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?

A slightly belated April reading round-up

I’ll start with an apology: I’ve not been on my A-game with keeping up with the blog lately. Lots of life distractions, many of which I’m hopeful will start to settle down soon.  It’s not been easy.

So, it is April, and a number of things out there have caught my eye.

The March print edition of JAMASurgery included this systematic review and metaanalysis of causes of attrition in general surgery residency. While I’m reasonably certain we can’t get the rate to zero because there are factors we cannot control, we must do what we can.

While we are all becoming painfully aware that too many narcotics are being prescribed for our patients, we tend to not have a good understanding of what constitutes too many or too much.  This study provides an important baseline for us as surgeons. I will also note that Annals of Surgery will have an ongoing series examining the opiod crisis from a surgical perspective.

We’re definitely talking more about delirium mitigation in our adult ICU patient population.  What about the children?  Apparently it’s a problem for them too (particularly with “inflammatory disorders,” which would definitely be my patient population!).

Going a bit outside of the medical journals, what’s next in hospital innovations to keep patients safe? I was thrilled to see my friend Amir Ghaferi‘s name as first author on this piece.

Pleasure reading?  Our book group is spending the next two months with one of my all-time favorites: The Amazing Adventures of Kavalier and Clay by Michael Chabon.  I am looking forward to re-experiencing it.

 

We’re all experts now

Or are we?

For my medical friends, we see it in the American patient predilection for paging Dr. Google. For those of us who follow the environment, we see it in the denial of climate change. And we ALL saw it in the 2016 election in the form of the echo chambers on both ends of political spectrum.

What is “it”?

Confirmation bias- that big, bad cognitive stumbling block that allows us to completely ignore information that doesn’t support our ideas/ opinions/ “facts”. Our brain is amazingly gifted at dispensing with inconvenient information, and confirmation bias, and neuroscience shows that we tend not to look for information that challenges our beliefs.

Think about that for a moment. When is the last time that you actively sought information that doesn’t align with something that you believe about the world? Be honest here. Oh, and think about how much you learned the last time that you did make that effort (because we know that confirmation bias limits our learning!).

It seems that the current political and social environment in the US has resulted in a flurry of writings about confirmation bias, particularly its impact on science and policy. While confirmation bias used to be a phrase that we mostly used to describe a failure to maintain equipoise as an investigator, it’s become a key part of the 2017 lexicon, particularly with the advent of terms like “alternative facts.” I have to admit that I’m not sure I feel any safer about people embracing alternative facts when we know that facts don’t change our minds.

Another often underestimated aspect of confirmation bias comes from deeply held personal values. Be it the risks vs. benefits of drilling for oil in the Arctic or how Planned Parenthood actually spends taxpayer dollars, many individuals have values-driven opinions that impair their ability to have meaningful dialogue around these topics (myself included at times). Instead, everyone fancies themselves an expert on topics that they aren’t, and instead of intellectual, meaningful dialogue we get meaningless and unhelpful shouting matches. Suddenly we’re back to that echo chamber of the 2016 election…

The medical tie-in for confirmation bias is, of course, when it impacts our diagnosis and management of patients. (Note: if you haven’t read Jerome Groopman’s How Doctors Think and you are in the medical field, you are doing yourself and your patients a disservice.) Certainly we base a great deal of what we do upon pattern recognition.  But what about those times when the patterns lead us down a primrose path that is…wrong?  It happens, even to fabulous clinicians.

How do we overcome confirmation bias if it is so insidious?

Simple.  Seek proof that what you’re thinking is a terrible idea.  Look for disconfirming data. Conduct small experiments that are capable of disproving OR proving that your idea is right.

In other words, prepare to be wrong from time to time.  It’s part of our human experience.

Ladies, get yourself a Girl Gang

I admit that I usually try to give you food for thought then let you draw you own conclusions and applications.

Tonight, on the eve of International Women’s Day, I’m making an exception.  I’m dispensing some invaluable career advice for my women readers, particularly those in surgery:

Get yourself a “Girl Gang.” If you are somewhere where one is already in place, find out how to become a contributing member. At all costs, though, find yourself a group of women who share your commitment to excellence.

This article examining mentor-mentee sponsorship and gender came to my attention over the weekend (HT: Susan Pitt).  She astutely pointed out that this gives us an “action item” for women in surgery- to do a better job with sponsorship as more of us move into leadership roles.

This came on the heels of my friend Harriet Hopf mentioning during a breakout session last Friday that she appreciated being asked to join a “girl gang” that we already had in place at Utah with the expressed goal of promoting one another for leadership opportunities and awards. She came here from an institution with plenty of women in her department and in leadership roles, so this wasn’t something instinctive for them to do. For those of us in departments and places with a paucity of women leaders, it’s critical.

How does our Girl Gang work?  It’s remarkably easy.  We watch out for leadership positions or awards (both within and outside of our institution) that align with one other’s skills and accomplishments, and we nominate each another. Also, if there is a recognition that one of us really wants, we have an understanding that self-nomination to another group member is encouraged, and they’ll take care of the actual nomination.

Certainly our effort focuses on a group of women who are at a certain stage of their career, and those people definitely comprise the active members of our Girl Gang. However, once you start doing these things for your peers, you realize that it’s easy enough to extend your influence beyond that core group. I suspect I’m becoming a bit notorious with some of our female faculty in particular for my “nudge” emails (“You are incredibly qualified for this…you should apply…how can I help?”). My basis for doing this is two-fold, and both are factual.  First, as women we tend not to apply for things until we’re overqualified.  Sometimes we just need someone to tell us that yes, we really are worthy.  Second, it helps take the stigma away of tooting your own horn– again, something that women are penalized far more heavily for than are men.

(Closing note: While our Girl Gang has focused heavily on promoting the careers of women, we are not exclusionary and we welcome allies. I solemnly promise that I’ve put men forward for awards, leadership roles, opportunities, etc…I just focus on it less because we’re nowhere near having a critical mass of prominent women in academic surgery.  Yet.)