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6 Start with Why How Great Leaders Inspire Everyone to Take Action - Explains the importance of developing a shared philosophy for business, teams, and frankly, any mission. It relays a vital concept, but the text is unnecessarily repetitive- it could be significantly shorter while maintaining the message. - Regarding a business model- your "why" is your basic underlying philosophy, motivation, and guiding principle, your "how" is your process, and your "what" is your product. - You can convince customers to buy your newest product, but you have to re-create your marketing with each novel concept. Loyal customers buy your product because they believe in your philosophy. Think about Apple. They don't sell a product. Apple customers will purchase the next Apple product, not because of the particular design or nuanced update, but because they believe Apple's "why." - Ask an employee or a teammate- what do you do? Is their answer a description of their daily tasks? Or is it a message, a principle that guides their action? - If your company's "what" becomes obsolete, your company becomes outdated. If your company was created to copy written text manually, you would be unlikely to adapt to the new technology that successfully automates the process. If your company's "why" was focused on the value of literature and facilitating easy access to books for everyone, this will allow you to remain relevant regardless of how the world changes. Previous Next

< Back Vent Mgmt #1: Basics The goal of ventilatory support is to maintain appropriate O2 and CO2 in the blood while offloading the work of the respiratory muscles and minimizing iatrogenic lung damage. Understanding this principle will help guide your ventilator management. Many variables can be manipulated on the ventilator, but there are a few key variables that truly control oxygenation and ventilation. While there is not one ideal setting for every scenario, there are a few basic principles that cover the majority of ventilator management. Basic Ventilator Settings First, it is important to understand what the ventilator does. The ventilator can push air into patients. You can control how much air is pushed in (tidal volume), the number of breaths per minute (respiratory rate, RR), and the concentration of oxygen molecules in the air itself (fraction of inspired oxygen, FiO2). It's also possible to control how quickly air is pushed in (flow)- but we will get to that later. It is important to note: the ventilator does NOT generate pressure- it only monitors pressure to prevent damage from elevated pressures (barotrauma). Breathing is controlled by three variables. Trigger- this determines when a breath starts. Either time, flow, or pressure. Time trigger is utilized when the patient is not generating any spontaneous breathing (ie mandatory breaths). Flow and pressure triggers are utilized if the patient has spontaneous respiratory activity. When the patient attempts to inhale, there is a change in flow and/ or pressure. This is sensed by the ventilator, and a breath is delivered. Limit- this sets the maximum value a parameter can reach during a breath. For example, volume-limited indicates that a breath can't exceed a certain max mL and pressure-limited indicates that the pressure monitored by the machine can't exceed a certain max cm H2O. For a graphic representation, please refer to the image in the section on Limit Variables in Deranged Physiology. Limits impact the shape of the waveform. Volume limited- flow ceases when the set/ target volume is delivered. Pressure limited- a large portion of the TV delivered at the beginning of the breath until the set/ target pressure is reached and then the flow tapers, slowly delivering the remainder of the volume until the breath is time or flow cycled (see next) Cycle- this determines the end of a breath. Time cycled- inspiration ceases at the end of a set time duration. Used in mandatory breaths. Flow cycled- inspiration ceases when flow drops below a certain level. Used in spontaneous breaths. Volume and pressure are not currently used to cycle breaths. The goals of mechanical ventilatory support are O2 delivery (oxygenation) and CO2 removal (ventilation). Effective oxygenation and ventilation are measured by an arterial blood gas- PaO2 indicates the partial pressure of O2 and PaCO2 indicates the partial pressure of CO2. Oxygenation is a function of the concentration of O2 delivered to the patient (fraction of inspired O2, FiO2) and the surface available for O2 exchange. Positive pressure maintains open airways, which maintains the surface available for O2 exchange. Mean airway pressure (MAP) is the parameter that indicates the average pressure measured in the lungs throughout inspiration (inspiratory pressure) and expiration (positive end expiratory pressure, PEEP). Expiration is usually 2-3 times longer than inspiration, so MAP is often simplified to PEEP when trying to optimize oxygenation. However, increasing inspiratory time can improve MAP without adjusting PEEP. Ventilation is controlled by minute ventilation (total volume of air exchanged every minute). Minute ventilation is respiratory rate multiplied by tidal volume. Therefore, respiratory rate (RR) and tidal volume (TV) are the two parameters that can optimize ventilation. Lung-Protective Ventilation Minimizing iatrogenic lung injury is also important when caring for patients receiving ventilatory support. Different types of trauma, including barotrauma (excess pressure), volutrauma (excess volume), and atelectrauma (repetitive opening and closing of alveoli), can damage lungs that are already diseased. The risk of barotrauma can be minimized by monitoring airway pressures (peak and plateau pressures). Volutrauma can be minimized by low tidal volume. Historically, larger tidal volumes were standard (10-12 mL/kg). Currently, the most commonly recommended volume is 6-8 mL/kg (there are some exceptions). Decreased TV leads to ↓minute ventilation and ↓CO2 clearance (↑PaCO2). This is the basic physiologic principle behind "permissive hypercapnia" during mechanical ventilation for ARDS. Atelectrauma can be minimized by maintaining PEEP, which keeps alveoli open. Additional References 1. Respiratory Therapy Pocket Reference Card Previous Next

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How to play nice in the sand box...and why it matters Consults < Back How to play nice in the sand box...and why it matters The department of Acute Care Surgery and Emergency Medicine frequently interact to discuss consults. Unfortunately, several factors predispose to an adversarial relationship between the ER provider and the consultant.(1) I won't pretend that I didn't contribute to some of the negative interactions I've had while responding to consults. However, I'm grateful that my years of experience have provided me with insight and perspective that reframed my thoughts about the consultation process. What are the different types of consults? #1 The patient requires something that is beyond the scope of practice of the emergency provider. This includes everything from hospital admission, surgical or procedural intervention (appendectomy, stop the bleeding from a penetrating neck wound, cardiac catheterization), or a plan for close follow-up. How to Respond? This is why we chose our specialty, and our business is patient care. If a consultant is not responsive, it might be because they are caring for more urgent clinical issues. It's also possible that they are a generally unpleasant person, and it has no relation to the nature of the consult..some people can be difficult regardless of the scenario. Admittedly, it might also be 2 am, and they just fell back asleep after their last page. As much as I hate to admit, it's harder to be pleasant on the phone when you're absolutely exhausted. #2 The unclear diagnosis. The patient is presenting with a complex issue, or the diagnosis may be outside the provider's experience. This could be the first time they encounter a particular clinical scenario or an unusual presentation of a common diagnosis. How to Respond? Depends on the scenario. If that patient requires emergent assistance, prioritize their needs. If no emergent need, but further workup is needed, provide whatever recommendations you can regarding the next steps of the diagnostic workup. If the patient's case falls under your specialty, refer back to #1. #3 The emergency room provider doesn't know who the appropriate consultant is, or they have had no luck reaching them. How to Respond? It's easy to brush off a call when the primary provider called the wrong service. This might occur if the provider cannot reach a particular specialist, and you are the next best option (example- plastic surgeon doesn't respond for a consult on a patient with a wound complication). Please, if you know how to reach that provider, lend a hand. Or, if they call the wrong service, take the time to give a little guidance about whom they should have called. They aren't trying to waste your time- they are likely also busy, and calling multiple consultants is not the best way to spend their time either. Whatever assistance you can provide is best for the patient. #4 The controversial consult. In my experience, during years of working with surgeons and emergency physicians, probably one of the most contentious consultations is the consultation for something that the consultant considers inappropriately simple or unnecessary. The surgeon may think that the issue is trivial or the need is non-existent and feel that the provider should be capable of resolving the issue without calling a surgeon. This disconnect might be the key patient interaction that can set the tone for the relationship between departments. How to Respond? First, and most importantly, please don't be dismissive when someone calls you for a consult. If you are receiving a call, it's because the person on the other end of the phone (and therefore the patient they are caring for) needs your help. Surgeons, along with other specialists, have extensive specific expertise, so it's easy to lose perspective and presume that the knowledge in our head is universal. It's become almost intuitive in our minds, so we might forget that the primary provider does NOT have the same specialization. We each chose our respective specialties, and our training and biases are quite divergent. It is unreasonable to expect ER physicians to share the same depth of knowledge in each of the many specialties, just as each of the specialists would not have the same ability to deftly juggle the wide array of clinical scenarios managed in the ER. I remember the plastic surgeon who showed me how to do a scar revision on a young woman's face. He spent his career training and practicing to perform plastic surgery. It was simple in his hands, but that doesn't mean the woman would have a similar outcome if the needle driver was in my hand. Please, think of the patient's best interest. Yes, the primary provider may be "an idiot" or "lazy" or whatever. But consider the other possibilities. I prefer to give my colleagues the benefit of the doubt and avoid automatically assuming incompetence. Regardless of the underlying issue, whether it's a flaw of the provider or its truly beyond their capability, the patient needs someone to take care of them. Do the right thing for the patient- in the end, that's what matters. 1. Koo A, Bothwell J. Tips for Working with Consultants. ACEP Now. Nov 2017. Previous Next

Favorite Websites and Apps < Back Kitchen Hacks #4 Favorite Websites and Apps How Sweet Eats Eating Well (previously Cooking Light) Cooking Substitutions Previous Next

< Back GERD What is GERD? Gastroesophageal Reflux Disease (GERD), more commonly known as heartburn, is caused by acid from the stomach moving into the esophagus, which causes a burning pain in the middle of the chest. Anatomy After swallowing, food moves down the esophagus and into the stomach. The lower esophageal sphincter (LES), which is at the connection between the esophagus and stomach, prevents stomach contents from moving back into the esophagus. The lower esophageal sphincter is located below the diaphragm, where pressure from the abdominal organs helps keep the sphincter closed. There are different causes of GERD, but the lower esophageal sphincter is key to preventing reflux. See below for more details about why GERD occurs. Source: UpToDate Images: Gastroesophageal Reflux (GERD) Causes of GERD Decreased pressure of the lower esophageal sphincter- if the lower esophageal sphincter is too loose/ relaxed, stomach contents move more easily into the esophagus. This can be a pre-existing condition but it can also be caused or worsened by lifestyle habits. For example, tobacco and certain foods such as alcohol, chocolate, caffeine, carbonation, mint, citrus/ tomato-based foods, spicy/ fried/ fatty foods, can also decrease the pressure of the sphincter. Eating too much/ too fast→ overfilling the stomach leads to increased pressure, causing stomach contents to be pushed into the esophagus Laying flat- when you are standing or sitting upright gravity helps avoid reflux by keeping food in the stomach, but when laying flat, stomach contents can move into the esophagus more easily. This is why symptoms are often more severe at night or first thing in the morning. Hiatal hernia - when the lower esophageal sphincter is able to move into the chest, it no longer has the external pressure normally present when it’s in it’s correct position, and it more easily allows stomach contents to move into the esophagus. See link for image. Obesity or pregnancy- increased pressure on the abdomen from excess weight can put pressure on the stomach and allows stomach contents to move into the esophagus for easily. GERD: Symptoms and Causes [Mayo Clinic: Patient Care & Health Information] Diagnosis Symptoms are often adequate to diagnosis GERD. A swallow study can provide further information. This study is performed in radiology, and involves drinking contrast material and having x-ray images taken to evaluate the esophagus and stomach while you swallow. This study can diagnose esophageal problems, such as poor muscle function leading to swallowing difficulty. In addition, a hiatal hernia can be identified. John Hopkins Medicine: Barium Swallow An esophagogastroduodenoscopy (EGD), also known as an upper endoscopy (see link) can be used to assess the inner lining of the esophagus, stomach and the first part of the small intestine (duodenum). There are many things that can be identified on an EGD, but specifically related to GERD, damage to the lining of the esophagus and the presence of a hiatal hernia can be identified with an EGD. Patient education: Upper endoscopy (Beyond the Basics) [UpToDate] Upper Endoscopy [Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)] Additional testing can be performed based on symptoms, results of initial testing and response to treatment. Esophageal manometry- a study to evaluate the muscle function of the esophagus ( pH test- a study to evaluate how much acid the esophagus is exposed to, which is one measure of the severity of GERD. GERD: Diagnosis and Treatment [Mayo Clinic: Patient Care & Health Information] Treatment Lifestyle Modifications [ Patient Handout: Anti-Reflux Diet and Lifestyle Modifications ] Eat slowly, avoid eating large meals and stop eating before you feel full. Avoiding alcohol, chocolate, caffeine, carbonation, mint, citrus/ tomato-based foods, spicy/ fried/ fatty foods. Avoid lying down for at least 2-3 hours after meals. Don't snack after dinner/ before bed. Elevating the head of the bed by 6-8 inches. This is NOT done by placing multiple pillows under your head- multiple pillows would actually increase pressure in the abdomen (like doing a sit-up or crunch). For more information, see this guide from the Kingsley clinic. Lose weight. Stop smoking. Avoid tight-fitting clothing. Medication Over the counter antacids Prescription medication Surgery Depending on how well medication and lifestyle modifications improve your GERD symptoms, and depending on the results of your other studies, such as your swallow study, esophageal manometry and pH testing, surgery may be an option for GERD. UpToDate Patient Education Patient Education: Gastroesophageal reflux disease in adults (Beyond the Basics) Previous Next

< Back Mangled Extremity- Keep or Cut? A 42-year-old male was struck by a vehicle as he was crossing the street. He was brought in by EMS. He had a depressed GCS and unequal pupils, and he was intubated for concern for airway compromise. He had a significant injury to the right lower extremity with diffuse bleeding, but no active arterial bleeding. Compressive dressings were applied. He had fluid in the LUQ window of his FAST. He was hemodynamically unstable. Initial evaluation and management? Imaging? Poly-trauma patients demand prioritization and quick decision making, and the simple step-wise algorithms designed for each injury in isolation are less helpful. Patients with blunt abdominal trauma and hemodynamic instability require emergent operative intervention. Patients with a depressed GCS and an abnormal pupil exam require emergent CT imaging to define the severity of their head injury and consultation with neurosurgery. Patients with a mangled extremity require a CT scan to define the vascular injury. In the setting of blunt abdominal trauma, a positive FAST and hemodynamic instability, he was transported to the OR emergently. If there was an option for a rapid CT en route to define his TBI, that would have been ideal. But hypotension is associated with worse outcomes for TBI patients, so the priority is stopping the bleeding. We performed a midline laparotomy, splenectomy, and repaired a diaphragm injury. We placed a temporary abdominal closure. Intraoperative Image What do we do about his mangled lower extremity? Consult vascular or ortho? Ex-fix? Amputate? There are several important tasks. Assessment of injury to neuromuscular structures is vital. If possible, rapid restoration of arterial blood flow is beneficial. However, it is vital to evaluate the need for amputation. This decision requires consideration of current physiologic status, co-morbidities, and baseline functional status. It's sometimes a question of life versus limb. Orthopedic and vascular specialists can be consulted, but it is important not to lose sight of the patient's overall clinical status. A brief temporizing procedure to restore blood flow with a shunt, stabilize bony structures, and preserve any remaining soft tissue may be appropriate, but a lengthy vascular repair and bony fixation are likely not ideal. The patient's baseline functional status, social support, and co-morbidities were unknown. Based on the severity of his extremity injury, high injury burden, and need for urgent head CT, my recommendation was for immediate amputation. This decision requires weighing the risks/ benefits of limb salvage (prolonged time in the operating room for stabilization, risk of ongoing tissue ischemia leading to systemic complications) vs amputation (limb loss). Our orthopedic specialists felt they could salvage his limb, and give him a chance to be an active participant in the decision-making. We agreed to a time limit to minimize operative time, so the limb was stabilized temporarily with a plan for ongoing evaluation of the limb viability. Managment of the Mangled Extremity WTA Algorithm Management of patients with mangled extremities remains controversial. Severe scoring systems have been created, with variable success in predicting who requires amputation. In the acute setting, the trauma surgeon must weigh the risks and benefits of limb salvage versus immediate amputation. If the limb injury is devastating (perhaps only hanging on by a small skin bridge), and the patient has other injuries that require immediate intervention, rapid amputation can be life-saving. If the decision to amputate is less clear, a second opinion from a colleague and orthopedics should be elicited. There have been remarkable advances in the ability to restore function to mangled extremities, and discussion with specialties can be very helpful. "Therapeutic advances in the treatment of vascular, orthopedic, neurologic, and soft tissue injuries have reduced the diagnostic accuracy of the MESS in predicting the need for amputation. There remains a significant need to examine additional predictors of amputation following severe extremity injury." Loja, Melissa N et al. “The mangled extremity score and amputation: Time for a revision.” J Trauma Acute Care Surg. 2017;82(3):518-523 The trauma surgeon must maintain perspective on the whole patient- spending hours doing meticulous vascular or nerve dissection/ repair or extensive orthopedic manipulation can be an intolerable burden on a patient with multiple other injuries. 1. Control active hemorrhage. 2. Restore anatomic limb alignment. 3. Assess distal arterial flow→ evidence of vascular injury→ CTA to characterize injury. 4. Assess neurologic function. Unable to control active hemorrhage or there is hemodynamic instability→ proceed to OR. Assess for the need for immediate amputation. Factors to consider: Complex, segmental, severely comminuted fracture. Large circumferential soft tissue loss or massive soft tissue necrosis. Compartment syndrome with myonecrosis. Nerve disruption. Massive contamination. Prolonged warm ischemia >6 hours. Poor distal anastomosis options. No immediate amputation→ intraluminal shunt to re-establish perfusion. Then assess bony and nerve injury. Evaluate risks/ benefits of limb-preservation. Previous Next

< Back Ultrasound: Misc Abdomen Assess for intra-abdominal fluid to rule-out an intra-abdominal source of hypotension. Examine the gallbladder- gallstones, wall thickening (>3 mm) and pericholecystic fluid are consistent with cholecystitis Examine the kidneys and bladder- overt hydronephrosis concerning for mechanical obstruction. Distended bladder despite foley suggests obstructed foley. Vascular Presence of DVT- patent veins are fully collapsible with light ultrasound compression- pressure has to be lower than the pressure needed to collapse the artery. Vascular access for arterial and central line placement. Previous Next

8 < Back Continuing Med Ed (CME) National Organizations American Association for the Surgery of Trauma [Must log-in to access] Journal of Trauma and Acute Care Surgery articles Archived AAST Virtual Grand Rounds Certain Annual Meeting Master Surgeon Lectures and topic-specific presentations Region VII Sessions Critical Care Committee Journal Reviews American College of Surgeons Journal of the American College of Surgeons [Must log-in to access] Surgical Education and Self-Assessment Program (SESAP®) [$685 for 168 CME credits] Training Courses ATLS Traditional Student Course - 16 AMA PRA credits BEST, ATOM, ASSET ACLS, PALS Annual Medical Conferences Other Sources UpToDate Local conferences at your facility (Morbidity and Mortality, Grand Rounds, etc) Military training courses Previous Next

< Back Pack the Guts https://video.wixstatic.com/video/3b6ff6_f29c38a601b645459ef002f51792fc87/1080p/mp4/file.mp4 Previous Next

< Back Blast- Multiple Penetrating Injuries A 32-year-old male soldier sustained a severe blast injury with a chest wound and a supraclavicular wound, a tangential right shoulder wound, and right hand wounds. He arrives at the hospital for care. He was awake and alert, hemodynamically normal. A secondary survey revealed these wounds. Injury Pattern What are the possible injuries based on this wounding pattern? Intra-thoracic (cardiac, pulmonary), great vessels/ right subclavian vessels Next steps in evaluation? Extended FAST exam to evaluate for fluid in chest, abdomen, and pericardial space. CXR to identify for retained foreign body. Helpful to place radio-opaque markers on wounds to help establish trajectory. Plain film of chest/ upper abdomen What additional injuries are possible based on these wounds and imaging? Any organ in the path of the wounds can be injured- this includes intra-abdominal structures (small and large bowel, stomach, spleen, kidney), retroperitoneal structures (kidney) and the diaphragm. How do we determine which body cavity to explore first? Hemodynamic stability and wounding pattern can direct how to proceed. A hemodynamically unstable patient requires swift intervention concurrent with ongoing resuscitation, while a stable patient can be approached more deliberately. The clinical exam can suggest which body cavity is causing the instability. Peritonitis, abdominal distension, grossly positive FAST in the abdominal views suggest the abdomen as the site of injury. Signs of thoracic injury causing instability include decreased breath sounds, jugular vein distension, muffled heart sounds, fluid on pericardial view of the FAST fluid, and a large volume of bloody output in the chest tube. In addition, location of projectiles on plain film help determine trajectory, and any structures along the trajectory can be injured. This patient was managed in a deployed environment by an austere surgical team. We did not have access to CT imaging and we had limited capacity for continuous monitoring. Therefore, in order to rule-out cardiac and intra-abdominal injuries, we performed a midline laparotomy. We performed a pericardial window through the laparotomy. There was no fluid in the pericardium. We performed an abdominal exploration. There were no intra-abdominal injuries. Wounds in the Cardiac Box In the classic description, the “cardiac box” is bordered superiorly and inferiorly by the sternal notch and the xiphoid process, and laterally by the nipples. However, thoracic gunshot wounds outside these confines can just as readily result in a cardiac injury. The diagnosis of cardiac injuries starts with a physical exam and FAST. Physical exam findings can include hemodynamic instability, muffled heart sounds, and jugular venous distension (Beck's triad). FAST will reveal pericardial fluid. If the patient is awake, they may be panicked and have an impending sense of doom. Penetrating cardiac injuries require operative repair. FAST Examination Online Tutorial Society for Academic Emergency Medicine SAEM FAST Exam YouTube Video Previous Next

< Back Mentorship What is mentorship? Mentorship is a partnership between a more experienced and knowledgeable individual (mentor) and a less experienced individual (mentee) seeking to learn, develop skills, and advance their career in the healthcare profession. The mentor is typically someone who has achieved a level of success that the mentee aspires to reach. Through this relationship, the mentee, who could be a medical student, trainee (resident or fellow), or junior staff member, can benefit from the mentor's expertise and past experiences, gaining valuable insights into the healthcare profession. The mentor can serve as an advisor, consultant, or coach depending on the mentor's expertise and the mentee's needs. For example, a mentorship relationship can be designed to help the mentee improve clinical skills, navigate the job search process, or advance research endeavors. It's common to have different mentors for different purposes, as each mentor may have different strengths. Mentorship also provides networking opportunities, as the mentor can facilitate connections between the mentee and other professionals in the field. In summary, mentorship is a valuable tool for professional development in healthcare, offering guidance, support, and connections that can help mentees achieve their goals. Do I really need a mentor? Throughout medical school and residency, I didn't have any formal mentors, but I did actively seek the opinions, advice, and feedback of several surgeons I respected. As a young staff surgeon, I still didn't actively pursue mentorship, though I now recognize that it could have been highly beneficial. My first formal mentorship relationship was late in my training, when I was an Acute Care Surgery fellow and I was required to choose a staff member as a mentor. It's not uncommon for trainees to lack mentors, and one possible explanation resonates with me. "Many young people today who end up in residency…have been on a fast track. They’re essentially high-achieving, highly driven professional students who have been on a fairly regimented pathway…and they haven’t reached a point where there are multiple pathways they could take."(1) As someone who has been on a straight path since high school, progressing from high school to medical school to residency to being a junior faculty, I potentially missed out on a valuable asset. It's important to note that having a mentor is not a requirement, but developing a strong relationship with a mentor can positively influence one's success. It's highly recommended that individuals consider formal mentorship, but it's equally important to recognize that they have the ability to end relationships that are toxic or not a good fit. How do I find a mentor? Mentorship relationships can be an essential aspect of professional growth for medical trainees. These relationships can develop organically or be assigned by program directors in residency or fellowship programs. If you are assigned a mentor, it can be a great experience, but it is also possible that you may not mesh well if the assignment was not carefully considered. It's essential to recognize that if you find yourself in a mentor-mentee relationship that is not productive, amicable, or beneficial, it's okay to end the relationship and seek out another mentor. On the other hand, organic mentorship relationships can also be incredibly fruitful. As you work with various individuals in different settings, such as the operating room, during rounds, or while discussing consults, you will begin to form opinions and may find that you gravitate towards a particular person. If you respect and trust them and they demonstrate skills or expertise that you want to learn from, they might be a viable option as a mentor. The process of finding a mentor can be as simple as asking the person you would like to work with if they would be willing to mentor you. Remember, the worst they can do is say no, so it's worth taking the risk to ask. If they don't have the time to commit to being a mentor, they may be able to connect you with someone else who could be a good fit. It's important to recognize that mentorship relationships require effort from both the mentor and the mentee. While your mentor can offer guidance, support, and feedback, it's ultimately up to you to take ownership of your own professional development. Be clear about your goals, seek out feedback, and be receptive to constructive criticism. By putting in the work, you can make the most of your mentorship relationship and set yourself up for success in your career. Finding a mentor can be a great way to help you achieve your personal and professional goals, but it's important to have a plan in place to make the most of the relationship. Here are some steps you can take after finding a mentor to ensure that you get the most out of the relationship: 1. Set specific goals: Take some time to think about what you hope to gain from your mentorship. Are you looking to improve your skills in a particular area? Do you want help navigating a career transition? By setting specific goals, you can make sure that you and your mentor are on the same page and working towards the same objectives. 2. Establish communication: Once you've set your goals, it's important to establish how you will communicate with your mentor and how frequently you will meet. This can be done through formal meetings, phone calls, or casual chats over coffee. Make sure that both you and your mentor are comfortable with the frequency and type of communication. 3. Complete assignments or tasks: Your mentor may assign you tasks or provide you with guidance on specific projects. It's important to take these assignments seriously and complete them as directed. This could be anything from revising your CV to drafting a study protocol. By following through on these tasks, you can demonstrate your commitment to the mentorship and make progress towards your goals. 4. Reassess and refine: As you work with your mentor, it's important to regularly reassess your progress and refine your goals. This may involve checking off completed tasks, adding new objectives, or removing items that are no longer a priority. By keeping your goals current and relevant, you can make sure that you are making the most of the mentorship. Overall, finding a mentor can be an incredibly valuable experience. By taking the time to set goals, establish communication, complete assignments, and reassess your progress, you can make sure that you get the most out of the relationship and achieve your personal and professional objectives. 1. Darves B. Physician Mentorship: Why It’s Important, and How to Find and Sustain Relationships. NEJM Career Center. 2018 Feb. Previous Next