After many grueling years of surgical training, which included five years of General Surgery residency, three years of clinical and basic science research, and two years of clinical fellowship, I was ecstatic to be finally done with my training. I have finally become a “grown-up.” However, little did I realize that being on the other side of the table merely meant I was in a different phase of growth accompanied by different types of growing pains.
These pains mostly involve mundane tasks like time management, completing charting/documentation, juggling OR cases, being involved in resident teaching, attending committee meetings, administrative meetings (many other random meetings), while still attempting to pursue research endeavors. There are also more challenging pains, such as learning how to balance resident autonomy and supervision, handling difficult peri-operative decision making, dealing with complications, and most importantly realizing my limitations. Knowing when and how to ask for help when I need it is paramount, whether in or outside of the operating room.
Due to unforeseen circumstances, shortly after I joined the Department of Surgery, my already small Division was left with only two full-time faculties consisting of my Division chief, a breast surgeon, and myself, a complex general surgical oncologist. I had (so I thought), nobody to turn to for clinical or academic advice and nobody to assist me on complex surgical operations that required help above the level of an assisting resident. As time passed in this anxiety-filled environment as junior faculty, I became more independent, confident, resourceful, and above all, I realized that our surgical community is a collaborative community and learned that help does not always have to come from within the Division.
Being an attending has been one of the most humbling experiences of my life and I would like to share some things I have learned from previous mentors and from my first year as an attending surgeon.
- Balancing resident autonomy and supervision – I provide progressive autonomy while setting up expectations. Luckily, I work with a chief resident for a 4-6 week rotation where I get to know their personalities, style, skills, and limitations. Allowing residents to do a complex part of the operation does take a bit of a leap of faith and at times can induce anxiety and palpitations! However, the residents will never learn how to find the recurrent laryngeal nerve or place sutures on a 3 mm pancreatic duct on a soft gland IF you do not let them.
- Be a “yes” person – This is what my old program director told me to be when I first became an attending and it has worked so far. Being a “yes” person allowed me to be part of the community, gain trust within the Department, and has provided great opportunities to meet people within and outside of the Department.
- Phone a mentor – When I first started as junior faculty, I used to call different attendings at OSU, 1-2 times a week for advice. Mostly clinical advice and sometimes career advice. I call them less frequently now, but I still call them for difficult cases and every time I call, they are always happy to talk with me.
- Phone a friend/colleague – I feel fortunate to have bonded with my co-fellows who will forever be my colleagues, regardless of where we live. I talk/text with them routinely to discuss patients issues, including complications and complex post-operative management. Unfortunately, complications are bound to happen in surgery even in the best of hands, but having someone to talk to makes them more manageable.
- Make friends in and outside of your Department – I have been fortunate to meet so many great surgeons and physicians within and outside of the Department of Surgery, who are happy to help me, collaborate on research projects, and have provided me with invaluable advice on patient care as well as on career development.
- Forget your ego – As my prior Division chief Dr. Pollock used to tell his patients, “The biggest ego in this room is the tumor.” Humility goes a long way, even in surgery, and knowing your own limitations will get you and your patients out of trouble.
- Plan ahead (way ahead) and be flexible – Realize that everyone else around you are as busy as you are, so try to be accommodating. It is okay to overbook your clinic and your OR schedule because referring physicians, and most importantly, their patients count on you.
- Online resources – If all above measures fail and you still feel like you are alone in this journey, there are available online resources to get mentors and to get clinical advice. AWS offers a formal mentor/mentee application and matching process1 and AAS offers mentorship and career guidance program through Annual Fall Courses2. Additionally, ACS offers an online community bulletin board where you can post questions online to the surgical community.3
Career advancement and academic progress are essential parts of being an academic surgeon, but at the end of the day, patient care and safety take precedence and having a surgical community and a support system is essential. Together, we can deliver better and safer patient care.
For those who are about to become an attending or are a junior attending, you should know that you are not alone in this journey and it is completely normal to have anxiety. There are resources available if you take the time to discover them. Remember, no one has to endure these growing pains alone.
- https://www.womensurgeons.org/in-practice/mentorship/
- https://www.aasurg.org/meetings/fallcourses.php
- http://acscommunities.facs.org/communities/
Mio Kitano MD, MS
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