E31 Grace Rozycki On Trauma Ultrasound, Gender Equity, And Mentorship

Listen to this podcast on SoundCloud

Chad Ball  00:15

Welcome to Cold Steel, the Canadian Journal of Surgery podcast with your hosts Ameer Farooq and Chad Ball. The goal of the CJS podcast is threefold. The first is to highlight the best research currently being completed by Canadian surgeons. Second is to offer educational topics for both surgeons and trainees alike. And most importantly, the third goal is to inspire discussion, thoughts, creativity and career development in all Canadian surgeons. We hope you enjoy it.

Ameer Farooq  00:50

There are very few people that really embody the word pioneer like Dr. Grace Rozycki. Dr. Rozycki is a trauma and critical care surgeon at Johns Hopkins University. In this episode, we talked to her about her unlikely path to medicine her pioneering work in trauma ultrasound, and get her thoughts about gender equity and mentorship in surgery. Dr. Rozycki, thank you very much for joining us today on Cold Steel. We really appreciate your time and and know how busy you are. Can you tell us about where you grew up and in sort of your path to medicine?

Grace Rozycki  01:26

I grew up in northeastern Pennsylvania, the Wilkes Barre Scranton area, little town called Ashley, Pennsylvania population of about 5000. I am very small town, I went to the same grade school high school throughout my life. We had only 38 in our high school graduating class. So you can imagine that’s pretty small town. So a lot of the students I got to know throughout my entire grade school in high school time and it was very nice to be able to have that personal touch with them. And then for undergrad, I attended college, Misericordia.  Misericordia is the Latin word for mercy. And it’s now  Misericordia University. And that also is in northeastern Pennsylvania. It was a commute each day, I was one of 225 in our class, which I thought was enormous. But as I understand it, afterwards, it’s actually quite a small school, but very nice. And part of that was also my Catholic education, because I had Catholic grade school, high school Catholic college. And then afterwards, I did graduate school at University of Scranton. And then of course, there were the Jesuits there. So I’m probably one of the very few who had 18 years of Catholic education. So I’m very nice. And of course, my medical school was at Jefferson medical school in Philadelphia.

Ameer Farooq  03:06

There’s this moment that you talk about, where you’re dissecting a frog, and you just know that that’s what you want to do is that you want to become a physician. Do you think that that, you know, it was that moment that you were dissecting the frog? Or had you kind of always known all along that’s what you want to do. Or tell me a little bit about that inspiration or that moment?

Grace Rozycki  03:27

I think I’ve known all along, I have a belief that we are born for a purpose. And my purpose was to become a doctor. And it was the dissection process that I realized I wanted to be a surgeon. So you know, I’ve just been one of those very fortunate people who’ve known very early on, I was on a mission. Never doubted it for one second, I was going to get there no matter what. And and I did. And I’m very grateful.

Ameer Farooq  03:57

Yeah, it’s a it really is amazing when when you see someone who just has that sense of drive and purpose and just knows that that’s what they want to do. I think another amazing thing about your story is that you actually didn’t initially start out in, in general surgery. But you actually started out in neurosurgery. What was the impetus for you to make that switch in that transition? And do you ever look back and think about that choice?

Grace Rozycki  04:25

I really enjoyed general surgery a lot. And somehow when I rotated on neurosurgery, I thought it was just so intellectually fascinating. So I got distracted there for a little bit, but then came back to the fold with general surgery and especially with trauma. I think it’s a fascinating subspecialty and I think some a part of me is still there with it, intellectually. It’s a, I think, very challenging, but I’m still glad I came back to the fold with general surgery, and especially with trauma.

Ameer Farooq  05:01

Well, I think the world is happy that you decided to come back. I think it really does work, it is worth highlighting what your residency was like. Tell us again about how where you went to residency. And in particular, you have that you talk about this, them setting up this trailer, literally setting up a trailer outside of the hospital, where you can live and you do two or three nights of call. What was that experience like? Like, it’s, it’s almost hard to imagine someone doing that, in in an era now where we have duty hour restrictions. And it you know, it’s all about wellness. And those things are important, but but tell us tell us what it was like to actually be in that mode. And in that grind and, and that intensity of training?

Grace Rozycki  05:56

Well, actually, it was a great opportunity. And how I got to that point was that when I decided to switch from neurosurgery back into general surgery, I was at the Medical College of Virginia in Richmond, which is now Virginia Commonwealth University, and they didn’t have a spot for me. So by the grace of God, Dr. Mall, Dr. Kimball Mall, one of my chief mentors, was leaving the Medical College of Virginia and then becoming the chairman at the University of Tennessee Medical Center in Knoxville. And that program was a very small program and only finished one resident per year and had been on probation. So they really needed him. And he did a miraculous job. Not just the growth and the development of the program, but setting a high educational standards. And of course, brought trauma there, which they never had as a level on level one trauma center. So I was very fortunate to go with Dr. Mall to become a resident there. And of course, I was the only resident at my level. And the good news was that it was like a kid in a candy store, I got to pick any case I wanted to do. I showed my case list to my husband one time and I said this is what I did in a week. And it was, you know, several aorta bythams and ruptured triple A’s and you know, carotid arteries, and it was just a phenomenal experience. So when I supported the idea of becoming a level one trauma center with Dr. Mall, they had to have a senior resident in house each day, and night. And there’s only one residence at each level. And I jumped at the chance to say I’d love it. And I did. And I spent two out of three nights on call. It was a phenomenal experience. Was I tired? Yeah, sure. I was tired some time. But it was a great experience. I wouldn’t trade for the world. And I felt that it was a good initiator for me to begin to see what I could do by immersing myself so much in the clinical picture. So wonderful opportunity. I wouldn’t trade it for a minute.

Chad Ball  08:15

Dr. Rozycki you you’ve trained so many Canadians, and when Lorraine and Neil and I get together and we talk about our time with you at Grady and Emory. We all agree without question that you really the heart and soul of that institution for a long period of time. We’re curious what sort of ignited your passion in particular on the trauma critical care side because not only were you so so beautifully great at it, but your that passion and that fire was undeniable to everyone around you.

Grace Rozycki  08:46

Well, I appreciate that. But honestly, I think the area is just first of all it matched with my personality. I’ve really enjoyed it. And secondly, I think it’s a team effort. I you know, I was privileged to have Dr. Feliciano there as you know, you glean so much from his presence, and his leadership, putting education at the top and equality at the top. So you can’t almost help but to immerse yourself in that environment and feel as though you’re bringing value to something but you’re getting so much more value in the long run to yourself. So, you know, it was just that environment that helped so much.

Chad Ball  09:27

It’s such a unique place there’s no doubt. I’m curious what prompted you to move from from Medstar in DC to Grady in Atlanta. What was that process like?

Grace Rozycki  09:37

Um, as you know, things change and Medstar had some leadership changes there administratively and educationally and one of my colleagues was Gage Ochsner, and we both decided that the changes would no longer be in alignment with our career goals and we both decided to leave. So you know, initially I cast a wide net, and was looking for advice from a lot of individuals. And I’m very grateful for the advice they gave me. And, of course, in the meantime, I had known Dr. Feliciano and, and they did need a trauma director at Grady and I thought it was worthwhile to take a look at that particular position. So again, the prompter was just changes that were not in alignment with my career goals. Of course, it was one of the best decisions I’ve ever made, my career just skyrocketed. I’m still very grateful for all that I had at the Washington Hospital Center. I was there in the midst of the crack cocaine wars. And it was, I learned a ton. And we did an enormous number of cases, there’d be nothing like it for us to do four and five cases in a night. And I met some wonderful people. And I’m still in contact with them today, dear friends and mentors that I really enjoyed working with and respected tremendously. So all in all, it was a good move.

Chad Ball  11:15

That’s such an interesting story. I never did know that. In that scenario, how do you recognize when it is time to go?

Grace Rozycki  11:23

Well, again, I think it’s one of the things you have to know and sit and think about is crystallizing your own goals. What is that you want to accomplish? It’s not so much, oh, I want to become president of something or I want to get promoted. I think you have to know, what is it that drives you? And where do you want to have your career go? What trajectory? And I think having that information helps you tremendously to align what’s going on in your environment, and whether there’s value for you and whether you’re bringing value so that that career can be enhanced?

Chad Ball  12:07

That makes so much sense. Obviously, Dr. Rozycki, you’re synonymous with many, many things. And mentorship is one of them. And we’ll get to that in a minute. But on the clinical side, there’s no question that that you are perceived to be and are the matriarch of bedside ultrasound and trauma. And most of the people listening to this podcast, certainly at the training level, of course, would would really not imagine evaluating a sick, critically injured patient without ultrasound. But I was wondering if you could tell us what the origins of that story were. And I’m sure you know, when talking to you over the years there, there was some speed bumps and some naysayers. And it was it was quite a path that you traveled to, to really drive this into the mainstream with passion and science. And it’s something now, as I said, it’s really standard of care.

Grace Rozycki  12:54

Well, Chad, thank you actually, it’s a team effort. And it really began while I was at the Washington Hospital Center in Medstar in DC, and my boss, Howard Champion, had contacts in the UK as he trained at Edinburgh, and came back and said, you have to look at all of these surgeons in Germany and the UK are using ultrasound, why don’t you give it a try? And I was actually one of the naysayers and I said, I’ll try it but I don’t think it’s going to be very accurate. But I think that the difference that I made was a carefully crafted decision that if I was going to study this, I wanted to study it the correct way. So much to Dr. Champion’s credit, he hired a an ultrasound technician who came in at night when the trauma came in, obviously, who helped teach ultrasound. I also crafted a curriculum based on ultrasound physics, that’s my belief, if you understand the physics, you can ultrasound almost anything. And we did this as a research project. Clearly, it was a prospective study, but it was a prospective observational study, we didn’t put the patients at risk or anything. And I think over time, what happened, at least with our first paper was that we recognized a few things came to the surface. Number one, this was rapid, it was a rapid and noninvasive test. And you know, you know that intuitively. But prior to that, you have to remember that surgeons did an awful lot of diagnostic peritoneal lavage, which is not only an invasive procedure, highly sensitive, but maybe even too sensitive. So the rapidity was deemed by surgeons in this study to be its most valuable quality and I think that fits with the personality of a surgeon. We don’t want to get into the weeds trying to figure out little tiny things, we want to ask a question, get an answer and then get out. And I think that ultrasound was in alignment with that. We also looked at the results of the study. And we said, well, How can we make this better. And so in the next study, we had a little bit better. And then of course, there were others throughout the country who were coming out of the woodwork who did their studies. I mean Mark McKinney, in Miami, and others who just you know, some of your colleagues and yourself in Canada, so everybody made a contribution. And I think some of the tipping points were that people like Steve Shackford, who was chairman at the time at the University of Vermont, got the American College of Surgeons behind us. And we developed the national ultrasound faculty. And we then as a voice and this was a multidisciplinary voice. It wasn’t just trauma, it was, you know, it’s Baron who did breast ultrasound, and others who did vascular, and so forth. So we were then speaking as a one voice to deem that no one owns this technology. You can talk about turf wars, and who can do ultrasound. But if we’re trained, right, no one knows the technology. Clearly, our colleagues in obstetrics and cardiology have been using this for years. I think some of the other things that came out very early on that somebody probably doesn’t have a sense for now is, it’s just the evolution of it. You know, when we first started using ultrasound, the machines were clunky, and oh, my gosh, they were heavy. And they all said, words that were not warzone doable, so to speak. And we recognized that working with the ultrasound companies, eventually they recognized us as real users here. And they helped us really refine the machine. So the machines were lighter, smaller, more easily mobile, from one bay to the other. And you have to remember that as ultrasound was being used by a lot of other colleagues, especially the radiologists, those machines never moved. They stayed put in the radiology suite, and patients came to them. And this is a little bit different. We had to have the machine there. And it had to be warzone applicable, so to speak. So I think, you know, that’s part of the whole story. And then of course, it grew from there. Just validating different parts of the examination, conducting multicenter trials. And eventually, just like any other diagnostic test, data were coming out that showed ultrasound has a real niche. It’s a great screening tool. It’s not perfect, but it’s great for pericardial tamponade. And it’s great for the hypotensive patient with blunt trauma. Because if there’s blood in there that patients likely to need an operation. So, you know, I think overall, you kind of take it for what it’s worth. It’s a it’s a tool now that’s been around for well over 25 years, but almost 30 years, and it’s withstood the test of time.

Chad Ball  18:32

It’s amazing story, as always, you’re so humble, Dr. Rozycki, but the truth is that I mean, there was lots of places in Canada, throughout the world, really, that specifically traveled to Germany at the surgeon level, saw what you saw, and came back and sort of said, I don’t really think it’s going to work and stop there. So what was it that you figured out or that you you believed or that or that you saw that really said we have to keep going here there’s something super helpful in the long run?

Grace Rozycki  19:07

No, I think there’s several factors. One is again, it’s noninvasive, and I think we needed, the patient needed an alternative to diagnostic, peritoneal lavage and remember too that, still when this was coming out CT, although it was great, it was still not all that fast. And the CT suites were a somewhat at a distance whereas we really needed something, the patient needed something better. And I think that kept me going and also the fact that it was just rapid. Again, it’s suited to you know, anyone on the front lines, emergency medicine, surgeons, anybody right there at the front lines, especially when dealing with diagnosing pericardial tamponade. No and the really old days it was insertion of a central line and look at the CDP and then putting the patient in the ICU and watching the CDP, that’s it’s almost you possibly even think along those lines. So, again, it’s just looking at patient care, what does the patient need, and that drove me a lot.

Ameer Farooq  20:19

Dr. Rozycki, we wanted to shift gears here a little bit, and I wanted to point out to our listeners that you were the first female to actually go through your residency training program. And really, were a pioneer in many aspects, including paving the way for many female trainees. You know, the time is kind of finally come, I think, to actually talk about gender equity, and to actually make some really big gains for our female trainees, but they still face a lot of challenges that that male trainees just frankly don’t face. I’m curious what your thoughts are on what it was like to be the only female trainee and what that experience was like? And then furthermore, what do you think we can do to improve gender equity in surgery?

Grace Rozycki  21:07

Well, Ameer, thank you for the question. But I’m going to give you an answer, that’s probably not what you’re expecting. I never gave it a thought. I never saw myself as the first female anything. I was there, I was a surgeon, I was very grateful to be a surgical resident. And I just honestly never gave it a thought. And I look at what is ongoing today and a sort of inequities or whatever. I think the bottom line is, I would say to male or female, do your job, do it exceptionally well. And do it with not the idea that you’re trying to gain an edge over a man or gain an edge over a woman or anything like that to it for the patient. It’s the right thing to do. And it’s the right attitude that I think, adds longevity to the whole picture of more equity for all.

Chad Ball  22:21

Dr. Rozycki, Ameer mentioned it a bit earlier at least hinted at your Western Trauma Association, as well as your AAST presidential chats or speeches. In particular, the one title, what do I know for sure was, was really, you know, inner worldly change changing for a lot of us. And I’m curious, with regard to the concept of mentorship, how do you personally define it? How do you approach it? How do you view it? And what got you so passionate about that concept?

Grace Rozycki  22:58

Well, it’s, I think it’s all of us will say that we would never be anywhere without our mentors. And so it certainly is a good way to give back. And you can look at all qualities of a mentor, you know, the advisor, the encourager, and I think all of that falls into play. There’s no question about it. I think that approach wise, a good connection, a good chemistry between mentor and mentee is very important. I think there has to be some good, what I call culture or infrastructure that allows everybody to feel comfortable in that environment. I think looking back initially, when I had the medic, Emory medical students come to me and say they wanted to spend a summer with me. And that was what I was talking about in my Western Trauma presidential address. I I think my philosophy is everybody has something to bring to the table. You don’t have to be a brilliant orator. You don’t have to be knowledge base where you can be like Dr. Feliciano and quote an article from 1940 years. I think you just have to have a thought that you share your wisdom and make the other person the mentee feel very comfortable. The story behind that and why I’m so passionate about it is because I didn’t get into medical school at the first try. I didn’t get in the second try. I didn’t get in the third try. I got in on the fourth try. And it took me so long. And I really thought that after I finally got into medical school, that someday I would be a surgeon. Someday I could help someone else. And that’s really why I’m so passionate about it. It’s my way of giving back. I am so grateful for the career I have had. I am so grateful that I surgeon and I can help patients intellectually stimulating it is by far wonderful in terms of being able to cure and it’s great to be able to pass that knowledge on to somebody else. There are days where I feel like I’m getting more out of it than they are getting out of it.

Chad Ball  25:23

Yes, totally.

Grace Rozycki  25:25

It’s just a great opportunity.

Chad Ball  25:28

You know, it’s, it’s so interesting to hear you say that, that you didn’t walk into medical school as, as many would assume, because so many of the iconic and pioneering people that we’ve interviewed now, including you provide that same story. You know, and there’s something deep seated in inherent in, in all of you as individuals that that moves forward and pushes forward and follows that vision and ends up you know, as you say, maybe fate sense where you’re supposed to be. You know, what, one of the things and being around Grady for a couple of years was watching you mentor, as you say, young medical students in that program, and the inspiration that you that you delivered to them was palpable. You know, I would interact with them quietly in the hall or in the OR just around and, and then they always had such amazing things to say about you. It’s, you know, it’s it was always remarkable. I mean, they they really thought of us as Mother Teresa, in so many ways. And I mean, that literally. How do you foster those relationships at such a clearly a deep and profound level in such a short period of time?

Grace Rozycki  26:37

Yeah, thank you for those comments. So Chad, but I honestly I don’t even know if I have an answer for you, I can just say that I just being myself and wanting to help others. It just comes across, I think as authentic. And that’s probably something that students pick up residents pick up. They’re pretty smart. They can pick up authenticity. And when you’re just being yourself and being authentic, they understand that you’re sharing something pretty special with them. You know, there’s a saying that says the greatest thing that we can give of ourselves is our time, everything else they can read in a book. And I like to believe that.

Chad Ball  27:18

Yeah, yeah. That’s so true.

Grace Rozycki  27:20

There’s some wisdom there that we have the opportunity and somewhat the obligation to share. So very special and again, you don’t have to be brilliant to do it. But authentic communication and authentic sharing of wisdom and help is it means a lot.

Chad Ball  27:45

Yeah, your your impact on those on those folks. Really, like so many of us, will, will be forever, there’s no doubt. I just wanted to touch on your your AAST Presidential address, and it was called a legacy of caring. And you talked about developing institutional surgical culture. Can you tell us what sort of how you come to that, how you came to that view? Why that’s so important? And maybe in particular, if you have any ideas on how we mechanize that at a local level, whether you’re in Calgary or, you know, in, in Nairobi, wherever?

Grace Rozycki  28:21

Well, I think the thing to think about, first of all, that the presidential address I interviewed it was qualitative research. I interviewed a lot of surgeon leaders, most of whom were actually double AAST members and past presidents. And I asked them certain questions, and that was one of them. And in terms of getting the culture right, at an organization, and how much is that critical to just about everything quality patient care and learning and so forth. And I think it settles with the proper leadership, it’s got to start from the top. And that’s got to permeate through all levels. If you have the right leader, with the right motives, and the right indicators of what really needs to get done, get the right people in place on the bus and make sure that bus is going in the right direction. A lot of that will create the right culture. It takes a while, you know culture is not something that you can easily transfer from one organization to another. It takes a while before something becomes part of the culture or a leader feels that the culture is making a difference in for example, quality patient care. So I think those are the essential elements of it. What certainly is done in one organization doesn’t necessarily translate to another. But I think we can all be contributors and leaders of that to help create that culture.

Chad Ball  30:13

That’s interesting. What would your advice be, you know, if a young staff ends up in a scenario where they don’t seem, as you mentioned earlier to, to necessarily align with the institutional goals, so they look around and they, they’re, they’re concerned about the surgical culture in their immediate environment? How should they assess that or engage that? Or should they leave? Or what’s your sense of that?

Grace Rozycki  30:37

Well, it’s, it’s a tough situation, because when you’re trans, transitioning from, whether it’s resident to attending or a fellow to an attending, it’s different. And sometimes that has a growth period that you have to go through. I think I would say advice would be is to get as much advice as you can from mentors, leaders that are currently in the system and outside the system. You know, when I had decided to move from one job to another, that was one thing I always thought was, one of the best things I did was cast a wide net. I didn’t necessarily just talk to famous people or talk to friends, I talked to people I never spoke to before, for advice, and you’d be surprised at how many are really pleased, and have some good words of wisdom. So I think that’s first of all is and don’t make any decisions, hasty decisions based on one element, and never take a job based on one element too. Remember that as you assess your position, or assess taking a job or leaving a job, it shouldn’t be made on one particular issue. You always want to weigh all you can, I’m a very visual person. And so I like putting things on paper, pluses, minuses, risk benefits. And I think that helps get the overall picture in place so that you can make a good, solid, rational decision. And then I would say, finally is, you know, all these decisions are tough. You’re never going to feel 100% about something, but listen to your heart, listen to your insides, because if something’s telling you something, you have to at least pause and examine it. And sometimes, if we choose make a decision, and it happens to be the wrong decision, I think the most important thing is to learn from it. Just like you learn from failure, failure is not necessarily a bad thing. It’s it’s something telling us that we need to go in a different direction, but you have to take the quiet time, listen to yourself, listen to others, and then piece it all together.

Chad Ball  33:07

It’s interesting, you bring up the concept of failure, because, again, that sort of harkens back to many of the of the guests we’ve had on the on the podcast, that that failure is maybe not a part of everyday life, but it’s certainly a part of every year life and in so many people. And it’s how they react to failure and how they use that as fuel and education to move forward that. Again, it’s one of those things I think clearly differentiates super successful folks that are that are happy in their career with the others. Dr. Rozycki, maybe the penultimate question I’ll ask you is you were clearly the program director for the fellowship in Atlanta for a long period of time. And I’m curious how you viewed you know that role? And in particular, how you try and get the best out of maybe a fellow that’s struggling or not, not performing the way that he or she might want?

Grace Rozycki  34:04

Yeah program directors deal with this. Not often, but it does happen. I think that some conversation with that particular fellow is important because it may be just one area, maybe they don’t have the insight that they’re not performing the best. So I think the conversation has to be open and the different options there as to what the situation really is. I think the second thing is that the program director is responsible to provide crystal goals, crystallized goals so that the fellow knows what is expected of him or her. I think that that burden is on us if they’re not clear. If the goals are not clear, then it’s not going to do anybody any good. You can’t just throw somebody in there and say here learn. They have to know what those goals are. And I think the third thing that helped me was that I was running a small fellowship, I didn’t have 10 fellows. So, you know, having a collection of fellows that I knew the other offices were there helped me keep tabs on them so that if something was going awry, it wasn’t going awry for a long period of time. And I think that’s very helpful is to know the fellows and residents very well. I would be, for example, I still had to prompt them may know where the data Let’s go, you know, we have an abstract deadline coming up. But I think the issue was, being there firsthand, does help.

Chad Ball  35:56

You know, one of the questions maybe just in closing that we try and ask everybody is if you were to think back in time, and give the young you maybe at different stages of your career advice that that you wish you had known or things you had known at the time, what would that be?

Grace Rozycki  36:13

I would say one word, that is focus. Think quality, think focusing on what you’re doing. And don’t get distracted being too worried about power or titles. Because all that will come with time. Use what you have, which is as a young attending, taking care of patients and recognize the influence that you can have through the clinical care of patients. I think everybody has that opportunity. And if you just focus and do quality work, the rest will fall into place.

Ameer Farooq  37:07

You’ve been listening to Cold steel, the official podcast of the Canadian Journal of Surgery. If you’ve liked what you’ve been listening to, please leave us a review on iTunes. We’d love to hear your comments and feedback. So feel free to email us at podcast.cjs@gmail.com or connect with us on Twitter @CanJSurg. Thanks again.