The American College of Surgeons (ACS) Committee on Medical Student Education, sponsored by the Division of Education, will host a three-hour program this morning, Saturday, October 23, for medical students interested in plotting their next steps on the road to a career in surgery. Ajit K. Sachdeva, MD, FACS, FRCSC, FASCME, MAMSE, Director, ACS Division of Education, welcomes the medical students, noting how the coronavirus (COVID-19) pandemic has transformed what is traditionally a three-day, live program into a three-hour, virtual session.

The Medical Student Program will begin at 9:00 am Central Time. This year’s program features panel discussions and lectures exploring various lifestyle issues in surgery, decision-making on the path to residency, navigating the residency application process, interviewing successfully, and developing skills as a teacher. Special emphasis will be placed on the specific ways COVID-19 has affected medical education and the residency experience.

Referring to the effects of COVID-19 on medical student education, Stephen C. Yang, MD, FACS, Chair of the Committee on Medical Student Education, says surgeon educators “have improvised, adapted, and overcome, and … now evolved—all traits  surgeons are known for.” Surgeons are considered “the best innovators to handle tough situations based on our passion, training, and altruism,” he continues.

During a panel discussion on submitting electronic applications to residency training programs, members of the committee will offer advice on what to do and not do while waiting to hear back from prospective institutions. A sampling of specific tips to be discussed includes the following:

• First, don’t panic, but be proactive. Stay in touch with your advisor. If you’re not hearing back from programs, ask your advisor what you can do next.
• Start preparing for interviews, and role play virtually both with mentors in medicine as well as with friends in other professions.
• Get comfortable reading surgical textbooks.
• Create a biographical sketch; learn how to talk about yourself.
• Go to informational sessions, such as webinars, open houses, and online hangouts.
• Do your homework, and be prepared to start life as an intern.
• Let your connections know which program is of most interest to you.

Applying to med school in the COVID era

Incoming ACS President Julie A. Freischlag, MD, FACS, FRCSEd(Hon), DFSVS, notes that this is the first class of medical students to go through the entire residency application process virtually. “Once you get that interview, it’s great. You need not worry. They want to talk to you,” she says.

Dr. Freischlag says medical students should not be discouraged if they don’t get into their highest-ranking program. They can still have a residency experience that will serve them well in their career. “I matched at the University of California (UC) Los Angeles, my third choice.” Nonetheless, she has had a productive and esteemed career at Johns Hopkins University Medical School, Baltimore, MD, then at UC Davis, and now as chief executive officer, Wake Forest Baptist Health, and dean, Wake Forest School of Medicine, Winston-Salem, NC.

“You need to have enhanced recovery as you’re coming through this [process],” Dr. Freischlag says, noting that getting involved in the ACS is a good starting point. “The ACS is the House of Surgery. The ACS was instrumental in helping us get through the pandemic by telling us how to delay surgery, how to be safe in the hospital, how to get personal protective equipment, how to train surgeons and residents despite the pandemic,” she notes.

“The other piece of advice I’d give you is say ‘yes’ a lot,” she says, encouraging medical students and residents to rarely turn down invitations to go to meetings, present, write papers, shadow chief residents and faculty, and so on. “Get those experiences,” she says, noting they will teach you how to conduct research and how to be a great clinician, so you’re best prepared to provide quality care.

“Make sure you can go forward and do incredible things—and you will do incredible things,” Dr. Freischlag says.

Preparing for the residency interview

Jacob A. Quick, MD, FACS, a member of the Medical Student Education Committee, will lead a panel discussion on transitioning to residency. The panelists, current residents from throughout the U.S., will address a range of topics of concern to graduating medical students, including the pros and cons of virtual interviews. The panelists encouraged medical students to do the following:

• Find a quiet, well-lit place to interview.
• Demonstrate enthusiasm.
• Attend as many meet-and-greet programs, open houses, webinars, online hangouts, and so on as possible to get a sense of the culture and academic environment.
• Google the neighborhoods around the hospital and university to determine whether they are conducive to your lifestyle.

Yes, you’re a teacher

As residents progress through training, they encounter many teachers and, ultimately, are teachers in their own right. “A teacher is more than simply the conveyer of knowledge,” says Adnan A. Alseidi, MD, EdM, FACS, who will present a session on Becoming a Teacher. Teachers empower students to learn and to want to learn, he explains.

Paul J. “P.J.” Schenarts, MD, FACS, MAMSE, Vice-Chair, ACS Medical Student Education Committee, will explain why every physician should be a teacher. Dr. Schenarts notes that throughout medical history, physicians have been depicted in art surrounded by patients and learners—“always teaching medical students, residents, and faculty how to be better.”

“It turns out, all of medical education is based on one simple concept—reaching down to those below you in rank or below you in experience and essentially pulling them up to your level,” Dr. Schenarts says. Many other health care professionals contribute to physician education, including nurses, pharmacists, pathologists, technicians, biologists, anatomists, and so on. “But only the physician can put it all together,” he adds.

He notes that even postgraduate year one (PGY-1) residents and medical students can be excellent teachers because they will go through each step of placing a central line, for example, whereas this process has become so routine for more experienced surgeons that they may gloss over all but the most fundamental processes.

“One of the most rewarding things you can do in the medical field is to be a teacher, mentor, or coach,” says James N. Lau, MD, MHPE, FACS, member, Committee on Medical Education. Dr. Lau will describe the keys to creating a positive educational environment. He says the focus should be on the student’s goals. Students have goals as learners, as members of the patient-care team, and as individuals, he notes. More specifically, they want to learn, to be acknowledged as contributors to the patient-care team, and to be treated fairly and with respect, Dr. Lau says.

He explains that during a “teachable moment,” it is important to balance the student’s goals with the teacher’s goals. The teacher should seek to educate, acknowledge how the student contributed to a positive outcome, and avoid placing the student in an embarrassing position.

Jeremy Lipman, MD, FACS, also a member of the Committee on Medical Student Education, says that medical education takes GUTS—Goals, Undertaking, Technique, and Sign-out. Teachers and mentors should talk to learners about their goals for participating in an operation. Next, show them the tools and instrumentation necessary to undertake the procedure. Then demonstrate the proper technique during the operation, and finally, sign out with a discussion of what they did well and areas for improvement.

“Feedback is very important because it’s hard to estimate our own ability,” Dr. Alseidi says. “It helps us identify our blind spots.” Formative feedback is provided during the learning process, identifying strengths and weaknesses, he says. Summative feedback occurs at the end of the learning process and benchmarks performance against established standards.

Brenessa M. Lindeman, MD, MEHP, FACS, a member of the Committee on Medical Student Education, will speak about critical thinking as a four-step process:

• Gather and assess all of the information.
• Come to a conclusion.
• Test the conclusion against standards.
• Evaluate decisions.

“Put the learner in your position,” Dr. Lindeman says. “Ask questions, then be quiet until you get a response.” More specifically, ask the learner to connect the dots on how each action affects the operation and recovery, she says.

The joy of surgery

Scott Levin, MD, FACS, Chair, ACS Board of Regents, will speak on The Joy of a Career in Surgery. Dr. Levin is a self-described disciple of William Stewart Halsted, MD, FACS, who established the concept of residency training with graduated responsibility. A world-renowned hand transplant surgeon, Dr. Levin says, “Every day, I come to work excited.”

“Prepare to work hard [as a resident and in practice], but the rewards to you will be immeasurable,” he adds.

Dr. Levin also will explain the role the ACS can play in a surgical career, describing the organization as “the backbone of surgery.” The College’s motto is “to serve all with skill and fidelity,” he notes. To do so, Fellows and staff of the organization are expected to espouse and exude five values: professionalism, excellence, innovation, inclusion, and introspection, also known as PEI³.

Making a good impression, virtually

The session will close with committee members offering advice on interviewing for residency positions. Committee member Barbara J. Pettitt, MD, FACS, session moderator, will offer suggestions on how to make a professional visual impression in virtual interviews. She suggests wearing solid colored clothing because patterns can be distracting. She also recommends covering up any tattoos and removing any piercings to keep the focus on the interviewee’s experience, skills, and interests. She also recommends dressing for success from top to bottom, just as one would if participating in a live interview, because it makes the wearer feel more prepared and confident psychologically.

Most importantly, she says, “Practice, practice, practice.” Be prepared to answer uncomfortable questions about your grades and medical school experience. Record yourself on Zoom and think about the visual cues you may be sending. Answer a question, give an example of how you demonstrated an attribute in a difficult situation, and then stop, she advises.

Dr. Lipman also will speak on technical considerations in virtual interviews. He says it is worthwhile to make the investment in high-powered Internet service and a good camera and microphone. Be seated in a comfortable chair that is positioned so that you are centered and looking straight into the camera. The best light is natural light with soft lighting on the sides. In addition, remove or blur any visual distractions in the background, he says.

According to Dr. Pettitt, residency interviews typically fall into one of two categories: the friendly interview or the stress interview.

The friendly interview usually begins with a low-stakes question, such as, “Tell me a little bit about yourself.” In this case, it is likely that the interviewer either knows a great deal about the interviewee’s medical school experience or very little about the interviewee’s track record. In either case, it is important to give an interesting, brief answer to this query, including one example of the qualities you are trying to demonstrate. Most interviewers “make their judgments about candidates within the first 90 seconds” of the dialogue, she says. So, answer the question and then stop.

“If you’re caught off guard by a question, pause momentarily, and say, ‘that’s a great question,’ and pause again” while formulating a response, she advises.

The stress interview is a different experience and may involve multiple interviewers rapidly firing off questions, Dr. Pettitt says. “Try to control the conversation,” she says. Also, “It’s okay to say, ‘I don’t know’” rather than try to think of an inadequate response. Just avoid saying it too often. Maintain your composure, she advises.

Sometimes interviewers will ask “illegal questions,” she says, including questions about your lifestyle, marital status, plans to have children, other programs to which you have applied, and their rankings. In these instances, “Smile and give a noncommittal answer,” Dr. Pettitt says. “You can answer questions you are comfortable with, but once you open the door, you can’t go back,” she adds.

Dr. Lau will offer tips on questions to ask when you are unable to visit the institution. Ask where residents attended medical school and where they have moved on to, he recommends. To determine culture fit, take advantage of any website videos, program webinars, open houses, hangouts, and so forth. “Ask interviewers what they like about working in the department,” he adds.

The Medical Student Program and other Clinical Congress 2021 sessions are available to registered attendees for on-demand viewing for a full year following Congress on the virtual meeting platform.