“When life gives you lemons, you try everything you can to make the best lemonade possible.” – Dimitrios Stefanidis, MD, PhD, FACS, FASMBS.

Biographic summary

Dr. Dimitrios Stefanidis is an internationally renowned surgeon, researcher, and leader. He is the Harris Shumacker Professor of Surgery at the Indiana University School of Medicine, the Chief of Minimally Invasive and Bariatric Surgery, the Vice Chair of Education, and the Director of the Surgical Skills lab at the Department of Surgery at Indiana University.

Dr. Stefanidis obtained his medical school degree from the Aristotle University of Thessaloniki in Greece, and his PhD at the University of Bonn in Germany. He completed his general surgery residency at the University of Texas Health Sciences Center in San Antonio, a surgical simulation research fellowship at Tulane University School of Medicine, and his minimally invasive bariatric surgery fellowship at Carolinas Medical Center in Charlotte, NC.

Prior to moving to Indiana University, Dr. Stefanidis spend 10 years at Carolinas Healthcare System where he established a busy minimally invasive and bariatric surgery practice and also served as the Surgical and Research Director of Carolinas Simulation Center.

Dr. Stefanidis serves as a board member of the Association for Surgical Education (ASE), as program chair of the 2017 ASE annual meeting, as the chair of the SAGES Guidelines Committee, the co-chair of the Research and Development Committee of the Accredited Education Institutes of the American College of Surgeons, the associate editor for the Journal of Simulation in Healthcare, and the ASE recorder of the American Journal of Surgery. He is an active member in numerous other national committees. His contributions to the education of surgeons and other healthcare workers have earned him the educator of the year award by the Charlotte Business Journal in 2012. He also received a presidential citation in 2016 for his contributions to simulation by the Society for Simulation in Healthcare.

Dr. Stefanidis has served as principal or co-investigator on research projects totaling over 2 million dollars, has hundreds of peer-reviewed publications, written several book chapters, and has won numerous competitive grants and research awards. His research focuses on surgical education, simulation, surgical outcomes, and patient safety. His most recent research projects include the development of a mental skills curriculum for surgeons funded by the Agency for Healthcare Research and Quality (AHRQ), and the development of a coaching mechanism for practicing surgeons funded by the Centers for Medicare and Medicaid Services (CMS). He has mentored numerous surgical fellows, residents, and medical students over the years and has helped them grow as clinicians and researchers.

Interview

Q: Could we start with your background and early education?

A: I grew up in a small village of nearly 300 people near the city of Edessa, which is the capital of the Pella region of Central Macedonia in Greece. Edessa is full of small bridges and picturesque waterfalls and has a special place in Greek history. It is located very close to the town of Pella, the birthplace of Alexander the Great and the principal city of the ancient Macedonian kingdom.

Edessa is also close to the town of Vergina, which is located near the ruins of Aigai, the original capital of the Macedonian kingdom and the burial site of King Philip II of Macedonia who was Alexander the Great’s father.

My father was a teacher and when I was in third grade in elementary school we moved to Germany, as he was appointed under a governmental program to teach children of Greek immigrants in Germany for five years.

We then moved back to Greece where I completed my high school education and, after a notoriously difficult national admission testing, enrolled in the medical school at the Aristotle University in Thessaloniki, the largest university in Greece. I actually followed in the footsteps of my sister, who was also a medical student, two years older than me.

As a third-year medical student, I saw a flyer around the university campus about the ERASMUS (European Community Action Scheme for the Mobility of University Students) – a European Union student exchange program established in 1987. Both my sister and I applied and got accepted into a 12-month exchange program at the University of Bonn in Germany. Besides taking classes, I was very productive in research work in neuroscience, and this led to my program being extended for another year to finish a PhD program. After completing the fourth and fifth year of medical school at the University of Bonn, I returned to Greece, and completed my sixth, and final, year of medical school.

As you know, in Greece, as in the rest of European Union, the medical school is 6 years and starts immediately after high school.

Furthermore, in Greece public university education including medical school is free of tuition. In return, upon graduation from medical school, students are required to provide public health service for 1 year before they can apply for residency training. I was assigned to work in the surgery department at the General Hospital of Florina, a mountainous town in northern Greece.

I must confess that while I was interested in surgery when I entered medical school, I did not necessary enjoy the experience during my surgery rotations, and I felt that surgeons were arrogant and aggressive. As such, I was planning on an internal medicine career. However, during my service in Florina I worked with surgeons in a relatively low-resource setting, and it was there that my passion and love for surgery was invigorated.

After the public health service, I completed the mandatory 18-month national military service.

Q: How was your life journey from Greece to the United States?

A: While at the University of Bonn for her exchange program, my sister fell in love and got married to a US exchange student of Greek origin. They subsequently moved to New York City. This made me decide to explore opportunities to complete my surgical training in the United States.

I was about to discover that, as an international medical graduate, the journey to becoming a surgeon in the United States is not easy and usually follows a tortuous path.

After passing the USMLE exams, I applied to both ENT and General Surgery residency programs. I did not get any ENT interviews and was only granted one interview for a categorical general surgery position at the Medical College of Georgia. I vividly remember the interview day and the feeling of certainty that I failed the interview after naively asking the interviewer “How can trainees manage working more than 100 hours per week?”. While this question surely surprised, and perhaps horrified the interviewer, at the time it felt normal for me being used to fewer work hours in Europe. Alas, my fate was sealed for the moment, and I was not offered a position. This made me very disappointed and discouraged.

I returned to Greece and started the General Surgery training at the AHEPA University Hospital in Thessaloniki. After one year, I re-applied for general surgery residency in the US. I sent 30 applications for categorical spots and got one interview at the University of Texas Health Sciences Center in San Antonio in Texas. Unfortunately, I did not match again, and started preparing for the scramble, now known as SOAP (Supplemental Offer and Acceptance Program). Fortunately, I was accepted as a preliminary general surgery intern at the University of Texas Health Sciences Center in San Antonio. I was very excited. What continued was extremely hard work, studying, lack of sleep, and re-applying for the match, while being uncertain about what future would bring. One of my categorical co-interns suddenly quit, and I was very fortunate to be given the opportunity to fill the vacant spot and join the program as a categorical second year resident.

Following general surgery training, I matched for a two-year minimally invasive bariatric surgery fellowship at Tulane University School of Medicine in New Orleans. It was there where I got involved in education research focused on simulation. Again, while this was not necessarily my research choice at that time, it was an available opportunity that I took full advantage of and became very productive in the first year of the fellowship.

Just when I thought that I was on a predictable path, uncertainty struck again, this time as part of widespread devastation. In August of 2005, we travelled back home to Greece with our newborn son for his baptizing ceremony. While there, I saw on the news about the Hurricane Katrina hitting the southeastern United States, breaching levees in New Orleans, and causing widespread death and destruction. For days I tried frantically calling my friends, co-residents, and my program director but could not reach them. When we finally reconnected, I learned that medical centers and training hospitals in the New Orleans area had closed and that the Tulane University School of Medicine relocated temporarily to the Baylor College in Houston, Texas.

As local surgical trainees were relocated to other programs to continue their education, I was exploring opportunities for continuing my fellowship training. I was lucky to be accepted to train under B.Todd Heniford at the at Carolinas Medical Center in Charlotte. Following completion of my fellowship, I was recruited at Carolinas Medical Center where I established a busy minimally invasive and bariatric surgery practice and served as the Surgical and Research Director of Carolinas Simulation Center. My research productivity helped me tremendously with another significant challenge that most international medical graduates face when looking for a job: the visa status. I was able to transition from a J-1 visa to the much-coveted green card.

Years went by, and one day I got a call from Gary Dunnington, at the time the chair of the Indiana University School of Medicine Department of Surgery, who is an icon of surgical education. He invited me to join him at the Indiana University and I happily accepted. It has been an amazing experience since.

Q: When looking back on your career, what were your characteristics that contributed to success in clinical work, education, research, and leadership?

A: As an International Medical Graduate there is a lot of uncertainty and high stress in building a career and life in the United States, or in any other country for that matter. The stakes are very high, it is not just about a job, your whole life and your family are on the line. Therefore, perseverance and resilience are crucial.

Q: What has been the role of mentors in your journey?

A: I have been very fortunate to have met great mentors in my career. While at Tulane I learned a lot from Daniel Scott on how to conduct research, write, and publish. At Carolinas I was mentored by Rick Greene who served as chair of the Department of Surgery and B.Todd Heniford. At Indiana University I received great mentoring on leadership from Gary Dunnington.

While now we formally match our trainees with mentors, in the past this was not the case. In addition to directly interacting with mentors, I learned a great deal by observing people who I considered role models, and I would highly recommend it.

Q: There is an increasing awareness on the importance of a healthy work-life integration for surgeons. How to you balance work with life? What are your hobbies and interests?

A: As a trainee before the 80-hour work week, I did everything I had to survive and achieve my goals. During the little time outside work, I dedicated all to my family focusing on spending quality time with them. As an attending, I try hard to participate in activities together with my kids and spouse. For example, I did taekwondo with my kids for years, and we even won black belts together.

I also enjoy dancing; I grew up dancing Greek folk music, and now I teach it to others. In fact, in about 10 minutes I will have to start the Greek folk-dance class for Greek children. We have also organized dancing sessions for our bariatric patients, as well as for our surgical residents.

Q: What has been your experience on giving back and remain connected to your country of origin in terms of clinical, research, teaching, and research expertise?

A: In the last five years I have had more opportunities to give back. Once or twice a year I go back to Greece to teach, lecture, and mentor. I am currently collaborating with Greek surgeons on adopting the safe cholecystectomy guidelines to prevent bile duct injury during cholecystectomy.

Q: Throughout the years I have followed with great interest your research work on improving surgical performance of our trainees. What is perspective on what can we as surgical educators do better?

A: First, I think it is important to change the paradigm in surgical education by reforming its integration with service. I do feel that currently there is too much pressure on our surgical trainees to provide service with education being considered a byproduct of service. Finding a right balance is a challenging task that requires input from all stakeholders, including residents, educators, as well as healthcare administrators.

Second, I believe that to maximize the educational benefits while providing adequate care to our patients, there should be a better integration of intra-operative learning with educational interventions outside of the operating room. It benefits no one when trainees try to learn even the most basic skills only in the operating room. Formalized out-of-the-OR skill session curricula should be instituted with clearly established milestones to be achieved by trainees prior to transitioning to intra-operative learning. This becomes even more important with the current advances in the minimally invasive techniques, including robotic surgery.

Another area of improvement is performance assessment and feedback optimization. I am optimistic that the evolution of artificial intelligence in this area will lead to more impartial real-time assessment and feedback for our trainees which will positively impact their learning and performance.

Q: Do you have a favorite quote or mantra?

A: Yes, my favorite quote is: "When life gives you lemons (something unexpected or unfortunate), you make lemonade (the best of a bad situation). Its first known print use, is attributed to the writer Elbert Hubbard in 1909, reads: “A genius is a man who takes the lemons that Fate hands him and starts a lemonade-stand with them.” It is a very familiar proverbial phrase that encourages optimism and a positive can-do attitude in the face of adversity.

I have faced so many expected and unexpected challenges in my journey to where I am today. I only succeeded because I remained optimistic, resilient, and worked very hard to overcome adversities and become the best I could be. So, my personal addition to the lemonade quote would be" When life gives you lemons, you try everything you can to make the best lemonade possible."

Q: As an International Medical Graduate, myself, I would like to congratulate you on your amazing career and tremendous achievements. You have lived through different healthcare and educational systems, and for that matter different societal cultures and expectations. Would love to know your perspective on how this influenced your life and career and if you have any advice for students and trainees that are aspiring to embark in a surgical career abroad?

A: I firmly believe that these diverse experiences, while challenging, helped me mature faster, become more flexible, easily adaptable, and more resilient. In other words, they are probably part of my success. It is also true that life experiences influence your career as well and vice versa. I would, therefore, advise students who are aspiring to embark in a surgical career abroad to not be afraid to take the first step and to persist until they make it. They should expect to fail before they succeed, often times more than once; the road to success goes through failure. I would be remiss if I did not emphasize the importance of hard work; in the environment we work in, success without hard work is not possible and even if it were to be achieved serendipitously it will most likely be ephemeral.

Q: Any other important perspective that you would like to share with our readers?

A: I very much enjoyed our discussion Dr Kristo and appreciate the opportunity to share my story with you and your readers. Perhaps an additional advice I would like to share is that as an IMG you will often feel alone and likely discriminated against. Keep your head down, work hard, and demonstrate to others your value. Surround yourself with people who care about you, whether immediate family or friends and ideally both. You will face hard times and you will need the support of people who love you to stay on course and achieve your aspirations.