Jason Han
@JasonHanMD
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@modern_surgeon Cardiac surgery resident @PennMedicine & Writes a column @PhillyInquirer | @JACCJournals @ArtifOrgans | talking about surgery plainly and openly
Philadelphia, PA
Joined May 2017
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5 years of cardiac surgery residency down -- here are 5 lessons I wish I could have told my younger self prior to starting
After witnessing and experiencing many of life’s extremes in this process, both good and the bad:
== Thread 🧵==
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When I was applying to residency, a surgeon describing their program once said to me,
“One of our residents graduated with >100 publications! If you come here, we can make you that superstar.”
Think about that... >100!
And it kept happening… 🧵//
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When applying to residency, most people dread writing personal statements.
Having written and given feedback on many personal essays over the years, here are 5 tips that I think can make it a little easier. // 🧵
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"To succeed, make sure that each day you study 1 hour, exercise 1 hour, read 1 hour, spend time with family and friends for 1 hour, relax for 1 hour, sleep 7-8 hours, cook your own meals, cultivate hobbies..."
- advice often given to those with 16-hour workdays in medicine
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(5/5) Integrity matters
Some people around you will cut corners or take dishonest shortcuts to success. It never stops hurting to see jerks get ahead.
But people notice sooner or later. Integrity matters. Character matters. And they always will.
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The new application cycle is coming up.
Many people are leaving academia bc of "publish or perish." Authors are literally paying money (instead of being paid) to publish their work.
Can we agree to stop this harmful race, and stop glorifying this metric?
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(3/5) As you become more successful, try harder at the basic things
Some of the most successful (and busiest) people around me still reply to emails kindly & reliably, remember people’s names, and offer help to others. This is not a coincidence.
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But this perception is toxic.
The # of pubs does not encapsulate who you are as a provider, trainee, teacher, or teammate. It does not measure quality, impact, or altruism.
It’s just a crude metric. And it has started some very alarming data trends in med ed… /
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What I thought being a great surgeon (or any professional) was all about at the start of residency but have since come to change my mind
A thread 🧵🧵//
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(2/5) The most obvious problems are the ones worth working on
You may be tempted to distinguish yourself by coming up with “rare,” “prestigious” ideas.
But what the world needs more of are people who are willing to humbly work on the obvious, day-to-day problems.
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(4/5) No one else will say no for you
You might think that someone out there will tell you when you're doing enough. But that's not always in their interest.
Only you can tell yourself when you're doing enough & good enough.
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(1/5) No one is invincible or impervious to change
We start out believing we may be the exception.
“He burned out, but I’m different”
“She changed, but I won’t”
Do not give into exceptionalism, and instead be more mindful of your environment. Not all things bounce back.
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I'm sure our community can come up with better metrics, or better yet, talk about people more holistically
#surgery
#MedTwitter
@AspiringCTS
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Even though
#sugery
life and
#residency
is fraught with challenging situations, every once in a while, someone does something that leaves an indelible mark on your training and outlook.
This is a thread dedicated to those moments with a hope that more will follow / 🧵
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During surgical residency, I saw that we can unintentionally and unknowingly perpetuate certain norms, which can be unhealthy
This includes doing or not doing something, saying or not saying something.
Here are 5 things that I have since become aware of 🧵//
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Wil revisit this list when I’m done with 6 years of residency!
@AspiringCTS
@modern_surgeon
@ThoracicStudent
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In my training, I’ve seen two types of surgeons in how they respond to a member of the team not being fully trained and up to speed.
And I believe this simple difference makes all the difference in what they are able to accomplish in the long term as a team.
🧵 //
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It was our son, Julian’s 1st
#AATS2023
and as a dual professional family, we learned what it takes to bring a 4 month old to
@AATSHQ
and to balance our career goals in
#CTsurgery
.
@JMSoegaard
Great seeing friends!
@TSRA_official
@ThoracicStudent
On-site childcare next year?!
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In 2011, students who matched in dermatology and plastic surgery had 7.5 and 8.1 academic items.
Just 9 years later, in 2020, those numbers were 19.0 and 19.1
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…when introducing the grand rounds speaker or the society president, they would say,
“Dr. X has over 300, 500… 800 peer-reviewed publications.”
As an impressionable student, I came to believe the “# of publications” was the most important way to get ahead and open doors. /
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For as long as I’ve been a surgeon, I’ve been told that to be successful, one has to be a “triple threat.” But I wish to tell future surgeons to instead “Choose Your Own Threat” - and bring those diverse passions into surgery, even if they’re different
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I'm always amazed by how little of the journey to becoming a surgeon is purely technical. In reality, it is a lot more than that. The beginning may be technical, but the rest relies on judgment, teamwork, humility, even spirituality.
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1//
Moving fast -> Moving less
At first, I was drawn to the fast-moving hands as the mark of a great surgeon, but now I think the key to being good is to move less, without error, noise or flashiness. Not all movements lead to progress. /
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4//
Being remembered as the greatest of all time -> helping the next generation become greater
When I started, I thought it was a sign of success to be remembered as the best.
But now I think the true honor is to have your successors rise above your achievements...
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In 2011, 17.2% and 12.2% of the applicants matching in dermatology and plastic surgery had a Ph.D. or other graduate degrees.
Again, just 9 years later, 29.9% and 24.2% of them did.
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... because greatness sees, prepares for, and dreams of a future that is beyond itself.
Has anyone else's thoughts changed?
#Surgery
#MedTwitter
#SurgTwitter
@AspiringCTS
@modern_surgeon
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Anyone in surgery seriously interested in the topic of wellness, including fitness, ergonomics, nutrition, sleep? Please DM me
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Aspiring surgeons, it's easy to believe that where you are matters more than who you are. I used to think that 80% of what I'll achieve will depend on where I am, and 20% on what I bring to it. But in fact, it's the other way around. It's 20:80. You decide
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Surgery rotations are one-of-a-kind experiences.
In some ways it resembles an endurance race, and in others ways, an audition.
How can you do the best you can on your surgery rotation? A thread. 🧵 ... /
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Aspiring surgeons,
In grad school, I attended an event that forever changed the way I think about competition. The organizer split us into two teams, and told us to go finish as many tasks as possible, and we all assumed we had to beat the other to win.
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...but the reality is that I think it is much better - for the surgeons, the staff, and the patients - to be able to rely on a team of people who are content and dedicated.
No amount of individual talent can make up for the loss of a support network /
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So many things in healthcare were designed when the workforce was far less diverse, and we expected everyone else to just adapt to one "right" way.
Some of these examples will resonate with you... and some will make you cringe. Are they really that hard to change?
--Thread 🧵
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“Just learn to say no.”
Virtually every wellness talk I have been to in the past year has made this point.
“If you’re too busy, tired or burnt out, just remember to say no to more work.”
And each time I hear this, I nod and go home.
Then next day someone asks me … //
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Had an incredible week visiting and learning from
@tomcnguyen
at
@HeartUCSF
. Thank you so much
@TSRA_official
for making it possible to travel across the country to connect with leaders in the field. Looking forward to visiting again!
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3 years in the making! Started from a few nails and rubber bands on our kitchen table, and now a growing curriculum available for all trainees!
@AspiringCTS
@TSRA_official
@ThoracicStudent
@WTRCollab
Extremely honored and excited that our DIY coronary anastomosis simulator video () won the
@MMCTS_Manual
@EACTS
first annual Residents' Tutorial Competition!
@JasonHanMD
@iyengaramit
@williamlpatrick
@MarkHelmersMD
@BavariaMd
#Szeto
#Cevasco
@pennsurgery
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It recently became an option for residents, not only in
#CTsurgery
but also various other subspecialties to take
#paternityleave
, and being in the first wave of residents to ask for it, and knowing firsthand how challenging that can be, here’s a thread…
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To aspiring CT surgeons, we have a tendency to think that the highest point is the same as the tallest peak. But similar to how mountains may not all start at sea level, not everyone we know started at the same place. We should be mindful of that.
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3//
Being superhuman -> being human
At first, stories of superhuman endurance and work ethic were fun to admire, but now I prefer to be able to relate to the moments in which they are human, and accessible.
These moments teach us far more about what it means to be a surgeon/
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...what has kept you going through some of your worst days? What would you tell a person who doesn't think you can do it?
The answers you are looking for are hidden behind those questions. /
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Surgeon 2 slows down a little bit today to his team to become better each day
Surgeon 2 slows down a little bit today to deliberately show someone that he or she is a part of the team worth investing in
#MedTwitter
#SurgTwitter
@AspiringCTS
@modern_surgeon
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...acknowledge that you cannot be certain of where this path will take you. You may change. The field may change. It is a really complicated journey ahead.
Some people worry this is a sign of weakness, but I think it is a sign of humility, maturity and resilience.
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I've been thinking a lot lately about how good of a surgeon we should aspire to be.
How should we measure it? Volume? Speed? How should we know when we have reached our goals?
And I think I've come across a relatively simple answer. Read it here -
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Aspiring CT surgeons, it's easy to worry about pedigree and prestige as you go through the application cycle. But I think instead of looking at your peers’ pedigrees, try to read about where some of the greatest role-models in our field have come from
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This article caught my attention over the weekend because the topic is as surgical as can be, but it was published in "JAMA Internal Medicine." So I read on
It asks whether operating the night before leads to worse outcomes the next day for surgeons
/ 🧵
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2//
Being as independent as possible -> Being able to lead the best support system
I used to think great leaders created a system where they did not need to rely on anyone else... /
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1. Sending non-urgent work messages overnight and during weekends can perpetuate a lack of work-life boundaries
Even if your intention is to get stuff done whenever you can, this sends a message that no hours are off limits to others!
Try to schedule them for the morning.
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3. Sharing our successful feats but not complications can perpetuate a culture where we all try to hide our mistakes.
If you get the impression that everyone else except you are not messing up, would you feel safe in disclosing your complications?
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5/
One Fri evening an attending surgeon called me around dinner time. I thought I had made a mistake or missed a deadline.
But she called just to thank me for having taken good care of one of her patients, and I will always remember how that made me feel.
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1.Writing a personal statement requires reflection, not invention.
Remember that 99% of your essay is already written because you’ve spent the last however many years searching for and refining your reasons.
Ask yourself... /
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We never talk about improving our dexterity in surgery, especially when it comes to our non-dominant hand. What if the beginning of a solution is as simple as coloring?
@modern_surgeon
Introducing our second
#SurgicalSkills
Challenge, the
#ColoringChallenge
🎨! In this video, 👇 we explain the rationale, tips, and rules for the challenge. Have fun coloring and tag a friend who should try it!
#Surgeon
#MedStudentTwitter
#Dexterity
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After all, faith is strengthened by doubt, and experiencing some degree of uncertainty is a reflection of having lived it and thought about it more seriously.
#surgtwitter
#medtwitter
@AspiringCTS
@modern_surgeon
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2. Posting all of your publications, awards, and grants on social media can perpetuate a collective anxiety in all of us about not being productive enough.
Of course, it’s something to celebrate, but let’s be mindful how other people reading this can feel if we all do this
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3.State your desire, and commitment plainly.
These types of sentences may feel generic, or implicit (why else would you apply?), but they are so, so important.
Don’t underestimate the power of plainly stated truths in persuading others of your resolution. /
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In residency and beyond, you constantly risk losing faith in the possibility of change.
This is the definition of burnout.
Here are 5 assumptions I realized I was permitting in my life that prevented meaningful change, which especially resonate with me today
Thread 🧵-
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One Sun morning around 2AM, I woke up the attending surgeon at home to let him know about a patient who needed to go to the OR urgently.
Without ANY sign of being annoyed, he said OK, let’s do the right thing.
I have never worried about calling him again for pt care
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2/
One very (very) late Wed evening, I made a mistake while closing skin, and everyone in the room was upset.
The fellow who had not eaten anything all day patiently taught me how to do it better and handed the instrument back to me, and I haven’t made that mistake ever again
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The more I study surgery, the more I realize some of its greatest challenges are communication, empathy, and trust.
Like cutting and sewing, these processes require tact and precision, but mistakes here can be harder to repair. Here's our take at
@NEJM
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It’s important not to measure your success based on one narrowly defined variable (e.g. a specific school, program or a job title). When your sense of self worth relies on many aspects of your life, it’s liberating and empowering.
#MedTwitter
#surgery
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4. Promoting how much you’re working overtime can perpetuate a culture where we feel weak or lazy for working normal hours
If your colleagues are constantly talking about working late and sleeping little, how do you feel about going home early even when nothing is going on?
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Excited to start a two-year associate editorship with
@JACCJournals
fellows-in-training section with the brilliant Celina M. Yong and
@mvaduganathan
aduganathan. We look forward to reading your submissions! Our inaugural piece here -Picking up the torch.
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1 /
One Sat morning an elderly pt who was about to go home died suddenly from a terrible complication.
My attending surgeon hugged and comforted the grieving family members for the next 20 minutes, and I will never, ever forget how rare and powerful that was
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Check out the teaser for the
#HeartBox
, a cheap, DIY simulator, which we hope to share in a series of upcoming videos, and will encourage practicing at home with virtual training sessions!
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Try to be remembered for ONE great thing, instead of five good things.
Essays that say too much risk losing clarity, and ultimately the reader.
5. LASTLY, this one may be controversial but...
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4.Resist the urge to say too much, even if it’s all positive.
I understand that because the stakes are so high, the more we want to include every detail or feeling.
But sometimes simplicity is the most elegant, and memorable tool...
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To current and
@AspiringCTS
As education becomes more virtual, the
@TSRA_official
and
@ThoracicStudent
are proud to present our
#CT_Weekly_Spotlight
series
With access to excellent, free educational content online, we want to connect them to trainees and students worldwide (1/
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1: Aspiring surgeons, I think this is one of the most challenging topics I've written about during residency
The current system places a lot of emphasis on one's productivity (e.g., publications). It influences the Match, your first job, promotion...
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Aspiring surgeons, when we make mistakes, it is easy to think of it as a personal failure with permanent, pervasive consequences. But like with all things, we find a way to move forward. This, too, will pass.
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2.Opening with a story is effective, but it’s also easy to get carried away.
The purpose of a story is to engage the reader and make them care about what you have to say next - in this case, why you would make a great future “X.”
So, get there quickly with intention! /
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One of the best cardiac surgeons I know - who is known as the master of needle angles around here - once told me that "A" is all you need to perfectly carry out 95% of any operation. So why is it that online tutorials show "B"?
@modern_surgeon
@joshchen14
@John_J_Kelly_MD
Loading the needle at a ~45° angle (A), reduces wrist strain and allows for more versatile needle angles compared to simply loading it at a perpendicular angle (B)🪡
#MedEd
#MedTwitter
#Suturing
#MedStudent
#SurgicalTips
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5.Excellence in surgery is not loud
Surgery, at its best, is a silent choreography because everyone understands each other’s roles and needs.
The best kind of assistance does not try to stand out or race ahead. It seamlessly anticipates and responds. There is no ego.
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Do you ever wonder how much creative impact we might achieve in medicine if our first thought with each new idea or project does not have to be how to publish it in a journal? Who else has abandoned an idea because “journals won’t like it?”
@modern_surgeon
#MedTwitter
#surgery
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3/
One early Mon morning, while rounding quickly on 30 very complicated pts, the attending surgeon stopped by one of the rooms just to say, by the way, you helped save this patient’s life, don’t’ forget that.
For the rest of the month, it reminded me of what this is all about
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I know “it’s just social media” but I bet Twitter opened so many conversations at
@AATSHQ
this year that otherwise would not have happened
@tm_knapp
@MoAbdullahCTS
@miia_ll
@Neel_Prabhu
@lindaschulteMD
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On the last day of an immensely challenging year filled with countless lives lost and escalating worker burnout, I still believe that humanizing these encounters is necessary to get us through it all
@PhillyInquirer
@pennsurgery
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(1/5)
@1001cuts
wondering why the OR table can't go any lower?
I know tables that can go up high enough to be comfortable for surgeons who are 7 ft tall but have yet to see one that can go low enough to make surgeons 5'2" comfortable
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Do not let shaky hands turn you away from surgery! It affects everyone (your pulse literally causes a tiny one), and stems from so many factors, many of which can be overcome! Join us here
@modern_surgeon
to think about this with a positive mindset!
#Steadiness
is NOT a fixed trait! Like anything, it can be worked on and improved. Our next several videos will walk you through our thought process.
#MedStudentTwitter
#MedEd
#Surgery
👇
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5. Overstating your preparedness to do something can perpetuate a culture where we feel the need to project confidence no matter what
Do you want a culture where people feel like confidence is more important than competence?
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My column
@PhillyInquirer
@LetitiaStein
@SarahGantz
. Some of the most important lessons I learned about life came from doing procedures. This is one about finding the grace to forgive yourself and start over when you’re stuck
@modern_surgeon
.
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This concept took me an entire year to realize in med school because no one ever explained it. How amazing that one of the most experienced heart surgeons in the world made a video to help trainees?
@CUMCHeartSource
@ThoracicStudent
@TSRA_official
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Aspiring surgeons,
During the pandemic I looked around for educational content online and was pleasantly surprised to find so much excellent, free content.
Some programs share their didactic sessions online (e.g., MGH) with world-renowned faculty members
THREAD(1/)
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I feel that current journals do not openly and frankly discuss some of the most challenging and personal dilemmas we face as aspiring surgeons. My colleague
@williamlpatrick
and I hope to share our thoughts on these topics regularly and hope you'll join!
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When I read something I wrote six months ago and really dislike it, it's easy to feel discouraged initially about the quality of my work. But in reality, it just means that I've grown over the past six months. Constantly growing means you're never satisfied with your past work!
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One hour into the morning of the election I’m taking care of a tearful, hardworking woman who couldn’t afford her blood thinner (>$100 a week) and came in with a clot in her leg. As soon as the night shift is over I’m headed to the polls.
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A full day in the studio today working on the next set of
@modern_surgeon
videos with
@joshchen14
@John_J_Kelly_MD
#surgery
#MedEd
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Any CT surgery residents/fellows or med students interested in writing advice columns for a formal project? 500 words a month, topics are flexible. Please shoot me a message!
@TSRA_official
@ThoracicStudent
@AspiringCTS
@WTRCollab
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In medical emergencies, it’s just as important to keep your heart rate from getting too high as it is important to keep the patient’s heart rate from getting too low.
#surgery
#medtwitter
@modern_surgeon
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This is what surgical leadership looks like. Transparent. Detailed. Public.
COVID-19 Update: Wednesday, 3/25/20
Read today's
#COVID19
crisis update from Dr. Smith and previous updates here:
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So I’m in South Korea right now with my family and today was the local Election Day. It’s an official holiday here so all citizens can exercise their democratic right to vote. That’s the tweet.
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CT surgery enthusiasts!
@TSRA_official
now offers biweekly newsletters on important news, deadlines, resources, lectures...etc! ANYONE who is interested in staying informed should register here
That includes
@ThoracicStudent
@WTRCollab
@AspiringCTS
Share!
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At some point in my training, I realized the goal of becoming more competent was not so that I would never never make mistakes again, but rather, so that I would feel stronger and more prepared to take on greater challenges around me. A column
@PhillyInquirer
As a surgical intern, he feared making mistakes. Now, this resident understands the need to accept failure. | Expert Opinion
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Surgeon 2 on the other hand is very intentionally saying,
“You are making small mistakes.
But I want to help you understand and get better because we are going to be a team going forward and I am invested in you.
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Having a good forehand in surgery is like knowing how to pass the ball in soccer. It's a constant fixture of operating. For students starting out, make sure to become familiar with it! Our newest post
@modern_surgeon
.
@AspiringCTS
@pennsurgery
@ThoracicStudent
For a surgeon, knowing how to throw a
#Forehand
is like a
#Soccer
player knowing how to pass. It's nothing fancy, but it's fundamental.
Question👉 Should your needle driver be locked while driving the needle?
#Meded
#Surgery
#SurgicalTips
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Has any other aspiring or current surgeon wondered what makes someone extraordinary? Here's my thoughts after the first three years of residency. I'd love to hear what others think!
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My favorite moment from Malcolm Gladwell’s talk at our CT surgery conference was when he basically said - for a room full of really capable people with strong egos, we can be really timid when it comes to asking simple, bold questions
@modern_surgeon
@John_J_Kelly_MD
@AspiringCTS
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You can find the rationale and the instructions to our Do-It-Yourself simulator here!
@AATSJournals
@John_J_Kelly_MD
@pennsurgery
@AspiringCTS
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Please join us if you're a student who wants a crash course on how to publish in CT surgery! Just a little bit of knowledge can help you get your foot in the door and become productive!
@AspiringCTS
@ThoracicStudent
@TSRA_official
Our next event is right around the corner... Excited to co-host "PUBLISHING IN CT SURGERY 101" with
@TSRA_official
and dedicated resident mentors! Join us 4/28 @ 8pm EST! Please RSVP here:
#MedTwitter
@STS_CTsurgery
@CVSA_Heart
@AATSHQ
@WomenInThoracic
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Alright! If you’ll forgive the first time jitters for a video, here’s how we went about setting up a home simulation theater. More tips to follow soon
@modern_surgeon
!
@AspiringCTS
@ThoracicStudent
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On Thursday, May 27th, I will be moderating a
@TSRA_official
panel on "Early Career Advice in HTX and MCS" with
@FiedlerAmy
and
#MarisaCevasco
- come join to ask questions on how to set up one of the most rewarding practices in surgery!
Register here!
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