. Utilizing certain interventions that alter the patient’s quality of life as the impetus to have a discussion about goals of care can help patients have a better understanding of their condition and care to guide the course of interventions throughout their hospital stay. Palliative care is challenging for patients and providers alike. Coming to terms with what the future has to offer, as predicted by studies and interpreted through experience, is an honest conversation that tests the patient’s and family’s self-knowledge, as well as the physician’s ability and knowledge to provide the best clinical support. In life and in death, suffering may be inevitable, but it is within our realm as physicians to lessen it to the best of our ability. *![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/connie-150x150.jpg)Connie Shao is a fourth year medical student at the University of Chicago Pritzker School of Medicine. She is originally from Michigan and enjoys swimming, reading, biking, and painting. She is applying to general surgery residency and has been meeting incredible applicants and inspirations along the way.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, medical students, professionalism, resources, training **Tags:** cancer, end-of-life, Healthcare, medstudents --- ### [Why I Joined AWS](https://blog.womensurgeons.org/why-i-joined-aws/) **Published:** November 15, 2017 **Author:** mcooke@amrms.com **Content:** “*Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.*” – Margaret Mead I have been incredibly blessed in my life. My parents have been, and continue to be amazing role models. One of my Mom’s favorite sayings was, “Always seek and surround yourself with people who are smarter than you. They will stretch your viewpoints of the world.” My dad on the other hand had colorful proverbs and parables to emphasize learning points (I continue to joke with him about writing a book entitled, ‘My Father the Philosopher’). One of his favorites, loosely translated from our local Indian language of Malayalam, was “Beware of continuing to climb up the same coconut tree behind a baboon. Your view will always remain the same.” Diversity is a buzzword these days. There are numerous examples of the power of diversity in multiple fields of work. Heck, the United States is a testament to the power of immigrant diversity (or at least it has been till date). The conversations traditionally have centered on ethnicity and only recently, gender. This of course is important. But, can we have true diversity when we only pay attention to how we look? What about diversity in thought? This has been difficult to do in healthcare. In the field of Medicine, it starts with the admission process. High Board Scores – Check. Volunteering to work in clinics – Check. Recommendation letters from those in the field – Check. Straight A’s, Honor Rolls, and Dean’s Lists – Check, Check, Check. Admission committees, overwhelmed with an ever increasing volume of applicants, have to make difficult cut-offs for admission. With the knowledge that certain types of students have succeeded in the past, this knowledge flavors the admission criteria of today. And we as students embrace this mission and mantra. Study hard, deep dive into our books, relentlessly try and figure out the the various signs and symptoms of disease. Along the way we are influenced by various specialties, which ultimately lead to our final paths of training and establishment as Attendings. But where’s the time to diversify our thoughts? In Medicine, the world around us was historically encountered one patient at a time, one workplace environment at a time, one organization at a time. Experience was solely a personal journey. And this worked in a world that succeeded (and made lots of money) by homogenization, decreasing variation, and converting aspects of healthcare into assembly lines. Departments in Academia prided themselves on success in the form of traditional metrics – papers published, grants received, Blue Ridge Institute for Medical Research ([BRIMR](http://www.brimr.org/NIH_Awards/2016/NIH_Awards_2016.htm)) rankings and clinical reputation as publicized in traditional media reports. Past success influenced the current metrics, all of which are important, but should they be the only ones? Social Media has turned the learning experience on its head. There is no longer a need for your views and experiences to be confined to the walls of your institution. You can connect with anyone in the world at any time. However, there is a downside. Though you can find differing opinions, it is so easy to confine your experiences and thoughts to like-minded individuals or groups. Finding your tribes of course is reassuring and empowering. But the same traps of ‘homogenization of thought’ can occur on social media due to evolving algorithms aimed at user-targeted ads and personalized experience. If your timelines are filled with those who echo your same thoughts, who don’t offer differing opinions, are you truly diversifying? My journey to AWS came predominantly from social media. I was able to connect with many thought leaders who shared their wisdom with the world at large. They opened my eyes to the struggles they had in their work environments. Many of these struggles transcend boundaries – whether they be gender, ethnicity, or social backgrounds. Several took the step of forming groups, and transforming existing organizations to more pragmatic and powerful instruments of change. I was able to learn at a distance of the efforts of AWS, including their work on gender pay inequity, work-life balance, and how to empower others. I was thus inspired to learn more about their work up close. I had live-tweeted their conference last year, and hence thought, why not? I turned to one of my close friends, who I first met on social media – Dr. Amalia Cochran (@AmaliaCochranMD ). Amalia and I had first connected when we were at different institutions. Our first in-person meeting was when I had the opportunity to give Grand Rounds in Salt Lake City. One thing led to another, and now I’m on faculty at the same institution. I brought up how I had admired AWS from afar, and admitted that I only had a superficial knowledge about several issues such as inequity. Amalia, in classic Amalia fashion, had a mischievous grin on her face while she asked, “So why don’t you become a member?” My response – “I can be a member of AWS?” Hers – “Why not?” ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/image2-300x153.jpg)Image of #HeForShe support at the AATS annual meeting 2017 My only prior experience with issues on inequity had been with the #HeForShe movement. The [speech that Emma Watson](https://www.youtube.com/watch?v=gkjW9PZBRfk&sns=em) gave is inspiring. This past year, the department of surgery at the University of Michigan embraced #HeForShe and challenged others to follow. Quickly, other organizations such as SAGES, ASE and APDS followed suit. In Thoracic Surgery, our national AATS meeting was about to take place in May, and hence I turned to the Women in Thoracic Surgery organization to ask about interest. With overwhelming support and the help of then president Dr. Jessica Donington and the leadership team, we were able to pledge our support for the movement by our specialty. Awareness is of course the first step. But what happens next? ![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/image1-150x150.jpg)I joined AWS. Their creed – Engage, Empower, Excel – is something that all of us can benefit from. Engaging with those who have lived and overcome barriers is uplifting. Learning the skills to empower those around you to reach for greater heights is inspiring. And relentlessly applying the skills you learn to excel in your environments can change the world. We’re assembling a #HeForShe task force within AWS, with the goals of teaching the skills for men to effectively mentor and sponsor women surgeons. I personally am still learning, and in my heart believe that many men want to help. They just need to be taught how to do so effectively. I want to close with some quotes from those I admire: “*Reminder to us all in healthcare. We do not do this alone. Ever. I love having a team of superheroes to work with.*” – Dr. Amalia Cochran @AmaliaCochranMD “*Even those above you have knowledge deficits.*” – Dr. Julie Silver @JulieSilverMD “*If you want to know the secret of success, it is not being better than everyone else. It is showing up more than everyone else.*” – Dr. Sasha Shillcutt @SashaShillcutt Embrace diversity at all levels. Connect with those who come from different backgrounds. Constantly seek to diversify your thought. And of course, join us in the work ahead. *![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/Varghese-Thomas-e1518714189113-150x150.jpg)* *Dr. Thomas Varghese Jr. is the Head of the Section of General Thoracic Surgery, Co-Director of Thoracic Oncology, and Program Director of the Cardiothoracic Surgery Residency at the University of Utah. Dr. Varghese holds leadership positions in the Society of Thoracic Surgeons, Thoracic Surgery Directors Association, American College of Surgeons and the Surgical Outcomes Club. Views expressed in this post are personal, and do not represent official positions of these organizations. You can follow on Twitter [@tomvarghesejr](http://twitter.com/tomvarghesejr).* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, gender differences, leadership, mentorship, networking, professionalism, resources **Tags:** #HeForShe, Gender Disparities, ILookLikeASurgeon, LeanIn, sexism, stress, workplace --- ### [United We Are Stronger](https://blog.womensurgeons.org/united-we-are-stronger/) **Published:** November 12, 2017 **Author:** mcooke@amrms.com **Content:** [FuerzaMéxico](https://twitter.com/hashtag/fuerzamexico) [\#19S](https://twitter.com/search?q=%2319S&src=typd) Thirty-two years ago, Mexico City was hit by a devastating earthquake that left thousands dead, hundreds of buildings collapsed and became uninhabitable. It was an event that united us as a society and helped to implement a culture of prevention. The regulations for the construction of buildings in the city were modified and since childhood we were taught how to act and protect ourselves during an earthquake. Earthquakes cannot be predicted, but we can prevent many of their terrible consequences. On September 19th, a new earthquake struck the country on the anniversary of the 1985 earthquake. Two weeks after another strong earthquake shook the coasts of Chiapas and Oaxaca. What a terrible coincidence! That morning the City had participated in acts that commemorate the events of 1985. At the time of the earthquake (13:14 CMT), I was in the emergency room with several surgery residents when we felt a strong shake. Just at that moment the seismic alarm sounded and we tried to quickly go to the security areas together with some patients and their families. It was a matter of seconds but it felt like an eternity. When it was over, and after the initial shock, we all tried to get in touch with our families. Internet and telephone lines had collapsed. When the communication lines were reestablished, the terrible news began to arrive. Offices, buildings, houses, schools had collapsed all over the city, people trapped in the rubble, children lost. What to do, what to think in those moments of [despair](https://www.nationalgeographic.com/photography/proof/2017/09/mexico-city-earthquake-destruction/)? During those first hours of fear and uncertainty, when we all tried to know if our loved ones were safe, if our homes were ok, I witnessed the vocation and professionalism of the hospital staff, especially the surgery service, to which I am proud to belong to. Those who were in the operating room at the time of the quake only left during the tremor and returned to finish the procedures and put the patients in safe areas despite the risk of damage or gas leaks. [Some could not step away](http://metro.co.uk/2017/10/20/earthquake-hits-as-doctors-perform-open-heart-surgery-in-dramatic-video-7014104/). The residents voluntarily stayed to see what they could help with, organizing tasks, relocating patients who had to be evacuated from certain areas. Many of them, like hundreds of people in the country could not return to their homes for days, and many basic services failed. In these instances I saw how, despite the shortcomings, people kept going on. The people of Mexico City responded by [taking to the streets to help](https://www.nytimes.com/2017/09/20/world/americas/mexico-city-earthquake-photos.html). Young people raising debris to rescue trapped people, doctors organizing brigades, people preparing food for those affected, and volunteers, donations in unexpected quantities. Help came from everywhere and in all forms. The solidarity, strength and unity that the country showed in those days will be something I will remember forever. In the midst of chaos, despair and death, I confirmed that Mexico is still one of the most friendly, vibrant, and resilient countries in the world. The reconstruction work and help for those affected will continue for months and years to come. The important thing is that we do not allow us to forget that even during those terrible days there was hope and that all of Mexico was one. *A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email* [*blog@womensurgeons.org*](mailto:blog@womensurgeons.org)*.* *![](http://blog.womensurgeons.org/wp-content/uploads/2017/11/RCarrera-e1518714440857-150x150.jpg)Dr. Rocío E. Carrera Cerón is a thoracoscopic surgery fellow at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City, where she also completed her residency in general surgery. She received her medical degree from Universidad Nacional Autónoma de México (UNAM) in 2012. Her interests include general thoracic surgery, particularly tracheal surgery, and lung transplantation. She is engaged in clinical research studies and actively participates in several local associations of women surgeons trying to establish mentorship and sponsorship programs for young residents. A native of Mexico City, she is passionate about sports, cinema, and historical novels.* --- *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, leadership, residency, self-care **Tags:** AWSFood4Thought --- ### [New Therapies for Childhood Cancer](https://blog.womensurgeons.org/childhood-cancer/) **Published:** September 22, 2017 **Author:** mcooke@amrms.com **Content:** By Madeline B. Torres M.D. Arriving at the National Institute of Health (NIH) as a surgical oncology research fellow this summer felt like winning the golden ticket into Willy Wonka’s factory. I entered with high hopes to tackle one of the multiple roadblocks to the treatment of one of the many adult cancers. Little did I know that my path would lead me to investigate therapy options for the treatment of neuroblastoma. Neuroblastoma is the most common solid childhood cancer outside of the brain1, with an [incidence of 9.5 cases per million children](http://emedicine.medscape.com/article/988284-overview#a6); that is approximately [700 new cases per year](https://www.cancer.org/cancer/neuroblastoma/about/key-statistics.html) diagnosed in the U.S. alone. Standard of care includes surgery and adjuvant [chemotherapy](http://emedicine.medscape.com/article/988284-treatment#d6). Recent studies have shown a new promising target for neuroblastoma therapy, Glypican-2 (GPC2), a cell surface [oncoprotein](http://www.sciencedirect.com/science/article/pii/S153561081730346X) that may play a role in neuroblastoma growth and development. In studies by [Li et. al](https://www.ncbi.nlm.nih.gov/pubmed/28739923). and [Bosse et. al](http://www.sciencedirect.com/science/article/pii/S153561081730346X)., neuroblastoma tissues showed high expression of GPC2 but it was not detectable in normal tissues, making it a promising therapeutic target. However, neuroblastoma isn’t the only childhood cancer. The five most commonly diagnosed cancers in are: leukemia, brain and central nervous system tumors, neuroblastoma, Non-Hodgkin lymphoma and Wilm’s tumor. There are multiple subtypes of leukemia, the most common are Acute Lymphocytic Leukemia (ALL) and Acute Myelogenous Leukemia (AML), both have a high [5-year survival rate ](https://www.cancer.org/cancer/leukemia-in-children/detection-diagnosis-staging/survival-rates.html)ranging from 80% for ALL and 60-70% for AML. Despite the high 5 year survival rate, some children are resistant to treatment needing more research to develop new treatments. Tisagenlecleucel, is a recent breakthrough in treatment for chemotherapy resistant acute lymphoblastic leukemia (ALL) recently approved by the [FDA](https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm574058.htm). Kymriah is a type of Chimeric Antigen Receptor (CAR) T cell therapy, a form of [adoptive cell transfer](https://www.cancer.gov/about-cancer/treatment/research/car-t-cells), a type of immunotherapy. CAR T cell therapy is often called a “living drug,” it consists of giving patients genetically engineered T cells (cells are usually obtained from a donor) designed to recognize and kill tumor cells. CAR T-cells therapy unlike [Tumor Infiltrating Lymphocyte (TIL)](https://www.cancer.gov/publications/dictionaries/cancer-drug?cdrid=41004) therapy does not require the use of the patient’s own cells to create the medication. Despite all these advances, scientists continue to work tirelessly to find new therapies for childhood cancers. September is childhood cancer awareness month. This month, I ask that you consider contributing to developing new therapies for childhood cancer. You can call your state representative and ask them to continue to fund childhood cancer research. Over the next two years, I hope to make the best of my time at the NIH and make a small contribution to the treatment of neuroblastoma. --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/09/maddy-300x273.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/09/maddy.jpg)*Madeline B. Torres, M.D. is a research fellow in surgical oncology at National Cancer Institute (NCI) in Bethesda, Maryland. She completed two years of general surgery residency at Penn State Milton S. Hershey Medical Center in Hershey, PA. Dr. Torres was born and raised in El Salvador. She immigrated to the United States with her mother and brother at the age of nine. She then went on to obtain her B.S. in chemistry from the University of Colorado at Denver and earned her medical degree from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors. Her interests include: surgical education, surgical oncology, work-life balance and encouraging women and minorities to pursue surgery and careers in medicine.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [How to Maximize your CV in Medical School](https://blog.womensurgeons.org/maximize-cv/) **Published:** September 13, 2017 **Author:** mcooke@amrms.com **Content:** By Faith Robertson The curriculum vitae (loosely translated from Latin as “Course of life”) is a concise overview of your experiences and academic achievements over time. As a medical student, you will often be asked to provide a CV during applications for awards, grants, and scholarships, and on sub-internships for your specialty during 4th year rotations. Starting this document early on, and updating it periodically during your medical school journey, will not only help you prepare for those last minute grant opportunities, but also elucidate where you can continue to improve. The rules for outline style and content are inexact, but we will briefly discuss pertinent points on how to Reorganize, Reevaluate, and Revive your CV. 1\. Reorganize Your CV should be easy to read. Period. A study published by [The Ladders (2012)](http://www.bu.edu/com/files/2018/10/TheLadders-EyeTracking-StudyC2.pdf) tracked the eye movements of 30 professional recruiters as they reviewed job applicant’s resumes and online profiles. The results demonstrated the importance of how text organization dictates a reviewer’s course, that is, where and how long a person focuses when digesting information. Shockingly, this study revealed that while recruiters self-reported spending 4-5 minutes per resume, the study results demonstrated that most spent 6 seconds on their initial “fit/no fit” decision. Granted, this study’s credibility [has been questioned](https://resumegenius.com/blog/5-problems-with-the-ladders-6-second-resume-study) due to method quality, but many agree, organization is key. In general, your format should mirror the following: • Education • Honors/Awards • Research Experience • Service/Volunteer Activities (+/- Leadership within section or separate) • Publications • Submissions (for articles submitted but not yet published. Do not include articles in progress, as this work is covered under Research) • Presentations (can divide into Oral and Poster) • Professional Organizations • Other Interests If a category or heading does not apply to you, omit it; you can maintain a separate master version of your CV that contains these categories as placeholders for future updates. The AAMC has an excellent page on [Preparing Your Curriculum Vitae](https://students-residents.aamc.org/training-residency-fellowship/article/preparing-your-curriculum-vitae/) that includes additional tips and templates, as does [Vanderbilt School of Medicine](https://medschool.vanderbilt.edu/cim/cv). 2\. Reevaluate Now that you have augmented the aesthetics and organization of your CV, it is vital to assess the story you are telling. Yes, your CV represents the continuity and temporal accuracy of your current (and past) accomplishments, but it should also guide the reviewer in understanding your mission and vision. As mentioned above, maintaining a “Master CV document” can help you tailor your CV to the present goal/viewer to strengthen the impression you leave. Request feedback from faculty or specialists in your desired field. Elicit whether or not they can clearly interpret your trajectory thus far, and envision where you are going. Where are your shortcomings, and how can you improve? 3\. Revive Taking feedback into consideration, it is time to reevaluate where you can spend time making your CV more robust. Perhaps there is a research project you can pursue to demonstrate your knowledge of and dedication to your desired specialty that can bridge your interests from college or pre-clinical years to the interests you hold now. Or if you notice that the majority of “Awards” listed were from high school and college, try surveying announcements for award opportunities; it might be worth sitting down to write for that essay contest you have seen advertised in the weekly student news. Overall, continuous improvement and innovation are requirements for success in today’s hyper-competitive environment. At the 2016 [AWS New England Exchange](https://youtu.be/k97ZHUhS09M), Dr. Sandra Wong, Chief of Surgery at Dartmouth Hitchcock, discussed “What got you here won’t get you there.” This concept of continuous improvement is central to our journey as surgeons, and I hope this brief discussion about relaying your “course of life” will help you along the way. --- [![](%5Bsiteurl%5D/wp-content/uploads/2016/12/Faith_Image_2-213x251.jpg)](%5Bsiteurl%5D/wp-content/uploads/2016/12/Faith_Image_2.jpg)*Faith Robertson is a 4th year at Harvard Medical School, was the previous Vice Chair of the AWS National Medical Student Committee, and currently serves as an International Representative while taking a year-off to get an MSc in Global Surgery at King’s College London. Faith plans to pursue a career in Neurosurgery and Health Systems Improvement.* *Twitter: @FaithCRobertson* *LinkedIn: https://www.linkedin.com/in/faithrobertson/* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, medical students, training **Tags:** ILookLikeASurgeon, medical students, medstudents, Women in Surgery --- ### [Sepsis: A Surgeon’s Perspective](https://blog.womensurgeons.org/sepsis-perspective/) **Published:** September 6, 2017 **Author:** mcooke@amrms.com **Content:** *By Lillian Erdahl, MD* Around 1.5 million people suffer from sepsis and at least 250,000 die due to it each year in the United States. The majority of these individuals-7 out of 10-were recently treated in a healthcare setting and many of them have chronic diseases requiring frequent medical treatment.1 As a surgeon, I have witnessed how rapidly the process of sepsis can overwhelm a patient’s organ systems. Early, aggressive treatment of the infection and supportive care of the patient is not always enough to reverse the cascade of organ failure leading to death. Watching a person get sicker despite doing everything you know how to do is both humbling and incredibly disheartening. With all the advanced technology and modern precision medicine we have, we are still fighting single-celled organisms that can kill us from within. I imagine all healthcare providers feel the pain of being unable to successfully intervene against a deadly disease. It never gets easier for me to tell a family that their loved one is getting sicker even though I am doing everything I can to treat his or her illness. September is Sepsis Awareness Month which is a good time to talk about what we can do to prevent sepsis and sepsis-related mortality. 1. Infection Prevention: A number of interventions in both healthcare and domestic settings can help with infection prevention. Basic hand-washing with soap and water prevents the spread of infectious agents from one individual to another. In the hospital, a number of interventions have been shown to reduce infections including central line catheter insertion protocols. Surgeons are often making decisions about when to insert and remove central venous or urinary catheters. We must recognize and commit to preventive measures each time we interact with a patient. 2. Early Recognition of Sepsis: Recognizing sepsis early is the first step to early treatment. Early signs and symptoms include fever, chills, tachycardia, confusion, and shortness of breath. Patients who are immunocompromised may not manifest typical signs and symptoms, so a high index of suspicion is an important part of identifying sepsis in these high-risk patients. 3. Early Goal-Directed Therapy of Sepsis: Early recognition must be followed by early goal-directed therapy in order to impact the mortality related to sepsis, especially in cases of severe sepsis and septic shock. There have been many studies of how exactly to manage sepsis and septic shock, but it is clear that early antibiotics, source control, and supportive therapies directed at maintaining perfusion and oxygenation improve mortality.2 4. Education of Health Care Providers and the Public: The aim of Sepsis Awareness Month is to drive ongoing discussion and education on many levels. The CDC has a campaign which includes education on how to prevent, recognize, and treat sepsis. You can visit their website for resources that might be helpful during the month.3 References 1\. Sepsis. Centers for Disease Control and Prevention <https://www.cdc.gov/sepsis/index.html> 2\. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-1377 3\. Getting Ahead of Sepsis. <https://www.cdc.gov/sepsis/get-ahead-of-sepsis/index.html> --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/09/IMG_4188-225x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/09/IMG_4188.jpg)*Lillian Erdahl practices Breast and General Surgery at the University of Iowa Hospitals and Clinics where she is an Assistant Professor of Surgery as well as the Iowa City VA Medical Center. Her career pursuits include medical student and surgical education as well as improving breast cancer prevention and diagnosis. She enjoys cross-country skiing, yoga, cooking, gardening, and traveling with her husband and two children.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education **Tags:** Sepsis, Sepsis Awareness Month --- ### [AWS Day of Service 9/9/17](https://blog.womensurgeons.org/aws-day-of-service917/) **Published:** August 17, 2017 **Author:** mcooke@amrms.com **Content:** *By Simin G. Roward* Being a medical student is challenging: between studying, rotations and research, it seems there isn’t enough time for everything. Often, it’s easy to lose track of why we chose this profession in the first place. Community service and engagement are put on hold amidst other pressing responsibilities. The goal of the AWS National Day of Service is to designate a day on which medical students from all over the country would come together with residents and attendings and make service to others a priority. The members of AWS are compassionate, humanistic leaders, who chose the field of surgery because of the ability to make lasting improvements in people’s health and to provide a vital service to communities. These positive characteristics were exemplified in last year’s AWS National Day of Service event, where students nationwide provided much needed services and donations to their community. These service events differed from state to state- some schools put on educational sessions with high school and middle school girls to talk about medical school or to provide mentorship to students from disadvantaged backgrounds. Other schools organized clothing drives to provide supplies for shelters helping domestic abuse survivors or immigrant . Each service event was specific to the needs of the community: in Washington, students raised funds for a local non-profit organization after it had been broken into and vandalized. In Arizona funds were raised to provide pre-employment TB testing to refugee women. In Texas, cookies were baked with the residents of the Ronald McDonald house, and students in North Carolina helped girl scouts earn badges by teaching them First Aid. Students in DC spent the day packing meals at a local food shelter and Boston students volunteered at a clinic for the homeless. The participating schools should be proud of the events they organized and the important contributions they have made to their communities. The spirit of volunteering and community service are well aligned with the mission of the Association of Women Surgeons. As the AWS day of service will become an annual event, each year will build on the strengths of the previous year. This year’s AWS National Day of Service is September 9th, 2017, please contact us for additional resources or questions about participating! Pictures: [![](%5Bsiteurl%5D/wp-content/uploads/2017/08/usuhs-300x282.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/usuhs.jpg) *USUHS put together bags of food donations at Food for ALL* [![](%5Bsiteurl%5D/wp-content/uploads/2017/08/utmb-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/utmb.jpg) *University of Texas Medical Branch hosted a Valentines cookie baking event at Ronald McDonald house* [![](%5Bsiteurl%5D/wp-content/uploads/2017/08/plfsom-300x226.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/plfsom.jpg) *Paul L Foster School of Medicine (Texas Tech-El Paso)-organized a clothing drive for Anunciation house, a migrant shelter* [![](%5Bsiteurl%5D/wp-content/uploads/2017/08/ua-300x284.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/ua.jpg) *University of Arizona- Fundraising for pre-employment TB testing for Syrian refugees* [![](%5Bsiteurl%5D/wp-content/uploads/2017/08/unknown-300x226.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/unknown.jpg) *Boston Chapter-Hosted a game night with patients from their clinic* --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/08/ERAS-photo-200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/ERAS-photo.jpg)Simin G. Roward is a recent graduate of University of Arizona college of medicine. She is currently a general surgery intern at University of Texas at San Antonio and she is planning to pursue a career in pediatric surgery. She served as the community service chair for the Association of Women Surgeons during the 2016 school year and began the AWS day of service event. Her interests include global health, running marathons, traveling and participating in community service.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, current events, education, leadership, medical students, mentorship, networking **Tags:** AWS Day of Service, Community Engagement, Day of Service --- ### [BLOG for FINDING FRIENDS](https://blog.womensurgeons.org/blog-for-finding-friends/) **Published:** August 9, 2017 **Author:** mcooke@amrms.com **Content:** *By Beth Shaughnessy* This lifestyle we have chosen seems to come in 4-5 year runs, Each new phase of training means we may have to pick up and move somewhere else, again. At least until we get that first real job. And with that comes a little loneliness. What if we have never lived there before? What do I do to find a friend? Before I left for my fellowship in Los Angeles, I had lived in Illinois nearly my entire life – and was lucky enough to complete medical school and residency training close to home. I knew NO ONE in California except for my husband. As I started fellowship, he appointed me his social secretary! What to do? The social culture was a bit different in L.A. as compared to Chicago, as compared to Cincinnati where I now live. In California, people tend to live farther away, commuting long distances. Gone were the days of spontaneous get-togethers with co-workers. Locating friends nearby was not so easy. People kept to themselves more. Obviously, this was one of those times I would have to take matters into my own hands and be proactive. So, how did I find like-minded individuals? The easiest way for me was to find some common ground. These are some of the ways I was able to make new friends as an busy professional in a new city: - **Take a class:** My yoga friends have been around 12 years now. We support each other, we network, celebrate weddings, suggest restaurants, etc. No one else in this group is in medicine, and it is refreshing to get a different perspective. Find something that you are interested in, such as yoga, spinning, cooking, photography, painting/art, bee-keeping. - **Volunteer:** I helped to organize the Susan G. Komen Affiliate in L.A., then contributed to the new one in Cincinnati. Met lots of people through this organization.There are many ways to donate your time, such as putting on a running race or bicycle race, or help with the handicapped, or be a big sister through the “Y”. - **Join a club** for running, hiking, bicycling, book club, or an organization like Sierra Club, a club for a cause. - Neighborhood meet-ups. - **Network with existing friends to find names of people they know in this new city.** You are more likely to meet a potential new friend in someone who knows a friend of yours. - Become active in an **alumni organization** or chapter. In Los Angeles, I met up with women who had been members of my same sorority in college. They came from a wide variety of ages and backgrounds, from many parts of the country. - Get a dog and **walk** that dog. They don’t call it a people magnet for nothing. - Go to a **fund-raiser** that is meaningful to you, and introduce yourself to a lot of people, and/or volunteer to do something for that charity. In reading articles on new websites, [meetup](https://www.meetup.com/) is supposed to have notices of multiple meetings that you could possible go to. [Bumble](https://bumble.com/) is supposed to be a new way to find your next BFF. I haven’t tried it, mostly because they are new. Finding new friends as we get older becomes more challenging as we age. This is well-documented, but not impossible. Think about it; making a friend takes time and emotional investment. It takes a certain level of commitment, albeit as small or as large as you are willing to commit. And it usually starts with finding common ground. As the demands on our time grow, and we might get a career, get married and might start a family, the extra time shrinks. So does theirs. Friendships through classes or activities help to serve you in participating in an activity, but also having a friend with whom you have something in common. You can keep the commitment at the level of the activity only, or you can expand beyond it, depending on your time constraints. But take heart; remember you have made friends before, and you will make friends again. They don’t come prepackaged. Try to remain loose, flexible, and open to conversations and meeting new people. One lasting friendship I made casually through a discussion in a grocery store, commenting on the person’s sweatshirt design, and the individual became like family in time. --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/08/beth-201x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/beth.jpg)*Beth Shaughnessy was born and raised in the Chicago area, leaving to go downstate for college at the University of Illinois at Urbana-Champaign, but returning for medical school at the University of Illinois at Chicago. After residency at the University of Illinois’ program, she felt she became too inbred, so she left for Los Angeles to complete a fellowship in surgical oncology at the City of Hope National Cancer Center. She is currently a professor of surgery at the University of Cincinnati, in Cincinnati where she lives with her husband and son. She enjoys cooking, yoga, the arts, choral singing, and gardening.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, current events, networking, resources, self-care, training, women **Tags:** Friendship, Networking, Social Professional --- ### [Breast is Best, Supporting Mothers Is Better](https://blog.womensurgeons.org/breast-best/) **Published:** August 2, 2017 **Author:** mcooke@amrms.com **Content:** By Nickey Jafari My rotation in obstetrics & gynecology (OB/GYN) was full of emotional moments, and the first time I witnessed a mom breastfeed her baby was one of my favorites; in a culture that so overtly sexualizes women’s bodies, it reminded me that breasts had evolved for the purpose of nurturing a new human life. Of course, breastfeeding is not always easy, and the decision to breastfeed is a deeply personal one for a woman. Mothers who are unable or unwilling to breastfeed should never be shamed for it. However, the health benefits for both mom and baby are plentiful. We should seek to strike a balance between educating people on the myriad of reasons to breastfeed, while not making women feel pressured to do so. The [World Health Organization](http://www.who.int/mediacentre/factsheets/fs342/en/) recommends exclusive breastfeeding for at least 6 months and reiterates well-known benefits, such as reduction in gastrointestinal illnesses for baby, increased neonatal immunity to infections, and reduced newborn mortality. For mothers, the WHO states the **reduction in risks of both breast and ovarian cancers** as other reasons to breastfeed. Some of the contraindications to breastfeeding can be found [here](https://www.cdc.gov/breastfeeding/disease/), and include galactosemia and untreated, active tuberculosis. Given all its benefits, breastfeeding is a public health priority. The [CDC](https://www.cdc.gov/breastfeeding/data/reportcard.htm) Breastfeeding Report Card 2016 shows that most mothers *do* want to breastfeed, but rates of exclusive breastfeeding through 6 months are as low as 22.3% throughout the U.S. [Barriers to Breastfeeding](https://www.ncbi.nlm.nih.gov/books/NBK52688/) in the United States frames the issue of expectations on breastfeeding very well – **“even though breastfeeding is often described as “natural,” it is also an art that has to be learned by both the mother and the newborn”**. Thus, education on breastfeeding techniques, such as the best way to achieve a [proper latch](https://www.womenshealth.gov/itsonlynatural/overcoming-challenges/breastfeeding-checklist-how-to-get-good-latch.html), should be provided to moms. Empathy and encouragement go a long way, too. I remember on my pediatrics rotation, when we would check in on our new babies, a lot of moms would get frustrated if the process was not going smoothly because of this societal expectation that breastfeeding is an easy and innate process from the get-go. I noticed some moms who gave up because they felt like, since it was not going well, they were failing at being a mom, and others who switched to formula soon after because they were worried about their baby getting enough nutrition. Their decision did not come from any selfishness, but genuine concern for what is best for their child, and thus I always get upset, as someone who does enthusiastically promote breastfeeding and its benefits, when I see someone judge a woman who does not; we have no idea what her journey was. A little encouragement from clinicians to new moms that it is also “natural” for it to take some work, that they are doing a great job and should keep trying, that their milk amount will continue to increase after the first few days of [colostrum](https://www.sciencedaily.com/terms/colostrum.htm), can make a world of difference. Overall, there are far too many impediments to breastfeeding to address in a single blog post, but in addition to better education to new moms by their clinicians, they include changing societal norms and expectations, increasing social and family support, and creating work policies that allow women to breastfeed. Grace DeHoff [wrote](https://www.womensurgeons.org/first-delivery/) about her journey into motherhood as a medical student and touches on breast feeding time commitments. A great post about experiences pumping as a surgeon mom can be found [here](https://bfmed.wordpress.com/2017/04/28/surgeons-who-pump-ilooklikeasurgeon/). The fact of the matter is that “many women face barriers to breastfeeding; poor breastfeeding environments where women work, live, and obtain health care are among the biggest barriers” (read more [here](https://www.ncbi.nlm.nih.gov/pubmed/28707098)). One critical policy area where the U.S. lags far behind other developed nations is the issue of maternity leave. The[ Family and Medical Leave Act](https://www.dol.gov/whd/fmla/) only allows for up to 12 weeks of *unpaid* leave. The AWS maternity policy for surgeons in practice can be found [here](https://www.womensurgeons.org/aws_library/SurgeonPolicy.pdf). We can and should promote breastfeeding while not making women feel less than as mothers if it is not the best choice for them. We should be especially careful about promoting “breast is best” if we are not simultaneously working to create more flexible work policies, change societal expectations for new moms, and provide the tools that can allow women the chance to successfully breastfeed! --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/08/nickey-198x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/08/nickey.jpg)*Nickey Jafari finished her third year of medical school at the University of Kansas this past spring and is currently pursuing her Master of Public Health at the Johns Hopkins Bloomberg School of Public Health.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, education, family life, gender differences, networking, parenting, resources, women **Tags:** Breastfeeding, FMLA --- ### [Perception of Personal Success in Burnout](https://blog.womensurgeons.org/perception-burnout/) **Published:** July 27, 2017 **Author:** mcooke@amrms.com **Content:** *By Shree Agrawal* In the preclinical years of medical school, the idea of burnout among healthcare workers is more of an abstract concept. The unique environment of healthcare, regardless of specialty or academic/private practice settings, has been shown to make all healthcare providers vulnerable to burnout.[(1)](https://www.jstor.org/stable/258593?seq=6#page_scan_tab_contents)[(2)](http://www.sciencedirect.com/science/article/pii/S0002934303001177?via%3Dihub#BIB21) In my observations on clinical rotations, it seems highly successful peers, trainees, and faculty, who may have multiple publications, excellent clinical skills, and a strong work ethic, can also be the same individuals who unexpectedly experience burnout. Interactions with someone who does not realize they may actually be experiencing burnout are challenging, even for individuals who are at the fray of most clinical situations. Some of the key manifestations of burnout include emotional exhaustion, cynicism, depersonalization or isolation, feelings of ineffectiveness, and lack of accomplishment, as shown in Figure 1.[(3)](https://www.forbes.com/sites/johnrampton/2015/05/13/the-6-causes-of-professional-burnout-and-how-to-avoid-them/#25c9a09c1dde) Some of these features are difficult to fully notice in brief professional interactions with peers and superiors. Instead, common outward defining behaviors in burnout may be a focus on professional survival, fewer reflective practices, reduced desire to be at work, and/or a diminishing appeal of clinical and non-clinical activities.[(4)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101180/pdf/1471-2458-11-240.pdf) *Figure 1: Factors contributing to and subsequent manifestations of burnout* For all the successes visible to the outsider, the relevance of personal and professional accomplishments to the person, who may be burned out, appear less significant. A component of this perception could be individual focus on future goals and milestones. Regardless, I am curious. Does the perception of personal success change in the process of burnout? Do achievements seem less worthy in the face of factors contributing to burnout? Even though I would posit my observations are a multifactorial outcome, studies would imply this is not an uncommon phenomenon. Research within healthcare settings demonstrated insufficient recognition of employee contributions corresponded to healthcare providers feeling less respected and valuable to their organizations. This belief alone can cause providers to experience higher levels of emotional exhaustion, feelings of ineffectiveness, and subsequent burnout.[(5)](http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.555.2812&rep=rep1&type=pdf) Another study suggests individuals who identify as a minority in society may receive less recognition and credibility for their accomplishments/capabilities when compared to their counterparts. Many minority participants in this study expressed already feeling burned out in their training. They stated their role on the team was not viewed as meaningful, or worse, unsatisfactory. Alarmingly, some minority participants not only revealed their feelings of inferiority to their peers but also doubted their own accomplishments, abilities, and personalities.[(6)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168507/) The infrequency or lack of recognition in healthcare both contributes to burnout and reduces individual perceptions of professional competencies and capabilities. On the blog, we have talked about practicing gratitude and cultivating resilience in the face of burnout.[(7](https://www.womensurgeons.org/attitude-of-gratitue/)[,8](https://www.womensurgeons.org/gratitude-at-home-and-work/)[,9](https://www.womensurgeons.org/gratitude-10-things-to-be-grateful-for/)[,10)](https://www.womensurgeons.org/healthyself/) While these are important tools, I wonder if we should also encourage the practice of acknowledging both our own success ladders and those of the people working alongside us. Outward recognition, while not common within medicine, is crucial to defining individual success. It facilitates finding value in our professional responsibilities, validates personal efforts for growth, and positively changes the perception of personal success. Recognition ultimately nurtures essential skills, traits, and resilience required in the practice of medicine. --- *[![](%5Bsiteurl%5D/wp-content/uploads/2015/03/Shree-Headshot-0061-1-238x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2015/03/Shree-Headshot-0061-1.jpg)Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and serving as the Chair of the AWS National Medical Student Committee. Shree is passionate about research surrounding patient decision-making and medical education. In her free time, she enjoys blogging for AWS, practicing yoga, and boxing.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, leadership, mentorship, networking, professionalism, residency, resources, self-care, training **Tags:** burnout, Physician Burnout --- ### [#DearIntern: Social Media Mentorship to the Max](https://blog.womensurgeons.org/dearintern/) **Published:** July 12, 2017 **Author:** mcooke@amrms.com **Content:** By Marissa A. Boeck In April 2015, Dr. Amalia Cochran had an idea. The United States [Match Day](https://en.wikipedia.org/wiki/Match_Day_(medicine)) had come and gone, and while most fourth year medical students were enjoying their last moments of unbridled freedom before the oft feared start of [intern year](https://www.theatlantic.com/health/archive/2012/07/a-year-inside-a-medical-residency-part-1/260457/), Dr. Cochran was thinking ahead. As a burn surgeon and Vice Chair of Education & Professionalism at the University of Utah, she was well-versed in [the significance and misperceptions surrounding July 1st](https://en.wikipedia.org/wiki/July_effect), and knew it would come sooner than most would imagine. To ease this seemingly overnight transition from student to doctor, she reached out to gather intel on how to prepare for the big day from one of the best (and argua[![](%5Bsiteurl%5D/wp-content/uploads/2017/07/cochrantweet1-300x58.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/07/cochrantweet1.jpg)bly still untapped) resources in medicine: Twitter. The initial message asked: Dr. Cochran’s followers and interconnected community took it from there, and [\#DearIntern](https://twitter.com/search?f=tweets&vertical=default&q=%23dearintern&src=typd) was born. [![](%5Bsiteurl%5D/wp-content/uploads/2017/07/cochrantweet2-300x67.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/07/cochrantweet2.jpg) Since the first post and subsequent [blog](http://www.amaliacochranmd.com/dearintern/), the hashtag has re-appeared annually as the new year approaches. Although typically surgery participants predominate, the advice applies broadly. Related messages have used [\#DearNewIntern](https://twitter.com/search?f=tweets&vertical=default&q=%23DearNewIntern&src=typd) and [\#WelcomeToMS3](https://twitter.com/search?f=tweets&q=%23WelcomeToMS3&src=typd), among others. This also includes[ #TipsForNewDocs](https://twitter.com/search?f=tweets&q=%23tipsfornewdocs&src=typd), started back in August 2011 in the United Kingdom as an advice hashtag for rising junior doctors across specialties, which has successfully maintained a nearly year-round presence since. Upon reviewing expert posts from the past couple of years, broad themes emerge that can be organized into a **Top 12 #DearIntern List of Advice:** 1. **Medicine is a team sport:** Be open to and respectful about input from others; this applies to nurses, physician assistants, colleagues (both in your specialty and others), superiors, and students. Sometimes you know more, sometimes others do, but diversity of input is always valuable. Show appreciation when and where it is due. Also, if someone calls for help, help them, don’t ridicule. 2. **Golden rule: treat others as you would like to be treated…**or as you would want your grandma/important person in your life to be treated. It is almost always better to be working in the hospital than to be admitted to it; try to keep this perspective in mind during hard times. After all, we do this for the love of patients. 3. **Load the boat:** Find help from senior staff members early and don’t be afraid to ask, this is not a sign of weakness. It is better to call for help when not required, than to not call when required or when a rescue opportunity is lost. Also always have a plan…and a back up plan. 4. **When in doubt, look at the patient:** Electronic medical records have replaced a significant proportion of physician interactions with patients. An assessment for potentially acute changes in status requires actual facetime with your patient. Know them well and listen to them, they can teach you invaluable lessons. Keep a running list of interesting cases and patients you learned something new from; it’ll come in handy later. 5. **First impressions can be lasting:** Guard your reputation with your life, but also know there will be chances for clarification and/or redemption. 6. **Immerse yourself in your craft:** Scrub when the opportunity arises and be prepared (diagnosis, indication, anatomy, procedure, skills). Remember that you can learn a lot by observing an operation; never underestimate your opportunities. 7. **Show up (early) and do your best everyday:** Work hard, as there is no substitute for due diligence. Be affable and available. 8. **The truth shall set you free…**or at least keep you out of trouble. Be humble and admit when you don’t know something. We all make mistakes; and then learn from them to avoid making them again. You’re going to be yelled at. Don’t try not to be yelled at, just try to do the right thing for your patients. Trust but verify, never assume. 9. **Write down everything:** Trust us. 10. **Ask questions and be curious:** Read everyday, even if just for 10 mins, and learn a new fact. Be flexible, as medicine is always changing. 11. **Take care of yourself so you can take care of others:** Keep a hobby and do it. Your wellness is important; eat sensibly, exercise, and find support in your family and friends. 12. **Have fun:** Surgery is an awesome privilege. You’ll have good days and bad days, but the best moments in your professional life are ahead of you. Always try to keep your head up. Remember you are a valuable asset to the team. Through posts associated with the hashtag, additional valuable resources and commentary have come to light, which include: [How to be the Best Intern in the Hospital](https://wellnessrounds.org/2010/06/05/how-to-be-the-best-intern-in-the-hospital/?utm_content=buffer6bc51&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer) by [Dr. Mary L. Brandt](https://twitter.com/drmlb) (June 5th, 2010) [Hints For New Residents](http://skepticalscalpel.blogspot.com/2011/06/hints-for-new-residents.html) by [Skeptic Scalpel](https://twitter.com/Skepticscalpel) (June 20th, 2011) [Internship: Ready, Set, Go!](https://www.womensurgeons.org/internship-ready-set-go/) By [Dr. Callie Thompson](https://twitter.com/callie_mt) (2013) [What Every Resident Should Know on Day 1](http://www.hhnmag.com/articles/4123-what-every-resident-should-know-on-day-1) (July 7th, 2014) [Stuff Surgery Interns Should Know](https://itunes.apple.com/us/podcast/behind-knife-surgery-podcast/id980990143?mt=2), Behind The Knife podcast (June 23rd, 2015) [The “July Effect” and Tips for New Doctors](https://etechlib.wordpress.com/2016/07/01/the-july-effect-and-tips-for-new-doctors/) by [P.F. Anderson](https://twitter.com/pfanderson) (July 1st, 2016) [\#JulyOpportunity](http://www.aasurg.org/blog/julyopportunity/) by Drs. [Kevin Sexton](https://twitter.com/kwsexton?lang=en) & Julie Duke (July 28th, 2016) [You’ll mess up but save the day: advice to new doctors as they start work as interns](https://www.statnews.com/2017/06/29/doctors-interns-advice/) by[ Dr. Ilana Yurkiewicz](https://twitter.com/ilanayurkiewicz) (June 29th, 2017) Overall, this crowd-sourcing exercise highlights one of the many strengths of Twitter and social media: to generate global conversations connecting experts to those just starting out, and everyone in between. You’re able to shed the limits of location, time constraints, and hierarchies, and have the opportunity to connect with anyone, anywhere. Unlike published works, which retain their value for certain uses, these platforms uniquely enable a free flow of information that is constantly being revised and expanded, maintaining relevance to the here and now. On the flipside, the seemingly no-holds-barred rules to participation reinforces the need for discernment by the receiver, which is a useful skill to cultivate throughout one’s career both on and offline. So what’s stopping you? Join the conversation, add your voice and knowledge, and impact the #NextGen of surgical leaders across the globe! *Acknowledgements: Thank you to Dr. Amalia Cochran for her original idea and blog post input, and to the dozens of #SurgTweeting community members who contributed to the #DearIntern hashtag over the past few years. This post would not have been possible without your contributions and wisdom!* --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/07/boeck-190x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/07/boeck.jpg)Marissa A. Boeck MD, MPH is a chief general surgery resident at New York Presbyterian Hospital – Columbia, after which she will pursue a fellowship in trauma/critical care. She is passionate about diversity in the surgical workforce, the power of social media in medicine, and global public health, especially as it relates to injury prevention, emergency response, and trauma and surgical system strengthening in low-resource settings.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Fireworks on the Fourth](https://blog.womensurgeons.org/fireworks-on-the-fourth/) **Published:** June 29, 2017 **Author:** mcooke@amrms.com **Content:** *By Cheyenne “Cassie” Sonntag, MD MS* Say it with me: the Fourth of July. Just saying those words fills your mind with fond memories of watermelon, BBQ, and warm summer nights spent with family and friends lighting sparklers and setting off toy caps. It’s a familiar story, relatable to most who read this – but one unfamiliar to me. Sadly, I spent a large portion of my childhood living in locations with strict fireworks restrictions due to dry desert climates. As such, my firsthand experience with fireworks and firework safety has been limited to setting up a proper picnic space in the park to avoid being trampled in the dark while still maximizing one’s view of a public show. I was determined that this year would be different. My relocation to the lush lands of Central Pennsylvania for surgical residency and a favorable call schedule (about time!) has finally afforded me an opportunity to experience that all-American Fourth of July fireworks fantasy. Excited for my first Fireworks Fourth, I visited the Pennsylvania State Police website to find out exactly what shenanigans I could pull off within legal limits. To my disappointment, I discovered that state law (specifically [Title 35, Chapter 13A](http://www.psp.pa.gov/public-safety/Documents/Title_35_Chapter_13A_Fireworks_and_Explosives.pdf)) prevents the use of consumer or display fireworks without a municipality permit and purchase at a Department of Agriculture licensed outlet. However, my Summer of Sparklers was saved as further reading revealed that “ground and hand-held sparkling devices”, “novelties” and “toy caps” as defined by the American Pyrotechnics Association Standard 87-1 are actually designated [“non-fireworks”](http://www.psp.pa.gov/public-safety/pages/fireworks-safety.aspx) and can legally be sold at convenience stores and tent stands. Wanting to make sure I celebrate appropriately, I spoke with some of my co-residents about their experiences with fireworks to elicit product recommendations. While all expressed very clear favorites- from sparklers to bottle rockets- every person also related a “this one time” or a “just-missed” story as well. From a sparkler resulting in a singed pigtail and new haircut to a bottle rocket misfire that flew directly into a pile of unlit fireworks and sent a whole party ducking for cover, it was clear that even these designated “non-fireworks” could be extraordinarily dangerous. I certainly regret asking the opinion of a friend who incidentally spent the last Fourth of July on “hand call.” The Consumer Protection and Safety Commission (CPSC) website and their [Annual Fireworks Report](https://www.cpsc.gov/safety-education/safety-education-centers/fireworks) estimated that in 2015, 11,900 fireworks injuries were treated by US emergency departments. Sixty-seven percent of these injuries occurred between June 19 and July 19, 2015, with children under 15 years of age representing a fourth of those injured. To my dismay, the report estimated that my beloved sparklers accounted for 1,900 emergency department treated injuries that year.3 It became clear to me that that the absolute safest way to enjoy fireworks this Fourth of July would be to once again set-up my picnic blanket and enjoy the public show. However, for those of you for whom the temptation to light a sparkler may prove just too strong, the following are a few resources with fireworks safety advice for all ages that are worth reading: – [National Council on Fireworks Safety](http://www.fireworkssafety.org/safety-tips/) – [National Safety Council](http://www.nsc.org/learn/safety-knowledge/Pages/news-and-resources-fireworks-safety.aspx) I wish everyone an amazing summer, and a safe and injury-free Fourth of July. --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/06/cassie-210x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/06/cassie.jpg)*Cheyenne “Cassie” Sonntag, M.D., M.S. is a general surgery resident at the Penn State Milton S. Hershey Medical Center in Hershey, PA. Born in Colorado, she spent the formative years of her youth in Arizona before earning her B.S. in cell and developmental biology from UC Santa Barbara. Dr. Sonntag attended medical school at the Keck School of Medicine of the University of Southern California, where she also earned a Master of Science in Global Medicine. She is currently starting her second of two academic development/lab years a Penn State Hershey as a research fellow focusing on surgical simulation and surgical education. Cassie will be spending her Fourth of July once again observing the local public fireworks display, from a safe distance, on her picnic blanket.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education **Tags:** Fireworks, Fourth of July, national safety month --- ### [May is Mentorship Month!](https://blog.womensurgeons.org/may-is-mentorship-month/) **Published:** June 5, 2017 **Author:** mcooke@amrms.com **Content:** By Heather Yeo One of the most important factors in surgical training and a foundation along which much of our profession has grown is mentorship. Mentorship has many definitions, and a long historical tradition dating back to ancient Greece. The word Mentor was taken from the character of the same name in Homer’s Odyssey. Although it’s slightly a misnomer (as anyone who has worked with Dr. Murray Brennan knows), because Mentor himself was a bit of a fool, and it was actually the goddess Athena who took on the appearance of Mentor who guided the young Telemachus in his struggles. To me, mentorship is a relationship where one person shares their experience and knowledge with another person and helps to guide their career. The focus is on the career development of the mentee. Mentors can help with clinical, educational, research or personal growth. So how do you get started? ***Finding a Mentor*** **Formal:** Many surgery programs and professional societies have mechanisms that support mentorship (for example, through AWS, ACS, AAS), these are best if there are shared interests and not assigned blindly. It is good to apply for one of these programs-tell them what kind of mentorship would be helpful for you. **Informal:** Look around you, who is doing work that interests you, who has a career that interests you. One of the best things about academic medicine is that there are mentors everywhere. You don’t have to only choose one mentor. You can have a research mentor, a personal mentor, a career mentor. Having more than one mentor gives you different perspectives and can be good because you don’t overburden one person. ***Setting up rules to the relationship*** Like any relationship, **both the mentor and mentee must be committed**. To have a good relationship it needs to be balanced, meaning if your mentor is teaching you, you should be willing to learn and to take their advice. If you promise to do something, do it, and in a **timely manner**. I find that when I am working with good mentees they communicate their timeline and get things done. I find I am a better mentee myself when I set timelines and expectations. Talk about what each person is going to put into and get out of the relationship. [![](%5Bsiteurl%5D/wp-content/uploads/2017/06/Yeo-mentorship-300x237.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/06/Yeo-mentorship.jpg)*Here with my Mentor Dr. Julie Sosa and some of our surgical residents, in particular Dr. Jon Abelson who I have been mentoring for the past 2 years.* ***Sticking with or separating from a mentor*** Not all mentor-mentee relationships work. It is important to try to **fix them early**. If you do not align with your mentor or mentee, it is important to **communicate what you need and what you can give**. Sometimes a relationship isn’t working, this then lead to a formal separation, maybe asking the current mentor for other potential mentors on different interests (if yours have evolved for example), or sometimes the relationship just slows down. Always be polite, and always think about how you can learn from your mentor-mentee relationship to improve on the next one. Even if you are no longer close with a particular mentor, you never know when that relationship may sprout again as a new project comes up or in a different environment. Much of my success has been directly a result of supportive and generous mentorship, but I’ve also had mentor-mentee relationships that were not so good. In fact, I know I haven’t always been the best mentee. But every time I enter into a new mentor mentee relationship, I try to think about what I need and what I bring to the table and how to make this relationship even better than the next. Some additional resources on surgical mentorship opportunities: <http://www.surgicaloutcomesclub.com/fellowship-program> <https://www.womensurgeons.org/in-practice/mentorship/> <http://www.aasurg.org/meetings/fallcourses.php> <https://www.facs.org/member-services/yfa/mentor> <https://www.facs.org/member-services/ssc/mentoring> <https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/mentorship-call> A great longer piece from some of the amazing mentors at AWS <https://www.womensurgeons.org/in-practice/mentorship/strategies-for-building-an-effective-mentoring-relationship/> --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/05/Yeo-Pix--200x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/Yeo-Pix-.jpg)*Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College and Assistant Attending Surgeon at New York-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research and is focused on surgical outcomes and quality improvement in Gastrointestinal Cancer Surgery. Dr. Yeo became involved with AWS after receiving the 2013 AWS-Ethicon Fellowship Grant and is currently a co-chair of the AWS Communications Committee.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [Taking Precautions for my Well-Being](https://blog.womensurgeons.org/precautions-well-being/) **Published:** June 1, 2017 **Author:** mcooke@amrms.com **Content:** By Beth Shaughnessy, MD, PhD As the deadline approached for this blog, I found myself preparing to go to Las Vegas for a conference, my mind numb with encroaching burnout. I knew the signs—chronic fatigue, growing apathy, lack of alertness, decreased ability to organize and be efficient. I trained in the era of no restrictions on work hours; hospitals used residents to fill in the gaps when they lacked personnel in transportation and phlebotomy, especially at charity hospitals. Burnout used to be a state of being back then, but it didn’t have a label. I love what I do. But I face intermittent burnout from being in a field that mandates high volume to meet the RVUs benchmark—breast surgery. This is usually manageable, but randomly cases may pile up as patients return from neoadjuvant chemotherapy and I must mesh these women into the operative schedule with the new ones referred and the emergency ones. There is a modicum of randomness to the referral intensity, although I can rely on certain times of the year to be more intense. This relative randomness of work intensity creates an intermittent discord in the general flow of our lives. We can get so focused on providing the needed care to our patients that we begin to lose track of caring for ourselves. I just want to sleep; I calculate the years to retirement. I realized I was in a funk based on my husband’s behavior relative to discussions with him, or relative to my lack of discussion—I have come to recognize the disgruntled interaction from him, reflecting back on my own behavior. I guess the signs were there at the office as well. Recognizing the situation is half the battle. Immediately, I start to examine my surroundings and my practice to reduce and simplify. In my homelife, what events can be canceled or missed? I make sure that I incorporate those activities from which I derive pleasure and renewal. In my past life, I used to do Pilates in preparation for the dance season in high school and college. It was an easy choice to join a mat Pilates class following pregnancy, restoring so much energy and social interaction! And that morphed into yoga, which I still actively practice 17 years later. Over the long run, I have learned from my husband and my son. When planning travel for a conference, I reacquaint myself with friends who live there, or friends that are going to the conference. Arrange for a dinner or an event to share stories, in order to remind yourself to enjoy your life. If it is a city I know well, maybe I will arrive a half day or full day before, order to reacquaint myself with the city and what it has to offer. Take the meeting in Las Vegas, for instance. I arranged for a hot stone massage—my favorite—and participated in a yoga class. Serendipitously, I met another AWS surgeon whom I follow on Twitter before yoga began. Little things like seeking out an art museum or strolling along a quaint shopping district (when there is time) can make my day. Ultimately, do not forget to be kind to yourself and to those who are significant to you. Plan that special vacation to get away, shift gears, see the world from a different perspective! You will return, relaxed and refreshed, ready to tackle what the day may bring. So stop and catch your breath, recognize the signs and step back for a moment. It will make it so much easier to step forward. --- *Beth Shau[![](%5Bsiteurl%5D/wp-content/uploads/2017/06/beth-201x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/06/beth.jpg)ghnessy, MD, PhD is a professor of surgery at the University of Cincinnati. She was born and raised in the Chicago area, spending her undergraduate years at the University of Illinois at Urbana-Champaign, and returning to the University of Illinois at Chicago for medical school and graduate studies. She completed residency at the University of Illinois Hospital and Clinics, with rotations at Cook County Hospital, the West Side VA Medical Center, and Michael Reese Medical Center. Dr. Shaughnessy also completed a fellowship in surgical oncology at the City of Hope National Medical Center. She enjos academic projects and writing, in addition to singing in a choir (first soprano), gardening, practicing yoga, and riding her bike, & being a wife and mother.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* [![](%5Bsiteurl%5D/wp-content/uploads/2017/06/jordan-170x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/06/kerry.jpg) [![](%5Bsiteurl%5D/wp-content/uploads/2017/06/kerry-300x167.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/06/kerry.jpg) With my sisters in County Kerry, Ireland. With the family in Petra, Jordan **Categories:** Uncategorized --- ### [Medical Motherhood Part II: Residency](https://blog.womensurgeons.org/motherhood-residency/) **Published:** May 25, 2017 **Author:** mcooke@amrms.com **Content:** *By Grace K DeHoff, MS III* Many women in medicine struggle with when the optimal time to have children is during their medical training. Medical school is rigorous with limited time off available in the first two years with only a little more flexibility available in the last two years. For women who are not in a position to have children in medical school, the next option is during postgraduate training. Residency in any medical field is known to be difficult with long hours, large workload, steep learning curve, and limited time off. Some of these factors can be mitigated when programs have a large number of residents in each class allowing for the work load to be dispersed more evenly. The programs that accept larger groups of residents each year are better equipped to help arrange call schedules around maternity leave or unexpected sick days. Some surgical residencies only have one to two residents in each class, making workload a larger burden for the remaining residents during a woman’s maternity leave. **Policies for time off** The American College of Surgeons Women in Surgery committee released an updated statement on parental leave in February 2016. This association is [dedicated](https://www.facs.org/about-acs) to “improving the quality care of the surgical patient by setting high standards for education and practice”. The ACS has a Division of Advocacy and Health Policy which actively interacts with federal and state policymakers on issues that impact the surgical profession, including but not limited to payment reform, work hours, safety and liability and parental leave. This most recent statement on parental leave was directed at furthering support of entering parenthood as a surgical resident for both men and women. For women specifically, the policy stated that: ***“Surgery should be supportive of healthy pregnancy outcomes, and should not impose punitive repercussions on those surgeons who choose to have children”*** The full statement can be read [here](http://bulletin.facs.org/2016/04/statement-on-the-importance-of-parental-leave/). The new policy has statements that include a maternity leave of at least 6 weeks, being relieved of call during their leave without being required to make it up, and breastfeeding accommodations including reasonable break time and sanitary conditions to express breast milk in, all without prejudice. A quick search of various surgical residency policies shows many have maternity leave and family leave policies, but most programs still handle a pregnancy on a case by case basis. The biggest concern for any program is determining who will handle the caseload while a resident is out on paternity/maternity leave. Therefore, programs often prefer to know about a pregnancy and anticipated due date as soon as possible to optimize scheduling around your absence. **Pregnancy During Surgery** For surgeons in particular, there are a host of circumstances encountered during residency that make pregnancy even more challenging. Many surgeries in all specialties use fluoroscopy which includes the use of x-ray during the surgery. Typically, all staff in the room during these procedures will use a lead apron and thyroid cover to shield against the radiation, but in pregnancy there is always a worry about radiation exposure, especially if it occurs on a daily basis. Many surgeons elect to get scrubbed out of the room during the use of fluoro, or try to limit the cases they did where it was required. Other risks occur when surgeries include intraoperative chemotherapy or radiation treatments. Occupational physical activity that surgeons are typically exposed to include long work hours, shift work, lifting, standing and physical work load. A 2015 retrospective cohort study examined the obstetrical complication rate for medical and surgical residents and found that complication rates significantly increased when surgeons worked more than 6 call shifts per month (P<0.001) or worked more than 8 hours in the operating room per week (P<0.001). [Complications](https://www.ncbi.nlm.nih.gov/pubmed/?term=25764033) included higher rates of miscarriage, hypertension in pregnancy, placental abruption and intrauterine growth restriction. Surgeons should work closely with their OB-GYN during their pregnancy to determine what work restrictions will be most beneficial during their peripartum period. **Non-Structural Workplace Challenges** The many benefits of breastfeeding for the newborn infant are well-documented and the American Academy of [Pediatrics](https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Infant-Food-and-Feeding.aspx) recommends that all infants be “exclusive breastfeeding for the first year” of life. For surgeon mothers, this can be especially challenging . Pumping facilities in the hospital are now more often available as there are mothers of every job category that also use these resources. For surgeons, finding a location to pump is not the only challenge. Attempting to pump on a regular schedule can be disrupted by unpredictable schedules, late night calls, and long surgeries. On clinic days many women are able to schedule an empty appointment time that they can pump during and many surgeon mothers are very successful in their pursuit of providing breastmilk for their babies as long as they can. Under the Affordable Care Act, section 4207, the [Fair Labor](http://www.ncsl.org/research/health/breastfeeding-state-laws.aspx) Standards Act now states that an employer is required to “provide reasonable time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such an employee has need to express milk”. Despite the regulations in place to allow mothers this time, many surgeons struggle to find the time to express milk with such a rigorous and unpredictable career. In residency sometimes the resentment at the increased workload comes from both male and female colleagues who have additional responsibilities in the absence of another resident. However, many women have found a majority of their colleagues are largely supportive of their pregnancy and maternity leave. There are signs of progress to hear that surgical residency programs have become more supportive of their residents’ pregnancies. Many surgeons who have had children during residency have had positive experiences, but structural changes and policy support are necessary to protect residents choosing to have children. **Policy Change** In general, between the ACS and the ACGME regulations on parental leave, surgeons who decide to become mothers have increasing protections in their endeavors to start a family during residency. The difficulty persists in finding the right balance. Unlike with other careers, when we are not at work, the work does not necessarily stop. Someone else must pick up the work load, or our patients suffer. For women employed in fields other than medicine, 6 weeks is not considered sufficient to recover from pregnancy and labor and to begin the life of motherhood. For many surgeons though, 6 weeks is regarded as a fair compromise between having enough time to feel established in motherhood and getting back to practicing medicine before feeling as if they have missed too much time away from the practice of medicine and surgery. The balance is delicate; the fact that even a remote balance exists is regarded as a success in the context of a surgical residency. Practicing medicine, especially surgery,is a skill that takes devoted practice and it is difficult to obtain mastery in this skill without appropriate training and ongoing practice. --- *Grace D[![](%5Bsiteurl%5D/wp-content/uploads/2017/02/grace-202x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/02/grace.jpg)eHoff is a third year osteopathic medical student at Pacific Northwest University and is interested in pursuing a career in Neurosurgery. She is a Denver, CO native but currently lives in Boise, ID with her husband and one-year-old son. She is the Diversity Chair with the National Medical Student Committee for the Association of Women Surgeons. In her free time, she enjoys running and has completed several half marathons and relay races.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [How Medical School Turned Me into a Runner](https://blog.womensurgeons.org/medical-school-runner/) **Published:** May 4, 2017 **Author:** mcooke@amrms.com **Content:** *By Hilary McCrary, MPH* Prior to medical school, I considered myself athletic but never a runner. I could not run more than a few miles without an overwhelming sense of discouragement. When I began medical school in 2013, I found myself surrounded by individuals that had been running most of their lives. It was inspiring that people were able to juggle the demands of school and still properly train for a half or full marathon. Before long, I had set my first goal of running a half marathon. This race took place during my second year of medical school, which for me was the most academically challenging year with USMLE Step 1 looming in the distance. I was lucky to have a group of classmates that became my running buddies. We called ourselves the “wolf pack”, meeting after studying to run on the local river path. I found that training runs were always easier to complete with a group of friends. It is this companionship that keeps you going when you have a double-digit training run to accomplish. After several weeks of training, I ran the A-Mountain Half Marathon in Tucson, Arizona. This scenic trek around Tucson also takes you up a small mountain at about mile 6, which at the time was less than enjoyable, but once up the mountain you gain great panoramic views of the city. After completing the race, I distinctly remember thinking to myself, “Well, that was horrible. Maybe running isn’t for me”. Hours later, I was texting my running group to plan our next half marathon. **That is the thing about running – no matter how difficult a race is, it always has a way of bringing you back in to go for another.** Over the next two years of medical school, I completed six half marathons in various locations across the United States. Some of my friends and I even traveled to San Francisco for the Nike Women’s Half Marathon, which awards each finisher with a Tiffany’s necklace – a prize I still cherish today (Image 1). At first, my goal was to get through each race, yet I found myself gaining a certain level of competitiveness with myself. This led to me signing up for my first full marathon – the Nashville Rock n’ Roll Marathon. Not only is this hilly race known for the great live music along the course, it was also conveniently at the very end of my fourth year of medical school. With up to three months off during the end of fourth year, I knew I would have the time and dedication needed to properly train for running 26.2 miles. [![](%5Bsiteurl%5D/wp-content/uploads/2017/05/12140836_10208222901672927_5912613748967049008_n-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/12140836_10208222901672927_5912613748967049008_n.jpg)Among all things, having a realistic training schedule might be the most important. I used a Hal Higdon ([http://halhigdon.com](http://www.halhigdon.com)) novice running schedule, which I found to set weekly goals that I could accomplish. I also learned that it is okay if you miss a run; after all it’s a marathon not a sprint. **It is the work you put in over the course of several months that matters, not days.** One thing I did prioritize was my weekly long runs. I strategically placed those runs on days I had off, knowing it would take several hours out of my day. **Image 1:** The Nike Women’s Half Marathon in San Francisco with four medical school friends. I also relied on my wolf pack during these long runs; an 18-mile training run didn’t seem possible without the support of friends. Each long run was harder than the last, but you learn how to emotionally outrun the joint pain and mental exhaustion you experience, knowing that it is making you just that much better in the end. Soon after the flurry of Match Day and a post-match vacation, April 29th was here. I traveled to Nashville alongside some of my closest friends from medical school. Arriving at race day was invigorating and terrifying. The forecast for the run was 90 degrees with 70% humidity, which are conditions that even for someone from Arizona found brutal to run in. The first half of the race was about as expected. Running several half marathons gets you conditioned to become comfortable with this distance and type of race. It is the last 13.1 miles that I experienced a whirlwind of emotions. I went through feeling like I can finish the race to thinking I had made a massive mistake signing up for this. This is where running really becomes a mental game, which I found similar to some of the mental struggles I faced during medical school. What really got me through the race was walking when I needed to. Finishing a marathon doesn’t mean you need to run the entire race – in fact regular walking breaks can bring you to the finish line at nearly the same time as if you had run the entire race, typically with fewer injuries and pain. The feeling of crossing the finish line is a feeling you will never forget, because at that moment you are officially a marathoner (Image 2). [![](%5Bsiteurl%5D/wp-content/uploads/2017/05/18155836_10106153786644132_2719955743396775167_o-286x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/05/18155836_10106153786644132_2719955743396775167_o.jpg) While I initially would have never imagined myself finishing a marathon, I learned a lot about myself through this process. First, I can accomplish much more than I thought I could. Having a goal is the first step. Second, having an outlet from a busy, stressful life in medicine is healthy and necessary. Even though running takes a great deal of time out of my week to train, the rewards to my physical and mental health are well worth it in the end. Last, it is ok to not be so hard on myself. Taking a week break from running if I need to, walking if I need to – we all have different paths to get to the same place. **Image 2:** After finishing my first marathon in Nashville! --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/03/mccrary-258x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/mccrary.jpg)Hilary McCrary is the Chair of the AWS Medical Student Committee and is a fourth year medical student at the University of Arizona College of Medicine – Tucson. She will begin her Otolaryngology – Head and Neck Surgery training at the University of Utah this summer. She hopes to practice in an academic setting where she can operate, teach, and conduct research. <hcrees@email.arizona.edu>* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, education, leadership, medical students, self-care **Tags:** Half Marathon, Marathon, Running --- ### [Knocking on the Door of Disparity](https://blog.womensurgeons.org/knocking-disparity/) **Published:** April 27, 2017 **Author:** mcooke@amrms.com **Content:** *By Danielle Henry, MD* Before the end of National Minority Health Month, I am compelled to take the opportunity to talk about how a disease I’m passionate about affects black women – breast cancer. National Minority Health Month gives us another chance, outside of October, to focus on breast cancer’s impact on the black community. After being introduced to the [Sisters Network](http://www.sistersnetworkinc.org) by one of my patients, I gained a greater understanding of breast cancer’s impact on the black community. During one of the events I attended, “Stop the Silence”, there were women who traveled from near and far who were currently battling breast cancer, survivors of breast cancer, loved ones of those who previously passed away from breast cancer and simply supporters coming together to raise awareness. Many admitted that cancer was a taboo topic growing up, and went on to share personal stories of struggles, triumphs, and loss due to breast cancer. As a part of the event, we also walked door to door asking to speak with the women of the household to share breast cancer facts and invite them back to the event site for free mammograms. This part of the event stood out the most, as it took an active role of going into the community instead of passively waiting for them to present to the clinic. Below is a list of statistics shared during the walk, in addition to a few others, which resonated with me on the topic of breast cancer: 1. Among black women, breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer deaths. 2. Although the incidence of breast cancer is lower in black women, they have a 42% higher mortality than white women. 3. Only 52% of breast cancers are diagnosed at a local stage in minority women. 4. Twenty-two percent of breast cancers among black women are triple negative (loss of receptors for estrogen, progesterone, her-2-neu), which behave more aggressively, have a poorer prognosis and lack targeted therapy. I am motivated both by my experience with this grassroots event, as well as the overwhelming data that shows disparity in black women, to address and shed light on this disparity. With National Minority Health Month and this blog offering a prime opportunity to bring awareness, the rest of the months can be spent “Bridging Health Equity Across Communities”. Through the Office of Minority Health, you can find many resources for working with minority populations related to education, prevention and treatment strategies. Resources: [www.cancer.org](http://www.cancer.org) <https://minorityhealth.hhs.gov> \#NMHM17 --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/01/DanielleHenry-190x283.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/01/DanielleHenry.jpg)Danielle Henry is a chief resident at Orlando Health General Surgery Residency Program and currently serves as the administrative chief resident. She is planning to pursue her passion with a career in breast oncology after residency. She completed her medical degree at Florida State University and undergraduate degree in Applied Physiology and Kinesiology at the University of Florida. She enjoys playing soccer, a good game of scrabble and time at the beach. She also enjoys community service projects and mentoring medical students.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education, gender differences, networking, self-care, women **Tags:** Breast Cancer, National Minority, National Minority Health Month, NMHM17 --- ### [Grey’s Anatomy: 5 Reasons to Aspire to be Like Seattle Grace Hospital](https://blog.womensurgeons.org/greys-anatomy/) **Published:** April 19, 2017 **Author:** mcooke@amrms.com **Content:** *By Sristi Sharma MD, MPH* I confess–there are days when I like to unwind and binge watch Grey’s Anatomy. I revel at the personal drama, root for certain characters (Jackson!), cringe at medical atrocities and then spend (my precious) hours on the internet looking up this mythical hospital, that I can assure you, does not exist in the United States. All real-life medical doctors, especially surgeons, have several issues with Grey’s Anatomy: the medical science in the program is all wrong, interns in the show have an impossible life, the attendings have a severe I-need-to-do-it-all complex-and don’t even get me started on the hair! However, what Grey’s Anatomy does get right is the alternate reality of gender roles in the field of surgery. Here are 5 things that Seattle Grace Hospital Department of Surgery can teach the real-life surgical community: 1. The number of female surgery residents: As per AAMC 2016 residents report there are a whopping 163.4% more male surgery residents than female ones. This reflects the general surgery residency application figures which during the ERAS 2016 cycle had around 4870 males vs 2600 females. That is 187.3% more male applicants to these programs. The female heavy residency program at Seattle Grace Hospital does not reflect residency programs in the US. All programs in the country should make a better effort to recruit qualified women surgical residents. 2. Miranda Bailey as the Chief of Surgery is an outlier. There are 271 general surgery residency programs in the United States. Of these only 16 programs are headed by women. That number was 1 in 2014. So although it looks like we are headed the right way, a lot still needs to be done. The ACS recently hosted a webinar on Principles of Leadership for the Young Surgeon. The fact that it was presented by an advocate for gender equity in general surgery was a great step in the right direction. 3. In Seattle Grace Hospital the chiefs of cardiothoracic surgery, neurosurgery, orthopedic surgery AND pediatric surgery are all women. Time and again, the show reiterates the high degree of technical skill these women have in their respective fields. So clearly, Seattle Grace Hospital is promoting people based on their qualifications and not on their gender. In the real world however, there exists a glass ceiling that is quite difficult to break, particularly in fields like surgery.There are many reasons why there is a scarcity of women in surgical leadership roles, however inherent systemic biases are some of the most unaddressed reasons that hold women surgeons back. We need to address these biases one at a time and do away with the barriers that prevent women surgeons from achieving their fullest potential. 4. This year during the International Day of Women and Girls in Science, the UN deplored the bias and stereotyping against women in science and went on to make a bold statement “The world needs science and science needs women”. Melinda Gates has made it a personal mission to increase the number of women in science. Now here is a list of research studies that the women surgeons of Seattle Grace Hospital do: Cristina Yang’s Conduit Trial, Meredith Grey’s Alzheimer’s drug trial, Miranda Bailey’s diabetes research, and Callie Torres’ limb simulation trial, to name a few. Clearly, this hospital has great policies that support research activities among these surgeons. This in turn makes them great academic surgeons, which in turn explains their promotion as department heads. It is a cycle that keeps on going and growing. 5. Mentoring opportunities: The mentoring relationships portrayed in Grey’s Anatomy is what we all hope to have and give at some points in our careers. The deep bonds (although sometimes over-the-top) that every mentor has with their juniors explains why it seems every surgeon in the show is so successful. The show demonstrates men mentoring the women to rise to the top. A report published recently by Harvard Business School showed that male champions can change the workplace culture so that women actually get what they deserve. The women in turn mentor not just other women but also men (Arizona and Alex anyone?) and the entire system self-propagates. The report shows that companies which adopt gender diversity did better than others,which then kind of explains why Seattle Grace Hospital would be one of the ‘top choices’ for competitive residents. So yes, while interns going berserk with LVADS and a gunman roaming around loose in the hallways may not bode well for a successful setup, Seattle Grace Hospital has some great qualities which surgical communities in the country should aspire to if they want to be considered a success overall. --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/04/sristi-300x202.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/04/sristi.jpg)Sristi Sharma MD, MPH is an aspiring surgeon, a clinical researcher at the Brigham and Women’s Hospital, a previous Paul Farmer Global Surgery Research Associate and a proud alum of Manipal University, India. She is an passionate about advocating for global surgery. She was born in the Himalayas and is a Gorkha to the core.* *Twitter:* *@drsristisharma* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, gender differences, self-care, women **Tags:** Gender Disparities, Grey's Anatomy --- ### [National Minority Health Month](https://blog.womensurgeons.org/minority-health/) **Published:** April 12, 2017 **Author:** mcooke@amrms.com **Content:** *By Robin Williams, MD, FACS* Despite the vast advancements of modern medicine, significant health disparities remain amongst minority populations. Heart disease, cancer, stroke, diabetes, and unintentional injuries are the top 5 concerns that disproportionately affect minorities. Just to highlight a few disparities: - Thirty percent of African Americans are more likely to die from heart disease. Coronary artery disease occurs earlier in life and in higher percentage of Asian Indians than in other ethnic groups. - Seventy percent of African Americans and Latinos are more likely to be diagnosed with diabetes compared to non-Hispanic whites. Twenty percent of Asian Americans are more likely to have type 2 diabetes than their non-Hispanic white counterparts. - Although the incidence of breast cancer is higher in white women, African American women tend to be diagnosed at an earlier age (58 compared to 63) and have a death rate that is 42% higher. Hispanic women have among the highest rates of cervical and gallbladder cancer. The above information juxtaposed with the following heightens the need for awareness to be raised regarding minority health. - In 2008, approximately 33% or more than 100 million people identified themselves as belonging to a racial or ethnic minority population. - The Census Bureau predicts that by 2045, the racial and ethnic minority populations in the United States will grow to become one half of the US population. - The potential excess medical care expenditures for African Americans, Asians and Hispanics that were due to health inequalities is 30.6%. April is National Minority Health Month. Sponsored by the Office of Minority Health (OMH), the theme this year is “Bridging Health Equity Across Communities.” Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people.” This definition incorporates social determinants of health- where we live, work, play- as factors impacting overall health. OMH invites individuals and organizations to engage in their own communities to achieve equity. There will be a Twitter Town Hall on April 12 and a Twitter Chat on April 25. For more information, go to [www.minorityhealth.hhhs.gov](https://www.minorityhealth.hhs.gov/). *“Without health, and until we reduce the high death rate, it will be impossible for us to have permanent success in business, in property getting, in acquiring education, or to show other evidence of progress”* *~Dr. Booker T. Washington* References: Current Cardiology Reviews 2015 Aug:11(3): 238 – 245 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558355/table/T1/> The National Negro Health Week, 1915 – 1951: A Descriptive Account, Sandra Crouse Quinn, PhD; Stephen B. Thomas, PhD [http://health-equity.lib.umd.edu/541/1/National\_Negro\_Health\_Week.pdf](http://health-equity.lib.umd.edu/541/1/National_Negro_Health_Week.pdf) [www.cancer.org](http://www.cancer.org) [www.minorityhealth.hhs.gov](https://www.minorityhealth.hhs.gov/) --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/04/williams-252x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/04/williams.jpg)*Dr. Williams is board certified in general surgery. Her clinical interests are diagnosis and treatment of diseases of the breast. She is currently the Co-Chair for the Association of Women Surgeons Clinical Practice Committee. She is a member of the Tennessee Medical Association and serves on the Insurance and Constitution and Bylaws Committees. She is also a delegate for the Nashville Academy of Medicine. Over the years, Dr. Williams has been an active participant in the Nashville community. She has served as a board member of the Tennessee Breast Cancer Coalition, the Nashville Affiliate of Susan G. Komen for the Cure, and the MidSouth Division of the American Cancer Society. From 2000 to 2007, she was president of the Nashville Chapter of the National Black Leadership Initiative on Cancer.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education, gender differences, leadership, self-care, women **Tags:** Healthy People 2020, Minority Health, National Minority Health Month --- ### [CRC Awareness](https://blog.womensurgeons.org/crc-awareness/) **Published:** March 29, 2017 **Author:** mcooke@amrms.com **Content:** *By Nickey Jafari* Cancer is the second leading cause of death in the world, resulting in 8.8 million deaths in 2015 alone1. Colorectal cancer is the third most common cancer globally2 and the second most common cause of cancer-related deaths in the United States3. While your risk of colon cancer generally increases with age, a [recent study](https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djw322) from the American Cancer Society shows rates of colon and rectal cancer are increasing in younger populations, with those born in 1990 having double the risk of colon cancer and quadruple the risk of rectal cancer as those born in 1950. Other important risk factors are having inflammatory bowel disease, a family history of colorectal cancer, and certain genetic syndromes e.g. Lynch syndrome4. Lifestyle risk factors that are important to note since they are amenable to modification include lack of regular physical activity, low-fiber diets, lack of adequate fruit and vegetable consumption, and tobacco and alcohol use4. Common signs and symptoms of colorectal cancer include a change in your bowel habits, blood in the stool, weakness, weight loss, and abdominal pain6. Linked [here](https://www.cancer.gov/colorectalcancerrisk/) is a handy Colorectal Cancer Risk Assessment Tool by the National Cancer Institute. The earlier you detect colorectal cancer, the better the outcome. A National Cancer Institute database of patients diagnosed between 2004 and 2010 found a 5-year relative survival rate of 92% for a stage I tumor, while stage IV tumors had a 5-year relative survival rate of 11%5. Keep in mind these are only estimates and cannot predict individual outcomes, and our surgical and chemotherapy options continue to take great strides. You can find a very helpful and informative explanation of tumor staging [here](https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/staged.html). Given how critical it is to diagnose colorectal cancer early, we are fortunate, unlike other cancers such as pancreatic cancer, to have effective screening tools available. The U.S. Preventive Services Task Force gives a Grade A, the highest level, of [recommendation](https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening) for screening on adults beginning at age 50 with fecal occult blood testing, sigmoidoscopy, or colonoscopy. Each of these three methods has its different risks and benefits. The American College of Gastroenterology divides them into [cancer prevention and cancer detection tests](https://gi.org/guideline/colorectal-cancer-screening/), with colonoscopy every 10 years starting at age 50 (age 45 for African Americans) being the best colorectal cancer *prevention* test. Afterall, colonoscopy has the benefit of identifying growths called *polyps* before they even become cancerous, and often we can remove them during the procedure. Of course, these guidelines are for average-risk individuals, and everyone should discuss their risk factors and screening options one-on-one with their primary care providers. In the meantime, spread awareness to your loved ones and try and tackle as many of those lifestyle risk factors as you can! 1. <http://www.who.int/mediacentre/factsheets/fs297/en/> 2. <http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/colorectal-cancer-statistics> 3. <https://www.cdc.gov/cancer/colorectal/statistics/> 4. [https://www.cdc.gov/cancer/colorectal/basic\_info/risk\_factors.htm](https://www.cdc.gov/cancer/colorectal/basic_info/risk_factors.htm) 5. <https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html> 6. <https://www.cancer.org/latest-news/study-finds-sharp-rise-in-colon-cancer-and-rectal-cancer-rates-among-young-adults.html> --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/03/Screen-Shot-2017-03-13-at-10.13.08-PM-168x300.png)](%5Bsiteurl%5D/wp-content/uploads/2017/03/Screen-Shot-2017-03-13-at-10.13.08-PM.png)*Nickey Jafari is currently a third year medical student at the University of Kansas. She will be taking a year before beginning her fourth year of medical school to pursue a Master of Public Health at the Johns Hopkins Bloomberg School of Public Health. She is hoping to pursue an academic general surgery residency afterwards with current interest in surgical oncology. When she has free time, Nickey enjoys traveling and has been to over fifteen countries. She also loves spending time with her mother and father when she’s not too busy spoiling her little sister.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [It’s Colorectal Cancer Awareness Month!](https://blog.womensurgeons.org/colorectal-awareness-month/) **Published:** March 22, 2017 **Author:** mcooke@amrms.com **Content:** *By Anya Dyurgerova* In February 2000, President Clinton officially dedicated March as National Colon Cancer Awareness Month and March 3rd is national dress in blue day to raise awareness for Colorectal Cancer. But why is colorectal cancer so important? Worldwide, colorectal cancer (CRC) is the[ third most common cancer in males (746,000 cases, 10.0% of total cancers) and the second in females (614,000 cases, 9.2% of total cancers)](http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx) . It is the third most common cause of cancer death in the United States with 134,490 new cases and 49,190 deaths each year. However with early screening cancer can be found before it is advanced, greatly improving long term prognosis. [Age](https://www.uptodate.com/contents/image?imageKey=ONC%2F59440&topicKey=ONC%2F2606&rank=3~150&source=see_link&search=colorectal%20cancer) is the biggest risk factor for sporadic (non-hereditary) CRC, and the risk increases in those greater than 50 years old. Other risk factors for sporadic CRC include inflammatory bowel disease, history of abdominal radiation, obesity, diabetes, tobacco use, excess alcohol use and a poor diet. Out of the CRCs diagnosed in those under 50, 35% are caused by hereditary syndromes such as [Lynch Syndrome](http://www.cancer.net/cancer-types/lynch-syndrome) and [Familial Adenomatous Polyposis](https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-4-22) (FAP). Researchers have also found that some factors decrease the risk of CRC. These include physical activity, use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), postmenopausal hormone replacement therapy and a diet rich in vegetables. Multiple other dietary factors have been studied in relation to the risk of CRC, however most of the data is inconclusive. The most common presenting symptoms of CRC are rectal bleeding, change in bowel habits, abdominal pain, distention, fatigue and iron-deficiency anemia. If you experience any of these symptoms you must let your physician know so that the proper testing can be done. Colorectal cancers typically develop from polyps and removal of these polyps can prevent progression to cancer. Screening for polyps is done with a colonoscopy or sigmoidoscopy. While the [recommendation](https://www.cancer.gov/types/colorectal/hp/colorectal-screening-pdq) for most of the population is to begin screening at fifty years old, those with a strong family history of colon cancer should begin earlier. If you have a family history of colon cancer you should speak with your physician regarding when it would be the best time to begin screening for CRC. One in five patients presents with metastatic disease at diagnosis of CRC, and this stage of CRC has a much worse prognosis. Therefore, it is critical to diagnose CRC early before it spreads to other organs and to immediately begin treatment. The survival rate from CRC is one of the highest in the United States and this is due to nationwide screening, early detection and effective treatment. The five year survival for patients treated for stage I CRC is greater than 90%. Below are links for more information and for ways you can get involved: [National Cancer Institute](https://www.cancer.gov/types/colorectal) [Colorectal Cancer Screening Guidelines](http://emedicine.medscape.com/article/2500006-overview) [Dress in Blue Day](https://www.ccalliance.org/awareness-month/dress-in-blue-day/) [Screen for Life: National Colorectal Cancer Action Campaign](https://www.cdc.gov/cancer/colorectal/sfl/) --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/03/anya-217x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/anya.jpg)Anya Dyurgerova is a fourth-year medical student at Western University of Health Sciences in Pomona, CA. Anya will be starting residency in Otolaryngology in Michigan this July. Prior to medical school she received her bachelor’s degree at University of Colorado, Boulder in Molecular, Cellular and Developmental Biology and in Spanish. Outside of medical school, Anya enjoys spending time outdoors snowboarding, hiking and camping and doing yoga.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** Uncategorized --- ### [The History of the Match and the Perspective From One Medical Student’s Journey](https://blog.womensurgeons.org/history-match/) **Published:** March 16, 2017 **Author:** mcooke@amrms.com **Content:** *By Hilary McCrary, MPH* Throughout all of medical school, I always looked up to the current fourth year students. They seemed so seasoned and prepared to make the transition from student to doctor. The fourth year of medical school is also highly anticipated, as it is what medical students perceive as the first time they are solely focusing on their chosen career and traveling across the country for either away rotations or interviews. Now that I am towards the end of this process, I have had time to reflect on all of the components that go into the Match and what is takes to get there. The Match process was created in 1952 as a way to address concerns related to institutions offering a spot for residency training earlier than other competing institutions.1 This previous design put pressure on applicants to accept multiple appointments, as positions were typically offered over the phone with the intent of providing the institution an immediate answer or losing that training spot.1 This process was followed by attempts to make a uniform time for institutions to release intern positions. Ultimately, F.J. Mullin from the University of Chicago School of Medicine suggested that both students and institutions create rank-order lists that would end in a match between that individual and a hospital.2 There were growing pains associated with this transition, but the Boston Pool algorithm created a stable process in which the rank-order lists were updated as each student went through the matching process. This program became known as the National Resident Matching Program (NRMP) and is the program that is still used today.3 The most recent change to this matching algorithm came in 1998, which was aimed at making the outcomes as favorable as possible for the applicant.4 In fact, in 2012 economists Alvin Roth and Lloyd Shapley would go on to win the Nobel Prize in Economics for their contributions to creating a stable match process through their work on match theory.5 While some controversy surrounded the inception of the Match, it does provide applicants and hospitals a sensible system to determine where new physicians will spend several years of training. As attested by several students, even though not all individuals may get their top pick on Match Day, the system has a way of finding the program best suited for each individual. While every specialty has its own unique aspects to the Match, there is one piece of advice that I always listened to – apply broadly. As a student applying to Otolaryngology, I knew that I needed to apply to a large number of diverse programs. This serves two purposes. It allows the student to see enough programs to know what aspects of a training program will most suit their needs and it sets you up for success statistically, as the more programs you apply to the higher your odds are of matching. I applied to 70 programs across the nation, which seemed daunting at first. The process of receiving interviews was exciting and stressful. In the fall months, students receive a flurry of interviews via email, and typically must respond within minutes or that interview spot may be taken. As someone who was on a surgical rotation during this time, I found it hard to be in the operating room without worrying about what emails were popping up on my phone. Then comes the fun part – the traveling. As someone who loves flying and exploring new places, I was most excited for this aspect of applying to residency. In total, I attended 17 interviews, in 13 different states, over the course of three months. What no one prepared me for was how exhausting this process is. There were periods of time where I had four interviews in just five days, often associated with several flight delays and arriving at my destination city in the early hours of the morning. Furthermore, this process was financially difficult as well, as this entire process cost thousands of dollars. While in the thick of the interview trail I felt challenged, however, looking back it was an incredible experience that I felt lucky to partake in. Especially since I was given the opportunity to meet my future colleagues that I will collaborate with in the future, whether this is clinically or on research endeavors. Now I join thousands of other medical students and wait to see where this process leads me on Match Day – March 17, 2017, which happens to land on St. Patrick’s Day this year. After a lot of thought and reflection, my rank-order list is certified and waiting for processing. What I have learned is there is no right way to navigate the Match and at the end of the day it’s best to go with your gut. Really listen to what your intuition is telling you on an interview day and make sure to ask questions that are important to you. Take risks, as programs you never thought would be what you are looking for or be within your reach might be the perfect fit for you. Finally, seek advice from your mentors who understand your career goals; their insight can be invaluable in helping create your rank-order list. Best of luck to all medical students and future surgeons participating in the Match this year! References: 1\) Roth AE. The Origins, History, and Design of the Resident Match. *JAMA.* 2003;289(7):909-912. 2\) Mullin FJ. A proposal for supplementing the Cooperative Plan for appointment of interns. *J Assoc Am Med Coll.*1950;25:437-442. 3\) Roth AE. The evolution of the labor market for medical interns and residents: a case study in game theory. *J Political Economy.*1984;92:991-1016. 4\) Roth AE, Peranson E. The redesign of the matching market for American physicians: some engineering aspects of economic design. *Am Econ Rev.*1999;89:748-780. 5\) Rampell C. “2 From U.S. Win Nobel in Economics”. *The New York Times.* Published October 15, 2012. Accessed on February 11, 2017. --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/03/mccrary-258x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/mccrary.jpg)Hilary McCrary is the Chair of the AWS Medical Student Committee and is a fourth year medical student at the University of Arizona College of Medicine – Tucson. She is currently applying to otolaryngology and hopes to practice in an academic setting where she can operate, teach, and conduct research.* [*hcrees@email.arizona.edu*](https://mail.uhhospitals.org/owa/redir.aspx?C=Fq91n_NDP0yCXKByEfWud-M1ezmlQtMIa_FqZCv_gMcBov3gJeZknOzNc1KxUyY4bGFCUhXCiAg.&URL=mailto%3ahcrees%40email.arizona.edu) *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** career development, current events, education, medical students, mentorship, networking, professionalism, residency, training **Tags:** Match, Match 2017, Match Day, NRMP, The Match --- ### [March is Colorectal Cancer Awareness Month!](https://blog.womensurgeons.org/colorectal-awareness/) **Published:** March 15, 2017 **Author:** mcooke@amrms.com **Content:** *By: Heather Yeo, MD, MHS* March is Colorectal Cancer Awareness month an important time to talk about Colorectal Cancer, because it is a time of national focus and provides an opportunity for education and prevention for a common, but often “hidden” form of cancer. One of the reasons that I decided to spend my life treating colorectal cancer is because of the exciting progress that has been made in its detection, understanding, and treatment over the last decade and the potential for even greater progress on the horizon. While I deal with colorectal cancer every day, as I am caring for my patients, I am always researching ways to improve their care and quality of life. A few key points I would like patients to think about: **Prevention is Key.** There are certain risk factors that we know put individuals at higher risk, for example, consumption of red meat, smoking, and obesity all put patients at higher risk. Understanding [family risk factors](https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html) is important as well, first degree relatives with colon cancer, BRCA mutations, or any hereditary cancer syndrome should discuss their risk with a genetic counselor. There is some evidence that frequent long term aspirin use in individuals at risk may slow polyp formation and decrease the risk of colon cancer. **Screening Matters.** Colorectal cancer is the second most common cancer in the United States, affecting men and women of all ages. While it is most common after the age of 60, due to screening, it has been decreasing overall in the US population. [Screening colonoscopy](https://www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm) is recommended for all adults starting at the age of 50 or 10 years before any first degree relatives were diagnosed in those with a family history. However, for unknown reasons, [early onset cancer is on the rise](https://www.youtube.com/watch?v=S7ocvAaBpwU), so don’t ignore symptoms in [young patients](http://fightcolorectalcancer.org/prevent/symptoms/), particularly those that don’t go away after treatment. **Treatments are effective for localized cancer.** The good news is that cancers that are detected early are often cured with surgery alone. Those that have spread locally still have very good cure rates, but may require chemotherapy (you usually don’t lose your hair with newer medications available). When cancer is found at more advanced stage, medication can help slow their spread and certain measures can help people have good quality of life. **There is nothing to be ashamed of.** Colorectal cancer is not sexually transmitted or contagious, people of all ages, races and cultures are at risk. For many people there is a stigma associated with it because they are embarrassed to talk about digestive problems. I think the most important advice I can give, is to not ignore your symptoms. Colorectal surgeons and surgical oncologists are specially trained to deal with surgical problems of the GI tract and will treat you with respect and dignity. Because this is a common cancer, there are resources, support groups, and integrative therapies that may help you deal with the disease. Don’t be afraid to ask your physician for some of these resources. I have included some helpful links below. Additional Resources [Society of Surgical Oncology Colon and Rectal Cancer Page](http://www.surgonc.org/disease-sites/colorectal) [American Cancer Society](https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html) [Colon Cancer Alliance](https://www.ccalliance.org/get-information/what-is-colon-cancer/statistics/) [National Cancer Institute – Surveillance Epidemiology and End results](https://seer.cancer.gov/statfacts/html/colorect.html) --- [![](%5Bsiteurl%5D/wp-content/uploads/2017/03/yeo-249x220.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/yeo.jpg)*Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College and Assistant Attending Surgeon at New York-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research and is focused on surgical outcomes and quality improvement in Gastrointestinal Cancer Surgery. Dr. Yeo became involved with AWS after receiving the 2013 AWS-Ethicon Fellowship Grant and is currently a co-chair of the AWS Communications Committee.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, current events, education, professionalism, resources, self-care **Tags:** Colorectal, Colorectal Cancer Awareness, Dress in Blue --- ### [The Greenberg Spike: How speaking out on implicit bias and gender equity in surgery continues to trend](https://blog.womensurgeons.org/the-greenberg-spike/) **Published:** March 1, 2017 **Author:** mcooke@amrms.com **Content:** *By Marissa A. Boeck* When #ILookLikeASurgeon went viral in August 2015, many expected a short lived hashtag. Yet [Dr. Caprice Greenberg](https://twitter.com/CapriceGreenber), the president of the Association for Academic Surgery (AAS), has shown the conversation on diversity, inclusion, and equity in surgery is far from over. During the recent AAS and Society of University Surgeons (SUS) 12th annual conference in Las Vegas, Nevada around 2,000 medical students, residents, fellows, and attendings gathered to network, mentor, collaborate, and discuss academic surgery. Despite the abundance of stiff competition, the [AAS Presidential Address “Sticky Floors and Glass Ceilings”](https://www.youtube.com/watch?v=KHo1x2sk0gw&feature=youtu.be&t=12m44s) by Dr. Greenberg stole the show. All those packed into the large event hall immediately knew the focus: women in surgery. This subject continues to be pertinent and necessary to discuss despite many notable advances, such as both the current and incoming presidents of the AAS and SUS being female. Yet Dr. Greenberg steered the conversation away from traditional topics of “women in surgery” as she asked us to rethink what issues actual female surgeons face. She argued the challenges do not boil down to only those associated with parenting. This is especially true since [40.5% of female surgeons do not have children, while 91.8%](http://sitel.org/wp-content/uploads/sites/4/2013/08/work-home.pdf) of male surgeons do, which is why we need to talk about parental challenges and leave versus simply maternity. She then spoke about widespread biases and discriminations against women seen throughout society that also resonate in medicine and surgery, using the [Audi #DriveProgess 2017 Super Bowl ad](https://www.youtube.com/watch?v=G6u10YPk_34&feature=youtu.be), [Huffington Post Pinksourcing video](https://www.youtube.com/watch?v=k_m5AlsQqcs&feature=youtu.be), and [The Daily Show’s American Soccer’s Gender Wage Gap](https://www.youtube.com/watch?v=x9GqWoy6__s&feature=youtu.be) video as poignant examples. She showed data from a [study of academic science faculty](http://www.pnas.org/content/109/41/16474.abstract) exemplifying hiring gender biases for lab managers based solely on applicant names. Dr. Greenberg then honed in on specific items most relevant to surgeons: differences in salaries, promotions, and grant funding. The fact that in 2017, based solely on gender, with all other factors held equal or superior in females, women still earn less, fill fewer leadership roles, and have lower grant funding than men is unacceptable. The impact of Dr. Greenberg’s talk was palpable. From individual goosebumps and frequent murmurs, to occasional outbursts of disbelief and, finally, tears. No one in the room appeared unaffected, women and men alike. An objective measure could be visualized on social media, where metrics for the conference hashtag showed a large spike of almost 750 tweets during the 45-minute talk, greatly overshadowing the other subjects of the day (Figure 1). The diversity-championing hashtag #ILookLikeASurgeon showed a similar increase during the same period (Figure 2), disseminating Dr. Greenberg’s important message to a global community that has likely faced similar challenges in their careers. Figure 1. [![](%5Bsiteurl%5D/wp-content/uploads/2017/03/figure1boeck-300x120.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/figure1boeck.jpg) [Source: Symplur](https://www.symplur.com/healthcare-hashtags/ASC2017/analytics/?hashtag=ASC2017&fdate=02%2F08%2F2017&shour=00&smin=00&tdate=02%2F09%2F2017&thour=00&tmin=00) Figure 2. [![](%5Bsiteurl%5D/wp-content/uploads/2017/03/figure2boeck-300x120.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/figure2boeck.jpg) [Source: Symplur](https://www.symplur.com/healthcare-hashtags/ILookLikeASurgeon/analytics/?hashtag=ILookLikeASurgeon&fdate=02%2F08%2F2017&shour=00&smin=00&tdate=02%2F09%2F2017&thour=00&tmin=00) Besides firing everyone up for action, the most important part of Dr. Greenberg’s talk was the discussion of potential solutions. The global social media community agreed, as this appeared to be the most shared slide from a quick glance of the Twitter feed. Her suggested systemic interventions for surgery included: - Transparent, objective compensation plans - Blinded manuscript, grant, hiring, and promotion practices - Explicit, purposeful, and fair distribution of uncompensated teaching and service workload - Equal leave policies and tenure clock extensions - Objective measures of success and milestones for promotion that are defined a priori so everyone knows the rules - Institute educational programs on implicit bias and its impact Only through the wide adoption of targeted actions that aim to recognize and address surgical workforce inequities, such as those listed above, can we actually hope to erase them. This includes organizations speaking up, such as the [Association of Women Surgeons’ Statement on Gender Equality](https://www.womensurgeons.org/2017-statement-on-gender-salary-equity/). Although frequently labeled as women in surgery problems, these issues cast a wider net, encompassing all those affected by[ implicit bias](https://plato.stanford.edu/entries/implicit-bias/); in other words, potentially anyone. Yet together we can make surgery a field that accepts and promotes anybody who has the passion, stamina, and drive to succeed within a challenging but rewarding profession, irrespective of personal characteristics that have no bearing on one’s potential or worth. [![](%5Bsiteurl%5D/wp-content/uploads/2017/03/boeck3-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/boeck3.jpg) Photo credit: Dr. Danielle Sutzko @LoupesLoveMD Dr. Greenberg’s final slide starkly projected #ILookLikeASurgeon and #HeForShe in large white font on a black background, inviting the audience to continue the conversation, both on social media and in real life, until we all receive equal compensation and consideration for opportunities for professional and personal success. [![](%5Bsiteurl%5D/wp-content/uploads/2017/03/boeck4-300x225.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/boeck4.jpg) From left: Nelly-Ange Kontchou, Heather Logghe, Caprice Greenberg, Marissa Boeck. Photo credit: Dr. Susan Pitt Resources: [2017 AAS Presidential Address By Dr. Caprice Greenberg](https://www.youtube.com/watch?v=KHo1x2sk0gw&feature=youtu.be), Introduction by [Dr. Rebecca Sippel](https://twitter.com/rebecca_sippel) [Ladies Get Paid](http://www.ladiesgetpaid.com/) ([@ladiesgetpaid](https://twitter.com/ladiesgetpaid)) – Helping women advocate for themselves to get recognized and rewarded [He For She](http://www.heforshe.org/en) ([@HeforShe](https://twitter.com/HeforShe)) – United Nations Women’s mission for gender equality [Why So Slow? The Advancement of Women](https://mitpress.mit.edu/books/why-so-slow) by Virginia Valian Carnes, Devine, Baier Manwell, Byars-Winston, et al. “The Effect of an Intervention to Break the Gender Bias Habit for Faculty at One Institution: A Cluster Randomized, Controlled Trial.” Academic Medicine 2015; 90(2): 221-230. [Link](http://journals.lww.com/academicmedicine/Fulltext/2015/02000/The_Effect_of_an_Intervention_to_Break_the_Gender.29.aspx) --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/03/boeck-179x179.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/03/boeck.jpg)Marissa A. Boeck MD, MPH is a general surgery resident at New York Presbyterian Hospital – Columbia. She is passionate about diversity in the surgical workforce, the power of social media in medicine, and global public health, especially as it relates to injury prevention, emergency response, and trauma and surgical system strengthening in low-resource settings.* *Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.* **Categories:** advocacy, career development, current events, education, family life, gender differences, leadership, medical students, mentorship, parenting, professionalism, residency, training, women **Tags:** #HeForShe, ASC 2017, Gender Disparities, ILookLikeASurgeon --- ### [The Intersection of Race and Gender in Surgery](https://blog.womensurgeons.org/race-gender-surgery/) **Published:** February 26, 2017 **Author:** mcooke@amrms.com **Content:** *By Mohini Dasari* In light of February being Black History Month, I was inspired to write about the intersection of race and gender in surgery. As a woman of color currently applying to surgical residency programs, the issues of diversity and gender have been on my mind for quite some time. While diversity can also refer to socioeconomic status, religion and sexual orientation, I will be focusing on one definition of diversity: race/ethnicity. Why does race matter? Do we live in a post-racial society, where we can all identify together under broader terms such as “women”? Can all women identify under the single label of “women in surgery” within a traditionally male-dominated field? While I would like to say yes, for the sake of unity, I must say “yes and no.” Whenever I go to national meetings, or when I was on the interview trail, I usually count how many women are there. While I’m sure many of us do this, I also find myself counting how many women of color I see— as leaders, speakers or panelists. Not surprisingly, when the number of overall women in leadership positions is small, the number of women of color is even smaller– a phenomenon termed as the “double blind”. As a future academic surgeon and woman of color, I find that this representation (or lack thereof) affects me on a personal level. I was reading “Feminist Fight Club” in preparation for the AWS tweet chat, and the author made a great point about how the increased presence of women in meetings encourages more women to speak up. I posit that the same is true for racial diversity: when I see more people like me (women of color) in a group, I feel more empowered to speak up. I am grateful to have found some wonderful female surgical mentors in my career thus far. However, finding mentors who are also women of color is not always easy. Is this to say that women of color must only seek mentors who are also women of color? Of course not. Just like current/aspiring female surgeons can have mentors of any gender, the same can be said for women of color who are seeking mentors. However, I think there are unique challenges that women of color face when trying to enter fields that are traditionally dominated by men AND by people who are not racial minorities. These challenges include but are not limited to [implicit bias](https://oied.ncsu.edu/advance/wp-content/uploads/2012/02/Sanchez-HulcesandDavis.pdf), microaggressions, lack of representation in leadership, and difficulty confronting stereotypes. This post is intended to be a starting point to discuss the importance of the intersectionality of race and gender in surgery. As a woman of color and future female surgeon, I hope to serve as a [resource](https://www.aamc.org/download/465030/data/toolkitwfocindividualstrategies.pdf) and mentor for other women entering this field. As an inclusive community of female surgeons, I hope that we continue to have an honest discussion about closing both the gender and racial gaps in surgery. Recognizing these disparities is crucial to our mission of increasing diversity in surgery, in more ways than one. --- *[![](%5Bsiteurl%5D/wp-content/uploads/2017/02/IMG_7408-1-copy-217x300.jpg)](%5Bsiteurl%5D/wp-content/uploads/2017/02/IMG_7408-1-copy.jpg)Mohini Dasari is a fourth year medical student at the University of Pittsburgh School of Medicine. She is currently applying to general surgery residency programs, with career interests in global health, trauma and burns. She is the Mid-Atlantic Representative on the Association of Women Surgeons National Medical Student Committee. In her free time, she enjoys working out, writing, trying new restaurants, and spending time outside.* Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons. **Categories:** advocacy, career development, current events, education, gender differences, medical students, mentorship, networking, professionalism, training, women **Tags:** Black History Month, implicit bias, Race, Women in Surgery, women of color --- ## Pages ### [Home](https://blog.womensurgeons.org/) **Published:** June 23, 2025 **Author:** mcooke@amrms.com **Content:** ## AWS Blog Library The AWS Blog is a dynamic platform that amplifies the voices and experiences of women in surgery. Since its inception in 2013, the blog has evolved into a vibrant community space where surgeons, residents, and medical students share personal narratives, professional insights, and reflections on topics ranging from mentorship and leadership to wellness and diversity. With contributions from members worldwide, the blog fosters connection, inspiration, and advocacy, embodying AWS’s mission to empower women surgeons at every stage of their careers. Explore the latest stories here and find comfort in knowing that you are not alone and your voice will be heard at AWS. [ ![Dr. Kapoor headshot](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Screenshot-2025-07-09-132155-square-19cf46d28aa639c46ed2172f7b98b597-.png "Dr. Kapoor") ](https://blog.womensurgeons.org/doctors-need-to-give-better-talks-how-the-signature-speaker-series-can-help/) Jul 23 ## [ Doctors Need to Give Better Talks: How the Signature Speaker Series Can Help ](https://blog.womensurgeons.org/doctors-need-to-give-better-talks-how-the-signature-speaker-series-can-help/ "Doctors Need to Give Better Talks: How the Signature Speaker Series Can Help") by Nimmi S. Kapoor, MD, FACS Doctors give the worst talks. Now I understand why it is hard for me to stay awake, pay attention,… [Read More about Doctors Need to Give Better Talks: How the Signature Speaker Series Can Help](https://blog.womensurgeons.org/doctors-need-to-give-better-talks-how-the-signature-speaker-series-can-help/ "Doctors Need to Give Better Talks: How the Signature Speaker Series Can Help") [ ![Trisha Lal, MD headshot](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Screenshot-2025-07-29-140133-square-addbd222d58e48a26e42acbb7ccb1902-.png "Screenshot 2025-07-29 140133") ](https://blog.womensurgeons.org/permission-to-pause/) Jul 16 ## [ Permission to Pause ](https://blog.womensurgeons.org/permission-to-pause/ "Permission to Pause") by Dr. Trisha Lal Like many general surgery residents, I’ve opted to pursue two years of academic development during my training. After two clinical years,… [Read More about Permission to Pause](https://blog.womensurgeons.org/permission-to-pause/ "Permission to Pause") [ ![Headshot for Shreya Sankar](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Screenshot-2025-07-09-130536-square-8a14e3330770e1842d5ba6effd68a68f-.png "Screenshot 2025-07-09 130536") ](https://blog.womensurgeons.org/across-the-pond-the-language-of-healing/) Jul 09 ## [ Across the Pond: The Language of Healing ](https://blog.womensurgeons.org/across-the-pond-the-language-of-healing/ "Across the Pond: The Language of Healing") By Shreya Sankar I learned at a young age that medicine transcends the borders of culture and time. Growing up, our medicine cabinet teemed with… [Read More about Across the Pond: The Language of Healing](https://blog.womensurgeons.org/across-the-pond-the-language-of-healing/ "Across the Pond: The Language of Healing") [ ![Dr. Bellows headshot](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/bellows-square-c97c8eae9ca220208631ca8c00a60f63-.jpeg "bellows") ](https://blog.womensurgeons.org/applying-the-growth-mindset-in-surgery/) Jul 02 ## [ Applying the Growth Mindset in Surgery ](https://blog.womensurgeons.org/applying-the-growth-mindset-in-surgery/ "Applying the Growth Mindset in Surgery") By Fara Bellows In surgery, the only constant is change. With each passing milestone in our careers, we encounter new challenges, new demands, and new… [Read More about Applying the Growth Mindset in Surgery](https://blog.womensurgeons.org/applying-the-growth-mindset-in-surgery/ "Applying the Growth Mindset in Surgery") [ ![Avila](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Avila-square-a4a483246634389695d82f71bb45aedb-.png "Avila") ](https://blog.womensurgeons.org/what-transition-taught-me-about-gender-power-and-medicine/) Jun 29 ## [ What Transition Taught Me About Gender, Power, and Medicine ](https://blog.womensurgeons.org/what-transition-taught-me-about-gender-power-and-medicine/ "What Transition Taught Me About Gender, Power, and Medicine") By Jailyn Avila, MD, FP-AEMUS, RDMS One afternoon, when I was a young attending at a large academic center, I was paged to the trauma… [Read More about What Transition Taught Me About Gender, Power, and Medicine](https://blog.womensurgeons.org/what-transition-taught-me-about-gender-power-and-medicine/ "What Transition Taught Me About Gender, Power, and Medicine") [ ![Olivia Zhou headshot](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/olivia-zhou-square-1e86b074f4cd44513951c462f01bad11-.png "olivia zhou") ](https://blog.womensurgeons.org/preserving-hobbies/) Jun 25 ## [ Preserving Hobbies ](https://blog.womensurgeons.org/preserving-hobbies/ "Preserving Hobbies") by Olivia T. Zhou To me, the age-old adage of “you can’t pour from an empty cup” holds especially true today. Medicine is a deeply… [Read More about Preserving Hobbies](https://blog.womensurgeons.org/preserving-hobbies/ "Preserving Hobbies") [ ![Dr. Tannous headshot](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Screenshot-2025-06-23-115728-1-square-9c775999b08167bdaba164318ed55419-.png "Screenshot 2025-06-23 115728") ](https://blog.womensurgeons.org/beyond-the-banners-the-quiet-cost-of-pride/) Jun 23 ## [ Beyond the Banners: The Quiet Cost of Pride ](https://blog.womensurgeons.org/beyond-the-banners-the-quiet-cost-of-pride/ "Beyond the Banners: The Quiet Cost of Pride") by Anthony Tannous, MD, FACS This is a special edition blog post presented in partnership with the Association of Out Surgeons and Allies in celebration… [Read More about Beyond the Banners: The Quiet Cost of Pride](https://blog.womensurgeons.org/beyond-the-banners-the-quiet-cost-of-pride/ "Beyond the Banners: The Quiet Cost of Pride") [ ![Tala-Abedalqader](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Tala-Abedalqader-square-1160e04d24ae71fd1072b44a88b715f9-.png "Tala-Abedalqader") ](https://blog.womensurgeons.org/stitch-by-stitch/) Jun 18 ## [ Stitch by Stitch ](https://blog.womensurgeons.org/stitch-by-stitch/ "Stitch by Stitch") By Tala AbedalqaderI’ve always found a certain sense of purpose in using my hands. Whether it’s an embroidery thread sliding through fabric or suture material… [Read More about Stitch by Stitch](https://blog.womensurgeons.org/stitch-by-stitch/ "Stitch by Stitch") [ ![Screenshot-2025-06-16-162438](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Screenshot-2025-06-16-162438-square-8845ab871eb0f616069ab99d10bbf221-.png "Screenshot-2025-06-16-162438") ](https://blog.womensurgeons.org/to-come-out-again-or-not-a-surgeons-reflections-on-identity-in-the-workplace/) Jun 16 ## [ To Come Out (Again) or Not? A Surgeon’s Reflections on Identity in the Workplace ](https://blog.womensurgeons.org/to-come-out-again-or-not-a-surgeons-reflections-on-identity-in-the-workplace/ "To Come Out (Again) or Not? A Surgeon’s Reflections on Identity in the Workplace") This is a special edition blog post presented in partnership with the Association of Out Surgeons and Allies in celebration of Pride Month.By Dr. Kayleigh… [Read More about To Come Out (Again) or Not? A Surgeon’s Reflections on Identity in the Workplace](https://blog.womensurgeons.org/to-come-out-again-or-not-a-surgeons-reflections-on-identity-in-the-workplace/ "To Come Out (Again) or Not? A Surgeon’s Reflections on Identity in the Workplace") [ ![Ragupathi_Aparna_ERAS](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Ragupathi_Aparna_ERAS-square-58a8fa37f598ad2ab00999c77705b4eb-.jpg "Ragupathi_Aparna_ERAS") ](https://blog.womensurgeons.org/a-love-letter-to-pm-rounds/) Jun 12 ## [ A Love Letter to PM Rounds ](https://blog.womensurgeons.org/a-love-letter-to-pm-rounds/ "A Love Letter to PM Rounds") By Aparna Ragupathi\*All names have been changed for patient and staff privacy It’s 4:12 PM when I leave the PACU. One of the chaplains in… [Read More about A Love Letter to PM Rounds](https://blog.womensurgeons.org/a-love-letter-to-pm-rounds/ "A Love Letter to PM Rounds") [ ![Kangas-Dick](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/Kangas-Dick-square-56005378d2bbb3c1ed047345a76a21ad-.png "Kangas-Dick") ](https://blog.womensurgeons.org/visibility-and-possibility/) Jun 09 ## [ Visibility and Possibility ](https://blog.womensurgeons.org/visibility-and-possibility/ "Visibility and Possibility") This is a special edition blog post presented in partnership with the Association of Out Surgeons and Allies in celebration of Pride Month. By: Aeryn… [Read More about Visibility and Possibility](https://blog.womensurgeons.org/visibility-and-possibility/ "Visibility and Possibility") [ ![2025-01-10-Shannon-Small](https://blog.womensurgeons.org/wp-content/uploads/bb-plugin/cache/2025-01-10-Shannon-Small--scaled-square-09e7e558b32dbdd593a950d8945e6299-.jpg "2025-01-10-Shannon-Small") ](https://blog.womensurgeons.org/what-does-it-mean-to-be-an-advocate-reflections-from-the-acs-leadership-and-advocacy-summit-2025-2/) Jun 06 ## [ What Does it Mean to be an Advocate? Reflections from the ACS Leadership and Advocacy Summit 2025 ](https://blog.womensurgeons.org/what-does-it-mean-to-be-an-advocate-reflections-from-the-acs-leadership-and-advocacy-summit-2025-2/ "What Does it Mean to be an Advocate? Reflections from the ACS Leadership and Advocacy Summit 2025") By Shannon F.R. Small, MD, FACS The word “advocate” can mean a variety of things, especially within the medical field. Most commonly, patients are asked… [Read More about What Does it Mean to be an Advocate? Reflections from the ACS Leadership and Advocacy Summit 2025](https://blog.womensurgeons.org/what-does-it-mean-to-be-an-advocate-reflections-from-the-acs-leadership-and-advocacy-summit-2025-2/ "What Does it Mean to be an Advocate? Reflections from the ACS Leadership and Advocacy Summit 2025") - 1 - [2](https://blog.womensurgeons.org/page/2/?fl_builder) - [3](https://blog.womensurgeons.org/page/3/?fl_builder) - … - [57](https://blog.womensurgeons.org/page/57/?fl_builder) - [Next »](https://blog.womensurgeons.org/page/2/?fl_builder) ### Want To Write For The Blog? 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