AWAEM Awareness Jan_Feb 2012

January-February, 2012

AWAEMAWARENESS

A bimonthly update to inform you of the current activities of our Academy in an effort to make this organization a strong advocate for women in academic emergency medicine.

Table of Contents Good, Better, Best - A Word on Coaching

ELAM - What is it and why apply?

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AWAEM at SAEM - What’s in store for you!

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Featured Women in Academic EM - Rosemarie Fernandez, MD

News You Can Use - On childcare benefits and work-life separation

Available Committees

New Year’s Resolutions...

Spend time every day enjoying my kiddo’s smiles and remembering how lucky I am.

Total intermingling of work and personal life is not healthy….make barriers!

Done is better than perfect.

Try something new every month.

Learn to say “No” once in a while.

Improve my bedside/on the fly teaching.

Don’t forget to find some time for ME.

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AWAEM AWARENESS January-February, 2012

Good, Better, Best A Word on Coaching

All coaching is, is taking

By Gloria Kuhn, DO

Atul Gawande is a surgeon and extremely articulate writer who has written numerous articles and several books. In October of 2011 he wrote an article Personal Best[1] published in The New Yorker and available on line www.gawande.com.

The subject of the article is coaching.

Gawande notes that top athletes, singers, and even some teachers have coaches, and asks the question, should physicians do the same? He has been a surgeon for the past 8 years. He measured his complication rates against national data to determine his “competence”, and found they were below the average. His rates continued to decline until he hit a plateau at 2% several years ago. While most of us would be happy with that number, he wasn’t. Still good but not getting better.

About that time, an encounter with a tennis coach led to improvement in his serve. This made him question why athletes have coaches and the rest of us don’t. In medicine we have a lengthy training period but then “boom”, we are done and left to our own devices. In all of my years of practice after residency, no one has ever come to me and said, “Do it this way and it will work better.” In fact, what physician would “dare” to give unsolicited advice to a colleague? No one I know.

All of us are criticized in multiple forums but only after we have erred and someone has often been harmed. When that occurs, our emotions range from guilt, to grief, to denial, to anger, to shame, and sometimes, perhaps years later, to acceptance that there was truth in the criticism. We wear our mistakes like hair shirts. But our culture in medicine doesn’t look at helping us to avoid those mistakes unless it is the electronic medical record warning us that any woman between the ages of 15 and 50 might be pregnant if we want to prescribe doxycycline. We don’t have the concept of a managed program of continual lifelong improvement for all doctors that is personalized the way a coach would personalize training for a top athlete.

Gawande took a proactive approach and interviewed entertainers, athletes, and coaches to try to determine the value of coaching. In his article he describes the multiple benefits a coach confers to elite performers throughout a career. He decided to hire a coach, a retired surgeon who had been one of his attending surgeons.

a player where he can't take himself.

Bill McCartney

Introducing his coach to the surgical team was awkward at first, but he overcame the obstacle and the team accepted the concept. He describes how he and the coach watched tapes of his surgeries to better improve performance. This is a common practice in athletics and has been used in the past during trauma calls in the emergency department.

Having a coach worked beautifully: even on surgeries that had gone well the coach gave him some tips to improve what he was doing. It was intellectually stimulating and confirmed his belief that having a coach was really beneficial. But then came the surgery that didn’t go well. Mortification and regret at exposing his “judgment failure” overcame his rational examination of the event. He describes his emotions as he fought his way through that operation and its complications. “I wished I had never asked him along,” was a final thought.

There are many challenges and impediments to the concept of having a coach in medicine. Society accepts the concept of coaching in sports and some entertainers have lifelong coaches, but after completion of training, physicians don’t. At the end of his article Gawande describes the look of alarm on his patient’s face when he admitted to her that the person standing in the operating room that she had asked about was a colleague to look for ways her surgeon could improve.

Can we, and society, accept the notion that we are not omniscient, that we don’t know everything, and that we need to keep learning from someone who knows more than we do? I don’t know the answer.

All of us want the top surgeon, cardiologist and, of course, the best emergency physician. All of us want to be the best emergency physician. Can we tolerate having someone looking over our shoulders to tell us what to do better? It is something that we do with our residents; or do we?

Continued on page 6. .

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AWAEM AWARENESS January-February, 2012

The task of leadership is not to put greatness into humanity, but to elicit it, for the greatness is already there.

John Buchan

Executive Leadership in Academic Medicine (ELAM) What is it and why apply?

By Leila Getto, MD

“The Hedwig van Ameringen Executive Leadership in Academic Medicine® (ELAM) Program for Women is the only in-depth national program dedicated to preparing senior women faculty at schools of medicine, dentistry, and public health to effect sustained positive change as institutional leaders.” (from their website) ELAM is a fellowship program at the Institute for Women’s Health and Leadership at Drexel University College of Medicine in Philadelphia, PA. Since 1995, this year long program has aimed at developing skills for women in leadership positions. The goals of this program involve developing a broader vision of the participants’ role within their academic centers, leadership effectiveness, understanding of strategic finance, and ability to lead organizational change.

Women who graduate from this program become part of a network of female leaders, now totaling nearly 700.

Research about ELAM has demonstrated that program alumnae are at an increased eligibility for promotion and scored higher on many leadership indicators compared to mid-level and senior women faculty who did not participate in this program.

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Emergency Medicine ELAM alums include: Stephanie B. Abbuhl, M.D. (2005) Elizabeth M. Allen, M.D. (2002) Jill M. Baren, M.D., M.B.E. (2010) Ann S. Chinnis, M.D., M.S.H.A. (1999) Kathleen Janette Hill Clem, R.N., B.S.N., M.D., F.A.C.E.P. (2003) Elizabeth M. Datner, M.D. (2011) Gail D'Onofrio, M.D., M.S., F.A.C.E.P. (2002) Sheryl L. Heron, M.D., M.P.H. (2008) Katherine L. Heilpern, M.D. (2003) Geneviève Moineau, M.D., F.R.C.P.C. (2008) Debra G. Perina, M.D. (2008) Lynne D. Richardson, M.D., F.A.C.E.P. (2009) Suzanne R. White, M.D., F.A.C.E.P. (2004) Janet M. Williams, M.D. (2000)

Go to: http://www.drexelmed.edu/Home/ OtherPrograms/ ExecutiveLeadershipinAcademicMedicine.aspx to download an application brochure or contact 215-991-8240 or 215-991-8171 Email: elam@drexelmed.edu for more information.

AWAEM AWARENESS January-February, 2012

AWAEM at SAEM

What’s in store for you!

Dear AWAEM colleagues: We are planning some fantastic sessions at SAEM this year. As you can see, we will be tackling some of the important issues that face women in academic emergency medicine. We hope you will join us – we need your perspective, your wisdom, and your voice to build our strong community.

See you in Chicago!

Stephanie Abbuhl MD AWAEM President 2011-12 May 10, 2012 Didactic Sessions • 9-10a: Floodlighting the Hidden Threat of Unconscious Bias • 10-11a: 2012 Updates in Gender-Specific Emergency Care - A Pecha Kucha Style Presentation May 11, 2012 Academy Block: 8a-12p, Mississippi Room 8-830am: AWAEM Business Meeting 830-9am: The Status of EM Gender Research 9-10am: Career Development Tailored for Women: Programs for Success 10-11am: XX, XY and the Art of Asking: Case Studies in Negotiation 11am-12pm: Poster session/Informal Networking

Register Now at SAEM http://am2012.saem.org

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“...A community needs a soul if it is to become a true home for human beings. You, the people must get it this soul.”

- Pope John Paul II

May 11, 2012 12:30-2pm 3rd Annual Networking Lunch Proven to be an extremely popular event, our primary goal is for women in academics to meet and discuss items of mutual interest. During the lunch recipients of Academy awards are recognized and honored.

The final portion of the event will be facilitated discussions on topics that we feel merit the comments and opinions of all of you...our members! This year’s Topics for Discussion are: • Gender Bias: Problems, experiences, and solutions • Gender Research: Gaps, topics needing research, impact of lack of research • Negotiating: Handling rejection, negotiation for protected time, a new position, or scheduling requests These topics deliberately mirror our didactic topics to give members an opportunity to discuss what our speakers have taught and give us a chance to determine how to use what we have learned in our careers and lives.

An invitation to help with our annual lunch: We need members to help record during the Topics for Discussion session. The results of these discussions are then printed in this Newsletter so that all members can share in the decisions and recommendations made during this time.

AWAEM AWARENESS January-February, 2012

Featured Women in Academic EM Rosemarie Fernandez, MD

By Esther Choo, MD

This month’s inspiring academic faculty member is Rosemarie Fernandez, MD, Associate Professor in the Division of Emergency Medicine at the University of Washington School of Medicine. Dr. Fernandez completed her emergency medicine residency training at the University of Cincinnati in 2003. From 2003 to 2011, she served as faculty at Wayne State University School of Medicine. She completed the AHA/National Patient Safety Foundation Patient Safety Leadership Fellowship in 2011 and has dedicated her academic work to using simulation to improve safety in emergency care. At Wayne State, she was Director of the Medical Simulation Center at the Eugene Applebaum College of Pharmacy and Health Sciences and Director of Healthcare Simulation and Patient Safety at the Mazurek Medical Education Commons. She is credited as making this center a valued multidisciplinary statewide resource.

In 2011, Dr. Fernandez relocated to Seattle, Washington, where she is Director of Simulation in the Division of Emergency Medicine at University of Washington. “What’s remarkable about Rose is her ability to come in and so rapidly integrate herself as a collaborator in the simulation community,” says Susan Stern, MD, Division Head at UW. “She is an extremely hard worker, very motivated, very focused, and has a great understanding of the academic world and how to be successful in it… She is a great role model and advocate for junior faculty.”

Dr. Fernandez’ scholarship includes fourteen published original manuscripts primarily focused on the use of simulation in EM education and teamwork training. She has received funding for her research from the Emergency Medicine Patient Safety Foundation / SAEM, Blue Cross Blue Shield of Michigan Foundation, the Herrick Foundation, and HRSA, and, notably, is PI on a $1,050,000 grant from the Agency for Health Research and Quality for her for a project entitled Improving Patient Safety Through Leadership and Team Performance in Simulations. Her national roles have included serving as the inaugural chair of the SAEM Simulation Academy and Secretary for the Society for Simulation in Healthcare Emergency Medicine Interest Group.

Dr. Fernandez is mother to two four-year-old twins, who keep her and her husband “quite busy.”

In each issue of the AWAEM newsletter this year, we will profile women in academic emergency medicine who inspire us, whether through scholarly work, leadership, mentorship and support of other women, modeling of work-life balance, or service in SAEM and other national EM organizations.

AWAEM’s Questions for Dr. Fernandez: Why did you decide to stay in academia? What are its main challenges and rewards for you?

Looking back, I think the reason I chose to stay in academics was less of a rational decision and more of a “gut” decision- it just felt right…. Thinking about it now, I know that I like learning from my colleagues, I enjoy being around trainees who continue to challenge and question daily practices. Ultimately, I like being a part of something bigger, and I like the variety I have in my job. I spend some days running around in a busy ED, some days actively teaching using simulation, some days writing manuscripts, and some days planning research activities.

I don’t think I would be happy doing just one of those things all the time, although I have found that I enjoy writing quite a bit.

What are your "big picture" goals?

Perhaps when I retire I will know! I recently took a new position at the University of Washington as a step toward further developing my research career. So, I would definitely say I am hopeful for a successful research career, perhaps with the goal of becoming a Research Director for a simulation lab. Alternately, I could see myself further developing a role in faculty development. With so many faculty interested in teaching, I feel that my background and research skills could help fellow faculty members pursuing clinical educator careers become successful with scholarly activity and publications. Really, who knows what I will be doing!

What would you say to EM residents undecided about whether to choose academic vs. community practice?

I think they need to consider the things they like to do and the environment in which they like to practice. While it can be hard to transition from a community practice back into academics, no decision is forever, and you can always change your mind! I think that wherever you practice, the key to success is mentorship. Find mentors for everything you do. I can credit every one of my successes to mentors. There are people I consider my ethical sounding board, those who are incredible clinicians I try to emulate, and those who have provided me with opportunities in simulation and research. To list them all would be impossible, but I couldn’t possibly thank them enough.

“I think that wherever you practice, the key to success is mentorship.”

- Rosemarie Fernandez, MD

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AWAEM AWARENESS January-February, 2012

News You Can Use

News You Can Use

Flipping the Switch: Who Is Responsible for Getting Employees to Take a Break?

Medical Schools Get Creative With Child Care Benefits

By Stephanie Abbuhl, MD

By Stacey Poznanski, DO

What kind of childcare does your institution have? The AAMC points out how some medical schools are seeking the childcare advantage to attract the best residents and faculty...

Just put the phone down and back away slowly.

If you have ever referred to your smartphone as “my precious” or at least feel as if your work day never ends, here is an article for you. It provides some interesting information on technology and work-life barriers (or lack thereof). As a new mom, learning to set boundaries has been an important adjustment for me because I am certainly guilty of the addiction. Is there is a 12-step program for the “CrackBerry”?

Check out the article at the following link: https://www.aamc.org/newsroom/ reporter/december2011/268878/ childcare.html

Good, Better, Best

Check out the article at the following link: http:// knowledge.wharton.upenn.edu/ article.cfm?articleid=2941

A Word on Coaching

By Gloria Kuhn, DO

Continued from page 2.

Many find it difficult to give honest feedback.

How often do we temper the feedback with a compliment so we won’t hurt the resident’s feelings? One study found that negative feedback by supervising physicians, was so subtle that residents never realized that they had done something wrong. Do we as attending physicians have the courage to put ourselves in the position of accepting constructive feedback? In the best of circumstances, being sick is frightening. Being critically ill is terrifying for patients and families, and caring for the critically or severely ill is terrifying for the physician when things are going badly.

All of us want our patients to do well. The loneliest place in the world is at the bedside of a patient whose condition is deteriorating despite your best efforts.

Surrounded by nurses, technicians, residents, and students you are still alone with a patient who might die, whom you might not be able to save. Can patients, their families, or even you conceive that you might benefit from coaching?

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It opens the door to self-doubt and acknowledgement that after good comes better, and that best is always on the horizon. But, only by keeping best on the horizon can we continue to get better.

I think I would have loved having a coach and had even suggested this to my partners who looked at me in horror and then like I was daft. When I had trouble doing a procedure how wonderful it would have been to have someone whisper a tip in my ear or to look at a tape of my performance and make suggestions. Wouldn’t it be a relief to talk to our coach about tough cases before we get into trouble? Gawande found the courage and motivation to keep his best on the horizon and chased that horizon with a coach. I never acted on my idea. Did I lack the courage or the motivation? I will never know.

1. Gawande, A., Personal Best. The New Yorker, 2011.

October p. 44-53.

AWAEM AWARENESS January-February, 2012

Available Committees for 2011-2012 Time to get involved!

If you are interested in helping with any of these committees, as a member or possibly leadership role, please e-mail the Chair so you can be included. If you do not hear from the Chair within a week (or no Chair is listed) please contact Stephanie Abbuhl (stephane.abbuhl@uphs.upenn.edu) as sometimes messages do get lost in the cyberspace of e-mail land.

Membership Chair: Neha Raukar nraukar@gmail.com Co-Chair: Tracy Sanson

AWAEM Guidelines & Policies Chair: Gloria Kuhn gkuhn@med.wayne.edu Co-Chairs: Esther Choo, Sue Watts Awards Chair: Kinjal Sethuraman kinjal.sethuraman@gmail.com Mentor: Michelle Biros E-Communications Chair: Stacey Poznanski stacey.poznanski@gmail.com Co-Chair: Leila Getto Mentor: Gloria Kuhn Medical School Initiatives Chair: Preeti Jois preetijois@ufl.edu Co-Chair: Keme Carter Mentor: Bob Hockberger

Regional Mentoring Chair: Linda Druelinger ldruelin@medicine.bsd.uchicago.edu Mentor: Kerry Broderick Research Chair: Marna Greenberg: mrgdo@ptd.net Co-Chairs: Esther Choo, Julie Welch

SAEM Meeting Initiatives Chair: Alyson McGregor amcgregormd@gmail.com Co-Chairs: Esther Choo, Preeti Jois, Basmah Safdar, Julie Welch, Jeannette Wolfe AWAEM Development Chair: Maybe You?

“I’m a woman of very few words, but lots of action.”

Mae West

Many Photos found via Google Images. For a list of Photo Credits, please contact Stacey Poznanski, DO at stacey.poznanski@gmail.com

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