Corner Stitch: Acing the final training years

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In academia, the start of summer brings about new beginnings and a changing of the guard. Chief residents and senior fellows graduate and start new jobs. This month, we decided to pick some of their brains to share their lived experiences and lessons learned for those who will be transitioning. Although 2020 was an unusual year to be a senior trainee in vascular surgery given the clinical repurposing that occurred due to COVID-19, there are still lessons to glean from the experience of our graduates.

Contributing to this column are Zachary Wanken, MD, a Dartmouth integrated vascular residency graduate and new Washington University, St. Louis, vascular surgeon; Ignatius Lau, MD, a Mt. Sinai integrated vascular residency graduate and now vascular surgeon in Northern California; Brandon Downing, MD, a Washington University, St Louis, integrated vascular graduate and newest Community Health Network, Indianapolis, Indiana, vascular surgeon; and Laura Maria Drudi, MD, who recently became a University of Montreal, Canada, vascular surgeon. Juggling the final years of training and an active job search takes deliberation and discipline. Here’s what our columnists had to share about doing both with aplomb.

Operate

ZW: My #1 goal during my senior year was to make sure I became independently capable as an operative surgeon, both technically and from a decision-making standpoint. To that end, I scrubbed the most complex cases on our schedule and made sure to scrub a wide breadth of cases, too.

IL: Success as a chief resident or senior fellow boils down to operating as much as possible. The best learning occurs in the trenches of the operating room (OR), where mistakes may be made, near misses are discussed and emergencies are handled deftly. This stuff isn’t written in books. The only way to gain this knowledge is to increase the total number of cases that you do. As a chief, I chose high and low complexity cases to prepare me for what was to come.

LMD: The final year of training in Canada amidst a pandemic was challenging. I had to juggle chief responsibilities, studying for the Royal College of Physicians and Surgeons of Canada licensing exam, fellowship planning, and managing my soon to be surgical practice. Therefore, my priority in my final year was to ensure I was a competent surgeon. I knew the case history, operative planning, and divided tasks during the cases to ensure all members in the team had an opportunity to learn and participate. As a result, that year I became a leader in and out of the OR and my confidence grew exponentially.

BD: For your own training, it is important to continue to do the little cases because you will likely be doing far more “smaller” cases at the beginning of your career. My co-contributors have made some very excellent points. My only addition is to be mindful that the last few months of training can lead to burnout. Scheduling a vacation during those times is not a bad idea.

Develop your soft skills

ZW: My last two years, I focused on developing my management, leadership and teaching skills. This gave me useful experience in a safe environment where I could lean on the experience of my attendings. Focusing on these skills also gave me insight into the type of job I wanted.

LMD: Throughout training, I participated in several professional, leadership and educational development activities through the likes of the SVS. I always strive to be a better physician, surgeon and person for my patients, my colleagues and myself. I developed a reputation of being a compassionate and empathetic surgical leader. In terms of management skills, I feel it is a constant struggle for me to balance and integrate the various aspects of my life and career. Rather than view this balancing act as a struggle, I choose to see it as an adventure.

BD: To be successful in your final year of training, it is very important that you continue to support the workflow of all trainees to keep morale high for all. As you know, surgery takes a team effort, and now you play a major role in making that team function.”

Know your career phenotype

ZW: From my experience, the delineation b etween academic practice and private practice is an oversimplification. I think the job landscape actually offers a great variety of positions that don’t fit neatly within the traditional academic or private practice models. Therefore, it is more important to focus on what you want out of a job or career. For example, many academic or private practice jobs incorporate research, trainee education, clinical trials, etc. I would recommend reviewing all available options.

IL: First, you have to figure out what pathway you may want to pursue. There are timelines to consider also. For instance, academic jobs tend to be available in the winter and later when budgets are released. Private practice jobs, on the other hand, can become available as early July of your final year. Prospective private practice employers may want an answer within a month of an offer, which can be challenging if you’re considering multiple options..

LMD: Throughout my vascular surgery training I made an intentional effort to brand my name and image, knowing that I have always wanted to become an academic vascular surgeon, and knowing that the job market is limited in Canada. However, I followed my passions and opportunities opened up for me to pursue the career I wanted. Through my postgraduate training in epidemiology, I became an expert in frailty and vulnerability for patients with PAD. My branding came from several years of attending conferences, networking with vascular trainees and faculty, presenting research, and volunteering on committees.

Leverage your network

IL: Once the last year of training starts, meet with the chief of your division or section, and with trusted mentors to ask for references and to tap into the connections that they have. Be honest with them about your goals and what you’re looking for in a job. Make an effort to go to conferences in person and meet people. Sometimes, the first interview happens at these meetings. Pro tip: Meet with the representatives from each of the device companies that you have come to know and work with over the years. More often than not, they will have colleagues in the region of the country where you may be considering.

ZW: Visiting your potential new job location, if you haven’t lived there before, is important. Also important is speaking with graduating residents/fellows or erstwhile partners of your new practice.

LMD: I have continuously networked with the vascular surgery community. I attended my first VAM in 2011 and always attended even when I wasn’t presenting. I became passionate about vascular outreach. I even became a simulation instructor. I further engaged in committees that were meaningful to me given my lived experiences. I am truly looking forward to growing alongside the incredible mentors and sponsors who have been by my side along the way.

Christopher Audu, MD, is an integrated vascular surgery resident at the University of Michigan in Ann Arbor, Michigan.

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