The new year is a time for reflection. It is also an opportunity to rededicate, or if needed, reinvent ourselves. Vascular surgery training is long, at least five to seven years for most of us. Most of our reflection happens as we progress from one academic year to the next, and often our self-feedback loop is stuck on do better, go faster, publish more. In the midst of surgical training, we regularly internalize our failures but often fail to savor our victories.
This year, I’m trying something new. In business, SWOT (strengths, weaknesses, opportunities and threats) analysis is the gold standard to evaluate performance, reprioritize and reallocate resources, and set future goals. As a current second-year research resident, soon to start year six of seven of vascular surgery training, I’m sharing my own SWOT with you.
Strengths
Leadership, organization, communication: After a recent busy call weekend (during research time, we cover one shift per month as the acting “chief ” resident), operating all night and then rounding on 25 new patients, my attending texted me: “Great work this weekend, chief ! You’ll do well when you come back given your natural attention to detail. Thank you for your help.”
Weaknesses
I have many. First, the Vascular Surgery In-Training Examination (VSITE). Each year, I am determined to do all the Vascular Education and Self-Assessment Program (VESAP) and Vascular Surgery Surgical Council on Resident Education (VSCORE) questions, review Anki flashcards, and score higher than just average on the in-service exam, but to no avail. This year, I’m buddying up with a friend in the general surgery program, and we’ve scheduled weekly study sessions on zoom for accountability. I’m also using Dr. Thomas Creeden’s The Vascular Surgery Review Book. Second, lower extremity distal bypass and upper extremity thoracic outlet syndrome exposures. No matter how many times I review the anatomy, it doesn’t click for me. This year, I am using the Complete Anatomy 3D human body atlas app while I read. Third, taking on too many projects. Research time has been a blessing in many ways, but it is also an easy time to over-commit to seemingly disparate research and writing projects and lose sight of what you actually set out to accomplish during the two years.
Opportunities
Anatomy and simulation courses and training. With the continued concerns regarding open surgical training volume, doubling down on program-initiated, regional, or national courses seems like a no-brainer.
This past fall, our program had its first cadaver lab where we worked in teams of senior/junior trainees to cover all the major vascular dissections. I also attended the Midwestern Vascular Surgical Society (MVSS) simulation course, which covered everything from lower extremity bypass to ruptured endovascular aneurysm repair (EVAR), and ZFEN (Zenith Fenestrated AAA endovascular graft) to transcarotid artery revascularization (TCAR). Other courses on my list to attend are the Louisiana State University Fundamentals of Vascular Surgery Symposium, Top Gun skills competition at the Society for Clinical Vascular Surgery (SCVS) annual meeting, Houston Methodist open aortic training course, and the Weill Cornell Big Apple Bootcamp skills course.
Threats
Burnout and letting self-care fall to the bottom of my list. While I don’t think I have personally experienced burnout, I know that making sure to schedule yoga classes, meal prep, and family time on my calendar (just like all my other work commitments), makes me feel better and more whole. If you are clinical right now, this is hard. But even just fitting in a 15-minute high-intensity interval training video with my coffee in the morning before heading to the hospital, or after getting home from a long day before dinner, can shift my mood entirely.
This year, rather than resolutions, I would encourage you to write out your SWOT analysis and maybe even share it with someone else. Hearing a co-resident’s struggles, and then sharing your own, is a powerful way to connect and combat burnout. Don’t let one bad day, week, or month define you. Vascular surgery also doesn’t define you, but it’s a large part of who we are, who we have chosen to become. It is also a path of continuous evolution. Just when you’ve mastered one skillset, it’s time to feel uncomfortable again. This holds true through every transition, from intern to second year, second to third year, third year to research time, and research years back to the last two clinical chief years.
So, as I get close to starting up “Heartbreak Hill” with just a little more than two years left in training, I am reminding myself of why I chose and love vascular surgery: our patients have complex disease requiring our creativity and resilience, and yet they accept the redo-redo-redo procedure and remain grateful. We have lifelong relationships with our patients, and we are still the only surgical specialty I know to receive holiday cards and gift baskets from our patients and their families. We are the firefighters of the hospital, the service other surgeons call when they need help. We foster a culture of innovation and research. We are a close-knit community of approximately 3,000 vascular surgeons, who all seem to know each other, somehow.
Shernaz Dossabhoy, MD, is a vascular surgery resident at Stanford University in Palo Alto, California.
