It’s lonely at the top

Some of you may be aware that I’m about three years into a two year project** examining barriers to careers in academic surgery; in its current form, the project focuses on women in academic surgery.  In what isn’t likely to be a spoiler alert, while some gender-specific factors are identified, the preponderance of what we’re seeing is both systemic and cultural, therefore impacting the pipeline in general, not just for women.

The major gap in the information that we have to date involves hearing the stories of those who choose to leave academic surgery. I’m aware of this limitation and have plans to address it, which means that this Sunday Review from the New York Times struck a special chord with me. The glass ceiling is real in business and in academia, and while the need to fix it is widely acknowledged, we still don’t entirely understand its etiology. What we do know is that theoretically it should be less of a pipeline problem than it was 20 years ago. In spite of more women entering surgical training, a recent study shows that gender parity in academic surgery will not happen in my lifetime.

Advice on how to get ahead, while well-meaning, doesn’t serve to fix the deeply embedded cultural issues. Preaching to already high-achieving women about how to fix themselves is likely too little, too late, and engages to a degree in the “victim blaming” I’ve been known to rail against when discussing burnout.

Interestingly, there’s a tie between the loneliness described by the high-achieving women in the Sunday Review and burnout. While the basis for loneliness is complex and is only in part attributable to a sense of “other-ness” in those who aren’t historically represented in leadership roles, it quickly becomes obvious that it plays a substantial role in burnout…burnout can result in exit…exit results in loss of (diverse) talent…you can see the downstream effects here.

I’m offering myself some thought challenges that I want to extend to each of you (yes, you, as you say, “I’m not a leader!”).

  • What if today you tried today to bring more compassion to your team through a kind word or supportive act? Hint: “Thank you” counts as a kind word. If you can be specific in that thanks, it’s doubly valuable.
  • What if today you worked to get someone connected into a network of some sort? Confession: being a “connector” is one of my FAVORITE things to do!
  • What if today you helped someone celebrate a “win,” no matter how small that win feels- or if you celebrated your own? If you’re on Twitter, please share your own with #WednesdayWins.  We need for this to become a “thing” to remind ourselves of what’s going well.

 

**Not actually joking about the time line.  Anyone who has experienced the joy and misery of qualitative research and grounded theory understands exactly what’s going on here. 

Taking care of you, because no one else will

The concept of “self-care” is definitely a cornerstone of wellness discussions. It also appears to have become something of a generational battleground. Staying at work for a week and eating poorly and not seeing the light of day is no longer considered the badge of honor it might have been. Nevertheless, we all have these pesky adult and professional commitments that preclude us from focusing on ourselves all day, every day.  Surely there’s a happy medium in there somewhere?

A lesson I learned about 10 years ago is that I need to have a list of the things away from work that bring me joy, and that it also helps me to recognize how often I need for them to be part of my life.  Examples?

  • Walks with Olivia– daily, at a minimum. This is important head clearing time for me.
  • Running– the benefits for me are myriad.  It keeps my head on straight, it gives me time to think, and I just feel better for completing a good run.
  • Yoga– I know that going to a weekly group practice is best, and it makes a difference when I keep this in my schedule
  • Live music– A couple of times a month.  The rules match my OR music rules: No rap, no metal, no Britney Spears.  I love Americana and “alt-country” (again, as many of you know) and also have a great fondness for outings to the symphony and the opera.
  • Reading, particularly literary fiction- I still remember getting halfway through my intern year and realizing that I hadn’t read a novel all year (and that I really missed it). The moment our in-training exam was done in January, I dug back into good novels and haven’t stopped since.

I put my own list out there not with the goal of making it your list, although I’m always happy to share ideas in any of these areas. I put it out there so that you can see that none of these are majorly time-consuming unless I choose to make them a Big Deal in my schedule.  In fact, it’s pretty easy with some practice to prioritize all of them in a way that I get to push the reset button for an hour or two AND still manage my grown-up responsibilities. And even though I fight it sometimes, I know that these things really do contribute to helping me be my most effective self.

So, what about making sure we’re our most effective on a day-to-day basis, even in the midst of a chaotic day?  I loved this piece in last month’s HBR, probably because all of the ideas they raise are things that I’ve espoused or embraced in one place or another.

  • Cut yourself a break: I’ve previously summarized this blog post from Karen Walrond as “Try your best, cut yourself some slack at the end of the day, rinse, repeat.” Why is it so much easier to be kind to those around us than we are to ourselves?
  • Value time, money, and resources: No is a complete sentence if something doesn’t align with what you want or need to get done.  Truly.  Practice it often.
  • Take a victory lap:  How often do we celebrate our “wins”, either individually or collectively?  This week I started something new to me on Twitter with #Wednesdaywins. If you’re on Twitter, I hope you’ll join in there.  If you’re not, I hope you’ll develop your own practice.
  • Surround yourself with good people:  Maybe it’s a product of being in my 40s, but I simply no longer choose to have time for people who drain my energy (see “value time, money, resources” above). I definitely view friendships as a mutually supportive enterprise, and have chosen to surround myself with spectacular people whom I LOVE having as part of my life.  Some of you have heard me say, “Find your tribe. Love them hard.” It’s key when things get challenging.
  • Update your workspace: Okay, I really don’t have much to add here.  I am better than I used to be controlling my desk piles.  Mostly.
  • Recharge and reboot: Those walks with Olivia?  That’s part of it when I get out of the hospital.  At work, sometimes I’ll just go for a walk between the Burn Unit and my “real” office. I’ll pause and fix myself a cup of tea. I’ll walk through our therapy gym so I have an excuse to stop and visit with one of our rehabbing patients. Or I’ll sit down and simply chat with someone I find interesting; this person can be a co-worker, a patient, or a family member. Sometimes just getting your head out of what it’s stuck in can make a HUGE difference. If you want to be Zen about it, it helps you detach from whatever is troubling you.

So, what can you do this weekend to be more effective for next week? It doesn’t have to be onerous, and ideally it will be fun.  Most importantly, I hope it brings you some joy.

 

 

 

You can have it all, just not at the same time

“The price of anything is the amount of life you exchange for it.” -Thoreau

Common refrain from faculty (that may be a symptom of Impostor Syndrome):  “I just can’t do everything.”

My response: “Yes, you’re correct.  You can’t. None of us can.”

We have essentially two key limitations in the battle to do everything, as I see it.  First, our day has 24 hours in it.  We can fight that one all we want and pretend it’s not true, but that’s the day we’ve got.  Then there’s the second limitation of energy.  We’re not set up like the Energizer Bunny to simply go…go…go…quick battery change…go…go…go.  I’m sure almost all of us can think of the last time we tried that (all nighters in college, anyone?) and the net effect is never what we hope it will be.

As mentioned in the July Reading Round-Up, I’m working my way through Eric Barker’s Barking up the wrong tree right now.  Chapter 3 has a great section talking about someone brilliant who has a chronic illness that can be incapacitating. This individual adopted a strategy for many years of accomplishing one thing a day, even on the bad days.  Sometimes that meant that he was only able to cook dinner if that was the day’s goal; the key was to choose that one thing and do it.

Here’s what he had to learn that we all try to superhero our way out of at some point in our career: every single choice that we make to do something means we are choosing to not do something else.  When we spend hours on Facebook, we’re choosing (perhaps only subconsciously) to not work on that research project that needs our attention. When we spend time working on that research project, it comes at the time expense of watching Game of Thrones. When we spend time with our family, it comes at the expense of finishing the day’s charts.  If you have a background in economics, you’ll recognize this immediately as every choice we make in life having an opportunity cost.

If you have a young family or an aging parent, focusing on them may be your first choice for a few years and it may require you to choose to let something slide from a scholarly or administrative perspective. If you’re building a career as a researcher, you already know that forces choices about what you can and should do from a clinical perspective. If you’re trying to stay mentally and physically healthy, you might choose to save that manuscript where it is right now and leave for yoga or go out for a run (note: I often find that by doing this I end up being more productive, perhaps because it gets my brain into a different space).

Again, every time we choose to do something, we are choosing to not do something else.  That alone means that we can’t do everything.

Here’s a thought experiment for you, cribbed directly from Chapter 3.  What would you do if you were ill and could complete only one task per day?

There’s your answer to what matters most to you, and what should be done first.

And when you thought, “It would NOT be clean my house!”, that’s probably a hint to you too.

Here’s to a week of making wise choices, one at a time, that allow us to do those things that matter most.  What is your big goal this week?

(Title credit to Leigh Neumayer, content idea credit to Jamie Lewis)

 

 

July 2017 Reading (and listening) Round-up

It’s that time! Here’s the July, 2017 edition of what I’m reading, supplemented with some of what I’m listening to. Here’s a hint: It’s summertime, and I’m not going to give you any academic reading right now.  So there.

Fiction:

June’s book group novel was La Rose by Louise Erdrich.  The writing is lyrical, the story a bit magical…so much goodness, and it resulted in a juicy discussion.

I’m just settling into July’s selection: Case Histories by Kate Atwood.  I’ll report back, but the first 50 pages have been fascinating.

Nonfiction:

Barking up the Wrong Tree by Eric Barker– I’ve recommended his Sunday blog/ email more than once.  The book is a terrific complement to his usual investigation style that helps enhance personal success.

Other:

From HBR, ways to weave self-care into your workday.  I love that they also support the idea of not “shoulding” all over yourself.  It’s an unhealthy practice.

From the New Yorker, “America’s Future is Texas.” It’s a great explanation of how my home state really is a bellwether for current American politics.

Listening:

Sam Sanders (from NPR) is also an expat Texan and recently started his podcast, “It’s been a minute.” Tuesdays are a “deep dive” with another public figure, and Fridays are a catch-up for the week.  Highly recommended- I’m listening to his interview with Timothy Simons as I type.

For my foodie friends, I recently stumbled across “The Food Chain” from BBC.  Each week they focus on a food or food culture related topic in a very approachable manner.

Last but not least, a plug for NPR’s “Up First.” It comes out daily Monday-Friday and gives you 15 minutes of news highlights for the day.

Happy Dog Days of summer, folks!

 

Did it actually kill the cat?

“I have no special talents. I am only passionately curious.”

-Albert Einstein

Although my wheelhouse at this point in my life is obviously medical education, I follow several Facebook pages that are more generally about education. Two of my favorites are Edutopia and MindShift; both routinely post information and ideas that are easily extended to the world of med ed and surgical education.  This morning MindShift linked to a piece that’s a couple of years old, and that I honestly didn’t see the first time by; fortunately, my own curiosity was piqued to go read about what’s going on inside the brain of a curious child. And, of course, I got unduly excited about the idea of using curiosity as a guidepost for learning activities. When I complete resident and student evaluations, one of the highest compliments that I give is when I describe someone as curious.

Let’s start from the perspective of the life-long learner.  Why do we keep learning things or asking questions? I would argue that it’s because we are innately curious.  Several of us on Twitter today were using #alwayslearning to describe what “residency” year we’re starting today (PGY-20 for me, if you’re wondering); to a person, the folks I saw participating in this are people I know to be inherently curious people who are not intimidated by the idea of not knowing everything all of the time.  They’re people whom I consistently see asking thoughtful questions and providing helpful answers on social media, and they are physicians who engage across specialties and interests.

This, in particular, is an area in which I see a positive use of social media.  If we’re in a state of curiosity, we get a nice hit of dopamine when we’re learning, and we are more effective learners. In spite of studies out there showing us that Facebook and Instagram make us feel worse because we start comparing, we could extrapolate that curiosity-driven social media interactions are beneficial and make us feel good. Yes, I just helped you rationalize that half hour you spent on Twitter earlier (and did the same for myself).

Curiosity helps us learn stuff that we’re interested in, which is great. The fact that it can help with learning those things that we don’t find so interesting…that’s where I see the real grab here. What if we were to ask our learners, “What are you curious about today?” as a starting point for their learning? Not only could we use that to facilitate their skills as a life-long learner, we could also use it as a way to transition to information they may be less curious about but that we know is no less important for them to understand. It makes learning collaborative, it fosters adult learning, and it often generates excitement that makes the learning process far more fun for both learner and teacher.

What are you curious about today?

 

Perfect Circle

Wednesday was a bittersweet day for me.

I’ve previously mentioned Danny Custer, whose last day operating at Baylor Scott & White was Wednesday of this week.  Danny had a remarkable career as a pediatric surgeon.  He was also our clerkship director when I was a medical student, and proved to be a huge influence on me. Even though I had no intention of becoming a surgeon when I started medical school, between he and Sam Snyder (and some really spectacular residents, including the husband of a college roommate) I was a “clerkship convert” to this crazy life.  Anyone who has been in my OR when I’m directing how long I want suture to be cut has heard the words “bunny ears” more than once.  I inherited that phrase from Danny. Danny was amazing with families, adored the children, taught with the patience of a saint, and made every day of “work” an incredible amount of fun.  His passion for his calling was contagious and I always, always mention him as part of my own story in medicine and in surgery.

Wednesday morning I got a text from one of my former student mentees who is now a resident at Texas A&M/ Scott & White. Kyle went to Temple knowing that Danny was one of my mentors, and I appreciate that he texted me the first day he operated with Danny as an intern.  Wednesday’s text was to let me know that it was Danny’s last day and that he would be operating with him for his last case.

My first reflection was one of gratitude that I have mentees out there who stay in touch.  Those moments are why those of us who teach pour our hearts and souls into what we do.

My second reflection was also one of gratitude that Kyle was operating with Danny on Danny’s last day as a surgeon. There was something incredibly special in knowing that someone I have influenced for good was helping to close out the career of someone who had such a positive influence on me.

Bittersweet.  And an absolutely perfect circle.

 

Coming clean…

Obvious confession:

The blog has been a bit of a ghost town for the last few months.  You’re aware, I’m aware. Twitter hasn’t been an echo chamber, but I’ve not been as present there either.

Not-so-obvious confession to most:

Professional life has been messy and hard, and I’ve struggled with how to process that. Heart and Brain provide a near-perfect summary of what it’s been like (though I’m not sure the brown stuff would have been quicksand had I drawn them).

Personal life has been fine, great even. I have professional friends whom I’ve entrusted with what has been going on and who have been amazing advocates and supporters. I have other professional friends who haven’t been in the loop on things but who have consistently reached out with a kind word when I’ve needed it most (serendipity, FTW!). I have running  friends who have stuck with me when I’ve stopped for an ugly cry in the middle of a 10K. I have friends who have been around seemingly forever who are simply there and constant and kind. While you might not think that in your late 40s your sorority sisters would provide a life raft for you, they have done precisely that. As I told one of them a few weeks ago, “ADPi has saved my sanity the last 18 months.” Mom is great and healthy.  Dad is navigating the indignities of Parkinson’s with grace. Other than Belle!’s anxiety (maybe she’s channeling for me?), the animal support team is awesome. If you look at the ledger strictly from this side, I’m incredibly fortunate, and I won’t deny that. I am grateful for all of these things every day.

Then there’s the professional side.  Lots of things on the “good” side of the ledger there too. I work with the best team that anyone could ask for.  I take care of the most remarkable and resilient people that I could ask to be entrusted to care for. It’s a rare day for me to walk through clinic or the burn unit without getting a hug from a patient, family member, or both. Outside of my clinical work, I’ve been entrusted with leadership roles that I consider both a privilege and an honor. Again, these are the things that keep me going and for which I am grateful.

And yet…there’s this body of literature (which I am in the process of contributing to) that describes why women leave academic surgery and academic medicine. That literature has become intensely personal over the last 6-9 months for me. I’ve found incredible irony that the system that I’m trying to help fix, to make more equitable, has nearly chewed me up and spit me out. While I always found it tragic that many talented women were exiting academic surgery, even 10 years or more into what should have been remarkable careers, I now “get” how this happens. I would be a liar if I didn’t say I’ve thought about walking off. I don’t do disappointment and disillusionment well.

So what?

I’m still working on the answer to this question. What I do know is that I’ve moved past taking it all personally and simply being hurt. If anything, I’m realizing how important some of the intellectual work that I started out to do a few years ago truly is and that it’s time for me to double down on those efforts. I’m focusing more on my core mission(s) and doing the things that are the most meaningful to me. And I’m reminding myself at the close of every single day of those things I am grateful for; there are plenty of them, and they help maintain that sense of purpose that I need.

If you’ll excuse me now, I’m off to tilt at some windmills.  Thanks for joining me.

May 2017 Reading Round-Up

Brand new month!

So what’s out there that is catching my eye?

We all spend quite a bit of time thinking about how to improve teaching of technical skills.  What about using video-based coaching to supplement OR teaching?

What does the public know (and want to know) about overlapping surgery?

The 2016 State of the Science articles for burn care are out. These cover everything from burn resuscitation to community reintegration, and are all important comments on where we are in burn care (and how far we have to go).

And bringing out my inner policy geek, here’s a great overview from Politico on what the impact is for the GOP if/ when Obamacare repeal fails.

Catching my ear is the “Up First” podcast from NPR. I seldom have time to listen closely to the news throughout the day, so this is a great summary of what’s happening.

Happy reading (and listening).

 

 

What if it’s not our fault?

“If we are to achieve a richer culture, rich in contrasting values, we must recognize the whole gamut of human potentialities, and so weave a less arbitrary social fabric, one in which each diverse human gift will find a fitting place.” – Margaret Mead

In the last week I have found myself in the midst of two interesting Twitter conversations, both with a similar underlying theme regarding the impact of culture and how we seem to underestimate its impact on the individual.

Here’s conversation #1 (remember to start reading at the bottom):

I particularly loved the empathy behind the idea that the term burnout implies that it’s a personal choice. While we’re getting smarter about identifying organizational factors that drive burnout (ahem…my group’s call schedule), there still seems to be this idea that if you’re struggling with burnout, you’re simply not resilient enough. Reality check: I’ve witnessed some people who are remarkably resilient struggle with burnout, and without exception they have been in a work environment in which they had little to no control. Yes, I understand that individual characteristics may predispose people to burnout or may limit the impact of a dysfunctional system upon the individual…but at the end of the day, victim blaming and pretending it’s ALL about resilience?  That’s simply feeding the dragon.  It’s not helpful.

On to Twitter conversation #2:

(The link that you can’t see from here is this recent piece in the Atlantic.)

So, maybe it’s not about biological clocks or because we’re not ambitious enough.  Maybe, just maybe that ambition is situational…and that if we’re in an environment where we see other women hitting their heads repeatedly against the glass ceiling,  or we experience that ourselves, we adjust our expectations accordingly. Or we leave when we realize that we shouldn’t have to adjust those expectations because there isn’t anything wrong with them.

It’s time to stop telling us to try harder, or telling us that we can’t be mothers and academic surgeons, or telling us that we don’t measure up because we don’t know the 100 extra double-secret and unwritten criteria that you’re using to evaluate us. Most importantly, it’s time to create a culture in which we feel valued and supported, not because you tell us that we should, but because we actually are.

What if it’s really not our fault?

Why teach?

This past week was Surgery Education Week, the annual joint meeting of the Association of Program Directors in Surgery and the Association for Surgical Education. It’s a meeting that I first attended in 2001 and I haven’t missed a year since. I say that not as a point of boast, but to highlight my enthusiasm for this meeting; a week with people who share a passion for all things surgical education is professionally reinvigorating.  This year it definitely happened at the right time for me to get my bearings back.

My friend Chris Brandt was our ASE president this year, and he delivered a personal and heartfelt Presidential address on Thursday. Within the context of his speech, he asked an important reflective question for me as an educator, and one that I suspect will resonate with many of you:

“Why teach?”

Some of us fall into teaching semi-naturally; for me, it started with Vacation Bible School and helping in preschool Sunday School while I was still in high school, then teaching preschool part-time for part of College.  I  taught while I was in graduate school (if you haven’t read Dr. Seuss’ Butter Battle Book, you obviously weren’t in one of my international relations sections), and the one thing I knew in medical school before I was certain that I wanted to be a surgeon was that I wanted to teach.

But why?

For me, it’s the idea of paying it forward.  I’m certainly not going to wax philosophical about how every single teacher I’ve had has been amazing- that would be a flagrant lie. That said, I can tell you about my teachers who really made a positive difference for me. Steve Hoemann (English, 7th Grade). Carole Buchanan (World History, 10th Grade). Louise Bianchi (Piano teacher, 9th-11th Grade). Claudine Hunting (French professor, Undergrad). Mike Ward (Advisor/ International Relations, Graduate school). Jim Knight (Leadership in Medicine, Medical School). Danny Custer (Pediatric Surgeon, Medical school- I “blame” him for my career in surgery!). There’s one common thing that each of them did and that I value immensely: they made me better in some way. I know that I would not be who I am doing what I do in the way that I do it without this group of people, only two of whom actually knew each other. I also know that I am fortunate that they believed in me enough to challenge me, enough to push me out of my comfort zone, because they saw potential.

Why teach?

Because now it’s my turn to find that potential in learners, to nudge them out of their comfort zone, to help them be better.

Besides, the emails and notes that you get for this are pretty awesome. I can’t read any of them without smiling and thinking, “THIS.  This is why we put in the extra effort, the extra thought, the extra time.”

So, what’s your story? Why teach?