The MedEd Blog Takes a Break

The last post? Maybe or maybe not.

The MedEd Blog Takes a Break

The MedEd Blog is taking a break as the Transformational Times evolves ...  

For two years, I served as the founding editor-in-chief of the Transformational Times newsletter, a project that supported our community as it reeled from—and adjusted to—the COVID-19 pandemic while re-envisioning the future of medical education. 

Three months after the first TT issue in March 2020, I started this blog as a personal project. Although I was a faculty member at MCW, the blog has never been affiliated with either the Medical College of Wisconsin, the Kern Institute, or any of their funders. I held the password, set up the blog, and added every bit of the content. I did all of the work on my own time. 

Here's why I started the blog: As soon as one issue of the TT was released, the previous week's edition all but disappeared into a non-searchable corner of MCW's website. I conceived the blog as a way to give continuing life to some of the most interesting and inspirational essays that appeared in the Transformational Times newsletter. I was able to share links with the authors so they could do the same. 

This blog's format is searchable, although metrics tell me that there have never been many visitors and Blogger (the platform) no longer enables subscribers. Nevertheless, I persisted since the blog gave the essays some online presence and was invaluable when I curated the two Character and Caring books. 

For the few of you who have found this little corner of the Internet, I hope you will continue to use the tags and search function to browse the essays, poetry, images, and articles. They tell a fine story about a period of time when medicine went through a pandemic crisis and emerged. There are voices of strong and resilient people whose viewpoints are not regularly amplified. The blog explores visions of a future medical education that enhances, rather than suppresses, character and the entrepreneurial spirit. 

Reading and editing these pieces taught me much, made me stop and think, and exposed me to new perspectives. I didn't always agree with the essayists but know that I am a better person because I read what is contained here. 

The machinations of the institutions involved are completely opaque to me. Amplifying certain voices, though, might be counterproductive while the powers-that-be discuss the Transformational Times and the people who inspired and maintained it. Rather than inadvertently poking a bear, it seems best to suspend or even shut this down. Therefore, this 366th post might be MedEd Blog's last.

That said, I hope that my family and I will always be able to locate caring, character-driven physicians and healthcare workers. The remarkable accomplishments of the Kern Institute—reflected, in part, by the essays contained here—give me hope that the next generation will be more than up to the challenge. For those of you who spend time with the pieces archived here, I hope you catch the same vision.

Be well, friends. 

In appreciation,

Bruce

Bruce H. Campbell, MD FACS 

Gratitude: A Practical Application

 From the November 18, 2022 issue of the Transformational Times (Gratitude)

Gratitude: A Practical Application

Kathlyn E. Fletcher, MD, MA

Dr. Fletcher and Luke make a discovery together.

Me: “What are you grateful for today?”

My 12-year-old son, Luke: “That everyone was here today. My basketball games. And making tortillas with you.”

This is the nightly ritual that we have observed almost without fail since mid-winter 2021. I think it turned his life around; but let me take you back to the preceding months and you can judge for yourself.

We had endured most of the first year of COVID, like everyone else in the world. There was talk in the media of how the pandemic was impacting children, making them more anxious and worsening behavior. Maybe that was the explanation, but honestly, this storm had been brewing before COVID: My beautiful 10-year-old boy had become completely negative. He was certain that every activity on the horizon would be terrible, even the ones that he always objectively enjoyed (e.g., baseball practice). Every conversation we had was about his discontent. Nothing would placate him. Nothing brought him happiness. School was terrible. He didn’t like his teacher. His friends were never available. The list was endless and bleak.

On February 2, 2021, I took the day off to visit my sister in Lake Forest, IL. We had a lovely day. She made me a beautiful and delicious lunch, and we went shopping. 

As I drove home in the dark, it was freezing outside. Tiny snow flurries dusted the windshield on the lonely stretch of the interstate between the Wisconsin-Illinois border and the south Milwaukee suburbs. I turned on a podcast to pass the time. I don’t listen to a lot of podcasts, and I had never listened to Oprah’s before. I don’t know why I chose to listen to Oprah’s Super Soul episode called Grace and Gratitude, but something drew me to it that night.

At some point in the podcast, they discussed the study that showed that by writing down what you are grateful for every night, one can move from being pessimistic to mildly optimistic in three weeks. Right then and there, I made a Groundhog’s Day resolution: Luke and I were going to each say three things that we were grateful for every night for three weeks and then I would re-evaluate. 

It was a little rough at first. 

Luke: “Can’t you just tell me what to say?”

Me: “No.”

Some nights, the only things he was grateful for were breakfast, lunch, and dinner. But at least he was saying something. After a week or so, he asked me if I wanted to say a prayer after our gratitudes. Hmmm. That seemed promising. We persevered through three weeks, and then it was a habit.

I am not sure exactly when things changed, but after a month or so, he wasn’t actively resisting all new activities. A few weeks later, he would remind me if we hadn’t said our gratitudes before we started to read a new chapter in the Chip Hilton book we were sharing. Now, he still doesn’t like school, but we don’t discuss it every day. He walks into new situations with (mild) optimism. He has found a way to be comfortable in his skin and happy in his life.

A lot of other things have gotten easier as the early COVID restrictions have lifted but, again, this change in his outlook predated that one. It’s not scientific, but life is better, and gratitude was the major change. While I was open to the idea before, I am now a complete believer. 

In May 2022, a year and a half into the experiment, Luke got COVID. Isolated in his room, we couldn’t do our usual ritual, so he FaceTimed me at bedtime. “Can we do our gratitudes, Mom?” 

#winningthegame

Kathlyn Fletcher, MD, MA, is a Professor in the Department of Medicine at MCW. She is the program director for the Internal Medicine residency program and the co-director of the GME pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. She is an editor of the Kern Transformational Times.

Happy Thanksgiving from the MedEd Blog!

 

Being a Parent and a Pediatrician

Originally published in the October 22, 2021 Transformational Times newsletter

Being a Parent and a Pediatrician

Cassie Ferguson, MD

Every weekday morning, I am confronted with my failure as a parent. Instead of filling my three kids’ lunchboxes with a colorful array of washed and cut, 100% organic, GMO-free fruits and veggies and a lean protein-packed sandwich cut into a dinosaur shape, I am typically frantically grabbing for a Dole fruit cup, an unnaturally colored yogurt tube, and a bag of Fritos. Guilt inevitably washes over me every time I shove a PB&J made with Skippy and grape jelly on white bread into their lunch boxes, and I cringe thinking about the teachers seeing what I knowingly

feed my children.

What you are to be, you are now becoming

–Carl Rogers

I don’t know if I feel this guilt more acutely as a pediatrician—as someone who spent nearly a decade learning about how to keep kids healthy and should “know better”—because I don’t have a different perspective to which I might compare. My first son, Ben, arrived two weeks after I graduated from pediatric residency. Will arrived as I finished my pediatric emergency. medicine fellowship, and Nick three years after I became an attending in the emergency department (ED) at Children’s. I became a mother as I learned to become a pediatrician.

While the guilt may be sharper, there were advantages to my training when it came to caring for my kids when they were little. The nurses in the well-baby nursery taught me how to swaddle a baby so that they couldn’t free their tiny little arms. I knew that 100°F was not a real fever. And I could assure my husband (and myself) that our child would eventually learn to pee in the potty.

There were distinct disadvantages, as well. I also learned about the randomness with which a four-year-old is struck with leukemia. About what it sounds like to hear a mother’s heart shatter when she learns her sixteen-year-old has died in the car crash. The health and safety ofmy own kids can feel so fragile; regularly witnessing the suffering of kids and their families makes it difficult to believe that my own kids would be spared, no matter the real odds.

Every system is perfectly designed to get the results it gets

–Arthur Jones

Most of the suffering that we witness as pediatricians, however, is not a result of random chance. Disparities in the utilization of health care services and in overall health spending, structural racism, and residential segregation that limits access to good schools, jobs, healthy food choices and green spaces for the majority of Black and Latino or Hispanic Americans directly translates to poor health outcomes for the families for which we care. Kids dying from gunshot wounds, physical abuse, asthma exacerbations, drug exposures; these deaths are not random. They are a result of the systems we have purposefully built in America and continue to support with our inaction.

A friend once described having a child as forever walking around with your heart on the outside of your body. As a mom and a pediatrician, I’ve discovered that my heart can be broken not only when my own child falls and breaks their arm, or is bullied at school, but by anything that harms children anywhere. I have come to see this as our superpower—this tenderness and vulnerability spurs my colleagues to fight courageously for the radical redesign of our systems.

We are called to disrupt the cycle of interpersonal violence in our communities, to address food insecurity in our ED, to protest the attempt to ban books about racism from our schools, and to ensure that the way we treat acute pain is equitable.

Hope is the thing with feathers

–Emily Dickinson

This calling can feel overwhelming, particularly when I am in the ED managing twenty very sick patients and a full waiting room, and then receiving a page heralding the imminent arrival of yet another child with a gunshot wound. On those nights nothing we do feels like enough; it feels as if we are digging a hole in the sand as the walls are caving in around us.

On those nights, I come home defeated, or angry, or fearful; overwhelmed with the perspective on how dangerous the world can be for our most vulnerable citizens and feeling powerless to protect both my patients and my own kids.On those nights I come home to my kids and peer into their dark bedrooms, staring at their sleeping forms from the door, surprised at how easy and regular their breath comes. I renew

my vow to do what I can to make them feel safe and loved and find grace in the belief that this love is perhaps more communal than I realize.

Cassie Ferguson, MD, is an Associate Professor of Pediatrics (Emergency Medicine) at MCW. She is the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Remediation: A Story About Maryam

Reprinted from the January 27, 2023 issue of the Transformational Times

Remediation: A Story About Maryam 

Cassie Ferguson, MD 

 

Dr. Ferguson, who is a reknowned mentor and educator at MCW, tells the story of one student who came to her when on the edge of academic despair ...

The most rewarding mentoring relationship I’ve had with a medical student began the day she came to see me in my office to tell me about her experiences on academic leave. Maryam* had heard that I started a task force to learn about our school’s remediation process and wanted to share her story with me. I now know her to be a fierce, determined daughter of immigrants, but that day in my office she sat hesitantly on the very edge of her chair, backpack on, and glanced frequently at the door, as if she hadn’t yet decided to stay. Her voice was flat, and she rarely made eye contact when she spoke. She told me that after failing a course by less than a percentage point, she was asked to take an academic leave of absence before her first year ended. She might be able to come back, she was told, in the fall and repeat her entire first year. What she was not told was that when she drove to school the day after her leave began, her student ID would not work, and she would not be let into the school’s parking lot.  

“They just threw me away,” she said.   

Maryam’s story—her whole story—would take me years to learn. How she was diagnosed with multiple sclerosis during her first year of medical school after months of attributing her symptoms to stress. How she learned that she was dyslexic in her second year of medical school. How intense test-taking anxiety finally drove her to seek help from a psychologist. That information would be given to me in pieces as she grew to trust me, and I have slowly and carefully put those pieces together. Even now, four years after we met for the first time and three years of meeting with her every other week, I know that Maryam has not revealed all the pain she felt during that time, or during the struggles she has had since. I believe that this is in part because of her reluctance to seem as if she is making excuses, in part because of the intense shame that accompanies failing in medical school, and in part out of deference for the archaic medical hierarchy that still hangs over our profession, and the accompanying perception that my time is somehow more valuable than hers.  

That hurt we embrace becomes joy. / Call it to your arms where it can change.

-Rumi 

Medical school is not for the faint of heart. As a result, supporting medical students—particularly those who are struggling—requires love, grit, and fierce compassion. I have learned both through my own experience with failure and from working with students like Maryam that if we are to live up to the titles of teacher, mentor, and advisor we must walk with our students; we must show up even when showing up is uncomfortable. It is precisely when things get hard that we need to lean in and wade through the uncertainty and pain with our students. This requires that we recognize that we have something to offer because of our own life experiences, but I believe the bigger imperative is that we acknowledge that the boundaries of our experiences limit our ability to know what our students are going through. The only way to begin to truly understand is to get very quiet and listen to their stories.  

When we listen to a story, research using fMRI demonstrates that our brain activity begins to synchronize with that of the storyteller; the greater our comprehension, the more closely our brain wave patterns mirror theirs. The areas of our brain involved in the processing of emotions arising from sounds are activated, particularly during the more emotional parts of the story. Even more amazingly, when we read a story, the networks of our brain involved in deciphering another person’s motives—in imagining what drives them—prompts us to take on another person’s perspective and even shift our core beliefs about the world. 

It is impossible to engage properly with a place or a person without engaging with all of the stories of that place or person.

-Chimamanda Ngozi Adichie 

These findings should not come as a surprise to those of us whose work includes caring for patients. As an emergency medicine physician, I have heard thousands of stories. Whether they are snapshots relayed through EMS of how a 14-year-old child was shot in the head at two in the morning on Milwaukee’s north side, an exquisitely detailed account of a 3-year-old’s fever and runny nose from her mother, or a reluctantly provided history of pain and despair that led a 12-year-old to try and kill himself, each of these stories should transform us. They should move us to want and do better for our patients, for our communities, and for our world.  

At the same time, it is essential that as physicians and educators we also recognize what Nigerian author Chimamanda Ngozi Adichie describes as the “danger of the single story.” As an emergency medicine physician, I only hear stories of peoples’ suffering; I am listening to them when they at their most vulnerable, on what may be the worst day of their life. I only hear of the tragedies that have befallen a neighborhood we serve. As an educator who mentors students who are struggling, I often miss out on their stories that are not about failure or crisis. Adichie warns that when we only listen for the single story, there is “no possibility of feelings more complex than pity, no possibility of a connection as human equals.”  

So then our charge as physicians, as educators, and as human beings is to make room for more than just a single story—to remember that all of us are much more than our worst moments, and that compassion and connection arise authentically when we recognize the full spectrum of humanity in one another.  

*Names have been changed.  

Catherine (Cassie) Ferguson, MD, is an Associate Professor in the Department of Pediatrics, Section of Emergency Medicine at MCW and Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

The Difference Between Confidence and Competence: Growing with a Confident Humility

Originally publishsed in the June 18, 2021 issue of the Transformational Times

 

The Difference Between Confidence and Competence: Growing with a Confident Humility

 

 

Adina Kalet, MD MPH

 

 

Dr. Kalet shares one of the “hidden” tasks that each new resident faces: the need to develop competence without risking becoming overconfident. In this encore essay, she shares some of the pitfalls and invites housestaff to be part of the journey ...

 

 

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” 

- Mark Twain

Thousands and thousands of newly minted physicians begin residency training each year. At MCW, we welcomed our new residents in July, many of whom movied to Milwaukee for the first time. This is a poignant, anxiety-provoking, and exciting time, a new beginning, and a critical transition on the journey of becoming a seasoned and caring physician.

 

Incoming residents embark on the steepest leg of their learning curves. Not only have many of them just moved to a new city, found a new home, and located a new grocery store, each new day brings them an avalanche of firsts: the first patient, the first procedure, and the first time they need to find the cafeteria or the bathroom or the emergency room. Many important components of their new professional identify will take shape in these first summer weeks. Our newest physicians will work to discern how best to balance confidence and humility. Getting this equilibrium right is crucial, and I think MCW is an especially wonderful place to foster this process.

 

The difference between confidence and competence

As physicians on the front line, residents are expected to develop enough confidence to quickly analyze data, make crucial decisions, and act decisively. Think about how difficult and fraught that task can be! We want physicians to make critical judgements under emotionally charged and complex conditions. Even drawing blood for routine laboratory testing (a task interns do daily) means facing an anxious, fearful, suffering person, and causing them some pain. Confidence is critical, yet—to ensure that our teams provide the highest quality and safest health care—we stay on the lookout for overconfidence in ourselves and in others because of the complex and paradoxical relationship between confidence and competence.

The Dunning-Kruger effect, described in 1999, elegantly summarizes this complexity. Stated simply, people with low ability tend to overestimate their competence and, therefore, become overconfident. Conversely, people with high ability tend to be underconfident in their ability. Even worse, poor performers are often unable to recognize their own limitations, and overconfidence is especially pronounced for those at the lowest end of the ability scale. As ability improves with practice, confidence, paradoxically, can take a nose-dive because the difficult journey can create humility and self-awareness. This sense of deflation can feel terrible at the time but, in the long run, is good since it can lead to insight and growth.  

Numerous studies have confirmed that humans are just not good at objectively evaluating their own level of competence, but by honing one’s own metacognitive awareness or being observant—like a scientist—of one’s own thinking and feeling, a novice can guard against using his or her own confidence as an indicator of competence. As teachers, we must avoid making our trust judgements based on a trainee’s confidence alone. As Ronald Reagan was wont to say, we must, “Trust but verify.” Confidence is good, but we must guard against allowing our feelings of confidence to blind us to our own ignorance.

“Confident humility”

In his book, Think Again: The Power of Knowing What You Don't Know, organizational psychologist Adam Grant reminds us how critical it is to cultivate a mindset “confident humility.” From this stance, one can act even when they are not certain of what is right, but they act with a scientist’s curiosity and perspective, seeking evidence that might refute their current beliefs. Grant reviews the accumulating evidence that intelligence does not protect us from common human foibles. In fact, many researchers have pointed out that smarter, more tenacious people (like many medical students and residents) are prone to blindness to changing conditions and may have a harder time adjusting to new circumstances. They have difficulty admitting when they are wrong. Stubborn, inflexible physicians will run into obstacles when trying to provide competent, character-driven medical care.

 
If, however, a hypothesis survives repeated attacks, it becomes the working theory until such time as it can be disproven. Approaching one’s own competence in this rigorous way—repeatedly challenging beliefs and understandings—keeps a person humble, curious, adaptable, and learning. It is the key to deep, durable, and lifelong learning. 

The remarkable value of working in an institution defined by confident humility

 

Like many of us, I am a transplant from elsewhere, having arrived in 2019. I have traveled extensively and have lived and worked in other institutions in the northern and southeastern United States. To my delight, I have come to know MCW as a uniquely confident, humble place to work and learn. It is remarkable to me—given the excellence in clinical care and research—how little our institution tolerates the everyday self-promoting arrogance typical at many of our peer institutions. This institutional culture is a towering strength and I believe is one of the many reasons we have adapted and thrived for a century and a quarter. 

Adam Grant points out that a hallmark of wisdom is knowing when it’s time to rethink and collect data that might refute and, therefore, cause you to abandon what you think you know and who you think you are. This habit of honest reflection and an openness, or even a delight in learning when you are wrong, is a path toward a deeply satisfying confidence. It’s true in business and especially true in medicine.

So, to our house staff, I say, “You've got this!” You have several difficult tasks ahead, not the least of which is to master your chosen field. You will grow as you learn to work in teams, experience ambiguity, become lifelong learners, and bring your intellect and compassion together to tend the sick and heal the suffering. You will thrive if you tend to your own wellness and character. These are huge tasks responsibilities. We wish you all the best and are here to support you.

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

The Transformational Times is Taking a Sabbatical (although the blog will continue)

From the September 29, 2023 issue of the Transformational Times

Take Our Survey

The Transformational Times is Taking a Sabbatical

Adina Kalet, MD, MPH

Born on the fly to keep our medical community thoughtfully connected through the pandemic, the Transformational Times--like the rest of the world--is establishing its “new normal.” To do this, we are pausing weekly publication to gather reader input and intentionally consider how best to serve our community while continuing to reflect the transformational work at the Medical College of Wisconsin around character and caring alongside clinical excellence. Dr. Kalet shares what will happen behind the scenes, and invites readers to help shape the future of this thoughtful, medical education publication by participating in our survey ...

 

Dear Readers,

September is a time for renewal. Kids are back in school, the summer has come to an end, and in my faith, we gather to celebrate the birth of the world through our “high holy days.” At the Kern Institute we have been taking time to reflect and plan. We spent a day in retreat a couple of weeks ago, to contemplate where we have been and consider where are going next. In that spirit, the Transformational Times team is taking a short sabbatical to refresh our processes, update our vision and begin again.

 

The Transformational Times was born during the first days of the COVID-19 pandemic in March 2020, when the Medical College of Wisconsin (MCW) sent all of the students and many faculty and staff members home. As I have recounted before, we decided to transition our existing quarterly newsletter into a weekly offering, and rename it the Transformational Times. We hoped this would keep our work alive and support our medical education community.

 

As those early weeks turned into months then years, we kept up our pace, publishing 178 weekly issues of the Transformational Times and two curated books. We have taken only a handful of holiday weeks “off.” We are proud we have helped people share personal stories about their work and worlds. The tagline to be “delivering stories of hope, community, caring and resilience to our community,” has largely been honored.

 

The Transformational Times has been a success in many ways. We have grown our readership both inside and outside of MCW and received a great deal of supportive feedback and a few critical comments; we take all of our feedback very seriously. Through these efforts, we have hosted a hardy, broad conversation around the transformation of medical education and accelerated the expansive acceptance at MCW and beyond of new models for educating physicians that embody the character and caring essential to health and health care. This is the mission of the Kern Institute.

 

What to expect in the future

With the pandemic largely in the rear-view mirror, we are taking a break to reimagine the Transformational Times. Over the next few weeks, under the leadership of our new Co-Editors-in-Chief Wendy Peltier, MD and Himanshu Agrawal, MD, we will seek input from our readers. Our Editorial Board will ensure we continue to prioritize creating community and encouraging storytelling that promotes the ideas and discourse at the heart of health professions education.

 

Drs. Peltier and Agrawal will do this work along with our multidisciplinary editorial board which includes Bruce Campbell, MD (founding Editor-in-Chief); Kathlyn Fletcher, MD; Adina Kalet, MD, MPH; Karen Herzog (Milwaukee-based journalist); Justine Espisito, (Kern Institute staff); Joy Wick, (Kern Institute Communications Consultant); William Graft. Jr., MD (Resident, Internal Medicine/Psychiatry); and medical students Julia Bosco, Linda Nwumeh, Wolf Pulsiano, Sophie Voss and Emelyn Zaworski.

 

Our immediate goals are to work with Kern Institute members and the MCW leadership to:

• Refine our processes, policies, and submission guidelines
• Publish regular, theme-based issues that engage broad swaths of our community
• Leverage our Philosophies of Medical Education Transformation Lab (PMETaL) to build a civil discourse framework that enables diverse and profound conversations about our professions
• Have our editing team, including two former journalists, actively assist and encourage writers of all comfort levels
• Explore more flexible publishing platforms (video, audio, social formats, etc.)
• Integrate our work with the Kern Institute Podcast Network

 

We plan to continue and expand popular features of the Transformational Times, including:

• Themed issues for special days (e.g., Veteran’s Day, Valentine’s Day, Thanksgiving) and events in the medical education year (e.g., The White Coat Ceremony, Match Day, Graduation)
• Programmatic reports from the Institute, including The Learner Continuum Hub, Educator Development Hub, and the Medical Education Data Science, Human Centered Design, and the Philosophies of Medical Education Transformation labs
• Project reports from the Transformational Innovations (TI2), KINETIC3, and the MCWFusion curriculum, including Learning Communities, The Good Doctor Course, the Character and Professionalism Thread, and Learning Dashboards
• Works-in-progress on medical school to residency transitions, character measurement, and professional identity formation
• Summaries of Qualitative Research Methods, the Kern Institute Collaboration Scholarship (KICS) group journal clubs and collaborations, the Medical Education Matters Podcast, and our Medical Education Transformation book series
• Collaboration reports with Academic Affairs, the MCW Affiliated Hospitals (MCWAH) GME programs, MCW-Central Wisconsin, MCW-Green Bay, Thrive on King, the School of Pharmacy, the Physician Assistants Program, Genetic Counselling, Anesthesia Assistant Program, and the Graduate School
• Reflection on and coverage of the emerging issues of our times

Please Provide Input

While we won’t be publishing for a few weeks, we will be accepting submissions, and we encourage you to reach out to us with your ideas.

 

We want to hear from you! Whether this is your first or your 178th time reading the Transformational Times, please provide us feedback by taking our survey. If you have advice, opinions, or critiques, please reach out with your thoughts and feelings during this time. And thank you for reading, sharing, and caring.

 

In the meanwhile, watch this space for announcements of our Kern Institute events and related content.

Take Our Survey

Sincerely,

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Radical Candor in Medical Education

From the August 4, 2023 issue of the Transformational Times

Radical Candor in Medical Education 

 

Kathlyn E. Fletcher, MD MA – Program Director, Internal Medicine Residency 

 

 
Dr. Fletcher highlights a Kern offering to new interns to prepare them for their role as educators. These sessions took place during orientation and combined a workshop on how to show learners that they matter with a workshop on how to give effective feedback.  These are the building blocks of medical education radical candor ...

 

My introduction to radical candor 

 

I first heard the concept of radical candor from my sister Julia, who is a retired Navy intelligence officer. I must have been talking with her about how hard I thought it was to give feedback, when she got out a piece of paper. She drew a 2 x 2 table that is the central figure in a book about how to be a great supervisor. She explained that to give impactful feedback, you must 1) care about the person you are talking to and 2) be honest.  

 

I proceeded in my usual path to change -- somewhat slowly. I bought the book Julia was referring to called Radical Candor by Kim Scott and started reading it. I got about halfway through before I dropped it in the bathtub and decided that I had read enough to “get” it.

 

A few concepts in the book specifically resonated with me.  

 

First, the quadrant in which we care about the person, and we are honest is called “radical candor.”  The quadrant in which we care about the person, and we are NOT honest is called “ruinous empathy.”  

Ruinous empathy struck a chord because I thought about all the times that I had convinced myself I didn’t need to be completely honest in my feedback. Phrases went through my brain like, “I’m sure she will get better; it is so hard being a July intern.” Or “It’s impossible to know everything as a third year medical student; I am sure he will fill in that knowledge eventually.”  I spent SO MUCH time in ruinous empathy.   

 

As I began trying out radical candor, I came to see that if I believed in someone’s ability to improve, then I had to be honest about how they could do so. I started framing my feedback by saying “I wouldn’t suggest this to you if I didn’t think you were capable of it.” I think many learners were grateful for the careful attention to how they could improve. 

 

Developing medical education radical candor skills in the residents 

 

For the second year in a row, the Kern Institute has sponsored half-day workshops for incoming residents to allow them time to focus on their skills as teachers. In 2022, interns from five residency programs participated. In 2023, thirteen programs participated.  

 

These workshops focused on two skills: how to make learners feel like they matter and how to give effective feedback. Medical education radical candor skills!  

 

The two sessions on “mattering” this year were run by Karen Marcdante/Rachel Ashworth and Andrea Maxwell/Caitlin Patten. 

 

When the facilitators asked participants to describe times on clinical teams when they felt like they didn’t matter, the interns shared poignant moments that have stayed with them for years. The interns also described times that they knew they mattered. 

 

As I sat through these sessions, I noticed how small things made a big difference toward making someone feel that they mattered: calling them by name, giving them meaningful work to do, asking them about their life. Importantly, it doesn’t take long to establish that you care. You can set the stage in less than a minute, which means you can give honest feedback without waiting days or weeks to assure yourself that learners know you care about them.  

 

After the mattering sessions, interns learned how to give effective feedback. Himanshu Agrawal ran one workshop on feedback this year, and Seth Bodden ran the other. Their frameworks for how to give effective feedback included being timely, actionable, and (of course) honest. As with mattering, the intern participants could recall both helpful and not helpful feedback (“read more,” “good job”). Making time and finding space to give personalized feedback is itself an act of caring. 

 

The concept of radical candor reminds us to show learners that we care and that we must be honest in our feedback.  

 

I would take it one step further and say that giving honest, effective feedback is an extension of our caring and demonstrates our belief in the learner’s potential for flourishing in medicine. 

 

It was so freeing for me to realize that if I cared, then I had to be honest. No more ruinous empathy. Bring on the radical candor.  

 

 

Kathlyn E. Fletcher, MD, MA, is a professor in the Department of Internal Medicine at MCW. She is the program director for the Internal Medicine residency program and co-director of the GME pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.