i live here too.

It is one of the most clear memories I have from early on in my career.  Some friends were over and asked how long we had lived in our home.  When I answered, my eldest, in the sincerest of voices proclaimed “Mom, that’s not true.  Dad and I live here and you live at the hospital!”  It’s pretty hilarious now but at the time I was crushed.  CRUSHED.  I remember the days in residency when I felt like I hadn’t been home in forever.  Let’s be honest. Sometimes it still seems that way.  Home in time to eat and sleep and then back up before everyone else and off to work.

September is designated as Women in Medicine month by the American Medical Association. One third of our nation’s physicians are women. Many of these women chose medicine as a career during a time when they had very few role models who were women.  Many of them delayed starting their own families to learn to care for the families of their community. I have the privilege of training with, working with and knowing some incredible women physicians. These women spend many years training for a career in which they will give countless hours to improve the health of others. Most do it for a salary that is less than their male counterparts.  They juggle rounding and homework and office visits and basketball practice and charting and so much more.

Women are under-represented in leadership in medicine; and a recent survey of physician mothers revealed that most women have felt discriminated against because of pregnancy, breastfeeding or motherhood. Does this make men at fault?  Certainly not. But we work in systems that have long overlooked that its workforce is changing. Fortunately, physician moms are working to improve policies and procedures so the women that come into medicine after us have the opportunities to lead their communities to better health.

So here’s my shout out to women in medicine.  You are some of the toughest, smartest, most caring and passionate women I know. You will change the future of health. And you are unstoppable.

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Summer of fun.

I’m back!  It has been almost a month since my last post.  In that month I have felt TERRIBLE.  At one point I thought I would never stop coughing and that I would get diabetes from my cough drop consumption.  Don’t worry, I switched to sugar free. But now I’m about 89.32% better and have found the time to write again.  (Which is code for I can stay up late and finish things).  And so here we are.

It’s July.  For most people July represents the middle of summer.  Vacations, lazy days at the pool, short days at work.  In medicine July means ALL THINGS NEW.  As in, all the things are new.  New medical students, new residents, new academic calendar. You see, I work in Academic Medicine.  Which means that I work at an institution of higher education where we train medical students to become competent, caring, ethical physicians and then train physicians to be competent, caring, ethical specialists in their chosen field.  Sounds easy, right?  I will try to briefly introduce you to what the summer is like for those of us insane enough to participate in this great adventure of education.

Medical school is 4 years long and almost exclusively completed after a 4 year bachelors degree is achieved.  In the first 2 years students spend their time in courses learning anatomy, the complexity of each organ system, structure and function of the body and its cellular systems, human behavior and so much more.  They come to class, have small group sessions, read and read and read some more and take lots of exams. By the time they come to the third year they are ready to see how all they have learned can be applied to patients and diseases.  Oh and did I mention they also have to pass the first step of the 3 step medical licensing exam? In the third year our goal for a student is to be able to see a patient, perform a basic physical exam and formulate a differential diagnosis.  What that means is that when they hear a patient’s symptoms and know their history they can think about what diseases they are most at risk for and/or most likely to screen-shot-2016-09-25-at-6-38-08-pmhave.  Only once that is done can we as physicians begin to think about what testing and treatment someone might need.  Medical students don’t do anything without supervision.  Sometimes patients will ask if the medical student is going to perform their surgery or deliver their baby. I can answer that with a resounding NOPE.  What a medical student will do is participate in surgery with me where they will learn the hows and whys of that specific operation.  They will check on their patients in the hospital and often serve as an extra set of eyes, ears or hands to ensure that all the details of patient care are taken care of and nothing has been overlooked in making sure a patient makes it safely home after surgery.  In addition to all this they are reading, going to lectures, taking tests.  At the end of the third year we hope they have chosen a medical specialty.  Then they spend their final year of medical school spending time in areas of their chosen specialty, as well as interviewing for a residency position and taking the 2nd step of that all important medical licensing exam series I mentioned before.  So for me July means making sure the syllabus and all the materials our third year students get and use equip them to learn the most they can about women’s health.  It means making sure those 4th year students who have chosen my specialty have the best opportunity to train at the institution of their choice for residency.

July 1st also marks the day new residents begin their training.  These are recent medical school graduates who have gone through a very competitive process to secure their place in a residency training program. Each specialty in medicine has residency training and each specialty decides how long that training should be.  For example, OBGYN residency is four years long. Neurosurgery residency is 8 years long. (no thank you).  While in residency these doctors have a focused practice where they will learn every detail of their specialty.  It is also the time when they are trained to perform procedures and surgeries all in a supervised environment with the intention that at the end of their training they are ready to care for patients on their own.  In the meantime they will spend up to 80 hours a week in the hospital where supervising physicians will provide guidance, support, and supervision.  At the end of those at least 10,000 hours of training each resident will decide whether to join a private or hospital based practice, become an academic physician or, for those brave/crazy enough, pursue even more specialized training.  One of our greatest privileges is to watch those residents graduate and know that they will provide the kind of patient care you would want for your family and friends.

It’s a long journey into a career as a physician.  It can consume more than a decade of your life.  In truth the learning never stops.  For those in OBGYN we have a written and then oral exam to become board certified after residency.  To maintain our specialty certification we read articles and participate in chart reviews each year. We attend conferences and workshops to learn from one another and maintain and improve our skills. We read articles and travel across the country and collaborate to find the most effective ways to educate our medical students and residents.

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So if you see a medical student or a resident, give them a hug or a handshake or a pat on the back.  During a time when there is a lot of uncertainty in healthcare they have made the choice to commit their lives to the service of others. When no one can seem to agree who should have access to care or who will pay for that care, they have dedicated a huge chunk of their lives to ensure that care is available no matter what.  Now if you’ll excuse me, it’s July so I need a nap.

 

Schooled.

Last Friday I had the privilege of leading our resident education session.  We spent 2 hours together learning how to become better educators.  I say ‘we’ because, despite being in medical education for the last 12 years, I still have a lot to learn about teaching.

I think for a long time I bought into the myth that anyone can teach.  And that anyone can be an excellent teacher.  Like once you have mastered a subject, let’s say addition, that you will be great at teaching addition.  Well, you’re not.  Or at least I’m not.  I can distinctly remember my oldest child attending preschool and being sent home with a packet of sight words.  Until that time I had no idea how children would get from having a cry or smile as the only method of communication to speaking, reading and writing complex words.  Thankfully my child’s teacher knew the path.  In fact, her 2nd and 3rd grade teachers have more experience teaching than I have in being alive.  They knew where she had been and where she was headed in her educational journey.  And her 4th grade teacher will as well.

I teach adult learners.  Medical students and residents.  Medical Education is wonderful and also amazingly challenging.  When a new 3rd year medical student begins with us they have literally spent about 25 hours per week in the classroom in addition to the dozens of hours a week they spend studying in the library.  They soak up all the knowledge you give them.  They are early in their journey toward their final career goals and eager to learn all that medicine has to offer.  They want to know their patients and help create tangible positive outcomes for them.  My residents spend even more hours at work and in the learning environment than the medical students.  They are responsible for patient care as well as a huge chunk of the medical student education as well as making sure they learn all they can before leaving the training environment.  It’s a lot to accomplish.

What I have learned in medical education is that being a teacher is a huge responsibility.  It isn’t enough for me to have passion for the subject matter.  I have to translate that passion into meaningful experiences and into a format they can understand and retain.  It means more than just making sure the medical students know the basics about caring for women; it means that we have taught them how to have respect for their patients, to care deeply for the broken and hurting around them and to find a way to always have compassion.  The challenges come when you are consumed with your own work and you find it hard to stop and teach someone else.

I think this is a challenge for everyone in education.  Teaching is hard.  Being an excellent teacher is even harder.  For me, I stay in the Medical Education environment through the struggles because I remember the faces of the teachers that taught me empathy and compassion, because I still have a lot to learn and those medical students and residents challenge me daily to be better than my best, and because I hope that my community and my state are healthier and better cared for through the work we do in our teaching institution.

Hug a teacher you know. Hug all the teachers you know.  Or bring them a snack or send them a note of encouragement.  They leave each day having given all they can to some who will receive and some who might not.  They are not only teaching subject IMG_2943matter they are often teaching the life lessons of respect, empathy, compassion and kindness even when their own runs low.  They are the feet with which He is to go about doing good.  They are caring in places many of us would not dare to invest.

And if you know a medical student or a resident physician, give them a hug too.  Or maybe a cup of coffee.  They are always being challenged to learn more and do better. They spend themselves each day to do their best for others, using their hands and their heads and their hearts to care.    They teach me something every day and for that I am grateful.