Mastering Millennial Mentoring

MITE Monthly Tip: April 2019-Angela M.  Leclerc, PA-C

Mastering Millennial Mentoring

Generation gaps between teacher and learner are encountered every 10-20 years. Generations are shaped by unique historical circumstances.  Currently, millennials make up approximately 25 % of our workforce and this will increase to 40% and 75% of the workforce in 2020 and 2025 (1).  Adapting to changes in expectations and work habits is imperative to educating learners, preparing future master educators and fostering productive mentoring relationships.

Millennials are frequently labeled to be distracted, impatient, entitled and too engaged in social media and not infrequently found to be on personal device during moments of teaching.  These labels are often misguided.  This generational cohort has been dubbed the “digital natives” with most of their lives accompanied by rapid expansion in technologies, having information and instant communication at their fingertips within seconds.   The millennials have been characterized to appreciate honesty, instant feedback and collaboration. (2)

Here are some tips when mentoring millennials:

Tip What they desire How you deliver
Micromentoring accessibility, frequent short meetings, fast responses Hold brief meetings on narrow topics to discuss progress.  Meetings would be about a single topic with a focused question or set of questions to be addressed.
Reverse mentoring flat leadership structure Find strengths of the mentee, perhaps social media as a means of disseminating research, journal club and networking, harness and promote their unique leadership abilities
Mentorship teams collaboration A team of mentors, interdisciplinary, providing cognitive diversity and the ability to capitalize on the individuals strengths

Adapted from Chopra V1,2, Arora VM3, Saint S1,2. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018 Feb 1;178(2):175-176

Finally, the millennial generation has been shaped by the #metoo era.   I agree with the author in JAMA, Mentoring in the Era of #MeToo, with her fears of gender-based neglect.  I most certainly harbor a great amount of empathy for those women who have suffered from sexual harassment and sometimes worse.  However, many of my mentors have been male and have professionally influenced my practice and career path and are close colleagues of mine, likely for life.

The author refers to key behaviors exhibited by her male mentors:

  • Always demonstrate exemplary professional behavior during and outside of the work day (never compromised by alcohol consumption or flirtatious interactions)
  • Behave comfortably, but as if others are watching, demonstrating integrity
  • Refrain from physical touch except in larger social settings where you may give a hug in greeting.
  • Never mention anything about appearance or appearance of others and avoid generalizing comments about gender
  • Text with important or urgent things, and sometimes just very funny things, but never anything that wouldn’t share with either spouses.
  • Most importantly, they have chosen to speak up to support women while other men have chosen to sit quietly or, worse, offend (4)

 

References

  1. Waljee JF1, Chopra V2, Saint S3. Mentoring Millennials. 2018 Apr 17;319(15):1547-1548
  2. Williams VN1, Medina J2, Medina A3, Clifton S4. Bridging the Millennial generation Expectation Gap: Perspectives and Strategies for Physician and Interprofessional Faculty. Am J Med Sci. 2017 Feb;353(2):109-115
  3. Chopra V1,2, Arora VM3, Saint S1,2. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018 Feb 1;178(2):175-176
  4. Byerley JS. Mentoring in the Era of #MeToo. JAMA. 2018;319(12):1199-1200

Encouraging Reflection to Deepen Learning and Combat Burnout

Encouraging Reflection to Deepen Learning and Combat Burnout-Rebecca Hutchinson, MD

Kolb describes 4 stages of experiential learning, the type of adult learning that forms the cornerstone of medical education.1,2

Although all of these steps are important, reflection is believed to be particularly important to create deep or lasting learning.3  Reflection is a metacognitive process, or thinking about thinking; this process allows the learner to make connections between new information and prior experiences and knowledge.4  Effective reflection results in connections that increase accessibility of the learning, allowing application to relevant subsequent scenarios.  Reflection can be written or oral, there is no evidence to suggest superiority of one method over the other; this MITE tip will discuss methods of facilitating both.5

There are many ways that we can incorporate reflection into our education of medical trainees of all levels.  Prior to encounters, we can encourage reflection by explicitly discussing our objectives for the visit using questions such as: “What physical exam maneuvers might be most helpful to determine our management for the day?”  or “What questions should we ask the patient in order to further refine our differential diagnosis?”  This type of reflection will help the learner know what to focus on during the encounter, increasing the yield of the learning experience.  This type of ‘pre-visit’ exercise can help all members of the treatment team maximize their learning from a shared patient encounter even if they are not participating in an active way.  We can also encourage reflection after encounters.  Some examples of questions that could be used to reflect are:  “how did the physical exam compare to what we expected to find in this patient with advanced heart failure?” or “what emotion do you think the patient was having when you explained the plan for the day?”1

In addition to facilitating deep and lasting learning, reflection has also been shown to be an effective way to improve resiliency and well-being of the clinician as well as increase empathy for patients.6,7  It is particularly important to help learners take the time to reflect after challenging emotional experiences.  We can do this by having formal or informal debriefing sessions where all members of the care team have the opportunity to share how they are feeling or how the experience is impacting them personally.  We can also encourage reflection through writing, such as through the use of journaling.  Additionally, you could consider having medical students and/or residents do a writing exercise at the end of a month long rotation to encourage reflection.5  Some examples of prompts are: writing gratitude letters to patients, writing about a patient who surprised them and explaining why, reflecting on a time when they felt they communicated something difficult in a way that was effective (or not!).  One fun exercise to consider doing as a group to aid in reflection and team bonding is having everyone write a six-word story.  A famous example of this is “For sale: baby shoes, never worn,” attributed to Hemingway.  These writing exercises help our learners, but they can also help us.

References:

  1. Maudsley G, Strivens J: Promoting professional knowledge, experiential learning and critical thinking for medical students. Medical education 34:535-544, 2000
  2. Kolb DA, Boyatzis RE, Mainemelis C: Experiential learning theory: Previous research and new directions. Perspectives on thinking, learning, and cognitive styles 1:227-247, 2001
  3. Mann K, Gordon J, MacLeod A: Reflection and reflective practice in health professions education: a systematic review. Advances in health sciences education 14:595, 2009
  4. Sandars J: The use of reflection in medical education: AMEE Guide No. 44. Medical teacher 31:685-695, 2009
  5. Aronson L: Twelve tips for teaching reflection at all levels of medical education. Medical teacher 33:200-205, 2011
  6. Chen I, Forbes C: Reflective writing and its impact on empathy in medical education: systematic review. Journal of educational evaluation for health professions 11, 2014
  7. Zwack J, Schweitzer J: If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Academic Medicine 88:382-389, 2013

A Compassionate Script

A Compassionate Script-Kathryn Brouillette, MD

With stressors abounding of record-level hospital census, the opioid epidemic, flu season, the holiday rush and the day-to-day grind of showing up for work while also managing household IADLs, I hope to offer a little salve for burnout.

It is simply compassion, the root meaning of which is to suffer or feel (-passion) with (com-) another person, in this case, our patients and their families. A quick reminder as to what compassion is not[i]:

  • Pity or sympathy
  • Kindness
  • Benevolence
  • Social justice

Compassion is much more specific, regarding a particular person’s feelings about the present situation.   It requires[ii]:

  • Imagination, as we put ourselves in another’s circumstance.
  • Intimacy, as we learn of the hardships of another.
  • Honesty
  • Time

Providers may suffer atrophy in these qualities as their medical education and careers progress.  These are, however, precisely the items touted to be antidotes to burnout[iii], litigation[iv], and medical error[v].  How do we get them back into our lives, our patients’ lives, manage the patient’s care safely, and still make it home on time for dinner?

One possible answer of many: fake it till you make it.  Use a script, perhaps this one:

  • Sit down when you speak with a patient. Lean towards your patient.
  • Ask your patients to tell you about themselves in an open-ended way: “Tell me about your family. Where are you from?  How do you like to spend your free time?”
  • Let them speak, without interruption, for at least 2 minutes.
  • Find something you share in common with them, e.g. “I grew up in a small town as well…”
  • Offer information about yourself, perhaps even revealing some of your own vulnerability. e.g. “I really miss my family around the holidays, too, especially since my parents died.” Gentle humor can sometimes be appreciated
  • After gathering the necessary history/information and performing your exam. Use supportive statements as the history is recounted, e.g. “Oh my, that sounds very scary.” Summarize your thoughts on their case using plain language. If you have uncertainty about the diagnosis, tell them and explain why.
  • As you are leaving, provide supportive statements, e.g. “I am with you”; “I hear you”; “Let’s get you feeling better”; “You’re not alone”; or “I’ll be thinking about your care tonight.”

These added minutes do take time, but the payouts include:

  • A closer rapport with your patient, who will be more likely to divulge important information regarding symptoms.
  • An enriching human interaction for both provider and patient
  • A patient who feels both validated and cared for is more likely to comply with medical therapies.
  • Better medical outcomes for patients and providers.

Whether it is second nature to you, or something that takes practice, compassionate interactions, just like apathy, can be infectious.  Try to share them as much as you can.

 

 

 

[i] Pence, Gregory E.  Can Compassion Be Taught?  Journal of Medical Ethics. 1983, 9, 189-191.

[ii] Pence, Gregory E.  Can Compassion Be Taught?  Journal of Medical Ethics. 1983, 9, 189-191.

[iii] Vallerand et al.  On the Role of Passion for Work in Burnout: A Process Model.  Journal of Personality. 2010, 78(1), 289-312.

[iv] Levinson, Wendy.  Doctor-Patient Communication and Medical Malpractice implications for Pediatricians. Pediatric Annals.  1997, 26(3), 186-193.: I

[v] Shanafelt et al. Burnout and Medical Errors Among American Surgeons.  Annals of Surgery.  2010. 251(6), 995-1000.

Can you really make your brain BIGGER: Using cognitive science to increase your study efficiency and retention

Can you really make your brain BIGGER: Using cognitive science to increase your study efficiency and retention by Jason F. Hine, MD-Emergency Medicine SMHC

How are we as clinicians going to keep up with the ever-expanding fund of medical knowledge?

The rapid expanse of medical knowledge is a well-recognized reality creating a daunting circumstance for us as clinicians- trying to keep up with what we need to know.1 There are several strategies to help the practicing physician keep up. These include:

  1. “Peripheral brains” such as smartphone apps and pocket cards
  2. Secondary journals- which were discussed in our November Monthly Tips
  3. Efficient study techniques

Wouldn’t it be great if you could improve the efficiency with which you study and learn?

Enter cognitive science. While this is a vast field of research covering a range of topics, one area of study has been in the production and retention of memories.  A summation of this field’s findings can be found in the book Make It Stick: the Science of Successful Learning.2 Cognitive scientists Henry Roediger and Mark McDaniel teamed up with story teller Peter Brown to outline how we can improve our efficiency in learning and memory retention. In its simplified form, this involves four processes:

  • Retrieval Practice (R) – As a medical student you cannot spend 3 grueling hours on acid-base analysis, put the book down and expect to nail an ABG interpretation 4 months later. To solidify a memory into our long-term bank we must practice using it. Quite simply, this is the act of pulling information (a memory) from our memory back. This is retrieval practice.
  • Spacing (S) – The idea of spacing is linked to retrieval practice but gives greater detail about when we should be retrieving memories. It is fine to practice retrieving a memory 30 minutes after it is created (ie shortly after you read a new article), but it is more powerful and efficient in creating memory retention when some time has passed. Allowing for a bit of forgetting to occur and making the retrieval effortful leads to greater retention.
  • Interleaving (I) – Interestingly, cognitive science has found that when we mix our study of different subject matter we often gain a greater understanding of each. This is thought to be related to pattern recognition across topics, rule generation, and the linking of memories in our brains. By mixing our review of several articles, therefore, we can improve our retention of the take-home from each.
  • Generation (G) – The concept of generation is akin to an active rather than passive learner. It explains that in creating from our memory we again reinforce the content and improve retention. Activities such as recollective summaries or content application are much more retention-producing than passive actions such as rereading.

So, after reading an article use these steps to “Make it Stick”:

  1. Take a moment to write out the key points of the paper and how they may affect your practice (R, G).
  2. Create an alert 1 week later (via smartphone, calendar, post it notes, whichever structure works for you) to remind yourself to do a recollection exercise where you spend two minutes writing all you can remember on the article, then review and correct (R, S, G).
  3. Create a notecard with the article title on one side and short summation on the other (S, G).
  4. Whenever you sit to read a new article, review the notecard and simply speak aloud the major summative points (R, S, I, G). Once the article and its content become second nature, the notecard can be filed or discarded.

While more effortful than our inherent learning strategies, this method of study based on cognitive science is more time efficient. For most of us, our typical pattern involves reading an article, putting it down, forgetting it, and rereading it months to years later when we realize the content is lost. In the proposed study construct, after the first active reading session the subsequent retrieval activities are quite short, collectively require less time, and are higher yield for actually remembering the topic.

To learn more on the topic of memory retention, please read Make it Stick or use these links to my podcast website for my summary and interview with the author.

References:

  1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.
  2. Brown P, Roediger H, McDaniel M. Make It Stick : the Science of Successful Learning. Cambridge, Massachusetts :The Belknap Press of Harvard University Press, 2014.

November Faculty Development: Staying on Top of the Literature

Staying on Top of the Literature by Christopher Turner, MD Pediatric Surgery

When I was preparing for my pediatric surgery boards, I asked an emeritus professor for advice. He recommended what he had done for his boards: read every article ever published in the Journal of Pediatric Surgery. While this may have been feasible in 1979 with thirteen volumes, it was not feasible now with fifty-three. Not only have journals continued to churn out articles, they are doing it more quickly. The number of citations added to MEDLINE per year has almost tripled over the last twenty years from 322,825 in 1996 to 869,666 in 2016. Our ability to produce medical data as a community has exceeded our ability to consume it as individuals. I would like to offer you some strategies and resources to compete.

  1.      Primary Journal. Identify the primary journal for your specialty. Commit yourself to reviewing every issue.
    1. Make it a habit. Try to reserve time on your outlook calendar so it does not get skipped. Do it with a peer so you can hold each other accountable. Pair it with a treat (like a molasses cookie at Tandem!).
    2. If you like print, subscribe. If you like digital and free, consider Browzine (com). This is a service supported by our library that allows easy reading of most major journals on your tablet or phone. It also allows you to track individual journals and save articles.

2.     Secondary Journals. There are many services that curate the literature. Here are a few.

  1. Read (com/read-by-qxmd) or Case (https://www.casemedicalresearch.com) or Prime (www.unboundmedicine.com/products/prime). These apps send you the most popular articles in selected specialties. I have received a weekly email from Read since fellowship. It often shows me interesting articles that I would not have otherwise. Case allows you to listen to audio transcriptions of abstracts which might be useful for your commute.
  2. Journal Watch by the New England Journal of Medicine (org). A good option for medical specialties. It reviews 250 major journals and posts updates by email. The twelve specialties are cardiology, emergency medicine, gastroenterology, general medicine, HIV/AIDS, hospital medicine, infectious diseases, neurology, oncology, pediatrics, psychiatry, and women’s health.
  3. Patient Oriented Evidence that Matters (com). This sends email alerts with updates. I have not used it but it looks promising.
  4. Uptodate and Dynamed. Both of these review services also offer subscriptions to receive email alerts for “practice changing” updates. I have not used them either
  5. TDNet (com). This will send you the table of contents for the journals that you select. I find it clutters my inbox.
  1.      Deep Dive. Through myNCBI, it is possible to receive a regular email with all new publications from PubMed that match a particular search term. This can be overwhelming. It works well for very narrow topics and when you don’t want to miss a thing. Consider it for your research projects. Ask library staff to help you set it up.

I am sure many of you have your own habits and suggestions. Please send them to me if you are interested at cturner1@mmc.edu. I will try to post them here as comments.

I would like to thank Dina McKelvy and the library staff for their help compiling these resources and for their frequent kind assistance.

October Faculty Development: Strategies for Teaching Residents who Struggle with Time Management

Strategies for Teaching Residents who Struggle with Time Management by Carly McAteer, MD

Skill with time management and organization is essential for residents who are typically burdened with a large number of patient care, educational, and administrative tasks.  When a resident is struggling, it can be difficult to determine the particular cause.1  Residents who struggle with time management and organization present themselves by often being unprepared for deadlines, assignments, and patient rounds.  These residents can appear disorganized in appearance, shuffle through multiple documents while presenting at rounds, and often keep patients waiting while running behind.1  When it is determined that a resident is struggling with time management, some helpful strategies are:

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September Faculty Development: Measuring Competency as a Clinical Teacher

Measuring Competency as a Clinical Teacher By Elizabeth Herrle, MD

What does it mean to be competent?

  • Competence is a global assessment of an individual’s abilities as they relate to that individual’s current responsibilities. To be competent is “to possess all the required abilities in all domains in a defined context at a particular stage in clinical training”1.

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August Faculty Development: Teaching communication skills for difficult conversations

Teaching communication skills for difficult conversations-Annabelle Rae C. Norwood, MD MMP Geriatrics

As professionals working in the medical field, we are often tasked with difficult conversations of delivering bad news, disclosing medical error, or initiating advance care planning and end-of-life discussions with patients and their families. More often than not, skills needed to effectively communicate with patients about these difficult topics are not developed fully during medical training.  As such, the Accreditation Council for Graduate Medical Education now requires competency in communication skills for residents and fellows.1 There are different methods available in order to hone these skills.

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July Faculty Development: How to Excel as a Mentor, According to Mentees

How to Excel as a Mentor, According to Mentees

Kaylee Underkofler, MD/MPH Candidate, Maine Track ‘18

What does it take to become a great mentor? While many have pondered this immense question, Lee et al. and Cho et al. sought an answer from perhaps the most important judge of mentors: mentees.1,2 Their goal was to identify the characteristics and practices of exceptional mentors in the eyes of students. The five tips listed below are a unified summary of their results. It is proposed that these ideas could be used to self-assess mentoring abilities, to build faculty development programs, or to guide students and young faculty in the search for a mentor.2 While all the nuances that go into becoming a truly great mentor could not be captured here, this list does include what is most commonly cited as being appreciated by mentees and serves as a place to start for those looking to improve their mentoring abilities.

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June Faculty Development: Teaching Digital/E-Professionalism-Reflections for deepening understanding of professional identity on social media

Teaching Digital/E-Professionalism:  Reflections for deepening understanding of professional identity on social media

Nicholas Knowland, TUSM-Maine Track Program, M18

Ensuring the public trust in the medical profession is the reason for promoting professionalism as a key component of medical education. Therefore medical curricula place significant emphasis on the development of professional behaviors.

Digital professionalism, or e-professionalism, describes the increasing interaction of medical professionalism with the greater public through social media outlets. The terms are new but the reality that online images or postings can reflect on students or practitioners has been present for some time and is usually associated with negative connotations.  This has resulted in what some authors have described as a ‘hidden curriculum of digital unprofessionalism’ in which digital unprofessionalism is punished but rarely overtly taught. Despite the consequences that digital unprofessionalism lead to for a clinical student or clinician, the academic literature is increasingly focusing on the positive opportunities associated with professional physician social media use, such as using social media to actively share quality information.

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