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Gynecologic Surgeons Unscrubbed
Author: Society of Gynecologic Surgeons
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© 2019 Society of Gynecologic Surgeons
Description
Host Cara King, DO, MS, gynecologic surgeon from the Cleveland Clinic, focuses on surgical and medical education, featuring interviews providing expert pearls, patient perspective, and practice-changing discussion.
This serial podcast is created in collaboration with the Society of Gynecologic Surgeons. The information is provided for informational and educational purposes only.
This serial podcast is created in collaboration with the Society of Gynecologic Surgeons. The information is provided for informational and educational purposes only.
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Here's a sneak peak of Gynecologic Surgeons Unscrubbed.
A series-based podcast focusing on surgical and medical education, featuring interviews and practice-changing discussion, hosted by Cara King, DO, MS.
This podcast is a collaboration between MDedge and the Society of Gynecologic Surgeons.
Dr. Cara King (@drcaraking) hosts surgical leader and expert Tommaso Falcone, MD, Professor of Surgery at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Chairman of the ObGyn & Women's Health Institute at Cleveland Clinic. Dr. King also interviews women’s health advocacy expert Megan Evans, MD, MPH (@MeganEvansMD).
They discuss:
New leadership at the Cleveland Clinic in Cleveland
The Cleveland Clinic’s surgical hospital opening in London, England
Cleveland Clinic’s endometriosis center in Cleveland
Good judgement is birthed from bad judgement
The master surgeon: How is he/she defined?
Surgical meetings: importance to surgical education
Endometriosis
Women’s health advocacy with Megan Evans
How did Dr. Evans become an advocacy specialist?
Why is advocacy important to prioritize in our careers?
One of the most rewarding projects Dr. Evans has worked on in advocacy
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts surgical leader and expert Tommaso Falcone, MD, Professor of Surgery at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Chairman of the ObGyn & Women's Health Institute at Cleveland Clinic. Dr. King also interviews women’s health advocacy expert Megan Evans, MD, MPH (@MeganEvansMD).
They discuss:
What it takes to be a leader and the components of leadership to build an outstanding department (serving your staff, emotional intelligence, recognizing and fostering talent, living the passion for women’s health)
Identifying talent to build a successful team
Recruiting leaders
When a recruit does not work out
Advice for making the jump to department chairperson
The 3 types of mentors and their roles
* * *
Women’s health advocacy with Megan Evans
What is happening legislatively when it comes to endometriosis? 6368/A. 484: Bill at the federal level focusing on education. Introduced in New York by State Senator Monica Martinez and State Assemblymember Linda Rosenthal. It is awaiting the Governor’s signature. Requires State Commissioner of Health to provide educational materials on endometriosis to school districts (school nurses) and clinicians throughout the state—focusing on earlier diagnosis of the condition.
Which campaigns are using social media to get the word out about endometriosis? For the New York bill, the Endometriosis Foundation of America is running a campaign called #LetsTalkPeriod
Social media is a powerful tool to use for contacting local and national representatives to advocate for issues
Favorite social media platforms to discuss bills
What bills regarding endometriosis are currently active at the national level? Res. 118 (116th Congress): Bipartisan and bicameral bill that recognizes endometriosis as an unmet disease, designates March as endometriosis awareness month, and provides funding for endometriosis research. Introduced by Senator Tammy Duckworth and Congressman David Scott.
Other bills that include endometriosis (but are not specific to the condition) include a House bill introduced by Congresswoman Carolyn Maloney (HR 3865). It amends the public Health Service Act, which aims to reduce the amount of chemicals included in feminine hygiene products and investigate the link to included chemicals and female cancers, infertility, and endometriosis.
Another bill has been introduced and hopes to ensure contraception access (HR 2182 /S 1086), which is essential to women with endometriosis, as hormonal contraception is important as a treatment option for endometriosis symptoms.
A final bill also is in the introductory stages (S 1461 /H 2803), and it aims to require insurance coverage for infertility treatments.
* * *
Suggested reading
The Serving Leader: Five Powerful Actions to Transform Your Team, Business, and Community
by Kenneth R. Jennings and John Stahl-Wert
Team of Teams: New Rules of Engagement for a Complex World
by Stan McChrystal, Chris Fussell, and Tatum Collins
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts surgical expert Ted Teh Min Lee, MD, Clinical Professor of Gynecology and Reproductive Sciences and Director of Minimally Invasive Gynecologic Surgery at the University of Pittsburgh Medical Center Magee Womens Hospital. Dr. King also interviews women’s health advocacy expert Megan Evans, MD, MPH (@MeganEvansMD).
They discuss:
Lee’s challenges in moving to the United States from Taiwan at a young age and his career path
Cultivating extracurricular activities, such as fly fishing
Video’s importance in surgical education
Prioritizing learning and learning style
Lee’s break into gynecologic surgery with C.Y. Liu, MD
The challenges of subspecializing in MIGS in ObGyn
Tips for new graduates who are building a surgical practice
Case selection and specialized back-up in the OR
Taking appropriate risk during surgery
* * *
Women’s health advocacy with Megan Evans
How does a bill become a law? Step 1: A bill is born
Anyone may draft a bill; however, only members of Congress can introduce legislation, and, by doing so, become the sponsor(s). The president, a member of the cabinet or the head of a federal agency can also propose legislation, although a member of Congress must introduce it.
Step 2: Committee action
As soon as a bill is introduced, it is referred to a committee. At this point the bill is examined carefully and its chances for passage are first determined. If the committee does not act on a bill, the bill is effectively “dead.”
Step 3: Subcommittee review
Often, bills are referred to a subcommittee for study and hearings. Hearings provide the opportunity to put on the record the views of the executive branch, experts, other public officials and supporters, and opponents of the legislation.
Step 4: Mark up
When the hearings are completed, the subcommittee may meet to “mark up” the bill; that is, make changes and amendments prior to recommending the bill to the full committee. If a subcommittee votes not to report legislation to the full committee, the bill dies. If the committee votes for the bill, it is sent to the floor.
Step 5: Committee action to report a bill
After receiving a subcommittee's report on a bill the full committee votes on its recommendation to the House or Senate. This procedure is called “ordering a bill reported.”
Step 6: Voting
After the debate and the approval of any amendments, the bill is passed or defeated by the members voting.
Step 7: Referral to other chamber
When the House or Senate passes a bill, it is referred to the other chamber, where it usually follows the same route through committee and floor action. This chamber may approve the bill as received, reject it, ignore it, or change it.
Step 8: Conference committee action
When the actions of the other chamber significantly alter the bill, a conference committee is formed to reconcile the differences between the House and Senate versions. If the conferees are unable to reach agreement, the legislation dies. If agreement is reached, a conference report is prepared describing the committee members’ recommendations for changes. Both the House and Senate must approve the conference report.
Step 9: Final action
After both the House and Senate have approved a bill in identical form, it is sent to the president. If the president approves of the legislation, he signs it and it becomes law. Or, if the president takes no action for 10 days, while Congress is in session, it automatically becomes law. If the president opposes the bill he can veto it; or if he takes no action after the Congress has adjourned its second session, it is a “pocket veto” and the legislation dies.
Step 10: Overriding a veto
If the president vetoes a bill, Congress may attempt to “override the veto.” If both the Senate and the House pass the bill by a two-thirds majority, the president’s veto is overruled and the bill becomes a law.
ACOG’s advocacy efforts and lessons learned
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts surgical expert Ted Teh Min Lee, MD, Clinical Professor of Gynecology and Reproductive Sciences and Director of Minimally Invasive Gynecologic Surgery at the University of Pittsburgh Medical Center Magee Womens Hospital. Dr. King also interviews women’s health advocacy expert Megan Evans, MD, MPH (@MeganEvansMD).
They discuss:
Lee’s “favorite” surgical failure
The benefits of recording surgeries and producing surgical videos
Finding endometriosis as a passion
The surgical frustrations of treating endometriosis
Choosing a fellow: Who edges out their peers?
Taking your time to “interrogate tissues” and solve a problem
Creativity and flexibility in the OR
The importance of “always learning”
Evolving tissue extraction techniques when power morcellators removed from the market
Lee’s perspectives and plans for being president of AAGL in 2012
* * *
Women’s health advocacy with Megan Evans
How ObGyns can become involved in advocacy Sign up for ACOG’s government affairs emails
Follow Twitter feeds and consider joining Twitter
Become involved in your local medical and/or ACOG society Contact your state rep at ACOG
ACOG’s Gelhaus and McCain fellowships
The wellness benefits of advocacy
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts endometriosis patient advocate and educator Nancy Petersen, (@nancynursez637) retired RN who developed with David Redwine, MD, the first endometriosis excision treatment program in the United States. Nancy has spoken on the topic of endometriosis across the nation and currently serves as a mentor to women with the disease through Nancy’s Nook, a Facebook resource for endometriosis education, discussion, and support.
They discuss:
Nancy’s early life and influences to pursue nursing
Nancy’s back pain and initial diagnosis of endometriosis
The first hearing of Dr. David Redwine’s early research
“Endometriosis reconsidered” is published
Nancy’s second surgery for endometriosis
Nancy’s back pain forces her retirement
The Endometriosis Research Center chat group
The growth in the numbers of patients with endometriosis joining the social group
Reimbursement concerns for endometriosis gyn surgeons
Are surgeons looking in the right places statistically to find endometriosis?
Nancy’s worries in preparing physicians on the whole picture of endometriosis
* * *
Resources
http://endopaedia.info/
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts endometriosis patient advocate and educator Nancy Petersen, (@nancynursez637) retired RN who developed with David Redwine, MD, the first endometriosis excision treatment program in the United States. Nancy has spoken on the topic of endometriosis across the nation and currently serves as a mentor to women with the disease through Nancy’s Nook, a Facebook resource for endometriosis education, discussion, and support.
They discuss:
Are residents exposed enough to endometriosis education?
Targeting MIGS programs
The role of imaging in identifying endometriosis and preop planning
The importance of patients having high-volume surgeons
The strength of a multidisciplinary team
Nancy’s knowledge gathering in the disease state
Nancy’s Nook educates patients with endometriosis to advocate for themselves
How Nancy selects surgeons to be on their recommended list
Pregnancy before or after surgery?
Contacting physicians that you’ve visited in the past with no cure
Nancy’s one piece of advice to physicians who treat endometriosis
Multispecialty treatment centers
* * *
Resources
http://endopaedia.info/
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts expert urogynecologist Marie Fidela Paraiso, MD, Head of the Center for Urogynecology and Reconstructive Pelvic Surgery and staff physician in the Department of Obstetrics and Gynecology at the Cleveland Clinic.
They discuss:
FDA black box warning for transvaginal mesh for pelvic organ prolapse (POP) in April 2019
Vaginal mesh procedures versus surgical repair with native tissue
Complications of mesh implants
Varying types of mesh
Can surgeons still use transvaginal mesh for prolapse repair?
Outcomes with high volume vs low volume surgeons
Credentialing for repair surgeries
ASPIRE trial as part of the Pelvic Floor Disorders Network
FDA-mandated 522 studies
The opportunity of joining Cleveland Clinic’s FPMRS and MIGS sections to conduct prospective randomized trials
Dr. Paraiso’s AAGL presidential duties
Planned AAGL programs and celebration of global surgical education
Dr. Paraiso’s first AAGL presentation and early career aspirations
Opportunities that academics offer
The first female surgeons’ aspiring legacy of leadership
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking
For more MDedge Podcasts, go to mdedge.com/podcasts
On March 27, 2020, Dr. Cara King (@drcaraking) hosts Vicki Reed, MD, (@ReedVickiMD) Residency Program Director, Department of Obstetrics and Gynecology, and Vice Chair, Education, Cleveland Clinic
They discuss:
Cleveland Clinic’s unique ObGyn residency program
Resident prep for treating COVID-19 patients
Online learning resources
Resident participation in virtual visits
Redeploying residents in a pandemic setting
Work-hour requirements
The impact to residents long-term
Opportunities in competency-based education
Involvement of medical students
Ongoing emotional support
Potential for pushing back the academic year
* * *
Resources
Academy of Pelvic Surgery
Rosh Review
Open access SGS Video Library
SurgeryU
APGO
CREOG
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @ReedVickiMD
For more MDedge Podcasts, go to mdedge.com/podcasts
On March 27, 2020, Dr. Cara King (@drcaraking) hosts Sarah Cohen, MD, MPH, Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
They discuss:
AAGL guidelines – starting the discussion
Global collaboration among AAGL and other societies to craft guidelines
Potential viral spread during laparoscopic surgery
Potential viral spread during open procedures
Thinking outside of the box (minilaps and vaginal hysterectomy)
COVID-19 testing in surgical patients – what is possible today
Universal chest CT before surgery?
Recommended PPE for the OR
Rethinking MIGS surgical steps to optimize for infectious disease
Ideal surgical masks for the OR
Ongoing updates to AAGL joint statement guidance
Reliance on global colleagues
* * *
Resources
COVID-19: Joint Statement on Minimally Invasive Gynecologic Surgery
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking
For more MDedge Podcasts, go to mdedge.com/podcasts
On March 27, 2020, Dr. Cara King (@drcaraking) hosts Jonathan Dort, MD (@JonathanDort1), Vice Chairman for Education in the Department of Surgery; Program Director, General Surgery Residency; and Director, Minimally Invasive Surgery at Inova Medical Group, Falls Church, Virginia
They discuss:
SAGES’ COVID-19 resources
Assumptions being made about viral transmission during laparoscopic surgery
Should surgical patients be tested pre-surgery for COVID-19?
PPE for the surgical and anesthesia team in the operating room
Reducing operating teams to required personnel
Optimizing filtration systems
Which surgical cases are nonessential
Use of masks in the OR
COVIDsurg: Conoravirus global collaboration on surgical experience with COVID-19
Safety for residents and INOVA’s educational shift
A new way of conducting grand rounds
Working out virtual visit kinks for attendings and residents
GME start date of July 1: Should it be pushed?
* * *
Resources
SAGES COVID-19 resources
CDC Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings
Globalsurg.org/COVIDsurg
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @JonathanDort1 @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
On March 27, 2020, Dr. Cara King (@drcaraking) hosts Beri Ridgeway, MD, (@beridgeway) Institute Chair, Department of Obstetrics and Gynecology and Women’s Health, Cleveland Clinic.
They discuss:
Ohio’s state of affairs regarding COVID-19
Testing sites and tests completed to date
Who can be tested for COVID-19, based on allocation of resources and underlying conditions
The virtual approach to testing using telephones, FaceTime, and Google Duo
Insurance coverage of virtual visits and charity care
In-patient and out-patient visitation policy and hospital entrance checkpoints
Wearing masks: current evidence-based approach
COVID-19 modeling for Cleveland Clinic: contingency plans for worst-case scenarios
Reducing nonessential operations
COVID-19 preparations with many unknowns
Elective surgeries: the slowdown of operations
Supertracking GYN and early OB patients in a COVID-19 hot zone
Redeployment strategy for now low-volume providers, including ObGyns
Supporting staff emotionally
* * *
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @beridgeway
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Javier Magrina joins host Dr. Cara King (@drcaraking) live at the 2019 annual AAGL conference. Other experts join in the discussion, including Pouran Malekzadeh, MD; Laura Cano, MD; Rashad Pasic, MD; and Luis Gonzalez, MD.
They discuss:
Dr. Magrina’s path to pelvic surgery
The creation of ObGyn as a specialty 130 years ago
Limitations of low-volume surgeries
General ObGyn residency programs vs tracking residency programs
What the United States can learn from other countries
When to incorporate experts from other specialties into pelvic surgery
Video review of surgery, and it role in evaluating surgical skill
Subspecializing in surgery
Assessing residents for surgical expertise
What makes a good mentor?
Dr. Magrina’s most influential mentors
What can a mentee do to enhance the relationship with a mentor?
Dr. Magrina’s advice to the graduating resident
Views from podcast listeners on, “Should the OB be separated from the GYN?”
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts surgical researcher and educator Caprice Greenberg, MD, MPH, Professor, Department of Surgery, Division of Surgical Oncology, and Morgridge Distinguished Chair in Health Services Research.
They discuss:
Intraoperative surgical performance and the attending surgeon’s role in outcomes
Applying engineering factors to surgical performance
Surgical coaching: Proof of concept
Differences in surgical mentors, teachers, and coaches
Attributes of good surgical coaches
Identifying surgeons who will be good coaches
Creating a culture change to allow coaches in surgery
Matching coachees with coaches
The Academy for Surgical Coaching and its goals
Video-based platforms for interactive surgical coaching
Video-based surgical assessment
The Academy for Surgical Coaching’s summer 2020 summit
Resources
Academy for Surgical Coaching
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
Dr. Cara King (@drcaraking) hosts women’s health advocacy expert Megan Evans, MD, MPH (@MeganEvansMD). Dr. Evans is Assistant Professor, Tufts University School of Medicine, and Associate Program Director, Department of Obstetrics and Gynecology, Tufts Medical Center.
They discuss:
How GME is funded
Growth in resident training
GME caps for hospitals
CMS’s GME programs
Projected physician shortage
Increased enrollment in medical schools
Resident Physician Shortage Reduction Act of 2019
Opioid Workforce Act of 2019
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @MeganEvansMD
For more MDedge Podcasts, go to mdedge.com/podcasts
On June 29, 2020, Dr. Cara King (@drcaraking) hosts Beri Ridgeway, MD (@beridgeway), Associate Chief of Staff, Cleveland Clinic. They discuss:
Reactivating services at the Cleveland Clinic
Decision making for re-opening
Space studies and design
COVID testing for surgery
Capacity for COVID testing
Ongoing plans if COVID rate increases
Better understanding virtual care being provided
Reimbursement for telehealth visits
Cleveland Clinic’s surgical reactivation workflow
Antibody testing for COVID at Cleveland Clinic
This podcast is developed in collaboration with the Society of Gynecologic Surgeons
Email the show: podcasts@mdedge.com
Interact with us on Twitter: @MDedgeObGyn @drcaraking @beridgeway
For more MDedge Podcasts, go to mdedge.com/podcasts
In this episode, Dr. Cara King speaks with LaShyra “Lash” Nolen, a medical student at Harvard Medical School and the school’s first Black woman student council president. Lash talks about the systemic racism she has seen during her medical education and what motivated her to address it through writing with her first article, “How Medical Education Is Missing the Bull’s-eye.” She also shares what advice she would give to young Black students interested in medicine as well as her thoughts on how healthcare professionals can use their position to help change these deep rooted issues within the institution.
Resources:
"How Medical Education Is Missing the Bull’s-eye" by LaShyra Nolen
ACCEM
Becoming by Michelle Obama
LaShyra Nolen’s website
LaShyra Nolen on Twitter
In this episode, Dr. Cara King speaks with Dr. Linda Bradley, Professor of Surgery at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. Dr. Bradley is the first female African American surgeon to join the staff over 25 years ago and is the Medical Director of the American Association of Gynecologic Laparoscopists (AAGL). She talks with Dr. King about her upbringing in Cleveland and how she integrates her family into her work life. She also talks about her passion for cooking. Listen as she shares how to encourage more Black men and women to enter the medical profession and how to make the most out of a mentorship.
Resources:
The Warmth of Other Suns by Isabel Wilkerson
Coach Sam's Inner Circle Foundation
Celebrate Sisterhood
American Association of Gynecologic Laparoscopists (AAGL)
2018 Celebrate Sisterhood Flavor Over Fat: Cooking Made Simple! Cookbook
In this episode, Dr. Cara King speaks with Dr. Mathew Leonardi, an advanced gynecologic surgeon and sonologist (ultrasound specialist) at McMaster University Medical Centre in Hamilton, Canada. As March is Endometriosis awareness month, Mathew talks about advanced endometriosis imagery and how it impacts preoperative counseling, planning and intraoperative surgical intervention. He also talks about how he created his own path to get to where he is today. Listen as he shares how to build skills in advance sonography and incorporate this into residency as well as fellowship education.
Resources:
Dr. Mathew Leonardi’s website
Dr. Mathew Leonardi on Youtube
“How to perform an ultrasound to diagnose endometriosis” by Dr. Mathew Leonardi
IDEA (International Deep Endometriosis Analysis group)
MUSA (Morphological Uterus Sonographic Assessment)
International Ovarian Tumor Analysis (IOTA)
Closing the communication loop between gynecological surgeons, diagnostic imaging experts and pathologists in endometriosis: building bridges between specialties by Dr. Mathew Leonardi, Dr. Mercedes Espada and Dr. George Condous
In the first episode of a two-part series, Dr. Cara King speaks with Dr. Cecile Ferrando, director of the transgender surgery and medicine program at The Cleveland Clinic, following International Transgender Day of Visibility on March 31. Cecile talks about her journey into reconstructive transgender surgery and how she prepared for her first few cases post-fellowship. She also discusses the importance of transparency with her patients.
Resources:
Dr. Cecile Ferrando at the Cleveland Clinic
Dr. Cecile Ferrando on Twitter