Seminar 6: The Stress of Surgical Practice: Looking in the Mirror

Goal: Residents will identify their professional and personal goals and better appreciate their responsibility in achieving a balance between the two.

Objectives: By the end of the session, the resident will:

Cognitive Objectives 1. Define long term goals in order of priority: ?financial success, ?academic success, ?marital/family success, ?respect in the community 2. Appreciate responsibilities to spouse/significant other 3. Appreciate responsibilities to children 4. Appreciate responsibilities to yourself 5. Appreciate how a choice of practice pattern – now and in the future – affects the resident’s ability to achieve his or her personal and professional goals. 6. Understand the potential costs of achieving/not achieving your goals: depression, anxiety, substance abuse, marital/family dysfunction

Skills Objectives 1. Engage in independent and joint (significant other) decision making in determining practice pattern and family pattern 2. Understand that multiyear plan must be considered to achieve goals – setting five year and ten year plans 3. Recognize that goals can and should change over the course of your professional life 4. Identify mechanisms of dealing with stress both personally and professionally 5. Know the importance of forcing yourself to list priorities

Affective Objectives 1. Have self awareness surrounding the achievement of personal and professional goals 2. Understand that you have probably set unrealistic expectations for yourself

SPICE Section Outline: 1. Introduction/Agenda

2. Self Awareness Exercise “Where do you see yourself in 10 years?”

3. Group Discussion a. Identify goals and reality check b. Responsibilities to spouse/significant other. Since you did not really understand what you were getting into, your significant other certainly did not c. Divorce happens – approximately 50% of you will get divorced d. Do you regard your spouse’s career to be as important as yours? e. Joint careers – who gets the first geographic choice? f. What happens if your marriage is in trouble? g. Responsibilities to your children h. Should I choose a “mommy/daddy track” position as my first job i. How do I deal with not being at soccer games and school plays j. Should I bring my kids to the hospital – should I encourage or discourage a career in medicine for my children k. Responsibilities to yourself l. What happens if my marriage is in trouble or my kids get arrested m. What happens if I decide that I cannot stand my professional life as a surgeon, a year out of my residency? n. What do I do if I cannot make ends meet financially? o. Choice of practice pattern p. What do I do when I receive a contract in the mail from my first potential employer? What is the right amount of money to be paid for my first job? q. Do I have an obligation to try academic medicine since NYU picked me from 800 applicants to its residency? r. What happens if things don’t work out with my partners or department chairman? s. What constitutes job satisfaction for a surgeon?

4. Decisional Balance a. Try to analyze your professional responsibilities to your significant other and vice versa. “Going with the flow” will probably end up in divorce b. You will have to resolve the conflict about the time you want to spend with your children and the realities of your schedule. c. Allocate your time according to your priorities – if others do it for you, you will end up extremely unhappy or worse. d. Assume you will have more than one kind of position in medicine during your entire career.

5. Review of Principles

SPICE Relevant Literature

Kao, L. S., E. B. Wilson, et al. (2005). "Gender differences among spouses of surgeons." Am J Surg 189(4): 435-40. CONCLUSIONS: Male and female spouses contribute equally to the career choices of their surgeon spouses. However, female spouses, both surgeon and nonsurgeon, are more likely to make the majority of the decisions at home and contributions to household care.

Kao, L. S., E. B. Wilson, et al. (2005). "Perceptions and predictors of surgeon satisfaction: a survey of spouses of academic surgeons." J Am Coll Surg 200(5): 684-90. CONCLUSIONS: There are many positive and negative aspects to being an academic surgeon. Yet, despite the time commitment, work hours per se do not appear to contribute to either surgeon or spousal satisfaction. Spousal satisfaction is dependent on surgeon contribution to household and childcare activities. Despite the multiple potential detractors from an academic surgical career, most surgeons, as perceived by their spouses, would not have chosen differently and are satisfied with their career choices.

SPICE