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We Are Not Alone- Advice for Women Trainees

By F. Keshia Suhail MD, Rashmi Advani MD, & Aline Charabaty MD

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The structure of the modern residency programs originated during the last decade of the 19th century. The term “residency” stems from the belief that doctors must live in the hospital for much of their training, allowing residents to be truly committed in their learning of surgical skills and medical knowledge. As we have come to understand, this lifestyle has been difficult to sustain as we see many young trainees experience burnout, depression, diminished work satisfaction, substance abuse, and even suicide. Furthermore, as the number of women matriculating from medical school continues to increase, there is a growing awareness that women and men may experience medical training differently. We should lean on this growing awareness and have discussions with our peers and mentors to guide us through this journey. We need to recognize that we are not alone and there are resources available for all of us. As you enter or continue your expedition as a trainee, we wanted to provide you with some tips to help you undergo a balanced training experience in which you can also find joy and fulfillment.

  • Learn & Excel Daily

Medicine is an ever-evolving field. This vast and growing field can seem intimidating yet exciting and provides a multitude of opportunities for us to grow, evolve, and thrive. So how do we stay on top of new literature and new practice methods without feeling overwhelmed? James Clear describes one method, known at the 2-minute rule, in his book Atomic Habits. It is a simple rule to help develop habits. The 2-minute rule states “When you start a new habit, it should take less than two minutes to do.” You know all those journal subscriptions that keep filling up your mailbox? When you use the 2-minute rule, “I will read before bed each night” becomes “read one page every night.” The idea is to make your habits as easy-to-achieve as possible. This is a powerful strategy because once you start, it becomes easier to continue doing and build on it. What you want is a “gateway” habit that naturally leads to a productive path where you can excel daily.

But becoming an excellent clinician goes well beyond and deeper than gathering and accumulating medical information: it involves learning how to take it all back to the patients and keeping the patients at the center of what we learn and why we want to excel. It involves diving generously into the best of what human connections have to offer: learn to actively listen to patients in their vulnerable moments and create a safe space for them, explain a diagnostic and therapeutic plan with empathy and compassion, develop meaningful supportive connection with patients and their families, and remain humble and excited to learn every day something new from your fellow trainees and the faculty around you. It is from real people (the patients, the nurses, the physicians) that you learn how to judiciously put the pieces of the puzzle together, understand the complexity of patient care, and grow as a physician and as a person.

  • Laugh Out Loud with Friends

Caring for the ill, juggling clinical and scholarly activities, can easily lead to a constant high level of emotional and physical stress. You may have heard that old saying, “Laughter is the best medicine.” Well, it is true. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. When you start to laugh, it doesn’t just lighten your mood mentally, it can induce physical changes in your body like relieve your stress response, strengthen your immune system, relieve pain, and increase personal satisfaction. Laughing is part of self-care, and the better part, it's contagious and spreads a good mood around you. Sharing a good laugh with others brings people together and strengthens relationships. The more laughter you bring into your own life, the happier you and those around you will feel. So, don’t hesitate to share a good laugh with the staff, colleagues, and patients while always remaining respectful of the environment and the circumstances.

  • Be Kind to All and Yourself

It is hard to lose sight of what it means to “care about others” when the work days get busy with clinical duties and involves strenuous multitasking. So remember, be kind to others and to yourself! Being kind to others can be a small gesture such as thanking the nurses, giving a reassuring smile to a patient or something bigger like helping a colleague complete their clinical tasks on a busy day. Being kind to others is beneficial to our own psychosocial and mental well-being. In an interview, the Dalai Lama spoke about the impact of compassion and the happiness that comes in wishing others well. The opposite also holds true. As your own well-being increases, you are more able and likely to be patient, supportive and empathetic to patients, colleagues, family and friends. Some strategies to grow inner happiness and generous strength include: self-reflection, positive affirmations and meditations, self-care practices, and expressing gratitude and appreciation for all things in life. Remember that it is important to fill your own cup before you fill that of others. Respect and embrace your strengths and weaknesses, your successes and your mistakes; they are all part of your personal and professional journey.

  • Say Yes and No Strategically

As women physicians, we can often feel obligated to say “yes” when anyone asks for help or for our involvement in a particular project, even if it means overtaxing ourselves. Women have internalized society’s expectations and emphasis of “what women’s qualities are”: to always be available to others, to selflessly put others’ needs first, and to avoid disappointing or “letting down” others. The reasons why women have difficulty saying “no” are multiple. Unequal professional opportunities are given to women which leads to a mentality of lack and often to a misguided behavior to prove to others they are as (if not more) worthy and hard working as their male colleagues, and hence take on more duties and responsibilities. The fact that women are held to different standards than men leads to a fear of being labeled as selfish and not a team player when saying no (while men who say no are seen as positively assertive). However, it is important to set up healthy professional boundaries that keep you focused on your professional and personal growth and goals. Saying yes to tasks that do not serve your purpose or vision can negatively (and unnecessarily) impact your work-life flow, take time and energy away from opportunities that are more aligned with you, and leave you burned out and having accomplished little towards your true goals. Some key questions to ask yourself before providing your answer to a request made of you include: Do I have the bandwidth to do it? Am I the right person for the task? Does this fall in line with my current interests and passions? Does this request fit with my goals and objectives? If not, offer the name of an alternate person for the task and give that opportunity to another woman in medicine you know could benefit from it.

  • Crush Microaggressions

It is no secret that both gender and racial microaggressions toward under-represented groups unfortunately exist in the culture of medicine, especially in more male-dominated and often homogeneously white specialties. You may have already encountered this in the past and may have not known what to say or how to approach it. Thus, acquiring the following tools could help address this issue in an effective and professional manner.

a) Disarm the microaggresser: responding with statements such as “Those types of statements are not appropriate/not welcome in this work place.”

b) Ask for clarification: responding with statements such as “I heard you say ___, could you explain what you meant by ____?” or “What was your intention when you said ___?”

c) Challenge the stereotype: “My (male) colleague and I have earned the same degree, thus I would prefer you refer to me as Dr. ___ and not by my first name or “honey”.

d) Acknowledge your feelings to the microagresser: “When you said ___, it made me feel ___”.

e) Educating/Sharing your own process: “I heard you said ____. It is my understanding that ___(insert fact)____” or “A more inclusive term would be ____”

f) Change the culture of the workplace by reporting microaggression and finding leadership support.

Addressing microaggressions may seem intimidating. Having a tribe to support you can give you confidence when dealing with difficult situations. It is okay to seek guidance and to share your experiences with others to find strength and solutions together and ultimately make the medical field a safe and inclusive space for everyone to practice.

  • Find Your Tribe That Mentors and Sponsors You

Your tribe can often be described as the like-minded group of individuals you connect with and who support you. Surround yourself with people who encourage you to be the best version of yourself and who themselves exude the qualities you want to develop. Mentors and sponsors want to see you succeed and are invested in your professional growth, ready to guide you and open doors for you. The first step in seeking the right mentors and/or sponsors is to honestly assess your professional goals, your limitations, and your potential. Along the way you might find you need different types of mentors who can help you in different aspects of your growth, these include: life mentor, professional mentor, research mentor, formal or informal mentors. You may also wish to broaden your mentoring network outside your institution by getting involved in professional organizations, social media, and/or from existing contacts. Remember that building a strong mentor-mentee relationship takes time and requires patience, understanding, and commitment from both ends.

  • Be a Leader

Being a trainee is just as much about learning as it is about leading. You attract the energy you emanate, and others will follow as you lead by example. As a fellow, not only are you tasked with educating earlier-stage trainees, but you also now represent a growing group of women in gastroenterology. Which is amazing! Your professionalism, attitude, and work-ethic will be valued and modeled by others around you. During your training, once you start getting your bearings, look for avenues that may build your leadership skills whether it is through society committee work, local hospital or community involvement, or with an affiliated medical school. This can also help with building public-speaking skills and will help you feel more confident in your craft. There are plenty of opportunities if you seek them and may help open up future doors for you.

  • Remember that as a woman in medicine, you bring value to your field and to your patients: So shine your colors high and do so unapologetically

You have dedicated, sacrificed, and committed much of your life to your craft and patient care. As women, it can be easy to undervalue ourselves and focus on our perceived negatives. But, as a woman physician you bring a different perspective and approach to medical care, a better understanding (and solution) to clinical problems, and you represent half of the population we serve! You are valuable, worthy, and deserving.

Your worth as a physician is not determined by what your (often male) predecessors have defined as measures of success and is not limited to your degree. Your value is within you, taking strength from your own accomplishments as you define them and from the personal value you bring to patient care, research, and life outside medicine. Carve a career path that is aligned with your values, that adapts to your life events, and that fulfills your vision for yourself as a physician and as a woman. Take a step further, be a driver of change and actively create space for other women and under-represented groups in medicine, and inspire others to be the best they can be all while being true to who they are. Don’t be afraid to bring your personality to work and into your patient care. Keep the joy in what you do by being who you are fully, as a physician, woman, and everything else in between. Beyond growing your medical knowledge and accruing professional accolades, your growth as a physician include internal growth and expansion: aim for self-understanding, self-love, and self-acceptance. Acknowledge your self-worth and invest in yourself. Invest in your professional and personal dreams in a way that drives positive change in both medicine and society and lift-up others.

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