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I had Fine turn my knees. Think it's for inviting a second? Let's talk to give you guys a little bit of, ah, outlook on what it's like to be a woman and CT surgery in the US And with that I am. I wanted to kind of revisit some some terms that I think is very tightly interlinked. But the mission of like increasing limited surgery so the first one would be diversity, right? So this here is the new School of Medicine definition of diversity. And it is the perceived team and differences in appearance, thinking and actions which includes but is not limited. Race, ethnicity, gender, gender, identity, expert or expression, age, disability, religion and barrel status. Right? And so why is it that diversity is important? Well, because most several studies with business world and in the medicine that has shown that that diversity fosters innovation, it improves the quality of issue care and decreases health disparities. So in 2000 for the Institute, Medicine published this report, and it is in essence, it was a call to action Teo increase the diversity in the health care in the healthcare workforce, right? So this report summarized several states and demonstrated that increasing gender, racial and ethnic diversity among healthcare professionals was associated with improved access to care. Improve patient provider communication, which resulted in perfection, satisfaction with their care, improved health outcomes. And because we're all part of the academic mission for our learns a better educational experience. So if this is the U. S. Census, if the U. S census consistent 51% women, 18% Hispanic and 13% black people been, why is it that the diversity of the healthcare workforce doesn't reflect the sniper? See? So with that, uh, we'll dive a little bit deeper into what it's like to be a woman a CT surgery. So this is a little bit of history. And, uh, the American Board of breast Surgery initiate forms in 1948. It was until at least over a decade later that the first movement started by CT surgery, and these women were doctor need a bron Well, doctor and McAllen, Doctor to To And um, that was in 1961. Um, for those of you don't know Doctor Ronald, I feel like everybody. Every woman and CT surgeon probably knows her name and she was affiliated, worked at the NIH at U C San Diego at Harvard University. She was the part first participating successful prosthetic, mild replacement, prosthetic mitral valve replacements I in 1960 also developed that Ron would cut her valve. Several sensitive to grass she had over 115 publications was the first woman to join the 80 s. Fast forward. Two decades was when the women interested surgery as a recording ization officially formed, and at that point there were only less than 30 women who had certified CT surgery. And it wasn't until the year 2100 woman in CT surgery had certified. And if you think about that, that was not very long. So of all the words certified CT surgeons only 7% of female And this graph is a graph of the number of women who certified over the last six decades. And as you can see, there are several years of the beginning where there were none but certified and the first the following two decades there was less than five on average per year. That really wasn't until the last 10 years that we surpassed 10 women per year, it's certified. By 2019, they had only been 350 for women who had certified CT's it, you know, in CT surgery through the murder or thoracic surgery, I'd say we're so few that some of us, even though our numbers see, I don't know Doctor Davidson, if you like. What s So, for instance, Dr Kean was Who's the president of the outgoing president? Women in thoracic surgeon. She was that 213th woman to have certified. I was number 2 28. Doctor David was still 248% to certified. And so we thought to provide a 10 year update on CT stuff the status of women say to surgery. What we do is we created a red cap survey and provide unique survey likes to all the women had sort of find out through the A, B. T s, and of the women had certified, we were able to successfully contact you injured nine. I had a response rate of 57%. So what we learned was that 61% of female CT surgeons were either 50 years or younger and then we're joining a light 50% graduated from medical school 2000 or after, and about 20% reported having an additional graduate degree with a M. P. H uh, MBA and Peach State beat Caged evening. Most common my knee 1% trained in the Triggers Ultra program and about 37% of women a CT currently reported having also completed a fellowship meaning like a congenital fellowship or in my s fellowship, it cetera 97% of what may work full time. And I say this kind of the spells the belief that one don't work part time. And this is a heat pack of where the women lift currently left. So the darker the bread, you tend to get the red, the more women CT surgeons that are. And as you see, there's certain states California, uh, that have a lot more women CT surgery, you know, when my already might be a little more friendly to women. This is a breakdown of the difference of specialties. So about 36% of respondents practice journals from surgery. 23% practice about cardiac, 23% practice and mix practice and community. You know, Mexican classic, an adult cardiac and 10% practice congenital heart surgery. And just to kind of give you a background of what those numbers will you mean rate of all the doctors adult cardiac surgeons of the S C s membership, a only percent or female in general, thoracic, even though a good number of women in practice gentle prostate surgery, we only consistent 14% of practicing gentle plastic surgeons and in congenital, only 11% of all congenital heart. And for those who were in academia, about 30% are the instructor assistant professor level 40%. The associate professor level 22% are full professors we compared. The results are separate to the S DS work for survey results on what we learned with that meal, surgeons were older and more likely to have graduated from medical school before 2000. We spent the same amount of time training after graduating from medical school. Male female stirs were equally as likely to have an additional 23, including the idea of your page things. But for whatever reason, women have a slightly higher incidence of having an mph. Female surgeons were more likely to be practicing gentle thoracic strawberry than male surgeons and mill surgeons will more likely than women to be practicing in next practice. With that one interesting concept of equality, it's quality is the state of being equal, especially in status, rights and opportunities. On the other hand, equity recognizes the fact that different people need different resource is tow, have a similar outcome. So equities, a promotion of access, opportunity and fairness, the policies and practice is on appropriate for specific injury individuals. So every mentioned the breakdown of academic progress. Way didn't mention is that 10 years before we had a similar study, and at that time, about 15 with 60% of women were at the instructor assistant professor level, which was decrease, and in 2000 and 10, while they were about 20% full associate professors now reporting 40%. So we're demonstrating that there's progress and movement, and that's in that in that area. On the other hand, between 2010 and 2020 mean percentage of women and CT surgery who detained for professorship level actually had not changed significantly, which suggests some you know, stagnation in that the assistant professor level and we're talking about a 10 year time period between the two, so they should have moved up. What it also didn't mention is when we're looking at salaries. 85% of women reported a salary between 208 100,000, with really most the salaries clustering around 466 $100,000. Actually, where is the salaries for men clustered around 600,000 or greater? And so even after we factor in HCL it seniority number of years since graduating from medical school. So specialty in general, for instance, versus channel thoracic or what? Not practice location, since different parts of the country are, you know, more expensive living. So father's area just it accordingly and practice setting activated for some private practice. Even in a multi very real analysis, women insurgents were more likely to mention it less than 600,000. And then we're more likely than willing to take more than eight now. Just get a barely touch on leadership, which is what Doctor Davidson talk about and off. Of the 57 presidents for the Society of Thoracic Surgeons, only one was female and she was in a post him asleep. Unfortunately, she died of pancreatic cancer. And of the 103 presidents for the American Association for Breast Surgeons, only one is female and she hasn't even presided. Yes, so she won't be the president. 2000 and two. There is some suggestion that we have some progress. On the other hand, the current board of directors for STDs have for women, so it's 18% in the current board of directors for the 80 s has two women or, you know, roughly 12.5%. So we're getting more representation. Once again, Doctor David will go into a lot more details about national presence of women. CT. This is a study that was performed by Dr um It's really when I look down and see a DNC data on looking at women and minorities, um, of CT surgeons, faculty Onley, 17% or female in comparison of all clinical faculty, 43% of funeral and of all surgical faculty, 27% of people. So we're lagging behind even the surgical specialties of the trainees. 24%. You know, Woods again, like behind all clinical trainees. Off of them, about 46% are female and 36% of all surgical trainings are are female. So once that, and the 3% 5% of life expanded, we are once again not meeting a metric that either. So the last concept that wanted to introduce this conclusion conclusion is an approach designed to ensure that the thoughts, opinions, perspectives and experiences of all individuals on value to encourage considered while diversity insurers at a group of presentation, inclusion, solicits and centers, diverse contributions. I heard it put a different way. Universities like being invited to the party. But inclusion is like being asked to dance, right? And so inclusion is the crux to retention. So right. And so we need to assure that we have a welcoming environment, a welcoming, positive work environment in order to be able to recruit more women to surgery. So in 2018 of the whole Harvey Weinstein scandal came about and hash tag me to really decide rocketed the board of directors of the S. C. S approached woman in the last six surgery to do a deep dive in sexual harassment. Of course, you're, like off course literally. This can't be happening. And ct, right. Well, so we we sent out a survey to a less yes members. And these are the results. And what we found was that 81% of females CT survey faculty reported having experienced sexual harassment. We also send up the same serving to the residents. City has already group, and what they were imported was that 90% of females Chinese reported sexual harassment. And so I want to just remind you really quickly the CDC definition of sexual rest, which includes sexual coercion, which just literally physical contact, unwanted sexual attention, such as being asked on a date repeatedly, despite me turn down and gender harassment, which is side comments about love, etcetera. Uh, and so, as you can see, these are the breakdown of the various forms of sexual harassment I've been reported. In our experience. This is completely unacceptable, but we cannot recruit women's a CT surgery of 80%. 80 90% of us were being harassed with some way. We also did a tee time in gender bias, right? And so similarly, what we did was be created. Survey heads various scenarios about gender bias, and the response either had to agree or disagree with the statement on a like a light scale. For instance, in this statement, in meetings, people pay just much attention when women speak as when male surgeon speak, Ideally, would be agreeing right. But Female responded to disagree. Here's another example. Female surgeons are less likely to have influence on Department of Politics. Ideally, we would be disagreeing with a statement. Unfortunately, women surgeons were green fairly strong. Best. Here's another example. It is common for a funeral, certain to present in idea and get no response. And then for a real certain to present the same idea on the acknowledge and once again, ideally, we would not agree. But you're right. I agree with this statement and said, Well, women and CT surgeons were reporting was that we felt that we were to have very gentle vice environment we set. The same scenario is to mail surgeons as well. And the take home from this is that here are responses indicating we had a week perceived and gender bias to working hard. And yet the men, almost every scenario was we're disagreeing with us, and what's more disconcerting is that all of the leadership is male. All of that is changing right and get their making decisions for us, but they don't even perceive the biased working. But I haven't been working. No, the SS diversity test or similar set out a survey to diet. But I just look into, uh, veteran's see, and what they're sort of reported was 70% of women, 83% of black and 39% of agency T surgeons felt that they were being unfairly treated based on their gender or brace. And these are This is just if it's from another department. Other surgery, not just CT surgery studies that we know that female students are less likely have stand out and achievement words In the evaluation of recommendation letters, female residents are less likely to be given all our autonomy. Female faculty score lower and teaching evaluations and are less likely to refer patients and suffer more backlash following surgical complications compared to the faculty. Okay, I promise there's some positiveness. But anyways, when asked about wellness, you know, I guess respondents for someone mutual about what they burned out, they definitely disagree with the statement that they had become or callous. They, uh, without down said that they would choose medicine again and she ct against That's very positive. They would encourage family members to go into medicine and even in society. However, if you look at the statement, I believe CT is a healthy positive working for women do, uh, I was a little bit neutral, maybe needing a little bit towards statistic rate, which this is, this is what we need to work. And I think in the future will be really interesting. Is we do this again in 10 years? Now that we have more women, a CT surgery and more women in leadership and see if we've moved this little over two towards agreeable, and with that, I will pass over the might eventually want to stop families going, Teo, start getting it. Okay. All right. Can everyone see my screen? Okay, great. So thank you, Doctor Seba, we think that this is should be a nice, um, same way between our to talk. So, um, I am going to be talking about, um leadership, Um, and with some overlap of the points doctors up with me, but really, with the focus on unleash your ship and I'm really grateful for the invitation to talk with you guys today, and I really hope that, um, you guys will ask questions and we can have ah, engaging discussion afterwards. So, um, I don't have any disclosures relevance in this talk, But I do want to acknowledge my research resident, Kim Szymanski who? I'm gonna be presenting a lot of data that she worked on during her research here. So just from the start off for the question, you know, does it matter if there is a gender gap in CT surgery leadership and, uh, you know, I think it's doctor supper pointed out. Clearly, there is a gender gap in CT surgery. But, you know, I think credit could say, Well, does it really matter if we have a lot of boots on the ground? Just the leadership gap matter? Um, I think that the business world, you answer says with a resounding yes, there's lots of data. Doctor samples showed us a couple of examples. There's a couple more. Um, this was published in the harbor. Is this review demonstrating that for venture capital firms when they have increased numbers of female partners, that equals increased investment returns and more profitable exits? Um, which obviously is a huge metric. And then Deloitte published that companies with inclusive cultures are more likely to be innovative. So there's lots of data from the business world really showing us that diversity and inclusive cultures are really key. Now, I'm pretty much focusing on women today, but I really think that you could almost substitute women for any diversity variable. Um, so I'm again. I'm gonna focus on women, but it's not meant to be exclusive that way. So a starter step a showed us this craft. Um, you know, we see a lot of women in the assistant professor ranks. Um, there's fewer in the associate professor ranks. But then, you know, we're getting across the board, some professors, and obviously there's a drop yet each step. And it's the important question. Ask yourself, Is this a drop off or they're just not as many trainees or fully trained surgeons at these levels yet? And I would say, probably the answer is both, Um, so when Kim and I started looking at these issues we were really interested in how does this overall representation of women translate tour from leadership? And so we started looking at some of the historical data coming out of our, um, presentations and representation at scientific meetings. So this is data from the American, uh, college inserted. This clinical Congress and also the Academic Surgical Congress and the PSA blood line demonstrates the percent of women who were in some sort of Panelists or moderator role at those meetings. The trends, the dash line. And as you can see from 2013 or 2014 Teo over a five year period, there was an increase in the representation of women at these media is in sort of being on the podium, so to speak. Um, and there was more importantly, a decrease in the number of men on Lee panels or sort of cloak well known as mammals. So that certainly was a good thing. But when you think about what these positions reflect, they really reflect peer nominated positions. You don't necessarily reflect, um, positions that are associated with academic productivity. These were these were invited. So, you know, if I'm on the planning committee, I'm inviting my friends, etcetera. Um, so that's one thing also to consider. So again, these data are from general surgery. So Doctor Szymanski and I really wanted to look at it. What is it like in the CT world? For the most part here in the US. So, um, what we did was we looked at the annual meeting programs. Um uh, from the E. T s ds ds, that Western thoracic and the Southern Jurassic. Now, the these two bottom meetings are, um, regional organizations. They're much smaller than S C s and 80 s and age. Yes, and SDS probably could make an argument that they're more international organizations. So we looked at similar years 2015 to 2019 looked a total of 20 meetings, and what we decided to do was identify people who had been pure selected session leaders. So again, this is not based on abstract authorship. This is who's nominated to have a leadership rule at the meeting. And so we define that as moderators, Panelists and invited discuss. It's, um we purposely excluded sessions that required an extra ticket. Um, etcetera. Just because we didn't want to really get into the we felt like there were other factors that has influenced those invitations. So, um, we were making only excuse me mainly drink descriptive statistics here and looking at the total number of sessions leaders and, um, the way the percentages changed over time. So again, we identified 20 meetings, 679 sessions. And what we found was that, um, women represented about 13% of those session leaders overall. And, um, when we looked at a specific breakdown, the moderators Panelists and invited discussions, there was a trail off in the invited discuss. It's being women. And that was interesting because those and invited discuss it tends to be considered more of a subject expert. So we wondered if there was a little bit of, um of a bias or a perception issue that was more influencing that position a little more than the others. Um, but that was just a subposition. So next we looked at just how the proportions changed over time. And what we could see is that in the smaller meetings, the two regional meetings, the number of women in these leadership positions increased over time. It did nationally as well, but it was fewer numbers overall in the at the national meetings. So then we looked separately by specialty, and here similarly, doctor separate told us that you know, there were more women practicing general Cerasale, then cardiac or congenital. And we see that reflected in the proportion of session leaders by the specialty breakdowns. So cardiac, actually, this is adult cardiac. Had the the fewest, smallest proportion of female session leaders. Where's General Cerasale? Women represented about 23 percent of session leaders. So you could argue that that's actually maybe a little bit of it. Uh, overrepresentation, Because if you remember, Dr Separate told us that the number was about 14%. So and again, we looked at how that changed over time. And you can see for General Cerasale, the number of proportion increased significantly over time for adult and congenital pretty much states stagnant. So we also looked at the manuals and what happened with, um and they did go down over time? Um, not significantly, but they did go down. Um, So the last thing we looked at was this a concept of a unique session leader because, um, you know, it's one thing to have a very, um, diverse group of speakers. But if you're just taking that same group and rotating them to each session or each meeting, that's not really diversity. So we um looked it at how the numbers compared over time. So in 2015, there were actually about 77% of session leaders on the female side who were unique individuals. Then, in 2019, that number trucked to 50% meaning that the same women were kind of being asked over and over and over again. And then when we put both of years to combine, we found even more of the same people being asked over and over and over again. This was actually similar for Met, so suggesting that overall you're not very good about selecting peers who are unique. So I just plan that seed because I think it's a really, really important concept when we're thinking about ways of being inclusive. So some of the limitations here is I mentioned we only looked at gender, but I suspect that many of the seams trends that will see that we see for women we would see in other underrepresented groups and then again we restricted to pure selected positions because we were really interested in what's the human factor here, and how does the human factor influence leadership? So what do we do with this right? Well, we acknowledge right, the more be acknowledge, um, any type of inequity, the that's the first step to overcoming it. So we say, Yes, there definitely is a gap, a gender gap in leadership of CT surgery, and it is improving. But the improvements are very modest, especially when you compare to other surgical specialties. And we really have to make some of our unconscious practices conscious. And we do that by talking about them by learning about them by keeping them in mind when we are in positions of the other ship or have an opportunity to influence. So what the surgeon leaders need to do with these data? So one thing we all need to understand is that there is no need to sacrifice quality in order to practice diversity an inclusion. There are numerous numerous examples again mostly from the business world, about how diversity inclusion increases innovation increases, are efficiency and and really allows us all to be our best cells and whatever organization that we're working into function and it's optimal manner. So any person who tries to tell you that you know there's going to be a quality sacrifice doesn't really know what they're talking about. The next thing we need to do is I get, recognize any unconscious bias that we have in ourselves and that also, what is our organizational on countries bias that could be influencing some of these practices. Um, you know, you as a leader you're gonna be offering mentorship are sponsorship, and as a trainee or junior faculty, you're going to be seeking it. And you, you know, as someone who's might potentially seeking it, you want to be selective about who you see get from, and I'm gonna touch on this in a little bit more detail. Um, And finally, if you're in a position, Teo, plan a meeting go prepared. And I would say, you know, go prepared with a diverse list of potential people. You know, you generally will know if you're planning something, you're not going to know what your plan it and so go with a list of, you know, pencil in a list of names. And here in the US, we have several organizations that are really focused on underrepresented members society. And so those were good place to start for potential speakers, leaders, etcetera. And, um, I think we're seeing this. Now we're seeing where a lot of organizations will plan a meeting with a plan, other roster, and then they'll take a second step back and look at the roster and say, Okay, how many people are the same on this list? And you know how many people can, um can be replaced? And, um, for example, I'm on this yes program committee this year for the annual meeting planning, and we do exactly that. And we really tried to restrict rolls to one person you can moderate and one person you know one person can moderate and give a talk, and that's it. They're none of this idea where, you know, Elizabeth David is giving 32 talks and leading 40 sessions, and I'm the only one on the podium because that's not diversity. That's, you know, my it's me having a very strong influence on a meeting, which is probably not in that meeting or the Fields best interest. So what can future surgeons dio with these data? Um, it's really important again to acknowledge it and acknowledge the value that diversity breaks. So acknowledge the value that you all bring to an organization, even as a junior member. I think it's really important to also acknowledge the trends, right, Doctor Step and I both presented data on trends, and we're gonna see that this is these issues are getting better. They're getting better slowly, but they are getting better. And I think you know where you guys are today. 2021. Scott Going to be a very different world in 2040 or even 25th me. So I think it's really important, especially for women to lean into opportunities. Um, I don't know if people still read this book a lot, but, um, this book lean in was published in 2013 by Cheryl Sandberg, who was the seal Oh, of Facebook. And, um, it's got some really good principles in it. So if you haven't read it, I would highly encourage you to read it. Um, it is a little business focused, but very applicable. Um, two women in medicine, women in surgery. So again, I would really encourage you to read it. Um, one thing that she does, um, talk about in the book is you know, this idea of unique individuals. She talks a lot also about imposture syndrome. So I just want to kind of touch up that a little bit to Imposters Syndrome is defined as the inability to believe your success is deserved as a result of your hard work and the fact that you possess distinct skills, capabilities and experience. So it can also be thought of as your inclination to internalize that you got where you are by means such a look or being in the right place the right time. So, unfortunately, there are a lot of data that show that women experience imposter syndrome a lot more than men. But I'm bringing it up again to raise awareness, not necessarily to say that we're all doomed to experience imposter syndrome, but because we need to recognize it and realize when it's raising its head. So I'm gonna give you an example for my own life just in the last few weeks. So I got an email asking me if I wanted to leave Ah, committee that I have been on for a long time, and I my first thought was, Wow, I don't really know that I am, um, really the right person for the job. And you know, there are probably a lot more other people who are, um, more qualified, because I actually despite the fact that I've been on it for a long time of one of the more junior members of the committee. But I said, and this is probably be having a little bit of imposter syndrome. They're asking me to do it because they want me to do it. So ended up saying yes and I haven't started yet. But we had a meeting recently, and as I was participating in the meeting, I started to see things that I will be able to do to help this group function more efficiently. And it gave me a lot of confidence, and I I was so glad that I have said yes to the opportunity to lead because I realized that I can contribute in a meaningful way. And so I'm very glad that I didn't listen to that little voice saying, They're just asking you because you're a woman, because I don't really think that's the keys. So just one example again for my life toe keep in mind. So I want to end with this concept of you can't be what you don't see so as as doctor, supplemental. And you know this This resident black here is very large in terms of our hcg me residents in the US we have a lot of women who are general surgery residents. A lot of women who are cardiothoracic trainees, fewer who are a BTS certified. But this is where we are today. And so where will be will be in 2040 or 2050. That's really up to you guys and you know, yes, this is a small box right now, but it's it's growing, and it's going to continue to grow. So I think we've all probably seen this picture that was published in The New Yorker in 2017. With the hashtag, I looked like a surgeon. I would say we all look like surgeons. So if you want to do this, if you want to be a CT surgeon, go for it works hard, find us a lot of really great mentors and some sponsors and anything, anything you want, you can you can achieve. Just make a good plan for it. Thank you very much. Wonderful. Thank you, Doctor David, and are just up. Those were amazing talks and I think something I really took out from. It was that number's talk Onda. While there definitely is cause for optimism, there definitely is work that still needs to be done. So what we'll do next is we'll start a Q and A session on. We'd really love to get off since questions and have a really good discussion. So please, everybody do feel free to type of questions in the chat on myself and panel arm are happy to be about the questions on I was thinking while we get people to start asking the questions, I could, you know, kick off the discussion on. So as some of you might know, I'm the president of AWS Edinburgh on a thing that commonly has come up in right come up in some of our past events is the value on Theopylline mint that can come from women supporting each other. So Doctor said, I want it really interesting in your talk. You had mentioned how you know each other's numbers, like you were the so in such, uh, numbers surgeon to comments. And also you had mentioned, I looked like a surgeon, Dr David, so that kind of reminded me of that seem. And I was hoping for you to tell me about some experiences in which you have supported or been supported with your woman police on. Do you know how that's gone? Um, I can start. So I am, Uh, probably right now. Um, So I'm associate professor, and I've been in practice about 10 years, and, um, because of working hard and being a surgeon, you know, I delayed some of my personal life things and got married late. And I'm actually pregnant right now with my second daughter, and, um, I'm now, So this is my second pen that my baby and I will say that I, um, have really missed the collegiality and the ability to gather during cove it with, um my other female surgery call weeks on a national level here in the US because, um, I'm in a really big institution, but, um, I'm one of two CT surgery faculty here who are women, and the other is actually at our Children's hospital. So it she's not someone that I see on a daily basis. And, um, but you know, the women who because obviously right now, the one control that I'm pregnant so a lot of people don't even realize. But those who have found out have been super super supportive and, you know, really given me good advice. So that's for me. On a personal level. I have needed that support because, um, you know, it's very easy in the CT world, especially as a woman to really end up in a silo and to feel like you're the only person who is, you know, as a doctor, separate mentioned, you know, taking complications to heart, taking them almost harder than men take them. And so I think there's a lot of value in the in the true collegiality and in a way that's that's a form of sponsorship. And so, um, you know, I think that for me, the the Women and Thoracic Surgery Organization has been a huge part of where I am today. Um, it's been a huge personal support, but also a good leadership stepping stone for me. So I would really go. A lot of that is what I think be involved with breast surgery and just having that network. That kind of honestly, almost instantaneous network was very helpful. Um, I do have a circle of women. CT started like that Any time at Duke is one of them should get a week trained together where she, you know, I trained under her technically way honestly, have, like, almost weekly or every other week. We event sessions and, you know, we'll bring in her common way, bring it. Anybody wants to join us, Really? But I think that keeps a lot of our sanity. Um, I will say having, um this is also once again through your chest. But having people were senior to me, um, help me out. Like, for instance, I'm on one of the subcommittees for, um, more than one of the working committees for the Yes, Yes. And when I know, like, for sure. Shanda Blackman, Doctor Black one got me there. You know, the one games be nominated me. But that's from there. Then it takes off from there, because then I I'm sitting next to a lot of surgeons who now under my name. And then and then we're getting the other opportunities. So she's been the good sponsor. Think I'm not the only one. She's been a sponsor. Too many people. So she's done that too many of us for me. So it goes to that. That's like the doctor David had. What can you do in your readership? Well, when we get there were gonna help, too, right? Um and then, you know, certainly I try very hard with recruitment. Um, we were coming. A weather. Is that the medical student level? Don't surgeries since the level CT surgery, residency level or even faculty level. You know, just recruit our third one infinity t here. So? So I think that some, you know, there's truth to this, right? And the other thing is also let's not forget that. I mean, women aren't the only other people who help us out. Right? So one of my closest, um, colleagues, more so than my other female CT surgeon, is my male partner tastic surgeon. Dr. Burris's. You know, he's been fantastic. And, you know, we'll push me along and then at the same time, um, well, you know, I guess stand behind. Think he goes. What I say in constant pain is on purpose. I'll plant my ideas with him some time so that I know that will be better received coming from M versus me when we play you know, he helps me up, so that's not negate. You know, men who are supportive. Swell. Yes, that's that's a really interesting point. Thank you for that. So we have a couple questions and check. I don't want you just gonna mention that. Actually, I think Karen and I'm really mad and pretty similar questions concerning about finding a female mattress and CT surgery as a medical student. Um, I think Emily said that is given the small numbers of female CT surgeons. Her institution, she's struggling to find him enter on was wondering if there any outside resource is there opportunities? That's absolutely right. So, um, especially in this world of assume, it doesn't have to be in the same country. All right, let me. TSH is the speed mentoring sessions that we've had just three. Now I think they were planning 1/4 1 for the list, and you know, that's a great way to network and so medals to you to see a general surgery, residents and honestly and almost anybody can register. And in these sessions, that's where the connections are made. So that would be an excellent way to do it. Um, I would argue also that if you cold email, listen our emails on CTS debt and what not if you call the You know most of us will always be happy to say Sure happy that etcetera, etcetera. Let's track. I would echo that and I think to to touch on what I mean. He says, I Sorry, doctor Step, it says, I think you, um your mentor doesn't have to be a woman. Um, I would echo, you know, 100% when she, all of my partners and drastic surgery here are men, and they're not all. I'm actually the the second most senior person. But you know, we're a team and we help each other. And I think throughout my career I've probably had more mail mentors than female mentors. So don't get bogged down into I need to have the woman who I can call all the time. Um, because an engaged, active, invested mail mentor is just as valuable, if not more. I don't I don't know that it's more, but it's, you know, I think it's just a valuable and and the I think that the engagement and the investment is key, and you've got to remember that mentorship is a two way street, right? So it's You have to show the mentor that you are really invested in yourself, invested in the relationship, willing to work hard. You know, not be the person who emails five minutes before a deadline. You know, needing a letter or etcetera. You know you want to show some maturity and investment again in the relationship and in your self in her development and their in more likely to help you. That's great, thank you. So the next question is from Calci. And she says, What do you think US programs are doing to increase women in their CT training programs? Specifically, what our program's doing to help women go into cardiac or mixed practices with so few programs having female cardiac pretending? Um, I know in our practice. Um so as I mentioned, um, so I am the only female general cerasale surgeon here, us see? And you have one female attending at Children's Hospital there, no adult cardiac surgeons who are females. But our train, these are about I think our trainees are 60% men and 40% women, and the vast majority of our trainees want to be cardiac surgeons. So they are doing what I said. I mean, they recognize that right now they're direct. Mentors are men, but, um, we try Teo, get together to have our own little us see women and thoracic surgery gatherings, You know where where they can talk to me about things that they wouldn't talk to their mayor mail mentors about. And so I think that those those opportunities are very helpful. Um, And then again, you know, we try to get them connected with the W. T s and, you know, connected with female cardiac surgeons. But it's in a way, I think, becoming less of a less of an issue. They have a dream that they want to fulfill, and they're doing it. Well, I would say they're more female cardiac surgeons out there than we think. Me sure lessons general fasting. But they're plenty out that I could name with 10 off, you know, right now over my generation, Not even, but anyway, um, So what do you tend to the question? I would think all societies s C s A S C s a tester being very concerted in TV up a deputy s with regards to put getting the word out there in terms of its okay to be a woman. And I want to do CT and you know it's not specific. Do cardiac general brass it, but it's it's more of a like we're kind of create and welcoming environment. Teo two women were really also diverse again. Doctor David mentioned This is not exclusive. Just woman um So there's that end and, you know, just I can hardly, uh I think it could make the argument that with the ice extremity program high six are more women have been entering the field partly think because when gets like red, 50% med school graduates and Richard, what's your feet? So despite your numbers, um, and there was started flying more, uh, you know, at you we have a traditional track program and I six program. We have lying residents, six of my residents or female. And so it started. Just swing a little bit, you know, more in the favor of women. Just I do this. I just think it takes time for this change to be worth felt, but they're definitely plenty of opportunities of having a female cardiac surgery met her out there. Thank you for that. We have a question from Gwendolyn daily saying, um that she chose general surgery. And when she did so, she rejected the notion that life start the lifestyle of a surgeon is too hard for someone who wants to have a family extracurricular and dress etcetera. Onda, for some reason when concerning CT surgery that for fear really comes back, So is the lifestyle of the CT surgeon really more disproportionately difficult than other surgical about specialties? So I'm I'm not jumping on that one at first only because I I feel like sometimes maybe ST, uh, like misconceptions like that they gave you get, I guess, what? Mail? CT starches want to be home with their family, too, and they make it work, right? And so why can't we make it work as women and don't get me wrong? I do feel that a lot of the burden does fall on the woman, and, you know, I'm eating to surgeon family. I can assure you there's a lot of beef between my husband and I about who does how much home. But but it is dance of that question. I think it's It's it is completely do. Well, you know why? Because you'll make it work, right if you do what you want and you're passionate about it and know it sounds corny, but we've heard it multiple times in our training. Right. You will figure it out and you will make it work. It's either your starts. I don't know. Um, you didn't resourceful, which is what we do anyway. Circuits right. And so it is It is doing and also bear in mind that as faculty, you are more in control of your schedule, right? So as training is, it is hard and you're at the second call of your attendings. But as an attending, if I know that I have to be somewhere like right now I need to leave saying to take my Children today wasn't us. I I don't have a patients in my clinic schedule this afternoon. I am going to be going to watch my kids be miserable of skin. But But anyway, but that's what you do. You make it working. You have control over it and and you know I will say the if you're thinking about having a family and having a spouse, etcetera. She spell selections, actually, were were having someone truly is backing you up and there to push you and support your career is extremely. Yeah, I I completely agree. Um, you know, I think point about the lifestyle is different As fully trained surgeon, whether your academic faculty, you're in private practice, you know, don't look at the lifestyle of treaties when you're making a decision about your career. Um, I can tell you, since being a practicing surgeon, I've run four marathons and dropped my golf handicap and and two babies and get married. And, you know, I completely agree that your spouse selection is critical. Um, because that person, whether they're in medicine or not, has to be willing to put up with the Oh, I got to go to the over right now. Call. You're gonna have to deal with the next six hours of activities, and, um, but then, you know, there's got to be some given take where, um I mean literally this morning. About an hour before this. Meaning, You know, we got a phone call that our nanny, unfortunately, had a death in the family. And so we've got a scrambled for child care for the next three days. So you know, I can't just take three days off with the drop of a hat, and my husband can't either. So there's got to be given. Take, um and so that your your partner selection is critical. Um, and you can't do everything all this hot. Um, you know, I haven't run marathons. Well, I've been having babies and, you know, but I have been practicing surgery the whole time, So you can you can do it all. You just can't do it all the time. And it's not easy. And I think those of us who were drawn surgery are not necessarily drawn too easy things. So they tend to go hand in hand with the ability to balance a lot. Thank you. Think has very valuable advice. And especially, I'm assuming most of us are in a more junior states to seeing people. You having how to choose that with that right side is very inspiring. So I'm aware that we're almost out of time, so I think I can close with one last question and just a direct everyone panel is just put in the chat of feedback for. So if you'd like the certificate of attendance, make sure to fill that out. So what? That I just I saw one last question, and that is do you guys or what advice do you have for people at this junior stage in terms of, um, mindset or skills we should develop in order to become successful CT surgeons in the future? I think I think I would say, um just be passionate. Look passionate about what you do, right? Find find what it is that you enjoy it and throw yourself into, because then you'll you will be good at it. And by being good at what you do, then you well, you know, start progressing in your career are your stories Don't But not Yeah, um, I just wanted a little bit, but, you know, there's a great quote, um, about, you know, a goal without a plan is just a dream. And this is where I think mentorship can really be helpful. Um, so think about what your goals are, and then find people to help you make the plans that are necessary to achieve those goals. And like I said, I think a lot of people who are even considering surgery are pretty goal oriented people. Um I mean, that's the nature of what we do in surgery, right? The goal is to, you know, cure if we can, if not, you know, treat very well. And, um so I I would just think her and Judah think about what it is. You know, I've got even sitting on my desk now, like numerous had to do list goaless. Um and that's that's really helpful to me. And I use those when I'm talking with mentors and sponsors. So that's what I would encourage you to do. Thank you. I think there's a really great answers. And the session has been really helpful to thank you about so much. And ah, huge of virtual round of applause for Dr Seven Doctor David for agreeing to do this and sharing their knowledge with us. Um, so I sent a some links in the church after the the session was being recorded. I'll stop recording now, actually, so