Thread by @JenniferSpicer4

1/

Have you ever a junior member of your team ask you a question, and you had NO IDEA what the answer was?

Like, literally no clue.
Racking your brain.
Nothing.

Nope, just me?

This week’s #MedEdTwagTeam #ClinicalTeaching topic: Humility.

#MedTwitter #MedEd

2/

On my first day as a senior resident, I was terrified that my interns would ask me a question that I didn’t know.
…And they did.

So I said, “I don’t know, let’s look it up.”

And, (not surprisingly) they appreciated that.
Me, admitting my limitations & offering to help.

3/ Honestly, this fear of not knowing things still plagues me.
I have a weird combination of confidence + imposter syndrome.

Some days I feel confident.
Other days I wonder why everyone else is so much smarter than me.

Why can't I remember the names of those famous trials?!

4/

During residency I watched brilliant attendings solve mystery cases with ease.

I felt that I would never get there.

But then I realized that the “all knowing” physician was a myth.

We are all constantly learning & growing.

5/ And reading this passage from @DxRxEdu @Gurpreet2015 in @JHospMedicine tells me that I’m not alone.

“I don’t know.”
What a powerful phrase.

(Here’s the link to the full article: journalofhospitalmedicine.com/jhospmed/artic…)

6/ And, over the last few months, @ricapitt & I have had Resident as Teacher sessions with our new(ish) @emoryimchiefs PGY2 residents.

When we ask them what their biggest fear is about being a senior resident, it’s a familiar concern:
That they won’t know enough.

7/ But, funny enough, when I hear them say this, I know they are going to be just fine.

Because they are humble.
They recognize their limits.
And they are sharing their fears.

8/ Which all comes back to today’s concept of remaining humble.

Humility has helped me in 3 important ways on my clinical teams:

1⃣Flattening the hierarchy.
2⃣Establishing a growth mindset.
3⃣Creating trust.

9/ First, flattening the hierarchy.

On the first day of wards, I make it clear that everyone on the team has unique knowledge & value.

There is a LOT that I don’t know.
I’m very up-front about that.
I tell the team to correct me (and they do).

10/ I emphasize teamwork.
And I encourage everyone to speak up if they have an idea, even if it’s not “their” patient.

I make it clear that a “correction” from someone else doesn’t reflect poorly on the person who was corrected.

We are all a team, and everyone gets the credit.

11/ If you haven’t read Atul Gawande’s book “The Checklist Manifesto,” I highly recommend it.
atulgawande.com/book/the-check…

And this article from @MedEd_Journal is also a great read: onlinelibrary.wiley.com/doi/abs/10.111…

12/ Second, establishing a growth mindset.

If you aren’t familiar with the term growth mindset, here’s a link to a 2 page summary from @MedEd_Journal:
onlinelibrary.wiley.com/doi/abs/10.111…

Growth mindset = success is due to effort
Fixed mindset = success driven by innate ability

13/

Part of a growth mindset is recognizing that we all can improve.

So, in the spirit of a growth mindset, I remind my team that we are all (myself included) there to learn.

I HOPE they have gaps in their knowledge; otherwise, what am I doing there?!

14/ Third, humility engenders trust.

When trainees come to me and admit that they don’t know something (i.e. humility), it helps me trust that they know the boundaries of their knowledge.

I know that I can trust what they say and do.
And vice versa.

15/ So, in summary, consider how you can role model your humility by:

Admitting “I don’t know”

This will help your team by:
1⃣Flattening the hierarchy
2⃣Encouraging a growth mindset
3⃣Creating trust

16/ And keep an eye out for @GStetsonMD’s thread next Tuesday on ”Never Judge”

And check out the @MedEdTwagTeam if you want to see all of our threads in one place!

Thanks for joining, and we will see you next week!