Category Archives: Education

Your Inner GPS

I like to listen to podcasts when I cannot physically open up a book or don’t want to stare at screens anymore. Tonight, during a long ride of the A train in NYC, I listened to the Behind the Knife podcast episode with Dr. Freischlag. I became instantly amazed with her emotional intelligence, humility and aptitude for being a great mentor. She specifically addressed that not everything in life works out in your favor, and her input aspired me to write about the content below, which I named “Your Inner GPS”.

At this point, many of you know how to get back on track when a mistake has been made or when life throws you some dirt. For god’s sake, we are almost doctors, and we are more than capable of realigning our great ships, right? However, what you might not be good at is what to do when something goes wrong – completely wrong – and when you are forced to make a pit stop on your way to “greatness”. How well do you deal with things when you’ve worked so hard but are forced to change course, or worse, abandon? What about when you’re more than qualified, and you’re denied for a reason that shouldn’t be a reason at all? I’m sure many of you type As and overachievers also got completely chewed up by life from time to time, just like me. Of course, we get better and better at handling these bumps on the road, as we encounter more of them, like hypertensive arteriosclerosis. Let me assure you, none of us are perfect at handling lemons handed by life. We are young, and there’s still much to learn about how to best hit life’s curveballs.

Don’t despair. Take a step back, pause for a moment, think about the problem, come up with options, plan, and execute. We surgeons and doctors and teachers and parents and etc already got here with this method. This is our inner GPS, yet many of us still panic, complain, and ruin our along with our closed ones’ mood when we get into sticky situations laid down by life.

You have to be completely okay with not getting everything you ask for completely and all the time. In fact, you should rejoice (to a healthy degree) when you get something, especially when you worked so hard for it. There is no flow chart or algorithm in life that get you to exactly where you want to be.  Timing and serendipity are elements in addition to hard work that can make life so easy when present, and so miserable if without. Be prepared to fail and be lost for a bit. Enjoy, if you can, the process of learning from a rare mistake that you make, and be a better version of yourself. This self-searching process and reorientation would refine and sometimes define you.

Also, it should be okay for you to get rejected. It should teach you something every time, but the awkwardness and embarrassment that come with it should simply bounce off you. If they don’t, don’t worry, with few more rejections you will get there. Hey, I got here. Just think about this – under the circumstance that you are excellent, you’ve worked hard, and you’re true to yourself, you are simply filtering out your choices through rejections. Not everyone would like you even if you’re all of the above, but you will definitely have options, and eventually a great match.

Amidst all of these turmoils life gives you, try to stay the course and look at the big picture. There’s an expression that says you should look at the windshield, not the rear view mirror. I say look at both. Focus on the windshield and where you want to go and what you wanna achieve next, but also pay attention to the rear view mirror so you learn from the mistakes and never make them twice. You would be surprised the amount of takeaways and life lessons you can acquire from either direction.

Hold steady, and don’t let life ruin your party. Wherever you end up, be happy and never stop learning. There will always be someone ahead who you look up to, and someone behind who looks up to you. Don’t despair and certainly don’t lose purpose. Trust your inner GPS.

Eversion Carotid Endarterectomy Video

I had the fortune of seeing and assisting on over 10 Eversion Carotid Endarterectomy (eCEA) while rotating in China. I was starred in a video created to that demonstrates this procedure from beginning to end, particularly how to sew the back wall of an end-to-side ICA to CCA anastomosis so the repaired suture lines are facing towards outside of the anastomosis. Obviously, if the suture line faces into the lumen of the repaired vessels, it would create a stenotic waist at the takeoff of ICA. No textbook demonstrates how to do this well. Enjoy!

https://drive.google.com/file/d/1V_rJonCHM7NrtbMooCXiXsU8es27044O/view

China Vascular Surgery Elective

I am now in my last week of my 3 week vascular surgery rotation I set up in the First Affiliated Hospital of Zhengzhou University, in Zhengzhou, China. The experience has been eye-opening.
First assisting in CEA, learning about stent grafts and deploying them, and giving presentations in Mandarin are nothing but small gains I made during this trip. The more profound takeaways were the complexity of healthcare in China and the different training path surgeons in China take.

The Chinese citizen pays much more out of pocket for medical expenses, and crowds the big hospitals even for small problems such as a cough. There’s minimal insurance from the government and private companies, so patients pay 70% of the medical cost including the patch of CEA. Whenever there’s a medical problem, no matter how minimal, people rush to the biggest and most well-known hospital in their region because there are few family docs and the quality of care provided in smaller hospitals are inadequate. The result becomes that big hospitals like the one I rotated in end up having 25 people in a single elevator.

One can actually operate independently at age of 23 in China, after a licensing exam. That is because medical school and college are combined into a 5 year program. However, nowadays no decent hospitals would hire you to be an attending right out of medical school, so surgical trainees go on and do 2 years of masters degree and likely 2 years of doctorate degree in order to get a job at a respectable program. However, the surgeons in China are broken into specialties early on during the latter half of medical school, and their technical skills are much superior than their counterparts in the U.S. Their textbook and literature knowledge are lagging, in my opinion.

These are two fundamental differences in my surgical rotation that struck me. There are lots more interesting contrasts in healthcare and surgical care vs. the U.S. I encourage you all to take a global view on surgery. The scope-broadening and networking are simply phenomenal.

 

 

Advice about clerkship

I had the pleasure of talking to some MS2 who are interested in surgery recently regarding the most optimal way to set up the their third year clerkship. The general ideas are below:

  1. Try to take surgery clerkship in the latter half of the year if you can. It helps if you have a decent understanding of medicine going in.
  2. OBGYN rotation gives you an introduction of how to act in the OR. Good idea to do it before surgery.
  3. When studying for the surgery shelf exam, study medicine! 95% of the questions are medicine.
  4. Get to know a mentor early on, so you can jump on a research project and ask for rec letter later.
  5. Research doesn’t have to be in the surgery specialty that you’re interested. First authorship is first authorship.
Giving advice to MS2