There is no KeyLIME episode this week, so instead of our regular programming, we share with you a glimpse in to the life of a CE in the Netherlands. Enjoy! ~ICE Blog Admin
Paul Brand (@PaulBrandZwolle)
Paediatrician in asthma research, Isala Academy
Department of Medical Education and Faculty Development
Zwolle, the Netherlands
Paul Brand, PhD, MD, completed his PhD research in the department of Pulmonary Diseases at the Groningen University Medical Center from 1987 to 1993. In 1990, while still working on his PhD, he entered the pediatric specialist training program. After completing the program in 1995, he enrolled in a fellowship in Pediatric Respiratory Medicine (also at the Groningen University Medical Center), finishing in 1997.
A life lesson: there are many different routes to the same goal
Part of Dr. Brand’s specialist training in Pediatrics was done at the Saint Elisabeth Hospital in Curacao — a Dutch Caribbean island located North of Venezuela. He calls the two year period he spent there an enlightening and humbling experience.
“It taught me the importance of culture in health care,” he said.
Dr. Brand uses the following examples to explain further: in the Netherlands, parents of children are often hesitant to give medication to their children and only agree with a treatment plan after a sound explanation and rationale for the treatment has been provided by the doctor. In contrast, parents in Curacao often prefer that their children be treated with medications, irrespective of etiology, and desire medication for all the symptoms the child may present with. If medication is refused based on sound clinical judgment, for example, the parents move on to the next doctor until they find someone who is willing to prescribe it for their child.
A second striking difference he noticed was the intensity with which people in Curacao embraced death and expressed grief. Parents and family members of a deceased child expressed their grief elaborately, dramatizing their losses in ways that were unfamiliar to Dr. Brand. Training in Curacao, he said, “Taught me that the conventional western approach to medicine was not the only way of providing care.” This practice opened his eyes to a different way people deal with illness and end of life issues. As the Dutch say, “All roads lead to Rome” [translated].
The many hats of Dr. Brand
In 1997, Dr. Brand moved to his current workplace at Isala Hospital in Zwolle, the Netherland’s largest general teaching hospital, where he works as a pediatric pulmonologist. In 2001, he was appointed deputy director of the pediatric residency program and became the clinical director of the program four years later. In 2006, he was appointed the dean of medical education at the hospital’s institute of medical education. One of his first tasks as dean was to restructure the clinical training of residents. This charge arose out of his participation in one of the first the “teach-the-teacher” courses offered in the Netherlands. In addition, he was responsible for setting the course up for all clinician educators in the region. Through his participation in this activity, Dr. Brand gained a better understanding of his work as a clinician educator.
“I became more aware of why I was good in the things that I did well, as well as understood the areas where I needed to improve in,” he explained.
In 2007, he was appointed honorary professor in clinical medical education at the University of Groningen. Dr. Brand is also an author of two Dutch novels and the chief editor of a postgraduate medical educational journal of the Dutch Pediatric Society. By and large, he remains at heart a clinician with a deep interest in medical education.
Handling the disconnect between patients and doctors
In addition to balancing his clinical work alongside his educational and research activities, Dr. Brand faces the challenge of managing disconnects between the perspectives of patients and those of young doctors in practice. Despite the improved training in communication skills in medical curricula, he still sometimes encounters the phenomenon of “communication disconnect” (e.g. where junior doctors focus so much on the clinical problem at hand that they may disregard patients’ views, concerns and needs).
Dr. Brand believes that providing dedicated communication skills training during pre-clinical stages of training is not enough. Junior doctors must also receive sufficient amounts of structured and constructive feedback on their performances. This would enhance their clinical skills and enable them to grow professionally; the difficulty, however, is that it takes time and effort and the average clinician-teacher struggles with how to get all of this done during already busy clinical days.
Even so, Dr. Brand is optimistic about the effect of role-modelling.
“I am convinced that we can teach junior doctors better, when we as clinician educators continue to improve ourselves and invite feedback on our performances.”
How Dr. Brand spends his work hours
When asked how his work hours are divided between clinical practice, teaching, educational research and administrative tasks, Dr. Brand does not have an easy answer.
“It is impossible for me to separate patient care from medical education based on the firm belief that these two are completely integrated. A lot of my patient care involves outpatient clinics, which I rarely do on my own. There is almost always a house officer or a resident with me during the clinics that I teach and also from whom I learn. Moreover, chronic patient care involves a lot of teaching and education.”
Dr. Brand spends 75 per cent of his time on patient care and medical education, 15 per cent on clinical and educational research with the remaining 10 per cent on administrative responsibilities. He says his job as a pediatrician is manageable in the time he has available. What keeps his life busy, are the activities he adds to his schedule to keep his work challenging and innovative. Dr. Brand works four days a week and being a family man, he spends half of his day off with his wife and five children and the other half on research and reflection. He appreciates the ability to have this time to himself.
“The home day gives me the opportunity to step back from the day-to-day rat race and to reflect.”
Now that he is over 50, Dr. Brand has discovered that his resilience to long hours and night shifts has dropped slightly. That is one of the reasons he lists for wanting to cut back on clinical work in the future and to focus more on medical education research. His particular area of interest is medical communication and specifically, the process of shared decision-making. Regardless and whatever may come, he would not change a thing about his career.
He explained, “I think I have one of the most rewarding jobs you can think of.”
- Practice what you preach (if you want other people to behave the way you feel is important, you’d better lead by example yourself)
- Don’t assume you know what someone else is thinking, just ask and check (it is so easy and so tempting, but you get it wrong so often)
- Choose your teaching moments (an average day is crammed with opportunities to teach, but there is also so much else to do – so choose your teaching moments, identify them as such, and make them work)
- There is an inverse linear relationship between the degree of evidence there is on a subject and the degree of emotion with which viewpoints are being presented on the subject (Brand’s first law)
- To reflect on the day at the end of each day: what did I learn today, what am I thankful for?
- To really become good at something (including clinical teaching), one needs to practice deliberately and continue to fine tune these skills on a daily basis
Tell us about a day in your life as a clinician educator. Contact us at firstname.lastname@example.org