Like the title says, here is a random list of 10 things you should do tomorrow at work, in no particular order.
(OK, I get it… 10 are a lot of things to do. Then humor me and pick one. Let me know how it goes. Twitter: @MikeGisondi)
1. Look your learners in their eyes when they’re speaking with you.
Nothing is more annoying than trying to speak with a physician who is facing a computer… and inevitably reading the screen, holding back the urge to type, and clearly not listening. One study found that lack of eye contact from a faculty member can be shame-inducing for learners. It is a “breach of social norms for respectful conduct,” wrote Whelan et al. in their paper titled, Shame in medical clerkship: “You just feel like dirt under someone’s shoe.” (Quite a title… hat tip, Dr. Whelan.) If you have some extra time, the authors inventory a number of other shame-inducing behaviors you probably shouldn’t do tomorrow at work. But for now, let’s keep it simple… just start with good eye contact.
2. Use hypothetical questioning, never pimping.
Pimping is innocently defined as the senior physician on a team asking students questions about medicine. However, pimping can quickly devolve into shame-inducing interrogations about whatever irrelevant minutiae the attending is musing about at that particular moment. The pedagogy is faulty and the word is sexist. So don’t do it. Instead, use hypothetical questions that are open-ended and can elicit many different responses. For instance, “Great work on your assessment of that patient with hypertension. Now let’s change up the case a bit. What if the patient was pregnant? How might the management be different?” Hypothetical questioning helps learners link concepts together (e.g., hypertension and pregnancy) resulting in new heuristics and deeper foundational knowledge. It also introduces case variations that help learners develop adaptive expertise and practice elaboration. Hypothetical questioning is a great tool to have in your bedside teaching toolbox for rounds tomorrow. So give up pimping, once and for all.
3. Ask your junior residents: “What scares you?”
Then normalize their responses. We were all scared of making mistakes when we started out and those fears of failure were powerful. For some learners, even a small mistake can lead to crippling shame and guilt. (See above: Don’t pimp.) For others, the avoidance of negative emotions like shame motivates them to study. However, fear doesn’t often lead to significant learning. Blakey and Golden offer four strategies to mitigate student fears in another paper with an awesome title, “Of course they’re bloody scared!” Managing medical student fear to cultivate better learning. These include seeking an understanding of the student’s fears, normalizing them, adjusting teaching methods accordingly, and demonstrating caring for the students. Try it tomorrow. Just ask.
4. Teach health equity.
Systemic racism and racial injustice affect numerous healthcare outcomes. So do sexism, ageism, classism, and ableism. These biases result in differences in access to care, treatment options, and quality of health. Health equity is realized when every person has an equal opportunity for health services and the potential to achieve their best health. Examples of health disparities and health inequities are pervasive in our clinical practices. So sadly, you will have plenty of chances to discuss these important issues with students throughout your day tomorrow. If you don’t have much experience with this content, there are a wealth of useful teaching resources available from the AMA, IHI, AAMC, AAFP, and many other professional societies and medical school-sponsored institutes. Take a few minutes to explore these websites and find a teaching module you could review with your students in clinic tomorrow.
5. Actively role model something for a learner.
Here’s what you’re going to do: Take some learners to the bedside. Do something magical in front of them. Then take them to the physician work room and explain what you did and why you did it. Be deliberate and specific as you debrief. Role modeling is an active process. It’s also the practice of clinically excellent physicians, who may be regarded as such because they actively role model excellence. Chicken and egg? Excellence leads to role modeling or role modeling leads to excellence? Either way, it starts with you and some students at the bedside together tomorrow.
6. Use the Feedback Formula.
The Feedback Formula is a skillful method of providing feedback intended to build and sustain relationships between faculty and trainees. Our students will so quickly be our colleagues…. build positive relationships with them now. Or, tomorrow.
The Formula has six steps:
- “May I give you some feedback?
- I want you to be an even better resident than you already are.
- However, you did X incorrectly.
- The impact of doing X is Y.
- What was your experience of the case and your rationale for doing X?
- The next time we work together I want you to do Z instead of X.”
7. Send a positive text message to one of your residency classmates.
Text something like: “Are you still rocking it like you did in residency? I remember that time you nailed that pediatric subclavian line in seconds. You made it look so easy. Man you were amazing. I was just thinking of that day, and I wanted to wish you a Happy Wednesday.” Indeed, positive psychology literature shows that the receipt of positive or inspirational messaging can improve mood and support people with major depression. And one study found that messages of gratitude might be better communicated by text message than face to face! Obviously, I’d never suggest that you pick up the phone and actually call your friends tomorrow… that’s too much. Just send them a text. Baby steps. You’ll feel better for brightening their day. And if you need them, there are apps that will text you a daily positive message, too.
8. Make your classroom a safe space for LGBTQ+ students.
LGBTQ+ health is absent from the curricula of many health professions programs. This impacts the care of LGBTQ+ patients and the belongingness of Queer students. Find ways to make your classroom more inclusive. For instance, try this trick. Change the stem of some of your multiple choice questions to be inclusive of LGBTQ+ individuals. Example MCQ stem: “Mike and Derek bring their 13 year-old daughter to your office with ankle pain. What is the most likely diagnosis from the list below?” Mike and Derek’s marriage has nothing to do with their daughter’s ankle injury, but seeing that stem will make your Queer students feel welcomed in your classroom. Learn more techniques to include LGBTQ+ health content in your daily teaching here. Try one tomorrow.
9. Use Radical Candor.
“Radically Candid feedback is Caring Personally while Challenging Directly,” from the book Radical Candor by Kim Scott. If you’re not sure what that means, then buy the book tomorrow. Your work relationships will be better for it. Radical Candor will help you avoid Ruinous Empathy, Manipulative Insincerity, and Obnoxious Aggression. I hope you can define those terms, else you likely acted in one of those ways already this week. (Like I said, read this book!)
10. Ask your senior residents: “After all these years, what is one thing I still don’t know about you?”
As I write this post, it’s nearing the end of the academic year and soon my seniors will be on to their next career adventures. Sunrise, sunset. There is little time left with them. Make the most of it. Tomorrow. (Credit: Bonnie Kaplan, MD – Denver Health)
About the Author: Michael A. Gisondi, MD is a medical education researcher who lives in Palo Alto, California. He currently serves as Vice Chair of Education in the Department of Emergency Medicine at Stanford University. Twitter: @MikeGisondi
The views and opinions expressed in this post are those of the author(s) and do not necessarily reflect the official policy or position of The Royal College of Physicians and Surgeons of Canada. For more details on our site disclaimers, please see our ‘About’ page
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