Education BTK Podcast_Episode #5

Hello, everyone, and welcome to the fifth episode of the Behind the Knife podcast series brought to you by the Collaboration of Surgical Education Fellows, or COSEF. My name is Josh Rochelle. I'm a general surgery resident at the Brigham in Boston and a surgical education fellow at the Branch in Galveston, Texas.

Last time, we talked about how to navigate the hidden curriculum of the main residency match. In this episode, we're going to be talking about another complex and nuanced topic, personal and professional identity development during surgical training. Lucky for you listeners out there, the great doctors, Darian Hoagland and Maya Hunt are joining me as my co hosts for our discussion.

By the way, you'll want to stay tuned until the end of the episode to get some practical tips for your blossoming career. Hey everybody. I am Darian Hoagland, a general surgery resident at Beth Israel Deaconess Medical Center in Boston in my second year of academic development time as a simulation fellow.

I am super excited about this topic. I feel like medical students, residents, and even faculty struggle with the rat race of becoming a doctor where everything just feels like a means to an end.

Yeah, I absolutely agree with that, Darian. I'm Maya Hunt. I'm a general surgery resident at Indiana University in my second year of professional development time as an education fellow, and I'm also obtaining my master's in health professions education from UIC.

This is a really big topic, and I'm pumped to get into it. Like, what is a surgeon? Darian. Why are we surgeons? How do we want to be as surgeons? It's fascinating to think about. Wait, wait, before we get started, for all you new listeners out there, you might be wondering, what the heck is COSEF? Well, we're a multi institutional organization of surgical education research fellows working together to foster peer mentorship, networking, and scholarly collaboration.

We meet every week to discuss ongoing research efforts by individuals or by smaller groups within COSEF. And we collaborate with larger groups like the Association for Surgical Education and the American College of Surgeons as well. Put it simple. We're by residents. For residents. If you're a surgical education fellow or a surgery resident interested in education and you wanna

join cef, email us at cef connect@gmail.com.

That's C-O-S-E-F connect@gmail.com. You can also learn more about us on our fancy new website. Okay, thanks for the advertisement, Josh. Now, can we get into it? Be my guest. Uh huh. Get it, Maya? Um, yeah, that was great. Terrible. Anyway, professional identity can definitely be a nuanced topic to dissect. For all of our listeners out there, we want to make sure that you walk away from this episode with both practical tips and genuine insight.

Help us give you a well rounded perspective on the topic we've recruited some help. We are thrilled to be joined today by five general surgery residents from around the country. Kathy Lue is from Tulane and currently in her first year of professional development time in global surgery with UNC in Malawi.

Ariana Nassa is in her second year of professional development time at WashU St. Louis. Colleen

McDermott is in her second year as an educational research fellow at the University of Utah. Tanur Ahmed is in his second year of professional development time at Indiana University. And Ananya Anand is back clinically at Stanford after recently finishing her professional development time there as an education fellow.

Welcome everybody. Great to have you all here. Ananya, let's start with you. I know that you actually spent your professional development time researching professional development time and professional identity formation. That's honestly pretty meta. How does the academic community as a whole approach this concept of professional identity formation and professional development time?

Well, first, there's a difference between Professional Identity Formation and Professional Development Time, or PIF and PDT, respectively. So, starting with PIF, Professional Identity Formation refers to the development of your professional aspirations, values, and actions. So, for physicians, this is all about the dynamic process of learning how to think.

Think, act, and feel like a doctor. Professional

identity formation is influenced by many different factors, such as role models and mentors, formal teaching and assessment, symbols, rituals, clinical, non clinical experiences, and the attitude of patients, peers, and other healthcare professionals. Over the last several years, there's been a growing push in medical education to actively and explicitly teach professional identity formation.

So it's no longer something we assume people just figure out on their own. Instead, we're fostering an understanding of what professional identity formation really is, encouraging reflection and reevaluation, and even formally assessing how an individual's professional identity is developing. That seems like a big shift, especially in surgery, since we're pretty much pretty notoriously resistant to change.

Yeah, absolutely. So this shift is particularly important as the landscape of professionalization and surgery is evolving. For example, there's now more emphasis on work life balance and wellness, which challenges some of the traditional historic norms in surgery, like the stoic

ethos that historically defied physical or emotional weakness.

I'm sure we've all experienced or maybe even participated in conversations where residents talk about going for hours without eating, drinking, or using the bathroom as some kind of badge of honor, or we've overheard attendings talk almost nostalgically about working for three days straight in the hospital with no sleep or breaks.

So for some of the older generation of surgeons, this evolution of surgical culture can feel like a threat to the professional culture and identity they grew up with. But for newer trainees, it's an opportunity to. Define a more sustainable identity as a surgeon, and it's also possible that high rates of attrition in surgical residencies could indicate a possible identity dissonance where resident professional identity is at odds with their pre existing values and beliefs.

And honestly, I think residents should feel empowered to continue searching for their professional identity, especially in our current health care climate. Yes, so now compare that to professional development time, or PDT, which many of you know as

dedicated research time or academic development time. So this is a specific block of time, usually during residency, where trainees step away from the clinical grind to focus on personal interests or academic pursuits.

Over a third of general surgery residents now pursue PDT, and this trend has been growing. Back in the 1990s, only about 20 percent of residents took dedicated time off for research or academic work. But by contrast, in the 2000s, that number had climbed to nearly 40 percent. Wow. I didn't realize there were people taking professional development, and time had actually doubled in only a decade.

Yep. And a major part of it is that PDT offers a chance to explore passions beyond clinical duties, whether it's diving into a research project, earning an advanced degree, or even pursuing creative endeavors. It's a break from some of the more relentless demands of residency and a way for residents to engage with their personal and professional interests.

in a deeper and more meaningful way. So while PIF is about shaping who we are as surgeons and the values we carry into our

professional lives, PDT is about carving out time to develop specific skills, knowledge, or interests that can complement our clinical training. And both are important, but they address different dimensions of what it means to really grow as a surgeon.

Thanks for the insight, Ananya. They seem really separate, but are also really intertwined. I'm currently taking my PDT right now, and it's been quite formative for my professional identity, which I had really never thought all that much about previously, or at least I didn't do so consciously. This whole topic seems like it requires a lot of thought.

Forethought and honestly some pressure you feel like you have to get it right and make the most out of your PDT. I mean, people always tell me, you'll never get this much free time again to explore ever in your career. So I don't know about you guys, but I was definitely anxious about making sure that I do things, quote unquote correctly going into PDT.

Oh, absolutely. I think most of us probably felt that way at some point. That's what makes the distinction between PIF and PDT so interesting, right? So the thing about

PIF is that it's kind of a lifelong journey. It's this constant evolution of who you are as a surgeon and a doctor. But PDT is a bit different.

It's a legitimate opportunity cost, right? Taking time off comes at the expense of potentially your salary, your clinical experience, and even some of the momentum you've built during your training. There's a lot of internal and external pressure to make PDT worth it. So before we dive into a deeper discussion on professional identity, I think our listeners would really benefit from some boots on the ground advice for how to approach their professional development time.

Yes, I love practical knowledge and I know our listeners do too. So I think you can tackle the elephants in the room of PDT and PIF with a set of high yield questions. Think about it as who, what, Where, when, and how. So for example, Maya, who do you think should take time off for professional development?

It really depends on your future career goals. If you're interested in pursuing a fellowship, particularly a competitive one, such as

pediatric surgery, taking PDT to publish and present at national conferences will make you a more desirable candidate to fellowships. If you want a future career that would benefit from having additional degrees, such as an MHPE, an MPH in global health.

are masters in clinical research so you can run your own lab in the future, then it's worth it to take time to obtain these degrees, and some programs pay for them. If you're not sure what you want to do and are considering academia versus community practice, taking professional development time can help you decide if the future in academia is right for you.

The dissemination of scholarship, a. k. a. publishing, remains the currency of academia as a nearly universal requirement for promotion and tenure. Do you like the practice of research? PDT can help you answer this. Lastly, others choose to take a year away from surgical training to pursue a clinical fellowship, particularly those that are non operative, such as critical care or palliative care.

These may better fit your educational trajectory and help you avoid major interruptions and operative experience between chief year and

your first faculty position out of residency. Honestly, it can be a very high yield use of time. Exactly. And while this is a break from the typical rigors of residency training, this is not a two year vacation.

You are still working, it's just different from clinical time. While PDT can help those who are experiencing burnout, a recent study has actually shown it's pretty limited to those research years with no differences in burnout rates by PGY 5 years between those who do research and residents who don't.

Ah, so it really doesn't get better, huh? While there are also some very real and important ways to use this time outside of career advancement considerations, for those of us in particularly long residencies, this time is often the best time to manage health issues like that knee surgery you've been avoiding, or start a family without the physical and time stresses that come with clinical training.

With more and more data coming out about the increased risks of pregnancy in surgical trainees, this time mid training as opposed to waiting until you graduate. can be really important for fertility and family planning.

Also, when it comes to who, I think it's also really important to consider who you surround yourself with in terms of mentors when you're deciding about PDT.

That has a huge impact on your experience. Oh, absolutely. Look to those who are doing research in an aspect of your future career goals. This could be clinical, basic science, outcomes, education, research, whatever. You can also seek out those who have positions you're curious about potentially holding in the future to see what the job is like and how to set yourself up for success.

You also need to consider what you want and need out of a mentor. If you're working on projects in a new field or environment, you might need more hands on instruction, guidance, and follow up. If you're someone that desires more freedom and is really self motivated, then a more hands off mentor would probably suit you better.

I think mentorship is also about finding someone who truly invests in your personal and professional growth, whether that's helping you with grants and CVs or advising you about your professional identity formation. It can be informal, like an attending that you vibe with in the

operating room or someone you feel comfortable going to for even personal reasons.

Even if they're not officially your insert specific research niche here mentor and keeping those connections alive with small gestures like sharing a meme or a holiday message makes it easier to reach out when you actually need real advice. Absolutely agree, Josh. Well, since we know a bit more of who should take professional development time and who you should surround yourself with, the next question is obvious.

What should I do with my time? Colleen, could you help us out? For sure. Part of the appeal for general surgery for me was because I liked everything during med school and surgery seemed to have it all. But then I had the dilemma of having to turn liking everything into a cohesive research idea. And I'd done basic science in the past, like before I went to med school, I'd already.

I earned an MPH when I was a medical student, so I'd done some work in that space. The world was my oyster and I was paralyzed by choice, like should I get a master's in medical illustration? Should I write a book? Should I do a global surgery project? Okay, that's stressing me out even. How do you, how do you reign the ideas in?

First, I would talk with your mentor or whomever's in charge of your research division. These are faculty members who are usually used to working with trainees, navigating research time, and they can help you identify the faculty who are doing the types of work you're interested in. When I met with our research faculty, I got a great piece of advice, which was to research something that makes you angry.

Some of the questions I find most interesting are the ones that relate to things that drive me crazy. And those will always be pain points that you'll be motivated and excited to work towards fixing. That's so true. And I feel like we do a lot of that within CoSaf. I think it's so hard to motivate yourself to work on a project that someone else finds interesting, but it's not necessarily your passion.

So how do you figure out how to channel that rage into research? Like, are we talking here about researching how to avoid getting page about melatonin at two in the morning or what? No, that's actually not a bad way to start a project at all. A different piece of advice I heard was to make a list of all the things you love in life versus hate, and this can be big or small, like you can love having a nice cup of coffee, or helping a mentee not give up on their goals, and you can hate being stuck in traffic, or

you can hate seeing brilliant and motivated people leave medicine due to burnout, and not that coffee or traffic are necessarily going to be your research idea, but it's just that if no idea is too big or too small, it'll be easy for you to keep thinking, and once you've made your list, you can sit and circle it and look for patterns.

I never actually intended to do education work during my research time, but one of the things that inspired me to get an MPH originally was that I loved looking at the system and the context in which we practice medicine. I'd previously spent a lot of time looking at patient centered contexts, like, for example, social determinants of health or health systems.

Disparities, and now looking at a physician centered context has been really fascinating. When I look at combining some of the work I've done in the education space with practices from public health of looking at gaps, looking at disparities, looking at opportunities to avoid premature and avoidable losses, which in this case might be talent or quality in the physician workforce.

And it turned out that surgical education was where I could put a lot of this motivation to good use. I don't know, Colleen, that process sounds an awful lot like qualitative research if you ask me. Yeah, I didn't

necessarily create a code book because I hadn't done much qual work yet, but I identified themes of things that pissed me off and that gave me a lot of what I called million dollar questions.

For example, how do we train each trainee to be the best surgeon they can be? Or what's the balance between rigor and burnout? Or how do we fix a physician shortage? And then I used these big ideas to come up with more doable projects. Nerd. That's really cool though. I love that you did that. I really resonate with that advice, Colleen.

One of my mentors who actually interviewed me for residency said that it's really important to research something that pisses you off because if it pisses you off, it likely pisses other people off and that's how you start a movement. So, shout out Dr. Nays. Go Dr. Nays, that's some good mentoring. Yes, and coming back to what you should do, I think it's also worth considering doing a degree program because that can help you learn more about things that you might be interested in or pissed off about.

I'd actually never heard of public health as a field of study until I got to college and I asked a girl on my floor what her major was, she said public health, and I confessed that I didn't know what that

meant and she was like, Um, have you heard of the CDC? It's what they do. And so now I've gone from that level of understanding to learning more about things under the public health umbrella like outcomes research, DEI, health disparities, et cetera, that I might've not known about otherwise.

And the more you learn, the more questions and ideas you can have. And a master's program can also help you learn research skills that you can apply to other scenarios or an MBA can help be a great opportunity for developing leadership skills. Those are great points about how to find out just what you want to study.

Like you said, the point of your PDT is not necessarily to complete just one project. It's to learn and build a research skill set and a network. So similar to how clinical education works, I may not plan on becoming a bariatric surgeon, but doing the rotation taught me important things like laparoscopic skills.

anatomy, and the principles of managing malnutrition, but your research time similarly can help you build tools for future work, whether it's qualitative methods, learning how to code, getting really good at responding to reviewer comments, working with large

databases, or whatever. I personally tend to think about research in three main buckets, so basic science, clinical research and outcomes, and other.

Which is policy, QI, education, innovation. It does seem like the other category keeps on growing, so maybe I need to readjust my framework soon. But usually one or two of these will be inherently more interesting to you. But you're not limited to doing just one. A lot of people that I know, including myself, have their hands in projects in more than one of these domains.

But if you know, you want to have an academic career involving a certain type of research, this is the time to lay the groundwork for that. But for those people who are unsure, no, no, this is the time to figure that out. Some of it comes down to one, your personal goals and two, your program's goals for this time.

Is your goal to reach a certain number of publications? Then consider the timeline that it can take to complete certain types of projects. Unless you're going into a well established basic science lab, it can take a while to get a lot of these projects to

publication. Hey, isn't one of our COSF members, Joe, studying how long it really takes to publish?

Yeah, coming soon to a conference near you. But really, you can do database outcome studies fairly quickly, but mentorship and statistical support to do them well. Interventional clinical studies or big educational research projects typically require a lot of administrative and logistical work beyond just research design.

Do you personally have the skills to do that, or do you have team members who can support you in this? Aside from aiming for publications, you should have other goals for your time. These can include learning how to design a research study, how to do your own statistics, and more. How to write a manuscript, how to critically appraise and review others work.

Ultimately, a lot of the skills you will develop while working on your main projects will be translatable to other areas of research as well. And finally, though some areas may be more interesting to you than others, Access to these labs and established positions with funding are key parts of having productive years.

Sometimes the type of research you do can come from what people in your program have done before you or who your mentors are. So talking to those around you about what they've done will be super helpful. Whatever you choose to do for your professional development time, make sure it's interesting to you in some way.

This isn't just about filling time. It's about spending one, two, or even three years doing something you find meaningful. And if the work doesn't feel important to you, it's going to be a long haul. And beyond just being interesting, your PDT should help you reach your goals. You'll want something tangible to show for it, whether it's publications, presentations, or skills you've developed.

Think about it like research in med school. You want those lines on your CV and the ability to confidently discuss your work during fellowship interviews. So that's setting yourself up for what's next, while also making the most of this time. And so once we've decided on an area to focus for our professional development time, Josh, like, what are your thoughts about where you should do it at?

That's such a great question, Colleen. Where you do your PDT can make all the difference,

and once you've nailed down your focus, it's time to think strategically about the opportunities available at your own institution versus stepping outside to explore something new. Most of the time, staying at your home institution just makes sense, financially, logistically, and even emotionally, uprooting your life.

Maybe your family, friends, or that support system you've spent years building in residency for a temporary position might not always be worth it. So before you decide to go elsewhere, you should have a pretty solid reason why staying at home isn't the best option for you. Yeah, it can be a risky move.

Now, that said, sometimes going somewhere else is the right move. Maybe you've got family or a partner who lives far away from where you're doing your clinical training. Or maybe your interests evolve and you want to work with a specific mentor or gain access to resources or an environment that your home program just can't provide.

It's all about weighing the opportunity cost. Ask yourself, will I grow more here? Or is there something outside my institution that's worth

exploring? So my advice is to be proactive, talk to your program director, faculty, and other residents who've done their professional development time before. Find out what opportunities exist that your program and whether others have paved the path that you can follow.

If they haven't, you might be better off going to a program where the structure is already in place rather than trying to build something entirely new at home. And so if you do decide to leave your institution, you'll need to get a really clear idea on what you want to achieve during this time. Soul search a bit on what your ultimate goal is.

Use the internet. There are formal opportunities out there to use during your PDT. And honestly, Josh, even tools like ChatGPT can help you brainstorm ideas and find programs. I know we all love some good prompt engineering. Yeah, for example, if you're into surgical education, the ACS AEI Surgical Education Fellowships are a great option.

But pay attention to the details. Are these positions paid? Will your home program sponsor part of your salary? Practically,

you need to be able to put food on the table. Consider also what's required for the application, a CV, personal statement, recommendation letters, and what your day to day responsibilities would look like at this other program.

You can connect with faculty or even past fellows from these programs. Even better, talk to someone from your home institution who's done it, and they can help you figure out whether it's a good return on your investment. But if you do go away, don't completely disconnect from your home program. Staying integrated can be tricky but super valuable.

Before you leave, identify mentors at your home institution and try to set up regular check ins. Maybe keep a long term project going if it's manageable. And while you're away, send occasional where am I now emails or text messages. Throw in some photos. Share what you're learning. Trust me, your mentors will appreciate it.

Speaking of stepping outside of your institution, let's take this idea like way, way away, like across borders. Kathy, you're our global surgery guru. Can you share your thoughts on how professional

development time can open doors to opportunities in global surgery and what folks should consider if they're thinking about taking their training abroad?

Thank you, Maya. You're way too kind with the guru talk. We could actually spend hours with this question, but I'll try to keep it concise. To truly do global surgery, you need to spend time with your boots on the ground. So PDT can offer you the opportunity to go abroad, understand what it really takes to get things done in another culture.

For example, here in Malawi, where I am, it took me a solid month just to learn that a formal greeting here is absolutely essential, even sometimes to buy bread. It's all part of adapting to a new environment. But before committing a year or two to global surgery, you need to determine your motivation and what you hope to achieve.

My mentor once said that there are three main types of people who go into global surgery, the missionaries, mercenaries, and the misfits. Bye. The missionaries are motivated by a greater good, often

religious groups. Mercenaries are driven by professional financial goals. Well, misfits are kind of seeking self discovery for a new perspective on their career.

But most of us are actually a mix of all three. But the key is to be completely honest with yourself before you even start. That's a really helpful framework. So once someone identifies their motivations, how do they take the first steps? Again, so finding a mentor is critical. You will be navigating an unfamiliar culture where things don't work the way you're used to.

A mentor with resources and local connections can definitely help you to avoid some missteps. So try to establish something from scratch in a year is quite tough, actually. Especially if you don't even understand a local culture or sometimes a language or considering that long term impact on the community.

Sustainability is definitely the key here in global health, global surgery. So temporary solutions sometimes can even create more burdens than benefits.

Yeah, those are really important points. So where can someone find a mentor these global surgery opportunities? Yeah, so my number one advice would be start early.

Ideally, sometimes a year in advance. The training exchange program between institutions is one of the ways they can get involved. Especially if your institution has an established partnership already with somewhere else. The funding in this case can come from institutional support, grants like Bogarty, or some other smaller independent sources.

Recently, the Lancet Commission on Global Surgery has highlighted the need for global efforts, especially in the surgical field. So many societies now have a global surgery committee. So if you had already picked a sub specialty of interest or have other specific interests such as education or leadership in mind, you may be able to explore those specialty societies.

And find out if those societies also have a subcommittee on global surgery. Lastly, you can always cold

call and email to global surgery leaders, and this can absolutely open doors still. That's some very actionable advice. Thank you, Cathy. Okay, so we've decided what and where we want to do for PDT.

Ariana, can you help me out here with the next step? When should we be taking PDT? So timing your research years really depends on your program, but if you have the option, it's usually somewhere in the middle of residency, usually after PGY 2 or 3, everyone will have different opinions as with everything with professional development time.

And you'll hear all kinds of arguments for one way or the other, but it really comes down to what works best for you. My best advice is to think about practical things, like whether you're planning to start a family or trying to align your graduation date with that of a spouse. Maybe, too, you have personal milestones you want to focus on, like traveling or spending time with loved ones.

I personally got married, have taken a lot of bucket list trips during professional development time, and have been lucky enough to literally work from home and spend a lot of time with my family back in California. Research years can be a good time to do all these things because the

schedule is often far more flexible.

And just remember, if you're still figuring out your career path, research can absolutely give you the breathing room to sort that out too. One thing to consider is that your specialty choice might also influence the timing. For example, some pediatric surgery research programs prefer candidates who are PGY3s when they apply.

And certain enfolded fellowships, like the critical care one we've already discussed, also require PGY3 status. And then there's funding. If your department guarantees it. Amazing. But if not, you'll need to factor in the time for grant writing and securing that. At the end of the day, like we've said throughout this podcast, it's less about what others recommend and more about aligning the timing with their personal and professional priorities.

Okay, we're so close to being done with our not so quick hits, but I really want to hear from Shinur because there are definitely aspects of how to navigate this time that are pretty important to know up front, especially as the basic scientist of this group. What can you tell us about setting yourself up for success for all kinds of research?

Thanks, Maya. A common question is, how much

time should you take off for professional development? It really depends on your goals and whether you're doing basic science or clinical research. For basic science, two years is typical, but there's a sweet spot around 12 months, six months to settle into the lab and six months to wrap up and write.

The first six months can be slow due to onboarding, but you can offset this lag by preparing in advance. Start lab protocols, complete necessary training, especially for animal models and attend lab meetings before officially starting. Yeah, those city trainings alone can take forever. They really do, but early preparation can help you hit the ground running, especially with processes like IACUC approval.

The last six months are all about completing experiments and preparing journal submissions. Funding is also another consideration. National programs like NIH T32 or F32, societal grants through ACS, AAS, or SAGES, or institutional support can cover your salary. Yeah, and if you're pursuing a master's or a PhD during this time, keep in mind that some programs do come with tuition costs.

Absolutely.

And to offset costs, Mood Learning is a great option. It not only helps financially, but also helps to keep you connected to clinical practice. All right, folks, that's the who, what, when, where, and how of professional development time. We've wrapped up the big picture stuff, and before you get to hear about all the ups and downs of our own professional development time experiences, it's time for a major key alert.

Cue the music.

Darian, why don't you kick us off? Okay. First, I would recommend keeping a well organized list of your ongoing projects, which categories they all fall into, what your next steps are, your goal conference or journal for submission, and especially the deadlines for submissions for those. This can help you know what your true capacity is to say yes or no to new things and to make sure you're on track to get your abstracts in on time.

Learn from my mistakes. All right, Maya. What you got? All right. Do not waste hours

struggling with PowerPoint to make your poster. Tools like the BioRender Poster Builder are a game changer. They have professional templates that make formatting quick and easy, and you can even create high quality scientific figures directly into the design.

Seriously, it's worth checking out to save time and stress. I have spent whole days making thousands of tiny changes to posters before I knew this existed. Josh? For me, it has to be a reference manager, absolutely essential for staying organized during your research years. It takes some initial activation energy to learn new software, but whether you're Team EndNote, Zotero, or Mendeley, pick one and stick with it.

They'll save you so much time formatting citations and creating bibliographies. Bonus tip, learn how to use their cloud sync features so you can access your library from anywhere. Trust me, it's a game changer for your writing. I sat down with a friend who is a busy postdoc to get her advice as someone who does research professionally before I started my research here, and she said one of her best habits was to clear your inbox every day.

The point

was that by the end of the day, all emails had to either be addressed or flagged to deal with at a specific time, and this usually takes just a few minutes and keeps things from building up and creating anxiety, and the two minute email that would have taken two minutes to deal with then only really takes two minutes of your time.

I made folders in both my university email and Gmail to move correspondence about projects to refer to later. For those who have educational debt and are also doing basic science during professional development time, the NIH offers repayment of medical student loans up to 50, 000 annually for two years through the NIH Loan Repayment Program.

Applications typically open around September of each year, and this is a great way to engage in professional development time. While also tackling educational debt. Okay, I have learned so much already. Thanks guys. If you have access to the opportunity, I would highly recommend moonlighting. Not only to stay up to date like we've discussed, but it's also a super awesome way to make some extra income to treat yourself to something special as you celebrate finishing two or maybe three years of an incredibly

challenging residency.

Think about those trips you want to take or the things you wish you could splurge on that will not only make your professional development time way more fun, but your clinical residency time more fun to just be sure to look at this application requirements for obtaining a license to moonlight in your state because it can take upwards of six months to obtain.

These are some amazing tips. Also consider a professional coach that understands your background but is not one of your mentors. They can provide insight on your overall career path and bounce ideas off of without the fear of being judged professionally. Some societies, such as the Association of Women Surgeons, offer coach matching and referrals to professional coaching services.

And don't forget not to stretch yourself too thin. This can be a major pitfall of professional development time. It is easy, especially when out of clinical time, to say yes to a lot of different projects and endeavors. Since there is an assumption that you are more available, however, have realistic expectations and tangible goals for the

projects you take on and be able to set boundaries to ensure that you really do have the time to put most of your effort in things you are truly passionate about.

Okay, y'all. Thank you for those amazing tips. And now it is time. For the juicy stuff, I'm sure we've all come to some realizations during our professional development time. So what do you wish you knew before this chapter in your life? Would you change anything about your academic development time if you could?

Ooh, me first. Okay, here's the thing. There aren't any universal benchmarks for success during research years. What makes someone feel accomplished is going to look different for everyone. The most important thing is that when you reflect back on this time, you feel like it helped you grow. Both personally and professionally.

It's not just about how many publications you churned out, how many conferences you attended, or whether you added an extra degree to your name. Those are nice, but the real measure of success is what this time meant for you. Wow, you're speaking my language. I totally echo what

you said about success being personal.

Your mentors might have their own ideas of what success looks like for you during this time, and that may or may not align with your own vision. It's really important to be up front with your goals and not be afraid to turn down projects or opportunities that don't fit with what you want to achieve.

Learning to say no has been a crucial lesson for me, and It also helps me protect my time and sanity. And lastly, like Josh alluded to earlier, I highly recommend finding a mentor who isn't one of your PIs. Having someone who can help you navigate your professional identity formation, somebody who can advocate for you, share in your successes, or really discuss any problem.

It's hugely valuable. It's made a really big difference for me. Yeah, absolutely, Maya. Mine's totally related. I would really encourage myself to not say yes to so many things in the beginning. As overachievers, we often feel like we have to fill all of this newfound freedom with work. But, you don't have to.

You're allowed to work a normal schedule or, gasp,

even less! You'll get more fulfillment spending time on projects that align with your vision for PDT rather than just taking on things that are handed to you. Be patient, give yourself that space to craft the experience that you actually want. Yeah, this was my experience, too.

I wish I had been more patient with myself at the start. I came off a really busy PGY3 year, and maybe was a little burnt out at the end, and I just put so much pressure on myself to be super productive right away, whether it was signing up for every moonlighting shift, every project. And research time can feel so nebulous, it's easy to compare yourself to others, especially when previous fellows or colleagues can seem like they were rock stars, and they just were so, so productive, and you want to be like them.

But this is the one time you don't have to work 80 hours a week. So you can trust that you can succeed and have a more relaxed life anyway. Y'all get to relax. Just kidding. I wish I had onboarded into the lab earlier. Things like getting added to the lab protocol or submitting surgical experiments to IUCAA takes time to review.

If I had done that sooner, I could have hit the ground running

earlier. I don't blame you, Shannar. Personally, I wish I'd known how many people actually feel lost without the structure of clinical residency. Professional development time was always described to me as this amazing, relaxing, free time. But actually, without that structure, it can feel disorienting.

And I've actually found that this is a pretty common experience for people who have all of a sudden no clue what to do with themselves. Creating my own structure and finding new and fulfilling ways to fill my time outside of work, which was a truly novel concept for me after three years of surgical residency, were super important for adjusting.

This is also a good time to think about beefing up your support system, scheduling that self care, scheduling that therapy appointment that you haven't had time to do. Best ways to reorient yourself and give yourself some structure in this time snaps for therapy But also I'm still figuring out what my own structure looks like.

Yeah, absolutely I echo what everybody has said so far about not taking on too much and have a structure of your time Figuring new routines. So for

global surgery, my number one advice is to be patient. Also, what is a process? America is truly one of the fastest moving countries that I've been to. The rest of the world just does not really operate like that.

It will humble you and force you to start to adapt with slower pace. The hardest thing for me personally, still right now, is to learn to wait. The most widely used phrase in Chichewa, the local Malawian language, and Swahili are Pongono Pongono or Poli Poli. Which both means slowly, slowly. And I want to emphasize the importance of personal time and growth during your professional development time.

Undoubtedly, you will now have more time in your, than in your clinical years to be present at weddings, birthdays, family events, etc. So, make the most of that. Having basically every weekend off is a luxury, so I really maximized that time to spend with my friends and family and strengthened the relationships that may have taken a beating during residency.

I got married and had my first child during

professional development time, and those were probably the greatest highlights of my PDT. But also we're opportunities for tremendous personal growth, particularly in my new role and identity as a mother. It is totally doable to be academically productive during PDT, but also to be personally productive.

Enjoy the ability to be a yes person during this time as opposed to a sorry, but I can't make it because I'm on call person as we so often have to be during clinical time. Hopefully our listeners can take these lessons and create a professional development time experience that's both productive and fulfilling.

Okay, hang on. We still need to address the elephant in the room. How do you go back to clinical training?

It's such a different life. We've just talked about building skills, finding hobbies, and basically expanding on our professional identity during this time. So sometimes it feels like you're becoming a brand new person during these years. I know, I remember a

senior resident in my program once said that coming back to clinical training after your professional development time feels like choosing surgery all over again.

That stuck with me because it highlights just how transformative this time can be. That's totally understandable. There is actually a paper written by Smith et al. in the Journal of Surgical Education showing that when thinking about reintegrating back to clinical residency, moonlighting is a great way to maintain clinical acumen during research development time.

And while one may not necessarily have operative experience during moonlighting skills such as triaging acuity when you're in the ICU or doing bedside procedures and maintaining familiarity with the electronic health record can also help offset those aspects of being rusty while you transition back into clinical training.

But aside from being nervous about technical skills, one question that we're all asking even more now is How does this new me integrate back into a clinical resident role? Well, that's a great segue back into talking more about professional identity

formation. The transition back into residency can highlight a lot of the conflict between the professional identity you had before.

PDT, and the person you are now. PDT is a unique period where residents are removed from the environment that has been shaping their professional identity formation up to that point. It's quite possible that if residents PIF is significantly altered, questioned, or even destroyed during their professional development time, they might be at a higher risk of quitting residency.

a major problem that's facing surgical residency programs. So, it's essential that programs continue to support, mentor, and engage with their residents when they are removed from their traditional clinical spaces. Otherwise, the more removed residents feel from being a surgeon, the more likely they will be willing to give up that part of their identity.

Yeah, and something important to talk about, too, is clinical residency can feel like this structured, predefined path. Your role is clear, your day to day goals are really set, but when you're in professional development time, it's truly a whole different game. Suddenly you're given the freedom to delve into

something full time, whether it's research, education, or even innovation, and that kind of shift can feel liberating, but also really overwhelming.

Right. And there's an odd paradox here. In some ways, clinical residency is easier because the structure is there. You're expected to show up, take care of patients, and check off competencies. But in professional development time, you're building something basically from scratch. Your goals, your projects, your identity as a researcher or educator.

It's challenging, but rewarding. And what about the transition points? Like, starting PD time can be disorienting. Figuring out what you're supposed to do without a clinical schedule dictating your day. Then, at the end of PD time, there's this reckoning when you return to clinical residency. How do you carry your new identity back into that world?

It doesn't seem seamless. Yeah, and what if your professional identity evolves during PD time in a way that doesn't align with your institution's culture? So, say you found a passion for something niche, like surgical education or global health, but your program doesn't

fully support that or reflect it.

That can create real tension. It's tricky because identity isn't static. It evolves with your experiences. And if your institution doesn't reflect or support that evolution, it can feel deeply isolating. But I think part of the solution is building support systems, both informal and formal, that let you explore and really own your professional growth.

Yeah, and that's where academic development rotations can be such a game changer. They give residents a space early on to think about who they are and what they want. And it's not really just about building your CV. It's about intentionally shaping your identity. And programs that recognize and nurture that are the ones setting residents up for long term success.

Absolutely. And residents need mentors who validate those identities, even when they diverge from traditional pathways. It's about showing trainees that their unique passions and skills aren't just allowed, they're celebrated. So what if your professional identity evolves in such a way that you don't feel supported or that you belong at your institution?

Well, the real

takeaway here is that identity formation and residency isn't just an individual journey. It's a cultural one, too. Programs need to create infrastructure and support systems that meet residents where they are and help them grow into who they're becoming, not who the institution wants them to be.

That's what will drive meaningful change. All right, folks. These are some really important soul searching questions. One's that every trainee, whether they're taking PDT or not, should seriously think about. So going off of what Ananya just said, how can you, as an individual, or as a program as a whole, find or create an infrastructure within your surgical training program that supports identity development?

Well, I think one of the most important things we can do is just teach residents about this concept of professional identity formation, that it involves a mix of your clinical, academic, and personal goals, that it can evolve over time, and that building who you are as a whole physician slash researcher slash individual is not limited to professional development time.

And creating both informal and formal spaces for this would be key. Some programs in general surgery and other specialties have dedicated academic development rotations in the junior years to allow residents to get started early on thinking about their goals. There's an excellent example in a recent paper that describes a two week academic development rotation for junior surgical residents.

It gives trainees time away from clinical responsibilities to focus on mentorship, academic projects, and refining their career goals. It even led to more grant applications and funding successes. That's tangible proof that initiatives like this can make a lasting impact on surgical culture. And shout out to co staff member Michael Kochis for leading the charge on that study.

One thing that my program does that has been helpful along those lines is to have regular meetings with each individual throughout PGY 1 through 3 to learn about their personal and professional goals, connect them with those resources early, and help guide them towards the right plan for their time.

So while it's really easy to just focus on being a good clinical resident during those years, which is absolutely what I tried to do,

this forces you to spend at least some time figuring out what the heck you want outside of that. Wow, it's almost like to have a thriving physician population. We have to be supported in our individual goals by the larger institutional structure.

Well, y'all, it's been a fantastic discussion, and we hope it helps you, guide you as you plan your own professional development time. And if you're interested in learning more about mentorship or other aspects of professional growth, COSEF will be leading a grant sponsored panel. Panel webinar, webinar panel.

Whatever. A virtual interactive event on mentorship and academic surgery. One of my mentors will be there. Shout out to Dr. Holmstrom. So follow us on x at SurgeEdFellows and BlueSkySocial at COSA to stay updated. Well, I'll be there. A big thank you to all of our contributors today for sharing their experiences and insights.

If you're interested in reading some of the evidence behind what we talked about today, the papers will be linked in the show notes of this episode. Thank you for listening to the Behind

the Knife podcast, and as always, go forth and dominate the day.

Dude, why are you copying right now? We're literally recording a podcast.