October 2017 Reading Round-up

I ran away to Montana for a few days and suddenly it’s October.  I don’t know why these things often surprise me, yet sometimes they do- particularly the months that change on the weekend.

So, what do I think is interesting at the moment?

In the world of burns, this article is one of what I hope will be many looking prospectively at blood product transfusion in our patients. Thanks to my friend Tina Palmieri for her fearless leadership of this important multi center trial.

I’m excited to share this systematic review by my Utah colleagues examining endovascular vs. open repair of AAA. Hint: lower mortality, higher complication rate.

The October issue of the American Journal of Surgery is the annual Association of Women Surgeons issue.  Regardless of gender or specialty, there’s pretty much something for everyone in there.

I hope this piece in Academic Medicine can help some of my pre-tenure friends and colleagues normalize their experience a bit.  It’s not easy.  It is worth it.

In place of a bonus reading recommendation this month, you get a bonus viewing recommendation. I am completely smitten with Simon Sinek‘s work right now and am obsessed with finding ways to incorporate it into academic medicine. Don’t know who he is?  Here’s his TEDTalk on “How great leaders inspire action.”  18 minutes well-spent, I promise.

Happy Fall, y’all!

 

Step outside your comfort zone. Do scary stuff.

I had good intention of getting this post up early in the week.  And, like many good intentions, it’s now Friday…but I’m still within a week of doing something a little scary (for me) so it’s still sort-of news.

In July and August I took part in a fitness challenge that encouraged us to try activities that were new or different from our “usual.” I’ll confess that new things I have now tried include mixed martial arts workouts (hard and fun!) and ballroom dance workouts (harder than you expect! and good grief I’m not a dancer!). Most importantly, this challenge got me into the pool a few times and reminded me that I’m actually a reasonably competent swimmer.  And, interestingly, when I’m not swimming because it’s all I can do with an injury, I kind of like it.

Since I have a history with both cycling and running, some of you might see where this swimming revelation is leading. I haven’t totally pushed myself outside of my comfort zone since my first half marathon (December, 2014, for those who are keeping score), and I’ve been trying to figure out what I could take on that would challenge me.  Semi-logical answer?  Triathlon!

So, with only about four weeks to get swim training under my belt I signed up for the Brineman, sprint distance.  I put a few bricks- riding followed by some running- into my workout schedule. I stayed up late deciding if I needed a wetsuit for the race or not (decision was yes, and with the 45 degree temps that morning I was grateful!).  I ordered the cutest (and most functional) tri kit ever to wear and tested it out during my brick workouts. I practiced open water swimming in the Willamette River when I visited Portland over Labor Day weekend because that was the truly intimidating part of this whole crazy idea for me.

And last Saturday, I got up really early so I could swim, bike, and run. I was incredibly fortunate to have three friends who signed up to do the Sprint as a relay so I had an awesome cheering section.  And… another of our friends who has been on “injured reserve” from running magically appeared at the swim start and helped to sherpa gear, take great pictures, and cheer for all of us.  I know some of y’all have heard me say, “Find you tribe, love them hard” before, and Saturday morning they were there full-force.

Here’s the before.  And yes, I’m thinking, “I don’t have to do this…it’s not too late to chicken out!” when I’m standing there contemplating it all.

The tribe. I may be a little jealous of the two who have dry land legs for their relay. Also jealous that J has done a full Ironman so this swim is just a little thing for him.

 

 

Once I was out of the water (I just don’t want to discuss it other than my celebratory phrase being,
“I didn’t drown!”; in truth my performance in the water was Very Respectable), it was on to the bike.  Confession: this is my favorite leg.  Shh…don’t tell the people who think of me as a runner. Also, I love the dryland segments because of all of the cheering one another that goes on between athletes.  If you’ve run or ridden with me, you KNOW how I am about encouraging people!

Game face coming out of the Transition.

Then, the run.  The part that I know I can do and can do without trouble (3 miles is NO problem!). And I can’t tell you how much I loved the folks who commented, “Looking strong!”  That’s such a powerful reminder that yes, I’m strong, and I’m rocking this.

Coming out of Transition 2. Legs feeling a little weird. But I’m running and that’s my joyous place.

And…scene. I’m a triathlete!

If you’re wondering, yep, I’ll do this again, and with more than a month to train for swimming I’ll even look at a longer distance. I mostly loved it. I learned a lot about myself and my ability to be brave.  And I was totally outside my comfort zone (swimming, people, swimming) and did a Really Good Job with my first triathlon.

What’s my hope in sharing this story with you? Don’t be stagnant! What’s something that you can do that will challenge you, maybe even make you uncomfortable? Set a goal.  Go for it. That’s how we change ourselves.

Coeur Sports logo, which is pretty much my life mantra.

Heart and courage, as the logo on my tri kit says.  Heart and courage.

 

September Reading Round-Up

Yes, we’re almost a week into the month. In a somewhat unusual turn of events, I actually took the holiday weekend OFF.  I thoroughly enjoyed it.

So, what’s caught my eye recently? A few things.

  • Which surgery residents are most at risk for attrition? We have some ideas based upon this outstanding paper. Now we need to figure out WHY this happens.
  • We tend to be generous with pharmacologic therapies in the ICU setting, generally for good reason.  Nevertheless, medication errors are one of the most common safety report issues in hospitals. This Clinical Practice Guideline from SCCM reminds us that we do need to be good stewards and identifies the opportunities for doing so.
  • Are you struggling with giving your learners feedback?  It’s not a surprise with the dearth of high-quality, evidence based recommendations.
  • For those who aren’t aware that Montana has lost over 1 million acres to fires in the last two months, here’s a relevant online piece from the New Yorker. Between Harvey hitting my cultural homeland last week and watching a state I’ve grown to love burn, I’ve got a lot of sadness about events largely beyond anyone’s control right now.  Irma is the proverbial frosting on the cake.

Fun reading? I may have too many books going right now.  I pulled out some Brian Doyle (The Plover) for my trip to Portland last weekend because it only seemed appropriate. If you’re not familiar with his work, this essay gives you a lovely taste of it. I’m reading (and learning from!) Michael Bungay Stanier’s The Coaching Habit.  September book group is our annual foray into nonfiction, this month with Ta-Nahisi Coates Between the World and Me.

Happy almost-Fall, y’all.  Stay safe!

The rest of the story

Some of y’all have been helping me to celebrate a not-so-little piece of work that was published last week, and I truly appreciate the enthusiasm for the manuscript and what it means for our understanding of mentoring in academic surgery. When I posted that this work was a labor of love for me I meant it; I started looking into questions around mentoring in surgery when I was a resident through my ASE SERF project.  At that time, what I really wanted to do was a qualitative project that would help us better understand what mentoring should look like. Alas, 16 year ago I had neither the resources, the time, the know-how, or the patience to do this.  I’m still proud of the work we generated that year but it wasn’t what I really wanted as my major contribution in this area.

So, fast forward to 2014 (yeah, I know, that’s a long fast forward). I started on one of my curiosity/ passion projects, intending to expand upon work we’ve done describing barriers to careers in academic surgery. Again, the first pass was survey based and more quantitative, and just like the original mentors work I worried that something was getting lost in translation.  I believe in the power of story, I had learned quite a bit about grounded theory method through our professionalism work, and I had a couple of VERY willing accomplices who are also patient when projects take a while.  In this case, “a while” means 3 1/2 years from Interview #1 to online publication of the first manuscript from the project.

The interviews that I started in January, 2014, and that extended over the course of the next 16 months were intended to illuminate the barriers to careers in academic surgery.  I believe they’ve done that, and the barriers manuscript associated with it is in the works.  However, I realized about 6 interviews in that I was going to have the stories to write the mentoring paper that I wanted to write in 2001-2002; mentoring was raised as a critical factor in every single interview about career barriers, and this happened without any nudge from the interviewer. Of course, once the interviews were done my collaborators and I spent a few months working out our conceptual model, and once that was done there was manuscript submission, revisions, more revisions followed by rejection, selection of a new journal, resubmission, revisions, then acceptance.

Submitting this manuscript was arguably one of the hardest things I have done; in truth it was harder emotionally than submitting my professional paper in graduate school was, primarily because of the level of personal investment I have in this topic. Mentorship is something I am passionate about, it’s something I think is incredibly important (thanks to the interviewees who confirmed my bias!), and I love the work that Leigh and Will and I generated about it.  When you send a manuscript like this one out you want everyone to love it as much as you do, even though you know that’s probably not what will actually happen. That rejection HURT, particularly because of how long it took to get there after trying really hard. Perhaps it reminded me a bit too much of my last bad boyfriend.

Anyway, back to the relevant story. As part of the mentoring process I wanted to share with people (particularly junior faculty!) the time line behind all of this.  I know that the tenure clock doesn’t encourage projects of this nature, and I recognize that’s one of the shortcomings of our academic system as it currently exists.  My take home message would be if there is something that you MUST figure out, if there are questions that you MUST ask, don’t let go of them. It might take you 15-ish years, a fair amount of heartburn, incredibly patient friends/ collaborators, and some late nights puzzling over getting something that seems really minor “just right.”

It will be worth it.

 

Enough. Or perhaps too much.

It’s been a weekend that has highlighted some of the baser instincts present in our society, hasn’t it? While so many of us want to believe that we as a country are better than this and are achieving our ideals, events like Charlottesville provide an incredibly harsh reminder that we aren’t even close yet.

It’s easy to look and think, “I’m not in Charlottesville, and I’m not in Virginia. This isn’t about me or my neighborhood and there’s nothing I can do.”

I’m going to challenge you and tell you that this is about your city, your state, your community and that there is PLENTY that you can do. Reading the news, seeing the remarkable photos from Charlottesville, I’m using this as an opportunity to double down on my commitment to peace with justice and inclusion, and trying to not just provide lip service.  We have GOT to move from words to deeds, friends. Or, as you’ve heard me say more than once in this space, we must #lovelouder.

While you need to do what works best for you, here’s what I’m doing.

  • I sent yet another contribution yesterday to the Southern Poverty Law Center. The SPLC was founded in 1971 and is doing some of the most important work today on civil rights FOR ALL. I hope that you will familiarize yourself with their work and that you will consider providing them with financial support. What they are doing makes a real difference and is so critical in a time when hate crimes and racism are so prominent.
  • I’m speaking up. Yes, I know, y’all are used to me saying something when people are unkind and unfair. I’m going to be even more tuned in to comments that show bias…and I’ll be letting people know that’s not acceptable.
  • I’m educating myself and my community. Earlier this year I did a pretty good job sharing #TuesdayTeachings on Twitter, which were items that provided more understanding of the underpinnings of various forms of discrimination. I’m recommitting myself to learning more and to sharing what I learn with you- and I’m trying my VERY best to get that information from members of the communities experiencing discrimination.
  • I’m looking at my circle of friends for diversity and inclusion.  I like to believe that my circle of friends is pretty diverse- immigrants, POC, LGBT are all well represented. But I’m looking again to see how I can expand my circle, and I’m seeking guidance from those friends on how to be more inclusive both personally and professionally.
  • I’m listening. While I may not agree with or understand everything that people put in front of me, I will do my best to respectfully hear them and learn from their experiences. Sometimes that is really, really challenging!
  • I’m promoting minority friends and colleagues. It’s unfortunately easy for us to put names forward for awards/ panels/ leadership roles of people who look like ourselves; I refer to this as nominating the “usual suspects.”  While I’ve long sought to make sure to include the not-usual suspects, again, I’m doubling down here. As an additional comment, I am carefully looking at the program we are developing for Surgery Education Week next Spring to ensure that our speakers, moderators, and panelists are diverse. I want everyone to believe #Ilooklikeasurgicaleducator
  • I’m walking the walk. If you have seen me in action, you know that all of the above are more than words on a screen.  One of the most important ways that we can influence those around us is role modeling the behaviors we want to see in the world. I won’t say I get it just right every single day because, as I have said before, I don’t know what it’s like to be a member of many of the targeted communities. But I can make a good faith effort, I can ask for feedback from people I trust, and I can apologize when I mess up (and not make the same mistake twice). For those of us trying to be strong allies, these are important concepts.

I’m going to challenge each of you who are part of my reader community to choose something- no matter how small you think it is- and make that your focus to #lovelouder this week.  If you want to share in the comments or in social media your intention to make you more accountable, that’s great.  If you want to write it down on a post-it and put it on your computer, that’s also great.

Words and deeds that diminish any of us ultimately diminish all of us. Remember that, and please act accordingly.

August 2017 Reading Round-Up

It was the 4th before I realized it was time for a new reading round up.  How did August happen?!?  And, of course, we’re back to business this month after last month’s not-so-light reading.

The “opidemic” is an issue getting plenty of press right now. And, of course, while patients deserve proper pain relief after we do things that hurt them (surgery, for example), we have an obligation to be responsible in our approach. Here’s more data about how often prescription opioids go unused after surgery. I’m proud of our group’s practice of carefully monitoring our prescribing practices, educating on safe storage, and providing lockboxes to patients.

There’s no question that Oregon Health Sciences is ahead of the curve in their development and implementation of the concept of the Academic RVU.  Here’s their story on how this happened and what it means for faculty.

Intraoperative teaching is not easy, and we know less about it than we should.  This systematic review synthesizes what we do know- particularly that there is often a disconnect between faculty and learner perceptions.

And a recent nonfiction read that definitely provides some good food for thought: A Selfish Plan to Change the World by Justin Dillon. Any book that instructs readers to “find their riot”?  That’s good enough for me.

 

But I don’t WANT to!

Now that I’ve channeled my own inner toddler, I’m willing to bet I just channeled a few of your inner toddlers as well.

What is it I don’t want to do?

Networking.

Admit it, you might have cringed a little when you read that word. It’s something that’s foisted upon us as a necessary evil in career development. And it’s something that makes many of us feel…well, icky, for lack of a more professional word.

Certainly there are a group of people for whom networking comes naturally; the are able to dive in and meet people and find ways to connect to them. For the rest of us, networking is a more deliberate process, and one in which to keep our integrity we also need a way to remain authentic. If you want a quick fix, here’s an HBR article on learning to love networking that has four key steps.  I want to focus primarily on the idea of finding a common interest (which I also associate with help-seeking), one of them that’s quite easily controllable and that creates a specific type of culture.

Think for a moment about someone you know who is an amazing connector (I’m going to use that word to remove any negative connotations). That person who seems to know everyone, and whom everyone seems to know, and that familiarity is consistently in a positive sense. Chances are that person will in some way align with Adam Grant’s definition of a “giver,” which may be a secret to getting ahead, and certainly fosters a specific type of positive culture.

Where am I taking this?  I’m trying to move us from the idea of networking being transactional, because that seems to be when we get that dirty feeling about it. What if we thought about networking in a purely relational sense? What if we sought things that we have in common, and we asked questions and actually listened to the answers?  To quote from Eric Barker‘s recent book, what if we shared our Twinkies by finding small ways to help one another?

When we use a relational framework, networking seems strangely akin to friend making- it’s all about liking and being interested. Or, as Glennon Doyle Melton wisely phrased this a couple of years ago, “I really, really think the secret to being loved is to love. And the secret to being interesting is to be interested. And the secret to having a friend is being a friend.”

One more tangentially related thought: if you have friends you haven’t connected with recently, take this as a reminder that it’s time. I’ve not once regretted the coffee date, the run, the weekend when I’ve made time for it.

 

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)