Lee SharmaChief Medical Officer, PATHS · Physician, Conflict Analyst,Host of the “Scalpel and Sword: Conflict and Negotiation In Medicine” Podcast, Co-Founder of Lintel Health. Conflict IS the doorway.

EP36 – The experience of conflict in residency with Dr. Emily McInnis

26 Jan 2026 · 48 min

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48:10

In this episode of the Scalpel and Sword podcast, host Dr. Lee Sharma interviews Dr. Emily McInnis, an OB‑GYN who completed her residency at the University of Mississippi and now practices in Auburn. The conversation explores the intense, often unprepared start of residency—being thrust into C‑sections and labor calls without orientation—and the culture of negative feedback, “closet talks,” and “pimping” that reinforces hierarchy. Dr. McInnis describes how she deliberately broke the cycle of harsh criticism by adopting constructive, respectful feedback, and how she now models that behavior with trainees. The dialogue delves into the unique pressures of OB‑GYN, where physicians simultaneously care for mother and baby, requiring rapid shifts between two patients and constant mediation among obstetric, nursery, NICU, and anesthesia teams. Gendered expectations surface, with female residents facing double standards in assertiveness and work‑life balance, and the episode highlights the toll of burnout being mistaken for laziness. Wellness initiatives such as yoga, therapy sessions, and dedicated wellness weeks are discussed as emerging supports. Dr. McInnis emphasizes the importance of emotional processing after traumatic events, the value of peer support networks, and practical advice for medical students entering OB‑GYN—understanding hierarchy, preparing for “pimping,” recognizing the 24‑hour call reality, and securing personal therapy. The episode concludes with a call for more training on communication and conflict resolution alongside clinical skills.

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In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations beyond modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.
Hello, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst. And I am so excited to have on the podcast today, Dr. Emily McInnis. Dr. McInnis is a graduate of Auburn University. She did her medical school at the Edward Villa College of Osteopathic Medicine and her residency training in obstetrics and gynecology at the University of Mississippi. She is currently in practice back here in Auburn. And I am so excited because she is the first OB-GYN I have had on the show. So Emily, I'm so happy you're here.
Thank you for having me. I have been really excited about this. I've been looking forward to a good conversation about OB-GYN specifically.
I know one of the things we were talking about before we jumped on the mic, Was when you started your OB-GYN residency in that first month, how overwhelming and how crazy that was. And I feel like that's such a universal experience for us. Was that something in any way, shape, or form that anybody prepared you for, or was it just bam, this is my first day as an intern and this is nuts?
The latter for sure. I was blindsided when I jumped in. Of course I was excited and I had read through all of my practice bulletins and I thought I was ready for my first day and then I get to the hospital at 5:00 AM and they were like, I was Dr. Allen at the time. They were like, Dr. Allen, it's your C-section, jump on in. And I was like, whoa, this is me. This is my patient. And that was my C-section. And not only did I do that one, I did like 10 that day.
Yeah.
And it was just completely jumping on in. There was no prep. There was no easing into the water by any means. It was just, this is what we're here to do. And you had no choice but to swim and do it.
Absolutely. And I feel like that's such a common experience. I know my first day labor and delivery call, at that point, no one really knows who you are. My training program, we had 14 doctors per year, so it was a huge program. And when someone didn't know your name, they'd just say, are you an intern? And you kinda look over your shoulder going, I guess I am. And I'm just like, well, I'm—
They would all say young doctor. They would call all of us young doctor because they didn't know our names.
Also, my maiden name was Nagendran at that point, so no one could say my maiden name, which I'm sure contributed to the, hey you. It's like, hey, you. Hey, do you know how to deliver a baby? I'm like, that lady's crowning. Take her back and just like, okay. I mean, you have no clue what you're doing. And you start to also understand that when you're going through this really intense experience of being thrown to the wolves, you know, I think you and I both have that in common, that there was no positive reinforcement. There was no support. It was okay, onto the next one. And then you also start to realize, at least I think for me, that The main reinforcement I got was more negative. It's like, okay, if you do something wrong, you're gonna hear about it.
Absolutely. But you don't necessarily hear it if you're doing it right. So you finish a C-section, everything went well, or delivery was great. You just look around waiting on that praise from somebody and you never get it. And that can be a, something that I had to get used to was that doesn't necessarily mean you did it wrong, but they're just not gonna tell you if you did it the right way. But you're right. If you do it the wrong way, you definitely know.
Oh, you will be told.
We used to call it closet talks. I don't know what y'all called that, but if we got a closet talk, that was our upper level letting us have it in the call room.
Wow.
How interesting that you guys had a name for it. Like you named the experience. Like we used to talk about if you got pages when you were not physically in the building, you were gonna get seen something that you had done and they're calling you to yell at you. So the unscheduled page was what terrified us, but we did not have a name for it. That's Wild.
If you got closet talked and everybody talked about it, that was the thing. They'd be like, oh, Ellen got a closet talk last week. And it was just, you know, it was like shameful. You were embarrassed and you might've not even done anything incorrectly, but it was just whoever your upper level was that day and in the mood that they were in.
Were you ever in the position that you ever gave closet talks?
I never gave a closet talk. I can say that because I hated how it felt. Now, did I want to? Absolutely. But I tried to have conversations about, and I still kind of take that into my practice now with people that I interact with at the hospital or clinic, but I'm very much a fan of, I'm not going to shove something under the rug. If I feel like there's something that needs to be changed or something that needs to be done differently for whatever reason, I would much rather just say, and you can do it in a nice way. I think that's where some people really miss the mark is that you don't have to say it in a rude tone or yell. You can just say, hey, you know, you did it this way, but how about we do it this way instead because of XYZ? And people are usually very receptive to that. I think residency is why I try so hard to do that now, because it is not fun being constantly yelled and screamed at for whatever reason, no matter what you do.
There's so much wisdom in what you just said, and I wanna get into all of it. The first one is that you were able to take a negative experience And look at that experience because I do think, and I wanna know what you think about this, I do think there were times when I saw people in residency get yelled at, you know, the Parkland version of the closet talk. You know, you got paged off call and someone's gonna yell at you. And then when they became upper levels, they perpetuated that. This is done to me. And because it was done to me, this must be the way. And therefore I will do this to somebody else, or this is the only way I know how it should be done because it was the only thing that was modeled for me. So the fact that you were able to take that experience and go, I didn't wanna be the recipient of it, so I don't wanna be the giver of it. And just the fact that you were able to sort of break that cycle.
It's just not constructive. I guess that's where my mind went was it didn't really do anything for me when somebody was yelling. Like, that's not how I receive feedback, so therefore I don't wanna give feedback that way. But you're right. I think a lot of people, as they go through each year of residency, they think like, oh, well. You know, I did my time, so now they have to do theirs. And that's just a very backwards mindset to have. But I think that's why that does get perpetuated because people just think that I had my time of dealing with it and now I get to repay that back to people, which, you know, I don't think it's very constructive. So.
Not at all. And I would also be willing to bet that when you were an upper level, when you were a chief and you had residents working under you that they more enjoyed working under you because they knew they were gonna get that feedback in a kind, constructive way at some point, that they were not gonna get a closet talk from you.
And it's funny that you say that because I actually work with 2 of my underlevels right now. So Dr. Morum and Dr. Searles were, when I was a chief, Dr. Morum was a second year and Dr. Searles was a first year. So the fact that they both work with me now, maybe I guess speaks to that, but we all work together very well.
And I'm sure it does. I have no doubt that it does because they—
I have a lot of upper levels I would not have wanted to work with.
But see, that's the case, right? Because culturally it's like, even though culturally that was acceptable from a workplace, also too, once you get out of training and you do have that level of control of who you practice with, you're able to pick and choose. And if you've had a negative experience with somebody, it's like, I don't wanna work with you because I know what you're like. So I agree with you. I think the fact that you were that person and you were able to look at that process and say, this is not conducive to progress, I will not perpetuate it. But that also takes a tremendous amount of self-awareness and strength to do, especially as a resident when you're trapped in that hierarchy. That's hard to do.
And it's hard because I think, especially in a surgical specialty, you almost feel like that's just how things are and that's how you're supposed to be. If you go against the mold, people Or like, why aren't you getting your intern to go get you coffee every morning? Why aren't you giving more closet talks? So I think it surprises people, unfortunately, when you don't act like that, because it's just in people's nature in surgical fields.
I agree. And I think that's also part of when people start getting in these situations, you know, these are very emotionally charged, especially in residency. And I think that's one of the things that contributes to This emotional content that we experience in obstetrics and gynecology. One of the things that sometimes we have to wrap our heads around, especially in obstetrics, when things are going sideways, we really are taking care of 2 patients at any given time. And the fact that we're taking care of 2 patients at any given time, that to me added so much more to the feel of those situations. And I think especially, and I used to tell my husband this, and you know, in OB-GYN, we basically have 2 speeds. We have la-dee-da-dee-da-dee-da, and that's the only 2 speeds we have. There's no in between. You are either watching a clock tick, sitting there staring at the board going, sometime, or you're running through the halls doing this splash stat.
Yes.
And because of that, I think that is one of the things that contributes to, I'm not gonna say a higher level of conflict in OB, but I think it's unique to OB in terms of the way we feel that pace and that contributes to those interactions.
Yes. Having 2 patients, I think definitely makes it hard and even more so with Not just residency conflict, almost interdisciplinary conflict. Because I mean, with OB, I think in every hospital I've ever worked in, you've got the obstetrical team, then you've got the nursery team, and of course baby is their priority. And then you've got anesthesia who's just wanting to get things done quickly and get people to sleep and get epidurals in.
Mm-hmm.
And you've got the NICU team. So there's so many teams that work together and everybody's priorities are different. And it's not saying that they're wrong, but we're the ones who get caught in the middle and are weighing both the mom and the baby equally when everybody else doesn't necessarily have to. And so I think that makes it really hard to learn to balance that relationship. And sometimes I feel like you're just trying to keep everybody happy, right? Like you're trying to keep the nursery happy by certain timing of delivery, certain mode of delivery, and you're trying to keep anesthesia happy by certain mode of pain control, certain time of day of delivering, and you can't always please everybody. So sometimes that can be a stressor or conflict.
Oh, 100%. But that's such an incredibly insightful thing to say that actually you're looking at these teams interacting and understanding that all their priorities are different. And you are the person who's having to unify those teams. And I think that's such a tremendous realization. Was there a point that you really remember that you kind of saw that in action or maybe had a situation where that realization really hit you?
I wouldn't say there was a delivery in particular, but as the OB chief, it was always our responsibility when we had an extremely preterm delivery or a STAT come up, it was our responsibility to let the NICU know if it was under a certain gestational age and to notify the anesthesia chief. And I just remember always being so frustrated on those calls because I was contacting 2 people who wanted 2 very different things. Nursery wants to keep baby in, anesthesia's ready to get baby out. And then there I am in the middle looking at mom and baby and trying to balance, okay, what's best for both people? And I just remember that being one of the most stressful parts of labor and delivery call was trying to make everybody happy because obviously we want to keep the baby in as long as possible for health benefits. And anesthesia doesn't have that in mind. They're just ready to go ahead and deliver so that they don't have to worry about a 2:00 AM stat later on. I wouldn't say it's delivery in particular, but just in general, trying to balance that between the 2 teams was very hard.
Yeah. I also think, and you said something talking about that I think is really important, is that at some point in time, somebody's gonna get upset. It may be anesthesia, it may be the nursery, but somebody's gonna be upset because you are the one who is trying to maintain this very meta whole picture of what's going on with this dyad. And because of that perspective that you have, because you recognize that these are both my patients right now, that you are the one who is having to, in a sense, be the mediator between these two. And I think also sometimes as part of that, and I'm willing to bet this, just knowing how good you are, that you are able to communicate to both of them, look, I know you want the baby out. But if we can give at least 48 hours for the betamethasone to kick in, then we need to do that. And then talking to anesthesia, like, I'm going to do my best, my level best not to call us at 2 AM if I gotta, but I will do my level best to have this not be a middle of the night section. And you're having to, because you understand those perspectives so well, you're literally phrasing how you talk to them in such a way that they're feeling heard. Okay, she gets me. She understands what I feel like I need to do, but she's also keeping the whole picture in mind.
Yeah.
That's really hard to do.
Being a mediator is very hard, especially if you have strong personalities on either end. And it never fails when the shift work with anesthesia would get off for the night, or the team coming on rather, would pass by the labor and delivery desk on their way in. They'd say, okay, what time's everybody gonna have a baby? And I'm just like, I wish I could tell you. They wanted to know. And I'd try to, you know, take 10 seconds, take a deep breath before we have that conversation because it's Like, now, you know, I can't predict that. And then on the other hand, the nursery is walking by and they're like, all right, what time can we keep these babies in? They gonna stay in for 48 hours? I'm like, hope so, but we'll see how it goes. So it's like you're just constantly the mediator between multiple groups of people taking care of the same 2 patients. Yeah. So OB-GYNs are mediators a lot of the time.
In so many ways. And I do think that the people who kind of had a leg up in doing this, got that training early on like you did when you were in residency. When you were chief, you were already learning how to do this, and that bode well for you continuing to do this when you're in practice. Did you feel like that in terms of hierarchy, that that really contributed to some of this conflict when you were in residency? Did you have a very, this is the way, this is our hierarchy, we're not going to deviate from this, this has to go up the chain, down the chain. Was that very structured in your program?
Yes. I don't wanna speak for everyone. I had some great upper levels and great attendings that I really learned a lot from, and they were wonderful. But then I had some in particular that I can remember. It's funny how things stick with you. I had an attending that she was a maternal fetal medicine fellow and we were on rounds and something was said where I was trying to help one of the interns with one of the questions that they were asked. And she looked at me and she said, tell you something? And I just looked at her and she said, you think that this place is a circle. It is not a circle. It is very much a triangle and I'm at the top and you're at the bottom and you need to remember that.
She didn't know.
Oh, she did. And I remember to this day, I remember where we were standing, what we were doing. Like it stuck with me because I was just like, wow, she is serious. You really said that? And I had several upper levels. That one in particular that I was on night shift with, and I didn't do something the exact way she wanted it done. And because, you know, in OB-GYN there's a million ways to do everything. And she pulled me into the lounge and in front of everyone said, when I say jump, you say how high. And if I tell you that that grass out there is blue, then you're gonna agree with me. You do what I say. And I was like, okay. And you can't argue. She's your upper level. And unfortunately in my program, there was not a lot of backlash when that happened. The attendings would just kind of like shrug it off and that's just how the culture was. And that's just what I expected, especially from those people. And again, I don't wanna speak for everyone because it wasn't all like that, but those moments in particular will stick with you. And I still remember her saying that about the circle and the triangle and try to keep that in mind, especially when I have medical students.
Yeah.
Like, I feel like that is That's something I revert back to. And I can't imagine saying that to a medical student now. So it's just wild to me that that's part of the residency culture.
Yeah, that's wild that somebody actually said that, but also too said that to you in front of other people, because if they're making that statement in front of other people, then that's truly their walking around worldview that, you know, it is what I say it is. And if I don't say that's what it is, then You don't think that. And that's crazy to me. That was something that somebody actually said to you.
Oh yeah. And that's why, you know, OB-GYN residency, I feel like it doesn't just train you as a surgeon or as an obstetrician, but it tests your communication, your people skills, your self-identity. I mean, it tests so many different things. And I think that is the specialty of OB-GYN. In that because I had friends in other specialties and they would come home and hear my stories and then they're like, she said that to you? Or, you know, they got lunch in the lounge after doing rounds for the morning and they would bring home all the leftovers. And there I am like eating my first meal of the day at 10:00 PM. And I don't think I went to the bathroom all day and got called a triangle instead of a circle. And they're just like, man, this is horrible. So, you know, I think it is.
And it is very interesting, right? Because I think people from the outside looking in, people look at OB-GYN, other specialties, it's like, this is a softer specialty. You know, we're women's health. We're going to be a kinder, gentler nation. And we're definitely not. We are definitely not. And I remember the medical students at Parkland used to talk about, and I forget how the conversation went up, but I asked them one day, it's like, what residents are you most scared of in this building? And they were like, the OB-GYNs. Which at Parkland, you know, those programs are massive. And one of the medical students looked me straight in the eyes and he says, you really want the answer? I'm like, I really do. And he says, the general surgeons, all of them, and the OB women, y'all are the scariest. And I went, seriously? She's like, you guys are frightening. Like you guys will, as soon as look at us, you guys are really brutal. And I really thought about it. It's like, are we really that hard on our students? And we definitely had some that were.
Yeah.
I think I had some of this experience where I saw people get yelled at and dressed down, and I was like, I'm never going to do that to a student. I'm never going to do that to a student. And it does teach you on some level how to communicate in such a way that I'm going to let you know what I want from you, but I am not going to do it in such a way that you think I'm about to snatch your eyeballs out.
Right.
And that's a hard line to walk sometimes, especially with the pressure of time and performance and You are trying to be the best residents you can, but you're constantly on this basically vertical learning curve. I think it becomes a real challenge. I'm really glad that you were able to hear that and recognize that that's ridiculous. This is not what it's supposed to be.
And I think part of it, you hit on the fact that they were so scared of the female OB-GYN residents specifically. And I think that is also an obstacle, I guess, in our field is that When you have, and this is just how it is when you're in an OR and you have a male surgeon that yells or screams, he's doing a good job and being assertive, right? But if you have a female surgeon that yells or screams, she is a you know what.
Yes.
And has an attitude and nobody likes her. And so it's 2 people can act the same exact way, one being a female, one being a male, and give 2 completely different perspectives and people take that 2 completely different ways.
Yes.
And I feel like that's also a struggle with OB-GYN because it is more of a female prominent field. And when you have assertive females who, you know, we're all type A, we all like things very particular. I mean, that's how you get to where you are. And when you have females that are all together like that, it can be Very overwhelming for students, I'm sure. But I don't know, you know, I think about it, if we're a men predominant field, would people feel the same way? I don't know.
I definitely think there's a lot to be said. And what's interesting too, is I think a lot of male physicians don't, either don't realize or don't want to acknowledge that it is different for us. And I remember one of the first things I told my husband, and I forget why it came up. I forget the context of it, but I think he had gone to the floor to go demand something. I think he wanted a lab done or something like that. And I heard him on the phone. It's like, yeah, patient in this, do this. Thanks. Hang up the phone. And I just started cackling and it's like, what? It's like, you know, I could never do that. Right. And he's like, what do you mean? I couldn't. It's like, if I do what you just did, if I go to the floor and I go, you nurse from 14, now I'm a witch with a capital B. If I do that, I am hated. And he says, well, what do you do? And I say, oh, so I have a patient crashing. You know what I have to do? Like, hey, how are you? I'm so happy to see you. How is your little girl, by the way? Room 14 needs a stat hematocrit. Thank you so much. And I have to do it exactly that way. He's like, I had no idea. It's like the way that women and male physicians are perceived when you think about being in the exact same role. And I think especially as you said, being surgeons, we are still in the minority when it comes to being in the operating room. There's still more males than females, even in OB-GYN, especially with robotics and with the advanced surgeries that we're doing.
Mm-hmm.
We're still going to be outnumbered. I mean, I think that's changing, but I think in most places that's still the case. And as a result, the way we have to conduct ourselves in an OR is very different. And we have to be, we have to be aware of our communication styles, of the tone of voice that we're using, the things that we do when we get frustrated in a way that a lot of men don't do and don't understand that they, that We have to do. And so I think it's really unusual for them when we start to verbalize that. But it also, I think, is important because I think the more you illuminate those differences, what do you mean we can't do it the same way they do it? Why are we held to a different standard? And I think the more you talk about that, the more other parts of the culture start to change.
Yeah, I agree. It just adds another layer of something else we have to think about while we're working or operating. How did I make her feel when I said that? I don't want to be hurting anybody's feelings. I don't want to be coming off the wrong way. And men, not that they don't care about those things, they just don't think about it like we do and they don't have to. So it makes it a little bit harder for the females.
It does. It really does. And if you think about all the other things that you're balancing, you're thinking about balancing your work, your home life, your children, all the other things that you're having to incorporate into that and the mental bandwidth that it's taking to actually consider, I really want to think about this person's feelings. But I also want to give my best to this patient. I also wanna keep my schedule. I also wanna make sure that if my kid has a soccer game at 4 o'clock, that I'll hopefully be able to be there for that. There's so many other things that are in that space that I would like to devote mental energy to.
Well, and you know, speaking of that, I feel like we do have so many more things that we have to juggle, but at the same time, we want to be valued as an equal when it comes to You know, something I really struggled with in residency was you don't want to appear lazy. Lazy is different than burned out. We would work over the hour limits that we were supposed to have. I'd have a 30, 32-hour shift that I'm working, be so tired, and then have a patient come into triage and they're like, oh, do you wanna go see 'em before you go? And looking back, like I should have said, no, I'm tired. I need to go home. But if you say that, You feel like you are being looked at as lazy or not doing a good job. And I wish that that was not perceived that way. I wish that, and I think they're getting better at it now from what I'm hearing, residency programs, but focusing on wellness, focusing on your mental health, focusing on the fact that, you know, if you've gotten to your hour limit and you're ready to go home and see your kids or cook dinner or go out with friends, that's okay. You don't have to. I would go and do those things and feel so guilty that I had left something at the hospital, even though it wasn't my shift. And I feel like that perception of, you know, feeling like you're looking lazy or, or that people are looking down on you like you're not a hard worker. And back to the female and male comparison, you know, usually not in every case, but usually it's the female that is worried about the kids at home and cooking dinner and making sure you have a clean house.
Mm-hmm.
All the social aspects, getting kids to and from, but then feeling like you still have to be equal with your male killer parts. With how your workload and how late you're staying at work and what you're doing. And I wish that people didn't perceive that as laziness per se, but just realize that, hey, I don't wanna be burned out. I need to set limitations for myself mentally and for my family. And I do feel like people and programs are getting better at that, thankfully, because that, I don't know about you, but that was a big issue for us. It's almost like you're always competing with each other as to who's working the hardest, who's delivering the most babies, who's doing the most cases in the OR, who's doing the hardest cases, who's up for the longest shift. And I don't know why that's such a competition for everyone. I guess it's just how we're built, but that's definitely how it was at my program.
No, 100%. I want to talk about what you just said because that is such a tremendous insight. And I want to come back to this because I think this is a really important distinction. This idea that there's a difference between laziness and burnout. I think That's a really big thing to draw attention to because I think especially in our space, and I agree with you on this, that you did want to be the person that did the most deliveries, did the most breeches. How many stat sections? How long did it take you to do a stat section? How many twins have you done? Have you done vaginal twins? All these kinds of things that we used to, and we knew who did. Oh, trust me. We knew who in the program had done twins, had done breeches, had done stats.
We kept up with everybody really well.
Yes. And it was constantly of, oh, well, so-and-so did this. Oh, so-and-so did like 3 vag hysterectomies last week. That's a big number. I mean, all this kind of stuff that we talked about. And so when it came to my 24 is up, but I could run, go do one more thing. Guess what you're going to do? You're going to run, go do the one more thing. And I was talking to Jodi Green, who is the CEO of Clinician Burnout Foundation. She's an amazing, amazing support for all of us. And she's really drawing attention to burnout in the system. But I told her when I was an intern, it was one of those post-24. I was home. I had stayed up all night. I had stayed extra to round, you know, so it was technically more like 30 hours than 24. And so I was driving home. I was driving to my apartment, which was 20 minutes away. And I have this memory of sitting at a stoplight and then waking up To hear the car behind me honking its horn. I had fallen asleep at the stoplight. And so at what cost are you doing this? And 30 years from now, does anybody care that I stayed to do that one extra delivery? No, nobody does. And in fact, at that point, how safe am I? If I'm not safe to drive a car, am I safe to do a delivery? But we don't think of it that way. We think of it as, I don't want to be perceived as the lazy one. I feel like I agree with you in this, that the people coming out of training or in training now have a much bigger awareness of not only their own personal health and wellness, but the idea that not being well at work means we're not providing good care. And I think they have made that connection. And that was not something we really, I think, thought about training.
We did not have wellness week when I was there, but now they have wellness week. And like I've seen videos, they do a day of yoga. They cater lunch one day. They give everyone a free therapy session. And I just think that's awesome because those are things that I would've absolutely loved.
And it makes me very happy. I think that they are doing those things. I think that they are understanding that these are things that programs need, and especially the way that these people are training and the level of work they're putting in. Hopefully they'll be able to not only use this in residency and make them healthier residents, but also healthier caregivers as they proceed on. I think that's gonna be such a huge thing for them.
And I think, you know, kind of speaking on that and going from that topic is that you almost have a conflict mentally with yourself and you have to learn a lot about yourself because when you are pulling those long shifts and unfortunately with what we do, it can go from 0 to 100 really quick. I always tell patients 95% of our job is very happy, but the 5% that's not is very sad and very traumatic. And I'm sure you can remember specific horrible outcomes in residency that just rocked me to my core. And you have to learn very quickly and sometimes without any guidance, unfortunately, how to go from one room where somebody is having the worst day of their life. To the next room where somebody is having the best day of their life. And it is really hard to learn how to flip that switch and not let it affect you mentally. And I think it affects all of us mentally to some standpoint, but it's how you deal with that. And some people are really good at that and some people are not very good at that. And that's not saying that you're a good or bad OB-GYN, but it's a lot of emotions all the time. Every day that we go to work, you never know what And, and that makes it really hard. And it, it took a really long time for me to wrap my head around really was that the emotional aspect of OB-GYN, not even the knowledge or the, you know, how smart are you on paper or how skilled are you as a surgeon, but how do your emotions hold up when you're in a really crazy situation where there are 2 lives at stake?
And I think it's so awesome and really huge that you recognize that and that you're drawing attention to it and that we're talking about it, because I think there's such a tendency when people have these situations, because I mean, I have clear memories and I know you do too, of being in a really bad delivery or having fetal demise or just really rough situation for everybody involved. You, the patient, the family, the nurses, everybody involved. And then literally 2 seconds later, you're having to walk into another room. And you're having to flip a switch. And I think there's a real tendency to shut it off emotionally. I'm just not going to deal with it. And I think that sort of emotional shutdown that may serve you in that situation has to have a place. You know, you talked about having therapy during the wellness week. If there had been this awareness of you need to maybe take a few minutes and go sit down, and then later on you need to talk to somebody. Or maybe do some journaling or maybe actually do something where you're processing what you just went through. Those were not anything that I had ever even heard of. It was just the, you do the thing, it's horrible. And then you do the next thing and it's okay. And we're actually now understanding that when people don't deal with these emotions, that unfortunately they can manifest in other ways. They can manifest in conflict. They can manifest in personal issues. They can manifest In negative interactions with staff or with other colleagues, because you've got all this stuff inside of you and you don't know how to process it.
You have to release it somehow. That's not something that was ever taught or even mentioned to us. It was just, you know, put on your big girl panties and deal with it. And then after that happens, not only do you have to deal with it, but then you have to go to a full clinic and act like you're fine. And it can be mentally draining. Really. And that's one thing that I recommend to all of my medical students. when they're going to residency is no matter what field that you're going into, find a therapist. I wish somebody would've told me that. Find a therapist, and they have several that specialize in seeing medical professionals, and just have somebody to talk to. And you may not ever need that. You may not ever have a bad outcome where you need that, and that's great, but just having that person there as a way to unload what we—
Yeah.
Shove in these little closets in our head and sometimes don't process or deal with in a healthy way is so helpful.
I am so grateful that your medical students have you, that you are giving them that before they walk in the door of residency, that you're actually already, and you're also acknowledging something that's really important, which is that you are going to have these experiences. It's kind of like we talk about conflict. Conflict is inevitable. You're going to have it. Everybody does. You might as well go ahead and start thinking of ways and developing processes to work with it. Because you're going to, and you're already doing that with your medical students. You are going to have stressful, really difficult situations when you're in training. Let's go ahead and build in processes so that you can start to acknowledge it and work with it. And that's going to make you a healthier healer. I love it that you're already teaching them that. Is there any others? Because you've had experience and I'm sure you've got medical students that are going into OB-GYN. What else do you tell them to kind of help them get ready for this residency process?
There's a lot of things. I do spend a lot of time talking to them about the hierarchy in particular and warning them, because I feel like that was not something— I know we touched on that earlier, but I just didn't know. And I walked in day 1 and like walk up to an attending and asked a question and he just kind of gave me a look. And then I quickly learned, like I had my second year, third year upper level were like, you don't talk to the attendings before you talk to the second year. The second year talks to the third year, third to the chief, then the chief talks to the attending. And I'm like, whoa, I can't just ask him a question? No, you can't do that. So I had no idea that that hierarchy existed and that it was so frowned upon to not act on that hierarchy. So I try to warn them before they go on their audition rotations during their 4th year that, hey, this is how a lot of people perceive it. Make sure that, you know, don't try to outshine the intern on your service. That's a no-no. Make sure that you're asking appropriate questions to the right people. Make sure that you're prepared for the OR. Don't show up and not know how to scrub. Don't show up and not know how to do this. up and not know how to suture. I don't want them to be embarrassed. I always tell them, and you know, we haven't really hit on this, but we would always get, we called it pimping. Did you get pimped in residency?
Oh heavens, yes.
Absolutely.
One of my clearest memories, like the first week, and at that point he was a chief and now he's actually the chair of the department, Steve Bloom, but the first week Like a bunch of us are standing there and he's just firing questions at us and it's like, yep, here we are. And it was nonstop. I mean, this was the whole way through, you know, I think in my program until you got to really third year, you were constantly getting pimped. And even then, by the time you were a third year, you still would get fellows and attendings that would pimp you. So yes, it was so prevalent.
My first 2 years specifically, you would get pimped all the time. And my first day on GYN, with my second year. The attending was pimping her and she answered probably like 4 or 5 questions correctly. And then he asked her another one and she didn't know the answer and he dismissed her from the OR. And I was embarrassed for her. He said, I want you to leave and I want you to write me a 10-page paper on that topic and you're not to come back in my OR until you finish it.
Wow.
I was terrified that he was about to look at me and start firing away. But I warned them that unfortunately that's the case with some people. So it'd Be prepared. And if you don't know, just say, hey, I don't know, but I'll go look it up. Just try to prep them mentally for the way that it can be with the hierarchy, the pimping of questions. Some people, I had an attending once that was asking all these questions and I had really studied on the topic. And so I was doing good.
Mm-hmm.
And you could tell it was in a group of people. She didn't like that I was doing that good. So then she asked me how many divots are on a golf ball. I didn't know the answer and she humiliated me and was like, I can't believe that You don't know that. You should know that fact. And then moved on. So you're always gonna have those people, and I feel like it's just good to have a heads up that exists when some people may not realize it. But then also talk to 'em about the emotional aspect of OB-GYN. I make sure all the students know, hey, this field can be really hard. We make it look really fun all the time because we always have a smile on our face and it's everybody's, you know, the birthday parties are our favorite, having the fun deliveries, but don't forget. That there are losses. There are really bad things that happen. There are a lot of unexpected things that can occur out of nowhere in OB-GYN. We had an amniotic fluid embolism on my second year.
Mm-hmm.
Of residency. And those are just horrible. And those are things that you play the what-if game and what could I have done? What should I have done? And you feel so guilty. And I think that's really what hit me hard with that. In particular. And so I try to communicate that with them is that there's, you know, we're not God, right? We're the hands and feet of God. We do God's work. We're not God. God has a plan for everyone. And that's how I have had to cope with some of those things that happen and know that I'm not the rhyme or reason as to why. Only God knows the plan and the reasoning for why those things happen. And I can't question that. I have to trust that that is his plan and I cannot do anything to change his plan. And I don't know if you have any tips on how you handle those things, but I try to just talk them through that, really hit on the emotional aspect for sure, because I feel like that was one of the hardest things for me to start out with in residency.
I think one of the things I will say, having those things happen, and one of the things that I think was a blessing for me to have a big class is I ended up having many good friends in that class. And one of the benefits of having good friends and building your support system in residency, actively trying to find people either your year, year ahead of you, whatever, was when those things happened. I could sit down with them and say, I got to tell you what happened. Let me tell you the story. I'm going to tell you what I did. And I need you to tell me honestly, did I screw up? Did I do something? Is there something else I should have done? And when you build that relationship with those people who are in the trenches with you and are having the similar life experience and are really bright people because they've darn sure wouldn't be in this residency if they weren't. They will tell you. And these are people I trust. It's like, okay, I can't think of a thing. It sounds like you did everything right. Or maybe next time do X. I asked once, it's like, you guys miss us once we go? It's like, well, you're never really gone. I'm like, what are you talking about? It's like, you're always going to have something that happens. And the phone call goes, hey, how are you? I have this lady. That's how the phone call goes.
Yeah.
And I still call these people. I still have my personal board of directors that I call and like, okay, I did this. I had this outcome. What the heck? And then you can talk through it. And it's somebody that, you know, you can lay your heart out and you can tell them, but you also trust them to tell you, yeah, you messed up. Or no, I can't think of a thing that you did that wasn't appropriate. And either way, you have released that burden. Because, and I love how you say, you know, we are the hands and feet of God, but we are not God. That's so powerful because I think we can say that sometimes and not really emotionally receive it. Like I can say it, I know that it's true, but I still want to carry that burden when it's not mine to carry. My dad used to say, my dad was a general surgeon. And he used to say, you know, 80% of the people we treat will get better no matter what we do. 10% will get worse no matter what we do. There's probably 10% that our interventions actually make a difference in their clinical course and the The trick is finding the 10%. But when you have the 10% that are gonna get worse, no matter what you do, that's not on you. You do what you can, but I always encourage people when they're walking into residency, as you move through this, you will find people that will share the common experience with you. And the trick is to build that network with them so that it becomes a common experience and not an individual experience. And approaching it that way, I think makes a big difference in what residency feels like.
Yeah. And I guess you would call it trauma bonding. That's what we joke with each other about, but when you go Yeah. Goes to the trenches. This group of people, I mean, we have a group text and anytime that any of us have a complicated case or a complicated patient or just management questions in general, and some of us are in different specialties. So if I ever have a question for like reproductive endocrinology, one of my best friends from residency is doing that. And so I love being able to bounce ideas off of them and ask, hey, like what would you do if this happened? Or do you think I did this right? Or should I do something different? And It's a relationship really like no other because you know that they're not going to judge you. They're gonna be honest with you. They're gonna tell you exactly what they think, which is what I want. Yeah. And I receive that well from them because we have that respect factor with each other. And so yeah, you do make some really good friends through the residency experience.
Yeah. Because no one else can truly understand what you went through. Nobody else, unless they've experienced it, nobody can truly understand what that felt like. And it's really cool that you still have those relationships because you guys obviously were close and have maintained that. And then the ability to still continue to get that feedback from them and get that support. I think that's so powerful. If there was one thing, so you've got this young person and they're going into OB-GYN and they're so excited. Dr. McKinnis, you've inspired me. I want to go into OB-GYN. Is there one question that you would ask them? I don't wanna say cement the decision, but sort of in your mind, kind of let you know that they've really thought about what they're getting themselves into. You know, you wanna make sure this person's going into a very difficult specialty, a very difficult, challenging residency. I wanna make sure that you're actually knowing what you're getting yourself into. Is there anything you ask them or anything in particular you'd like to know before sending them off on that journey?
So I guess a few different things, really. One thing that I was asked when I was a 4th year. Before I started my OB-GYN residency was, would it make you upset or would you be aggravated if you got a phone call at 2:00 AM saying that you had to be to the hospital in 10 minutes? And I thought about that and I was like, I mean, if I'm delivering a baby or doing surgery or something that I love, like, no, that would not make me angry. And so I tend to ask my medical students that now that are wanting to go into OB-GYN because I think that they see The good aspect of it, and they're not always on call with us because they're working mainly in the clinic or in the OR. So they take a few shifts, but they're not really seeing what it's like on a day-to-day basis. And so I make sure that I tell them like, hey, I have a 2 and 4-year-old. We're potty trained. I took daycare this morning. I'm going to drop off lunch. And then after school, we're going to see the Christmas lights. We're going, you know, we're doing X, Y, Z. I'm hoping I can make it home in time to make some Hamburger Helper because that's where we are in life right now with cooking dinner.
Right.
And then we start the bedtime routine and then I wake up at 5:00 AM to have some me time. That's the only 30 minutes of my day that I have quiet.
Yeah.
And then go to work. I love my life. Don't get me wrong. It's just, I'm in a season of life where it's really busy and I still love what I do.
I get it.
I wanna make sure that they get the full picture because I feel like a lot of times you just see the sparkly part. You see the postpartum visits where people are so grateful for their care and the pictures of me with their babies that are on my boards. And you see all of the good stuff or any awards or things like that. But you don't see the early mornings, the driving to the hospital with slouchers on at 3:00 AM, trying to manage kids and, and balance cleaning a house and marriage with what we're doing. So I try to kind of get a grasp on if they really get the full picture.
Yeah.
But also pick something that isn't gonna make you angry when it sometimes interrupts your life. Because pages are going to call whether you are at your anniversary dinner or at a birthday or anything else with family or friends, you're going to get those interruptions at some point. And you can't be the kind of person that it's going to make you angry when that happens.
That's awesome. I think that's really important that you ask that question off the jump. And I love how you ask it because I think you can talk to somebody about You know, this is a really crazy schedule, but you put this in the very real context of when this call comes at 2 o'clock in the morning and you have to get out of your nice warm bed and you're going to have to go to the hospital and do X. How are you going to feel about that phone call? And being able to put it in that way, because I think one of the biggest things that makes such a difference in managing conflict, managing patients, or any kind of life experience is being able to make it very real. You have to make it real. And that's why I think doing things like role play and conflict resolution works so well is because you're not just giving them concepts. You're putting people in a situation. You put that person in a situation where they really have to ask themselves that. And I think making people think about that is so important because you are going to get the people that walk into the specialty with eyes wide open. Okay. Well, Dr. McInnis told me, okay, here's my call at 2 AM.
She told me this would bring up and now I'm walking the walk.
But if it's something that you truly love, that you truly embrace and gives you joy to do, the 2:00 AM call may not be the greatest thing in the world, but you know that you're there for the right reason.
I'm not saying I love getting out of bed at 2:00 AM, but I know that I'm going to do my job and my duty, and it motivates me to have that purpose. I guess I just make sure that they're all prepared for that. And it's funny, I have students and, you know, they're very honest with me. I have some students that are Like, oh man, I couldn't do that. Nope. I love my sleep. I don't think, I don't think that's for me. And then some that, you know, just, it's like an adrenaline rush for them. They love it. And thank God everybody's different. Everybody has their specialty that they love. But yeah, I feel like that's a big part of it is making sure that they're ready for the task at hand with what we do and having to do it quickly.
Yeah, absolutely. Emily, it has been a joy to have you on the podcast. This has been a great discussion. I feel like there's so many things like commonalities and, you know, in our residency experience. And I really think this is gonna be a good listen for a lot of people who are not only thinking about OB-GYN, but are currently in the trenches now. So thank you for being here.
This has been so much fun. And you know, I really hope that, like I said, I think programs are getting better, but we teach postpartum hemorrhages, we teach shoulder dystocia resolutions, but nobody really focuses on, hey, how to communicate with people. Or how to get through a personal conflict or how to interact with an attending that you might not care for the way that they're teaching you or the way that they're treating you. And so I really think that would be beneficial if people focus on that aspect of what we do as well.
Thank you for being here. I really appreciate it. Oh my gosh, this was so fun. You need to come back again. We'll have to have you come back again, cuz I feel like we've got a lot more we can talk about. So we'll definitely come back. For all of you who have joined us on the Scalpel and Sword podcast, thank you so much. And until next time. Time, be at peace.
Every episode is an invitation to speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.