Ask Me Anything with Dr. David Spain

General Surgery Residency Program Director Dr. David Spain invited our Instagram Followers to ask him anything, and he answered! From what he loves most about Stanford Surgery to when he last had hair, Dr. Spain offers candid responses to each question.

How can I find mentors in the field of surgery?

"I think it depends on who you're talking to. If you're a resident, it should be pretty easy to find a mentor. Your training program should help you do that and have a process to help you identify it. If you're a medical student, hopefully there's a training program where you're at. Should be easy to reach out to surgical leaders in that program and talk to them. If you're an undergraduate student, you really don't know. Some training program close to home in your state. Most surgery people we are actively mentoring people. So, if somebody reaches out to us, we're almost always happy to just pitch in and help. Worst thing that happens, you email somebody, they don't answer you."

Who is your favorite resident?

"Yeah, I can't really answer that question. But you know there are almost aspects of every resident you like working with. And I think that's the part you have to remember. You can't, you know, take any random people, put them together, and expect they're always going to click or get along great. But almost always there's some that resident that you can enjoy working with them or something you can help them work on and develop."

When did you last have hair?

"I can tell you I knew I was in trouble in 1993 when I saw a video that was shot from behind and I saw the top of my head and I knew it was just a matter of time before I was going to go bald. Somewhere a couple years after that, I was paying somebody to cut my hair and I was like, 'This is stupid.' And so, then I just went bought a number two, you know, or number or a Bick razor for two bucks and started shaving my head probably about 1995."

What do you hope your residents remember about their time at SHC - years from now?

"You know, obviously our number one goal is that they become great surgeons and that they get to have the career they want and can take care of patients and contribute to surgical care sort of beyond just the patients that they take care of. So, I hope hopefully they remember that we sort of help them achieve their goals, define and achieve their goals."

How do you balance teaching, efficiency, and safety in the OR?

"That’s getting increasingly challenging, and I think unfortunately sometimes we see teaching sacrificed for the goal of efficiency, but we are a teaching hospital that is part of our mission and so I think all of us have to figure out like how do we do both things right how can I be efficient and teach and you just constantly have to be thinking about it because if the minute you quit paying attention to it the first thing that's going to I was teaching."

How do you support med students rotating in surgery for cores and sub-Is?

"Slightly different groups. Sub-Is are usually somebody who's decided they want to go into surgery. And so, you know, our goal is to make sure that they know they've made the right decision and surgery is for them. For the core students, they're going to go into all sorts of different things. I've never been one to try to convince every student they should be a surgeon. Most of them shouldn't or don't want to be. It's not the right thing for them. That's fine. Whatever they go into, you want them to understand what a surgeon is, what a surgeon does, and how we should work together as colleagues someday in the future."

What qualities do you look for in applicants?

"This, I think, a good bit of a changing target. I think there's lots of ways to be successful. I think there's lots of ways to be a good surgery resident. I think there's lots of ways to be a good surgeon. I was talking about this with some of the residents recently and they've started working on an opinion piece and it really came out quite well. I was really surprised at what a great job they did and you just you want to be your authentic self.

Now, that has always been challenging in residency, kind of had a one-size fits-all mold. And now we're moving to this place where, you know, there's no such thing as a surgery resident personality. And so, how can a place help you be who you are?"

How are autonomy and supervision balanced as residents progress?

"Yeah, this is one of my soapbox kind of things. Um, I think when most people talk about autonomy, it's not particularly sophisticated discussion. Mostly they want to like leave residents alone in the OR. And I don't think that's, you know, necessarily the best answer. My job is to coach you how to be independent, right? So, there's almost no operation I can't make better by being there and coaching somebody. But part of the process through that five years of training is we need to coach you how to be independent so that when you're done you can go out there know what you can and can't do know when you should ask or help you know, and so I think that's the thing I think it's really on the faculty to really think about how do I coach this person that independence."

Academic/cultural goals the program's working toward - how are residents involved in that?

"Culture is the most important thing in a training program like almost any program around the country is going to good case volumes and breadths of cases for you to do. They're going to have pretty good teaching. If you go to an academic program, they should have all

the research opportunities for you that you want. If you're going to a community program, they should have all the learning and career opportunities available to you want that for you that you want. The question is how do you make sure that your personal goals align with the culture of the program? That's the tricky one and that's sort of what the whole interview process matching should try to help you figure out. But then again is you know if you go somewhere the minute you go to a place, and they think they have all the answers that's when they're like losing ground. So, we're constantly trying to evolve and constantly involving the residents and trying to figure out like where are we going next? Like what's our next thing? Where can we improve next and how can the residents help define that and contribute to it."

You guys have that one-day retreat, don't you?

"We do it every year. So, we set off like an evening, we get some food, the residents sit down, basically go through like every single rotation. So, what's working and how do we preserve that? What could be better? You know, and how can we make and how can we add that? And you know, every year we come up with a list of like, you know, eight or 10 things. And pretty much like every service or rotation we go back to and say, "Hey, the residents think if we did this, you know, something different over here that this would make this a better rotation." Pretty much everyone looks at it and goes, "Yeah, that's great." And then we add it to the program and again, every year try to build on our successes."

How is technology (AI/robotics) changing the ways you train residents or perform surgery?

"Yeah, it hasn't affected us yet. Like I think robotic surgery and the use of the robot is definitely coming and definitely changing operations and definitely changing how we train residents. I think its full impact hasn't hit yet and it but it will. And also the same with AI; I heard a quote recently and I think it's true: “I don't think AI is going to replace surgeons but I think surgeons who can use AI will replace surgeons who can't.” So how do we use this tool to make ourselves, you know, faster, better, stronger? It's going to happen. How do we do it intelligently is is going to be the big challenge."

Are there any books, classes, or experiences you recommend before college?

"It depends on what your goals at life are. Right? If your goal is to be a leader, the one consistent characteristic of every great leader is that they're almost always voracious readers. So, there's a whole cottage industry of books out there. Figure out what kind of resonates with you and what you like. Like some of my favorite leadership books are The Contrarian's Guide to Leadership, The Five Dysfunctions of a Team, and those are the big two. Those are probably the most common ones that I recommend people read."

What makes Stanford's residency program unique or different?

"You know, as I said, every residency program has its culture. You know, I think ours is over the last 10 years or so, we've had this sort of evolving ethos that, you know, it's possible to work really hard but still be treated well and still be treated like an adult. I think there's a little sort of a delayed growth mentality, I think, with residents somehow. You know, it's easy to forget they're 30 years old or 32 years old and still sort of think of them as kids, you know, and you realize like, you know, we delay sort of like professional adulthood by residency. And you know, most 32-year-olds have a lot more autonomy and stay in their job than a resident does. So, I think we've particularly Dr. Hawn’s leadership been really smart about like allowing our residents to really train hard and be great surgeons, but also at the same time realizing like we can treat them well. We can treat them as adults. We can, you know, they can have a life outside of work and, you know, be complete people and not just surgery residents."

What advice do you have for parents doing surgical residency?

"You need help, so you need a team. It's great if in-laws or other family members can be nearby. You have to be super organized, and you always have to have a plan because stuff happens you can't control."

What do you love most about the program?

"I mean, it's a little corny, but it is the people, right? Like my fellow faculty members, good people. They work hard. Their hearts are in the right place. They're trying to do the right thing. The residents are incredible. Like, they're super smart. They're really hardworking and they're really committed to taking great care of their patients and learning and becoming great surgeons.

I'm not 100% sure how it started, but one of my jobs as program directors to make sure I don't mess it up is we have this kind of like very good symbiotic relationship. We ask them to work really hard like we do, but they know we're doing it ‘cause we want them to be great surgeons and we want the patients to get great care and so they appreciate that and I think the faculty try to appreciate how hard the residents look. Yeah, we're not perfect. times we could all do better and pay more attention and you know but for the most part I think there's a sort of good symbiotic relationship where you know we ask a lot of them but they understand that we're also giving them a lot and so um you know it's been kind of nice to see and nice to see that continue to grow."

Final Thoughts

"There's a lot of surgery residency programs out there and there's a home for everybody and you need to figure out like what ones work for you and figure out like what's important to you and don't let anybody else try to tell you what should be important for you. You should decide what's important for you and then, you know, try to find a home that matches it and go out there and, you know, learn how to be a good surgeon and take care of patients and and then contribute how you want to contribute."