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A case-based framework for de-escalating conflict
Hospital medicine can be a demanding and fast-paced environment where resources are stretched thin, with both clinicians and patients stressed. A hospitalist’s role is dynamic, serving as an advocate, leader, or role model while working with interdisciplinary and diverse teams for the welfare of the patient. This constellation of pressures makes a degree of conflict inevitable.
Often, an unexpected scenario can render the hospitalist uncertain and yet the hospitalist’s response can escalate or deescalate conflict. The multiple roles that a hospitalist represents may buckle to the single role of advocating for themselves, a colleague, or a patient in a tense scenario. When this happens, many hospitalists feel disempowered to respond.
De-escalation is a practical skill that involves being calm, respectful, and open minded toward the other person, while also maintaining boundaries. Here we provide case-based tips and skills that highlight the role for de-escalation.
Questions to ask yourself in midst of conflict:
- How did the problematic behavior make you feel?
- What will be your approach in handling this?
- When should you address this?
- What is the outcome you are hoping to achieve?
- What is the outcome the other person is hoping to achieve?
Case 1
There is a female physician rounding with your team. Introductions were made at the start of a patient encounter. The patient repeatedly calls the female physician by her first name and refers to a male colleague as “doctor.”
Commentary: This scenario is commonly encountered by women who are physicians. They may be mistaken for the nurse, a technician, or a housekeeper. This exacerbates inequality and impostor syndrome as women can feel unheard, undervalued, and not recognized for their expertise and achievements. It can be challenging for a woman to reaffirm herself as she worries that the patient will not respect her or will think that she is being aggressive.
Approach: It is vital to interject by firmly reintroducing the female physician by her correct title. If you are the subject of this scenario, you may interject by firmly reintroducing yourself. If the patient or a colleague continues to refer to her by her first name, it is appropriate to say, “Please call her Dr. XYZ.” There is likely another female colleague or trainee nearby that will view this scenario as a model for setting boundaries.
To prevent similar future situations, consistently refer to all peers by their title in front of patients and peers in all professional settings (such as lectures, luncheons, etc.) to establish this as a cultural norm. Also, utilize hospital badges that clearly display roles in large letters.
Case 2
During sign out from a colleague, the colleague repeatedly refers to a patient hospitalized with sickle cell disease as a “frequent flyer” and “drug seeker,” and then remarks, “you know how these patients are.”
Commentary: A situation like this raises concerns about bias and stereotyping. Everyone has implicit bias. Recognizing and acknowledging when implicit bias affects objectivity in patient care is vital to providing appropriate care. It can be intimidating to broach this subject with a colleague as it may cause the colleague to become defensive and uncomfortable as revealing another person’s bias can be difficult. But physicians owe it to a patient’s wellbeing to remain objective and to prevent future colleagues from providing subpar care as a result.
Approach: In this case, saying, “Sometimes my previous experiences can affect my thinking. Will you explain what behaviors the patient has shown this admission that are concerning to you? This will allow me to grasp the complexity of the situation.” Another strategy is to share that there are new recommendations for how to use language about patients with sickle cell disease and patients who require opioids as a part of their treatment plan. Your hospitalist group could have a journal club on how bias affects patients and about the best practices in the care of people with sickle cell disease. A next step could be to build a quality improvement project to review the care of patients hospitalized for sickle cell disease or opioid use.
Case 3
You are conducting bedside rounds with your team. Your intern, a person of color, begins to present. The patient interjects by requesting that the intern leave as he “does not want a foreigner taking care” of him.
Commentary: Requests like this can be shocking. The team leader has a responsibility to immediately act to ensure the psychological safety of the team. Ideally, your response should set firm boundaries and expectations that support the learner as a valued and respected clinician and allow the intern to complete the presentation. In this scenario, regardless of the response the patient takes, it is vital to maintain a safe environment for the trainee. It is crucial to debrief with the team immediately after as an exchange of thoughts and emotions in a safe space can allow for everyone to feel welcome. Additionally, this debrief can provide insights to the team leader of how to address similar situations in the future. The opportunity to allow the intern to no longer follow the patient should be offered, and if the intern opts to no longer follow the patient, accommodations should be made.
Approach: “This physician is a member of the medical team, and we are all working together to provide you with the best care. Everyone on this team is an equal. We value diversity of our team members as it allows us to take care of all our patients. We respect you and expect respect for each member of the team. If you feel that you are unable to respect our team members right now, we will leave for now and return later.” To ensure the patient is provided with appropriate care, be sure to debrief with the patient’s nurse.
Conclusion
These scenarios represent some of the many complex interpersonal challenges hospitalists encounter. These approaches are suggestions that are open to improvement as de-escalation of a conflict is a critical and evolving skill and practice.
For more tips on managing conflict, consider reading “Crucial Conversations” by Kerry Patterson and colleagues. These skills can provide the tools we need to recenter ourselves when we are in the midst of these challenging situations.
Dr. Rawal is clinical assistant professor of medicine at the University of Pittsburgh Medical Center. Dr. Ashford is assistant professor and program director in the department of internal medicine/pediatrics at the University of Nebraska Medical Center, Omaha. Dr. Lee and Dr. Barrett are based in the department of internal medicine, University of New Mexico School of Medicine, Albuquerque. This article is sponsored by the SHM Physicians in Training (PIT) committee, which submits quarterly content to The Hospitalist on topics relevant to trainees and early career hospitalists.
Hospital medicine can be a demanding and fast-paced environment where resources are stretched thin, with both clinicians and patients stressed. A hospitalist’s role is dynamic, serving as an advocate, leader, or role model while working with interdisciplinary and diverse teams for the welfare of the patient. This constellation of pressures makes a degree of conflict inevitable.
Often, an unexpected scenario can render the hospitalist uncertain and yet the hospitalist’s response can escalate or deescalate conflict. The multiple roles that a hospitalist represents may buckle to the single role of advocating for themselves, a colleague, or a patient in a tense scenario. When this happens, many hospitalists feel disempowered to respond.
De-escalation is a practical skill that involves being calm, respectful, and open minded toward the other person, while also maintaining boundaries. Here we provide case-based tips and skills that highlight the role for de-escalation.
Questions to ask yourself in midst of conflict:
- How did the problematic behavior make you feel?
- What will be your approach in handling this?
- When should you address this?
- What is the outcome you are hoping to achieve?
- What is the outcome the other person is hoping to achieve?
Case 1
There is a female physician rounding with your team. Introductions were made at the start of a patient encounter. The patient repeatedly calls the female physician by her first name and refers to a male colleague as “doctor.”
Commentary: This scenario is commonly encountered by women who are physicians. They may be mistaken for the nurse, a technician, or a housekeeper. This exacerbates inequality and impostor syndrome as women can feel unheard, undervalued, and not recognized for their expertise and achievements. It can be challenging for a woman to reaffirm herself as she worries that the patient will not respect her or will think that she is being aggressive.
Approach: It is vital to interject by firmly reintroducing the female physician by her correct title. If you are the subject of this scenario, you may interject by firmly reintroducing yourself. If the patient or a colleague continues to refer to her by her first name, it is appropriate to say, “Please call her Dr. XYZ.” There is likely another female colleague or trainee nearby that will view this scenario as a model for setting boundaries.
To prevent similar future situations, consistently refer to all peers by their title in front of patients and peers in all professional settings (such as lectures, luncheons, etc.) to establish this as a cultural norm. Also, utilize hospital badges that clearly display roles in large letters.
Case 2
During sign out from a colleague, the colleague repeatedly refers to a patient hospitalized with sickle cell disease as a “frequent flyer” and “drug seeker,” and then remarks, “you know how these patients are.”
Commentary: A situation like this raises concerns about bias and stereotyping. Everyone has implicit bias. Recognizing and acknowledging when implicit bias affects objectivity in patient care is vital to providing appropriate care. It can be intimidating to broach this subject with a colleague as it may cause the colleague to become defensive and uncomfortable as revealing another person’s bias can be difficult. But physicians owe it to a patient’s wellbeing to remain objective and to prevent future colleagues from providing subpar care as a result.
Approach: In this case, saying, “Sometimes my previous experiences can affect my thinking. Will you explain what behaviors the patient has shown this admission that are concerning to you? This will allow me to grasp the complexity of the situation.” Another strategy is to share that there are new recommendations for how to use language about patients with sickle cell disease and patients who require opioids as a part of their treatment plan. Your hospitalist group could have a journal club on how bias affects patients and about the best practices in the care of people with sickle cell disease. A next step could be to build a quality improvement project to review the care of patients hospitalized for sickle cell disease or opioid use.
Case 3
You are conducting bedside rounds with your team. Your intern, a person of color, begins to present. The patient interjects by requesting that the intern leave as he “does not want a foreigner taking care” of him.
Commentary: Requests like this can be shocking. The team leader has a responsibility to immediately act to ensure the psychological safety of the team. Ideally, your response should set firm boundaries and expectations that support the learner as a valued and respected clinician and allow the intern to complete the presentation. In this scenario, regardless of the response the patient takes, it is vital to maintain a safe environment for the trainee. It is crucial to debrief with the team immediately after as an exchange of thoughts and emotions in a safe space can allow for everyone to feel welcome. Additionally, this debrief can provide insights to the team leader of how to address similar situations in the future. The opportunity to allow the intern to no longer follow the patient should be offered, and if the intern opts to no longer follow the patient, accommodations should be made.
Approach: “This physician is a member of the medical team, and we are all working together to provide you with the best care. Everyone on this team is an equal. We value diversity of our team members as it allows us to take care of all our patients. We respect you and expect respect for each member of the team. If you feel that you are unable to respect our team members right now, we will leave for now and return later.” To ensure the patient is provided with appropriate care, be sure to debrief with the patient’s nurse.
Conclusion
These scenarios represent some of the many complex interpersonal challenges hospitalists encounter. These approaches are suggestions that are open to improvement as de-escalation of a conflict is a critical and evolving skill and practice.
For more tips on managing conflict, consider reading “Crucial Conversations” by Kerry Patterson and colleagues. These skills can provide the tools we need to recenter ourselves when we are in the midst of these challenging situations.
Dr. Rawal is clinical assistant professor of medicine at the University of Pittsburgh Medical Center. Dr. Ashford is assistant professor and program director in the department of internal medicine/pediatrics at the University of Nebraska Medical Center, Omaha. Dr. Lee and Dr. Barrett are based in the department of internal medicine, University of New Mexico School of Medicine, Albuquerque. This article is sponsored by the SHM Physicians in Training (PIT) committee, which submits quarterly content to The Hospitalist on topics relevant to trainees and early career hospitalists.
Hospital medicine can be a demanding and fast-paced environment where resources are stretched thin, with both clinicians and patients stressed. A hospitalist’s role is dynamic, serving as an advocate, leader, or role model while working with interdisciplinary and diverse teams for the welfare of the patient. This constellation of pressures makes a degree of conflict inevitable.
Often, an unexpected scenario can render the hospitalist uncertain and yet the hospitalist’s response can escalate or deescalate conflict. The multiple roles that a hospitalist represents may buckle to the single role of advocating for themselves, a colleague, or a patient in a tense scenario. When this happens, many hospitalists feel disempowered to respond.
De-escalation is a practical skill that involves being calm, respectful, and open minded toward the other person, while also maintaining boundaries. Here we provide case-based tips and skills that highlight the role for de-escalation.
Questions to ask yourself in midst of conflict:
- How did the problematic behavior make you feel?
- What will be your approach in handling this?
- When should you address this?
- What is the outcome you are hoping to achieve?
- What is the outcome the other person is hoping to achieve?
Case 1
There is a female physician rounding with your team. Introductions were made at the start of a patient encounter. The patient repeatedly calls the female physician by her first name and refers to a male colleague as “doctor.”
Commentary: This scenario is commonly encountered by women who are physicians. They may be mistaken for the nurse, a technician, or a housekeeper. This exacerbates inequality and impostor syndrome as women can feel unheard, undervalued, and not recognized for their expertise and achievements. It can be challenging for a woman to reaffirm herself as she worries that the patient will not respect her or will think that she is being aggressive.
Approach: It is vital to interject by firmly reintroducing the female physician by her correct title. If you are the subject of this scenario, you may interject by firmly reintroducing yourself. If the patient or a colleague continues to refer to her by her first name, it is appropriate to say, “Please call her Dr. XYZ.” There is likely another female colleague or trainee nearby that will view this scenario as a model for setting boundaries.
To prevent similar future situations, consistently refer to all peers by their title in front of patients and peers in all professional settings (such as lectures, luncheons, etc.) to establish this as a cultural norm. Also, utilize hospital badges that clearly display roles in large letters.
Case 2
During sign out from a colleague, the colleague repeatedly refers to a patient hospitalized with sickle cell disease as a “frequent flyer” and “drug seeker,” and then remarks, “you know how these patients are.”
Commentary: A situation like this raises concerns about bias and stereotyping. Everyone has implicit bias. Recognizing and acknowledging when implicit bias affects objectivity in patient care is vital to providing appropriate care. It can be intimidating to broach this subject with a colleague as it may cause the colleague to become defensive and uncomfortable as revealing another person’s bias can be difficult. But physicians owe it to a patient’s wellbeing to remain objective and to prevent future colleagues from providing subpar care as a result.
Approach: In this case, saying, “Sometimes my previous experiences can affect my thinking. Will you explain what behaviors the patient has shown this admission that are concerning to you? This will allow me to grasp the complexity of the situation.” Another strategy is to share that there are new recommendations for how to use language about patients with sickle cell disease and patients who require opioids as a part of their treatment plan. Your hospitalist group could have a journal club on how bias affects patients and about the best practices in the care of people with sickle cell disease. A next step could be to build a quality improvement project to review the care of patients hospitalized for sickle cell disease or opioid use.
Case 3
You are conducting bedside rounds with your team. Your intern, a person of color, begins to present. The patient interjects by requesting that the intern leave as he “does not want a foreigner taking care” of him.
Commentary: Requests like this can be shocking. The team leader has a responsibility to immediately act to ensure the psychological safety of the team. Ideally, your response should set firm boundaries and expectations that support the learner as a valued and respected clinician and allow the intern to complete the presentation. In this scenario, regardless of the response the patient takes, it is vital to maintain a safe environment for the trainee. It is crucial to debrief with the team immediately after as an exchange of thoughts and emotions in a safe space can allow for everyone to feel welcome. Additionally, this debrief can provide insights to the team leader of how to address similar situations in the future. The opportunity to allow the intern to no longer follow the patient should be offered, and if the intern opts to no longer follow the patient, accommodations should be made.
Approach: “This physician is a member of the medical team, and we are all working together to provide you with the best care. Everyone on this team is an equal. We value diversity of our team members as it allows us to take care of all our patients. We respect you and expect respect for each member of the team. If you feel that you are unable to respect our team members right now, we will leave for now and return later.” To ensure the patient is provided with appropriate care, be sure to debrief with the patient’s nurse.
Conclusion
These scenarios represent some of the many complex interpersonal challenges hospitalists encounter. These approaches are suggestions that are open to improvement as de-escalation of a conflict is a critical and evolving skill and practice.
For more tips on managing conflict, consider reading “Crucial Conversations” by Kerry Patterson and colleagues. These skills can provide the tools we need to recenter ourselves when we are in the midst of these challenging situations.
Dr. Rawal is clinical assistant professor of medicine at the University of Pittsburgh Medical Center. Dr. Ashford is assistant professor and program director in the department of internal medicine/pediatrics at the University of Nebraska Medical Center, Omaha. Dr. Lee and Dr. Barrett are based in the department of internal medicine, University of New Mexico School of Medicine, Albuquerque. This article is sponsored by the SHM Physicians in Training (PIT) committee, which submits quarterly content to The Hospitalist on topics relevant to trainees and early career hospitalists.
The importance of self-compassion for hospitalists
A mindful way relate to ourselves
Physicians, clinicians, providers, healers, and now heroes, are some of the names we have been given throughout history. These titles bring together a universal concept in medicine that all human beings deserve compassion, understanding, and care. However, as health care providers we forget to show ourselves the same compassion we bestow upon others.
Self-compassion is a new way of relating to ourselves. As clinicians, we are trained investigators, delving deeper into what our patient is thinking and feeling. “Tell me more about that. How does that make you feel? That must have been (very painful/scary/frustrating).” These are a few statements we learned in patient interviewing to actively engage with patients, build rapport, solidify trust, validate their concerns, and ultimately obtain the information needed to diagnose and heal.
We know the importance of looking beyond the surface, as more often than not a deeper inspection reveals more to the story. We have uncovered cracks in the foundation, erosion of the roof, worn out siding, and a glimpse into the complexities that make up each individual. We look at our patients, loved ones, and the world with night-vision lenses to uncover what is deeper.
Clinicians are good at directing compassion toward others, but not as good at giving it to themselves.1 Many health care providers may see self-compassion as soft, weak, selfish, or unnecessary. However, mindful self-compassion is a positive practice that opens a pathway for healing, personal growth, and protection against the negative consequences of self-judgment, isolation, anxiety, burnout, and depression.
What is self-compassion?
Kristin Neff, PhD, an associate professor in educational psychology at the University of Texas at Austin, was the first to academically define self-compassion. Self-compassion brings together three core elements – kindness, humanity, and mindfulness.2 Self-compassion involves acting the same way toward yourself when you are having a difficult time as you would toward another person. Instead of mercilessly judging and criticizing yourself for self-perceived inadequacies or shortcomings, self-compassion allows you to ask yourself: “How can I give myself comfort and care in this moment?”
Mindfulness acknowledges a painful experience without resistance or judgment, while being present in the moment with things as they are. Self-compassion provides the emotional safety needed to mindfully open to our pain, disappointments, and defeats. Mindfulness and self-compassion both allow us to live with more acceptance toward ourselves and our lives. Mindfulness asks: “What am I experiencing right now?” Self-compassion asks: “What do I need right now?” When you feel compassion for yourself or another, you recognize that suffering, failure, and imperfection are all part of the shared human experience.
The physiology of self-compassion
When we practice self-compassion, we feel safe and cared for because there is a physiological pathway that explains this response. Self-compassion helps down-regulate the stress response (fight-flight-freeze). When we are triggered by a threat to our self-concept, we are likely to do one, two, or all of three things: we fight ourselves (self-criticism – often our first reaction when things go wrong), we flee from others (isolation), or we freeze (rumination).
Feeling threatened puts stress on the mind and body, and chronic stress leads to anxiety and depression, which hinders emotional and physical well-being. With self-criticism, we are both the attacker and the attacked. When we practice self-compassion, we are deactivating the threat-defense system and activating the care system, releasing oxytocin and endorphins, which reduce stress and increase feelings of safety and security.3
Why is self-compassion important to provider well-being?
Research has shown that individuals who are more self-compassionate tend to have greater happiness, life satisfaction, and motivation; better relationships and physical health; and less anxiety and depression. They also have the resilience needed to cope with stressful life events. The more we practice being kind and compassionate with ourselves, the more we’ll increase the habit of self-compassion, and extend compassion to our patients and loved ones in daily life.4
Why is self-compassion important? When we experience a setback at work or in life, we can become defensive, accuse others, or blame ourselves, especially when we are already under immense stress. These responses are not helpful, productive, or effective to the situation or our personal well-being. Although in the moment it may feel good to be reactive, it is a short-lived feeling that we trade for the longer-lasting effects of learning, resilience, and personal growth. Self-compassion teaches us to connect with our inner imperfections, and what makes us human, as to err is human.
To cultivate a habit of self-compassion itself, it is important to understand that self-compassion is a practice of goodwill, not good feelings. Self-compassion is aimed at the alleviation of suffering, but it does not erase any pain and suffering that does exist. The truth is, we can’t always control external forces – the events of 2020-2021 are a perfect example of this. As a result, we cannot utilize self-compassion as a practice to make our pain disappear or suppress strong emotions.
Instead, self-compassion helps us cultivate the resilience needed to mindfully acknowledge and accept a painful moment or experience, while reminding us to embrace ourselves with kindness and care in response. This builds our internal foundation with support, love, and self-care, while providing the optimal conditions for growth, resilience, and transformation
Self-compassion and the backdraft phenomenon
When you start the practice of self-compassion, you may experience backdraft, a phenomenon in which pain initially increases.5 Backdraft is similar to the stages of grief or when the flames of a burning house become larger when a door is opened and oxygen surges in. Practicing self-compassion may cause a tidal wave of emotions to come to the forefront, but it is likely that if this happens, it needs to happen.
Imagine yourself in a room with two versions of yourself. To the left is your best self that you present to the world, standing tall, organized, well kept, and without any noticeable imperfections. To the right, is the deepest part of your being, laying on the floor, filled with raw emotions – sadness, fear, anger, and love. This version of yourself is vulnerable, open, honest, and imperfect. When looking at each version of yourself, which one is the real you? The right? The left? Maybe it’s both?
Imagine what would happen if you walked over to the version of yourself on the right, sat down, and provided it comfort, and embraced yourself with love and kindness. What would happen if you gave that version of yourself a hug? Seeing your true self, with all the layers peeled away, at the very core of your being, vulnerable, and possibly broken, is a powerful and gut-wrenching experience. It may hurt at first, but once we embrace our own pain and suffering, that is where mindfulness and self-compassion intersect to begin the path to healing. It takes more strength and courage to be the version of ourselves on the right than the version on the left.
What is not self compassion?
Self-compassion is not self-pity, weakness, self-esteem, or selfishness. When individuals feel self-pity, they become immersed in their own problems and feel that they are the only ones in the world who are suffering. Self-compassion makes us more willing to accept, experience, and acknowledge difficult feelings with kindness. This paradoxically helps us process and let go of these feelings without long-term negative consequences, and with a better ability to recognize the suffering of others.
Self-compassion allows us to be our own inner ally and strengthens our ability to cope successfully when life gets hard. Self-compassion will not make you weak and vulnerable. It is a reliable source of inner strength that enhances resilience when faced with difficulties. Research shows self-compassionate people are better able to cope with tough situations like divorce, trauma, and crisis.
Self-compassion and self-esteem are important to well-being; however, they are not the same. Self-esteem refers to a judgment or evaluation of our sense of self-worth, perceived value, or how much we like ourselves. While self-compassion relates to the changing landscape of who we are with kindness and acceptance – especially in times when we feel useless, inadequate, or hopeless – self-esteem allows for greater self-clarity, independent of external circumstances, and acknowledges that all human beings deserve compassion and understanding, not because they possess certain traits or have a certain perceive valued, but because we share the human experience and the human condition of imperfection. Finally, self-compassion is not selfish, as practicing it helps people sustain the act of caring for others and decrease caregiver burnout.6,7
Strategies to practice self-compassion
There are many ways to practice self-compassion. Here are a few experiences created by Dr. Neff, a leader in the field.8
Experience 1: How would you treat a friend?
How do you think things might change if you responded to yourself in the same way you typically respond to a close friend when he or she is suffering? Why not try treating yourself like a good friend and see what happens.
Take out a sheet of paper and write down your answer to the following questions:
- First, think about times when a close friend feels really bad about him or herself or is really struggling in some way. How would you respond to your friend in this situation (especially when you’re at your best)? Write down what you typically do and say and note the tone in which you typically talk to your friends.
- Second, think about times when you feel bad about yourself or are struggling. How do you typically respond to yourself in these situations? Write down what you typically do and say, and note the tone in which you typically talk to your friends.
- Did you notice a difference? If so, ask yourself why. What factors or fears come into play that lead you to treat yourself and others so differently?
- Please write down how you think things might change if you responded to yourself in the same way you typically respond to a close friend when you’re suffering.
Experience 2: Take a self-compassion break
This practice can be used any time of day or night, with others or alone. It will help you remember to evoke the three aspects of self-compassion when you need it most.
Think of a situation in your life that is difficult, that is causing you stress. Call the situation to mind, and if you feel comfortable, allow yourself to experience these feelings and emotions, without judgment and without altering them to what you think they should be.
- Say to yourself one of the following: “This is a difficult moment,” “This is a moment of suffering,” “This is stress,” “This hurts,” or “Ouch.” Doing this step is “mindfulness”: A willingness to observe negative thoughts and emotions with openness and clarity, so that they are held in mindful awareness, without judgment.
- Find your equilibrium of observation with thoughts and feelings. Try not to suppress or deny them and try not to get caught up and swept away by them.
- Remind yourself of the shared human experience. Recognize that suffering and personal difficulty is something that we all go through rather than being something that happens to “me” alone. Remind yourself that “other people feel this way,” “I’m not alone,” and “we all have struggles in life.”
- Be kind to yourself and ask: “What do I need to hear right now to express kindness to myself?” Is there a phrase that speaks to you in your particular situation? For example: “May I give myself the compassion that I need; may I learn to accept myself as I am; may I forgive myself; may I be strong; may I be patient.” There is no wrong answer.
Exercise 3: Explore self-compassion through writing
Everybody has something about themselves that they don’t like; something that causes them to feel shame, to feel insecure, or not “good enough.” This exercise will help you write a letter to yourself about this issue from a place of acceptance and compassion. It can feel uncomfortable at first, but it gets easier with practice.
- Write about an issue you have that makes you feel inadequate or bad about yourself (physical appearance, work, or relationship issue) What emotions do you experience when you think about this aspect of yourself? Try to only feel your emotions exactly as they are – no more, no less – and then write about them.
- Write a letter as if you were talking to a dearly beloved friend who was struggling with the same concerns as you and has the same strengths and weaknesses as you. How would you convey deep compassion, especially for the pain you feel when they judge themselves so harshly? What would you write to your friend to remind them that they are only human, that all people have both strengths and weaknesses? As you write, try to infuse your letter with a strong sense of acceptance, kindness, caring, and desire for their health and happiness.
- After writing the letter, put it aside for a little while. Then come back and read it again, really letting the words sink in. Feel the compassion as it pours into you, soothing and comforting you. Love, connection, and acceptance are a part of your human right. To claim them you need only look within yourself.
Experience 4: Taking care of the caregiver
We work in the very stressful time of the COVID pandemic. As medical providers, we are caregivers to our patients and our families. Yet, we do not give ourselves time to rest, recover, and recharge. Remember, to care for others, you cannot pour from an empty cup.
- Give yourself permission to meet your own needs, recognizing that this will not only enhance your quality of life, it will also enhance your ability to be there for those that rely on you. Our time is limited but self-care can occur both at work and outside of work.
- When you are “off the clock,” be off the clock! Turn off notifications, don’t check email, and be present in your personal lives. If you are constantly answering patient calls or nursing questions until 10 p.m., that means your health care system is in need of an upgrade, as you need the appropriate coverage to give you time to care for yourself, just as well as you care for your patients.
- While at work you can practice self-care. Take 2 minutes to practice relaxation breathing. Take 1 minute to show yourself or another person gratitude. Take 5 minutes before you start writing your notes for the day to listen to relaxing music or a mindful podcast. Take 3 minutes to share three good things that happened in the day with your family or colleagues. Take 5-10 minutes to do chair yoga. Take a self-compassion break.
- Implement a 5-minute wellness break into your group’s daily function with some of the previous mentioned examples. This will allow you to care for and nurture yourself, while also caring for and nurturing others in an environment that cultivates your wellness goals.
As a hospitalist, I can attest that I did not show myself self-compassion nearly as often as I showed compassion to others. I am my own worst critic and my training taught me to suffer in silence, and not seek out others who are experiencing the same thing for fear of being perceived as weak, inadequate, or flawed.
This false notion that we need to always be tough, strong, and without emotion in order to be taken seriously, to advance, or be held in high regard is rubbish and only perpetuated by accepting it. In order to change the culture of medicine, we have to change the way we think and behave. I have practiced self-compassion exercises and it has enhanced my perspective to see that many of us are going through varying degrees of the same thing. It has shown me the positive effects on my inner being and my life. If you are ready to try something new that will benefit your psychological and emotional well-being, and help you through pain, suffering, struggles, and crisis, you have nothing to lose. Be the change, and show yourself self-compassion.
In summary, self-compassion is an attitude of warmth, curiosity, connection, and care. Learning to become more self-compassionate is a process of moving from striving to change our experience and ourselves toward embracing who we are already.9 The practice of self-compassion is giving ourselves what we need in the moment. Even if we are not ready, or it is too painful to fully accept or embrace, we can still plant the seeds that will, with time and patience, grow and bloom.
When we are mindful of our struggles, when we respond to ourselves with compassion, kindness, and give ourselves support in times of difficulty, we learn to embrace ourselves and our lives, our inner and outer imperfections, and provide ourselves with the strength needed to thrive in the most precarious and difficult situations. With self-compassion, we give the world the best of us, instead of what is left of us.
Dr. Williams is vice president of the Hampton Roads chapter of the Society of Hospital Medicine. She is a hospitalist at Sentara Careplex Hospital in Hampton, Va., where she also serves as vice president of the medical executive committee.
References
1. Sanchez-Reilly S et al. Caring for oneself to care for others: Physicians and their self-care. J Community Support Oncol. 2013;11(2):75-81. doi: 10.12788/j.suponc.0003.
2. Neff K. Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self Identity. 2010;2(2):85-101. doi: 10.1080/15298860309032.
3. Neff K et al. The forest and the trees: Examining the association of self-compassion and its positive and negative components with psychological functioning. Self Identity. 2018;17(6):627-45. doi: 10.1080/15298868.2018.1436587.
4. Zessin U et al. The relationship between self-compassion and well-being: A meta-analysis. Appl Psychol Health Well-Being. 2015;7(3):340-64. doi: 10.1111/aphw.12051.
5. Warren R et al. Self-criticism and self-compassion: Risk and resilience. Current Psychiatry. 2016 Dec;15(12):18-21,24-28,32.
6. Neff K. The Five Myths of Self-Compassion. Greater Good Magazine. 2015 Sep 30. https://greatergood.berkeley.edu/article/item/the_five_myths_of_self_compassion.
7. Neff KD and Germer CK. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. 2013 Jan;69(1):28-44. doi: 10.1002/jclp.21923.
8. Neff K. Self-Compassion Guided Meditations and Exercises. https://self-compassion.org/category/exercises/#exercises.
9. Germer C and Neff KD. Mindful Self-Compassion (MSC), in “The handbook of mindfulness-based programs.” (London: Routledge, 2019, pp. 357-67).
A mindful way relate to ourselves
A mindful way relate to ourselves
Physicians, clinicians, providers, healers, and now heroes, are some of the names we have been given throughout history. These titles bring together a universal concept in medicine that all human beings deserve compassion, understanding, and care. However, as health care providers we forget to show ourselves the same compassion we bestow upon others.
Self-compassion is a new way of relating to ourselves. As clinicians, we are trained investigators, delving deeper into what our patient is thinking and feeling. “Tell me more about that. How does that make you feel? That must have been (very painful/scary/frustrating).” These are a few statements we learned in patient interviewing to actively engage with patients, build rapport, solidify trust, validate their concerns, and ultimately obtain the information needed to diagnose and heal.
We know the importance of looking beyond the surface, as more often than not a deeper inspection reveals more to the story. We have uncovered cracks in the foundation, erosion of the roof, worn out siding, and a glimpse into the complexities that make up each individual. We look at our patients, loved ones, and the world with night-vision lenses to uncover what is deeper.
Clinicians are good at directing compassion toward others, but not as good at giving it to themselves.1 Many health care providers may see self-compassion as soft, weak, selfish, or unnecessary. However, mindful self-compassion is a positive practice that opens a pathway for healing, personal growth, and protection against the negative consequences of self-judgment, isolation, anxiety, burnout, and depression.
What is self-compassion?
Kristin Neff, PhD, an associate professor in educational psychology at the University of Texas at Austin, was the first to academically define self-compassion. Self-compassion brings together three core elements – kindness, humanity, and mindfulness.2 Self-compassion involves acting the same way toward yourself when you are having a difficult time as you would toward another person. Instead of mercilessly judging and criticizing yourself for self-perceived inadequacies or shortcomings, self-compassion allows you to ask yourself: “How can I give myself comfort and care in this moment?”
Mindfulness acknowledges a painful experience without resistance or judgment, while being present in the moment with things as they are. Self-compassion provides the emotional safety needed to mindfully open to our pain, disappointments, and defeats. Mindfulness and self-compassion both allow us to live with more acceptance toward ourselves and our lives. Mindfulness asks: “What am I experiencing right now?” Self-compassion asks: “What do I need right now?” When you feel compassion for yourself or another, you recognize that suffering, failure, and imperfection are all part of the shared human experience.
The physiology of self-compassion
When we practice self-compassion, we feel safe and cared for because there is a physiological pathway that explains this response. Self-compassion helps down-regulate the stress response (fight-flight-freeze). When we are triggered by a threat to our self-concept, we are likely to do one, two, or all of three things: we fight ourselves (self-criticism – often our first reaction when things go wrong), we flee from others (isolation), or we freeze (rumination).
Feeling threatened puts stress on the mind and body, and chronic stress leads to anxiety and depression, which hinders emotional and physical well-being. With self-criticism, we are both the attacker and the attacked. When we practice self-compassion, we are deactivating the threat-defense system and activating the care system, releasing oxytocin and endorphins, which reduce stress and increase feelings of safety and security.3
Why is self-compassion important to provider well-being?
Research has shown that individuals who are more self-compassionate tend to have greater happiness, life satisfaction, and motivation; better relationships and physical health; and less anxiety and depression. They also have the resilience needed to cope with stressful life events. The more we practice being kind and compassionate with ourselves, the more we’ll increase the habit of self-compassion, and extend compassion to our patients and loved ones in daily life.4
Why is self-compassion important? When we experience a setback at work or in life, we can become defensive, accuse others, or blame ourselves, especially when we are already under immense stress. These responses are not helpful, productive, or effective to the situation or our personal well-being. Although in the moment it may feel good to be reactive, it is a short-lived feeling that we trade for the longer-lasting effects of learning, resilience, and personal growth. Self-compassion teaches us to connect with our inner imperfections, and what makes us human, as to err is human.
To cultivate a habit of self-compassion itself, it is important to understand that self-compassion is a practice of goodwill, not good feelings. Self-compassion is aimed at the alleviation of suffering, but it does not erase any pain and suffering that does exist. The truth is, we can’t always control external forces – the events of 2020-2021 are a perfect example of this. As a result, we cannot utilize self-compassion as a practice to make our pain disappear or suppress strong emotions.
Instead, self-compassion helps us cultivate the resilience needed to mindfully acknowledge and accept a painful moment or experience, while reminding us to embrace ourselves with kindness and care in response. This builds our internal foundation with support, love, and self-care, while providing the optimal conditions for growth, resilience, and transformation
Self-compassion and the backdraft phenomenon
When you start the practice of self-compassion, you may experience backdraft, a phenomenon in which pain initially increases.5 Backdraft is similar to the stages of grief or when the flames of a burning house become larger when a door is opened and oxygen surges in. Practicing self-compassion may cause a tidal wave of emotions to come to the forefront, but it is likely that if this happens, it needs to happen.
Imagine yourself in a room with two versions of yourself. To the left is your best self that you present to the world, standing tall, organized, well kept, and without any noticeable imperfections. To the right, is the deepest part of your being, laying on the floor, filled with raw emotions – sadness, fear, anger, and love. This version of yourself is vulnerable, open, honest, and imperfect. When looking at each version of yourself, which one is the real you? The right? The left? Maybe it’s both?
Imagine what would happen if you walked over to the version of yourself on the right, sat down, and provided it comfort, and embraced yourself with love and kindness. What would happen if you gave that version of yourself a hug? Seeing your true self, with all the layers peeled away, at the very core of your being, vulnerable, and possibly broken, is a powerful and gut-wrenching experience. It may hurt at first, but once we embrace our own pain and suffering, that is where mindfulness and self-compassion intersect to begin the path to healing. It takes more strength and courage to be the version of ourselves on the right than the version on the left.
What is not self compassion?
Self-compassion is not self-pity, weakness, self-esteem, or selfishness. When individuals feel self-pity, they become immersed in their own problems and feel that they are the only ones in the world who are suffering. Self-compassion makes us more willing to accept, experience, and acknowledge difficult feelings with kindness. This paradoxically helps us process and let go of these feelings without long-term negative consequences, and with a better ability to recognize the suffering of others.
Self-compassion allows us to be our own inner ally and strengthens our ability to cope successfully when life gets hard. Self-compassion will not make you weak and vulnerable. It is a reliable source of inner strength that enhances resilience when faced with difficulties. Research shows self-compassionate people are better able to cope with tough situations like divorce, trauma, and crisis.
Self-compassion and self-esteem are important to well-being; however, they are not the same. Self-esteem refers to a judgment or evaluation of our sense of self-worth, perceived value, or how much we like ourselves. While self-compassion relates to the changing landscape of who we are with kindness and acceptance – especially in times when we feel useless, inadequate, or hopeless – self-esteem allows for greater self-clarity, independent of external circumstances, and acknowledges that all human beings deserve compassion and understanding, not because they possess certain traits or have a certain perceive valued, but because we share the human experience and the human condition of imperfection. Finally, self-compassion is not selfish, as practicing it helps people sustain the act of caring for others and decrease caregiver burnout.6,7
Strategies to practice self-compassion
There are many ways to practice self-compassion. Here are a few experiences created by Dr. Neff, a leader in the field.8
Experience 1: How would you treat a friend?
How do you think things might change if you responded to yourself in the same way you typically respond to a close friend when he or she is suffering? Why not try treating yourself like a good friend and see what happens.
Take out a sheet of paper and write down your answer to the following questions:
- First, think about times when a close friend feels really bad about him or herself or is really struggling in some way. How would you respond to your friend in this situation (especially when you’re at your best)? Write down what you typically do and say and note the tone in which you typically talk to your friends.
- Second, think about times when you feel bad about yourself or are struggling. How do you typically respond to yourself in these situations? Write down what you typically do and say, and note the tone in which you typically talk to your friends.
- Did you notice a difference? If so, ask yourself why. What factors or fears come into play that lead you to treat yourself and others so differently?
- Please write down how you think things might change if you responded to yourself in the same way you typically respond to a close friend when you’re suffering.
Experience 2: Take a self-compassion break
This practice can be used any time of day or night, with others or alone. It will help you remember to evoke the three aspects of self-compassion when you need it most.
Think of a situation in your life that is difficult, that is causing you stress. Call the situation to mind, and if you feel comfortable, allow yourself to experience these feelings and emotions, without judgment and without altering them to what you think they should be.
- Say to yourself one of the following: “This is a difficult moment,” “This is a moment of suffering,” “This is stress,” “This hurts,” or “Ouch.” Doing this step is “mindfulness”: A willingness to observe negative thoughts and emotions with openness and clarity, so that they are held in mindful awareness, without judgment.
- Find your equilibrium of observation with thoughts and feelings. Try not to suppress or deny them and try not to get caught up and swept away by them.
- Remind yourself of the shared human experience. Recognize that suffering and personal difficulty is something that we all go through rather than being something that happens to “me” alone. Remind yourself that “other people feel this way,” “I’m not alone,” and “we all have struggles in life.”
- Be kind to yourself and ask: “What do I need to hear right now to express kindness to myself?” Is there a phrase that speaks to you in your particular situation? For example: “May I give myself the compassion that I need; may I learn to accept myself as I am; may I forgive myself; may I be strong; may I be patient.” There is no wrong answer.
Exercise 3: Explore self-compassion through writing
Everybody has something about themselves that they don’t like; something that causes them to feel shame, to feel insecure, or not “good enough.” This exercise will help you write a letter to yourself about this issue from a place of acceptance and compassion. It can feel uncomfortable at first, but it gets easier with practice.
- Write about an issue you have that makes you feel inadequate or bad about yourself (physical appearance, work, or relationship issue) What emotions do you experience when you think about this aspect of yourself? Try to only feel your emotions exactly as they are – no more, no less – and then write about them.
- Write a letter as if you were talking to a dearly beloved friend who was struggling with the same concerns as you and has the same strengths and weaknesses as you. How would you convey deep compassion, especially for the pain you feel when they judge themselves so harshly? What would you write to your friend to remind them that they are only human, that all people have both strengths and weaknesses? As you write, try to infuse your letter with a strong sense of acceptance, kindness, caring, and desire for their health and happiness.
- After writing the letter, put it aside for a little while. Then come back and read it again, really letting the words sink in. Feel the compassion as it pours into you, soothing and comforting you. Love, connection, and acceptance are a part of your human right. To claim them you need only look within yourself.
Experience 4: Taking care of the caregiver
We work in the very stressful time of the COVID pandemic. As medical providers, we are caregivers to our patients and our families. Yet, we do not give ourselves time to rest, recover, and recharge. Remember, to care for others, you cannot pour from an empty cup.
- Give yourself permission to meet your own needs, recognizing that this will not only enhance your quality of life, it will also enhance your ability to be there for those that rely on you. Our time is limited but self-care can occur both at work and outside of work.
- When you are “off the clock,” be off the clock! Turn off notifications, don’t check email, and be present in your personal lives. If you are constantly answering patient calls or nursing questions until 10 p.m., that means your health care system is in need of an upgrade, as you need the appropriate coverage to give you time to care for yourself, just as well as you care for your patients.
- While at work you can practice self-care. Take 2 minutes to practice relaxation breathing. Take 1 minute to show yourself or another person gratitude. Take 5 minutes before you start writing your notes for the day to listen to relaxing music or a mindful podcast. Take 3 minutes to share three good things that happened in the day with your family or colleagues. Take 5-10 minutes to do chair yoga. Take a self-compassion break.
- Implement a 5-minute wellness break into your group’s daily function with some of the previous mentioned examples. This will allow you to care for and nurture yourself, while also caring for and nurturing others in an environment that cultivates your wellness goals.
As a hospitalist, I can attest that I did not show myself self-compassion nearly as often as I showed compassion to others. I am my own worst critic and my training taught me to suffer in silence, and not seek out others who are experiencing the same thing for fear of being perceived as weak, inadequate, or flawed.
This false notion that we need to always be tough, strong, and without emotion in order to be taken seriously, to advance, or be held in high regard is rubbish and only perpetuated by accepting it. In order to change the culture of medicine, we have to change the way we think and behave. I have practiced self-compassion exercises and it has enhanced my perspective to see that many of us are going through varying degrees of the same thing. It has shown me the positive effects on my inner being and my life. If you are ready to try something new that will benefit your psychological and emotional well-being, and help you through pain, suffering, struggles, and crisis, you have nothing to lose. Be the change, and show yourself self-compassion.
In summary, self-compassion is an attitude of warmth, curiosity, connection, and care. Learning to become more self-compassionate is a process of moving from striving to change our experience and ourselves toward embracing who we are already.9 The practice of self-compassion is giving ourselves what we need in the moment. Even if we are not ready, or it is too painful to fully accept or embrace, we can still plant the seeds that will, with time and patience, grow and bloom.
When we are mindful of our struggles, when we respond to ourselves with compassion, kindness, and give ourselves support in times of difficulty, we learn to embrace ourselves and our lives, our inner and outer imperfections, and provide ourselves with the strength needed to thrive in the most precarious and difficult situations. With self-compassion, we give the world the best of us, instead of what is left of us.
Dr. Williams is vice president of the Hampton Roads chapter of the Society of Hospital Medicine. She is a hospitalist at Sentara Careplex Hospital in Hampton, Va., where she also serves as vice president of the medical executive committee.
References
1. Sanchez-Reilly S et al. Caring for oneself to care for others: Physicians and their self-care. J Community Support Oncol. 2013;11(2):75-81. doi: 10.12788/j.suponc.0003.
2. Neff K. Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self Identity. 2010;2(2):85-101. doi: 10.1080/15298860309032.
3. Neff K et al. The forest and the trees: Examining the association of self-compassion and its positive and negative components with psychological functioning. Self Identity. 2018;17(6):627-45. doi: 10.1080/15298868.2018.1436587.
4. Zessin U et al. The relationship between self-compassion and well-being: A meta-analysis. Appl Psychol Health Well-Being. 2015;7(3):340-64. doi: 10.1111/aphw.12051.
5. Warren R et al. Self-criticism and self-compassion: Risk and resilience. Current Psychiatry. 2016 Dec;15(12):18-21,24-28,32.
6. Neff K. The Five Myths of Self-Compassion. Greater Good Magazine. 2015 Sep 30. https://greatergood.berkeley.edu/article/item/the_five_myths_of_self_compassion.
7. Neff KD and Germer CK. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. 2013 Jan;69(1):28-44. doi: 10.1002/jclp.21923.
8. Neff K. Self-Compassion Guided Meditations and Exercises. https://self-compassion.org/category/exercises/#exercises.
9. Germer C and Neff KD. Mindful Self-Compassion (MSC), in “The handbook of mindfulness-based programs.” (London: Routledge, 2019, pp. 357-67).
Physicians, clinicians, providers, healers, and now heroes, are some of the names we have been given throughout history. These titles bring together a universal concept in medicine that all human beings deserve compassion, understanding, and care. However, as health care providers we forget to show ourselves the same compassion we bestow upon others.
Self-compassion is a new way of relating to ourselves. As clinicians, we are trained investigators, delving deeper into what our patient is thinking and feeling. “Tell me more about that. How does that make you feel? That must have been (very painful/scary/frustrating).” These are a few statements we learned in patient interviewing to actively engage with patients, build rapport, solidify trust, validate their concerns, and ultimately obtain the information needed to diagnose and heal.
We know the importance of looking beyond the surface, as more often than not a deeper inspection reveals more to the story. We have uncovered cracks in the foundation, erosion of the roof, worn out siding, and a glimpse into the complexities that make up each individual. We look at our patients, loved ones, and the world with night-vision lenses to uncover what is deeper.
Clinicians are good at directing compassion toward others, but not as good at giving it to themselves.1 Many health care providers may see self-compassion as soft, weak, selfish, or unnecessary. However, mindful self-compassion is a positive practice that opens a pathway for healing, personal growth, and protection against the negative consequences of self-judgment, isolation, anxiety, burnout, and depression.
What is self-compassion?
Kristin Neff, PhD, an associate professor in educational psychology at the University of Texas at Austin, was the first to academically define self-compassion. Self-compassion brings together three core elements – kindness, humanity, and mindfulness.2 Self-compassion involves acting the same way toward yourself when you are having a difficult time as you would toward another person. Instead of mercilessly judging and criticizing yourself for self-perceived inadequacies or shortcomings, self-compassion allows you to ask yourself: “How can I give myself comfort and care in this moment?”
Mindfulness acknowledges a painful experience without resistance or judgment, while being present in the moment with things as they are. Self-compassion provides the emotional safety needed to mindfully open to our pain, disappointments, and defeats. Mindfulness and self-compassion both allow us to live with more acceptance toward ourselves and our lives. Mindfulness asks: “What am I experiencing right now?” Self-compassion asks: “What do I need right now?” When you feel compassion for yourself or another, you recognize that suffering, failure, and imperfection are all part of the shared human experience.
The physiology of self-compassion
When we practice self-compassion, we feel safe and cared for because there is a physiological pathway that explains this response. Self-compassion helps down-regulate the stress response (fight-flight-freeze). When we are triggered by a threat to our self-concept, we are likely to do one, two, or all of three things: we fight ourselves (self-criticism – often our first reaction when things go wrong), we flee from others (isolation), or we freeze (rumination).
Feeling threatened puts stress on the mind and body, and chronic stress leads to anxiety and depression, which hinders emotional and physical well-being. With self-criticism, we are both the attacker and the attacked. When we practice self-compassion, we are deactivating the threat-defense system and activating the care system, releasing oxytocin and endorphins, which reduce stress and increase feelings of safety and security.3
Why is self-compassion important to provider well-being?
Research has shown that individuals who are more self-compassionate tend to have greater happiness, life satisfaction, and motivation; better relationships and physical health; and less anxiety and depression. They also have the resilience needed to cope with stressful life events. The more we practice being kind and compassionate with ourselves, the more we’ll increase the habit of self-compassion, and extend compassion to our patients and loved ones in daily life.4
Why is self-compassion important? When we experience a setback at work or in life, we can become defensive, accuse others, or blame ourselves, especially when we are already under immense stress. These responses are not helpful, productive, or effective to the situation or our personal well-being. Although in the moment it may feel good to be reactive, it is a short-lived feeling that we trade for the longer-lasting effects of learning, resilience, and personal growth. Self-compassion teaches us to connect with our inner imperfections, and what makes us human, as to err is human.
To cultivate a habit of self-compassion itself, it is important to understand that self-compassion is a practice of goodwill, not good feelings. Self-compassion is aimed at the alleviation of suffering, but it does not erase any pain and suffering that does exist. The truth is, we can’t always control external forces – the events of 2020-2021 are a perfect example of this. As a result, we cannot utilize self-compassion as a practice to make our pain disappear or suppress strong emotions.
Instead, self-compassion helps us cultivate the resilience needed to mindfully acknowledge and accept a painful moment or experience, while reminding us to embrace ourselves with kindness and care in response. This builds our internal foundation with support, love, and self-care, while providing the optimal conditions for growth, resilience, and transformation
Self-compassion and the backdraft phenomenon
When you start the practice of self-compassion, you may experience backdraft, a phenomenon in which pain initially increases.5 Backdraft is similar to the stages of grief or when the flames of a burning house become larger when a door is opened and oxygen surges in. Practicing self-compassion may cause a tidal wave of emotions to come to the forefront, but it is likely that if this happens, it needs to happen.
Imagine yourself in a room with two versions of yourself. To the left is your best self that you present to the world, standing tall, organized, well kept, and without any noticeable imperfections. To the right, is the deepest part of your being, laying on the floor, filled with raw emotions – sadness, fear, anger, and love. This version of yourself is vulnerable, open, honest, and imperfect. When looking at each version of yourself, which one is the real you? The right? The left? Maybe it’s both?
Imagine what would happen if you walked over to the version of yourself on the right, sat down, and provided it comfort, and embraced yourself with love and kindness. What would happen if you gave that version of yourself a hug? Seeing your true self, with all the layers peeled away, at the very core of your being, vulnerable, and possibly broken, is a powerful and gut-wrenching experience. It may hurt at first, but once we embrace our own pain and suffering, that is where mindfulness and self-compassion intersect to begin the path to healing. It takes more strength and courage to be the version of ourselves on the right than the version on the left.
What is not self compassion?
Self-compassion is not self-pity, weakness, self-esteem, or selfishness. When individuals feel self-pity, they become immersed in their own problems and feel that they are the only ones in the world who are suffering. Self-compassion makes us more willing to accept, experience, and acknowledge difficult feelings with kindness. This paradoxically helps us process and let go of these feelings without long-term negative consequences, and with a better ability to recognize the suffering of others.
Self-compassion allows us to be our own inner ally and strengthens our ability to cope successfully when life gets hard. Self-compassion will not make you weak and vulnerable. It is a reliable source of inner strength that enhances resilience when faced with difficulties. Research shows self-compassionate people are better able to cope with tough situations like divorce, trauma, and crisis.
Self-compassion and self-esteem are important to well-being; however, they are not the same. Self-esteem refers to a judgment or evaluation of our sense of self-worth, perceived value, or how much we like ourselves. While self-compassion relates to the changing landscape of who we are with kindness and acceptance – especially in times when we feel useless, inadequate, or hopeless – self-esteem allows for greater self-clarity, independent of external circumstances, and acknowledges that all human beings deserve compassion and understanding, not because they possess certain traits or have a certain perceive valued, but because we share the human experience and the human condition of imperfection. Finally, self-compassion is not selfish, as practicing it helps people sustain the act of caring for others and decrease caregiver burnout.6,7
Strategies to practice self-compassion
There are many ways to practice self-compassion. Here are a few experiences created by Dr. Neff, a leader in the field.8
Experience 1: How would you treat a friend?
How do you think things might change if you responded to yourself in the same way you typically respond to a close friend when he or she is suffering? Why not try treating yourself like a good friend and see what happens.
Take out a sheet of paper and write down your answer to the following questions:
- First, think about times when a close friend feels really bad about him or herself or is really struggling in some way. How would you respond to your friend in this situation (especially when you’re at your best)? Write down what you typically do and say and note the tone in which you typically talk to your friends.
- Second, think about times when you feel bad about yourself or are struggling. How do you typically respond to yourself in these situations? Write down what you typically do and say, and note the tone in which you typically talk to your friends.
- Did you notice a difference? If so, ask yourself why. What factors or fears come into play that lead you to treat yourself and others so differently?
- Please write down how you think things might change if you responded to yourself in the same way you typically respond to a close friend when you’re suffering.
Experience 2: Take a self-compassion break
This practice can be used any time of day or night, with others or alone. It will help you remember to evoke the three aspects of self-compassion when you need it most.
Think of a situation in your life that is difficult, that is causing you stress. Call the situation to mind, and if you feel comfortable, allow yourself to experience these feelings and emotions, without judgment and without altering them to what you think they should be.
- Say to yourself one of the following: “This is a difficult moment,” “This is a moment of suffering,” “This is stress,” “This hurts,” or “Ouch.” Doing this step is “mindfulness”: A willingness to observe negative thoughts and emotions with openness and clarity, so that they are held in mindful awareness, without judgment.
- Find your equilibrium of observation with thoughts and feelings. Try not to suppress or deny them and try not to get caught up and swept away by them.
- Remind yourself of the shared human experience. Recognize that suffering and personal difficulty is something that we all go through rather than being something that happens to “me” alone. Remind yourself that “other people feel this way,” “I’m not alone,” and “we all have struggles in life.”
- Be kind to yourself and ask: “What do I need to hear right now to express kindness to myself?” Is there a phrase that speaks to you in your particular situation? For example: “May I give myself the compassion that I need; may I learn to accept myself as I am; may I forgive myself; may I be strong; may I be patient.” There is no wrong answer.
Exercise 3: Explore self-compassion through writing
Everybody has something about themselves that they don’t like; something that causes them to feel shame, to feel insecure, or not “good enough.” This exercise will help you write a letter to yourself about this issue from a place of acceptance and compassion. It can feel uncomfortable at first, but it gets easier with practice.
- Write about an issue you have that makes you feel inadequate or bad about yourself (physical appearance, work, or relationship issue) What emotions do you experience when you think about this aspect of yourself? Try to only feel your emotions exactly as they are – no more, no less – and then write about them.
- Write a letter as if you were talking to a dearly beloved friend who was struggling with the same concerns as you and has the same strengths and weaknesses as you. How would you convey deep compassion, especially for the pain you feel when they judge themselves so harshly? What would you write to your friend to remind them that they are only human, that all people have both strengths and weaknesses? As you write, try to infuse your letter with a strong sense of acceptance, kindness, caring, and desire for their health and happiness.
- After writing the letter, put it aside for a little while. Then come back and read it again, really letting the words sink in. Feel the compassion as it pours into you, soothing and comforting you. Love, connection, and acceptance are a part of your human right. To claim them you need only look within yourself.
Experience 4: Taking care of the caregiver
We work in the very stressful time of the COVID pandemic. As medical providers, we are caregivers to our patients and our families. Yet, we do not give ourselves time to rest, recover, and recharge. Remember, to care for others, you cannot pour from an empty cup.
- Give yourself permission to meet your own needs, recognizing that this will not only enhance your quality of life, it will also enhance your ability to be there for those that rely on you. Our time is limited but self-care can occur both at work and outside of work.
- When you are “off the clock,” be off the clock! Turn off notifications, don’t check email, and be present in your personal lives. If you are constantly answering patient calls or nursing questions until 10 p.m., that means your health care system is in need of an upgrade, as you need the appropriate coverage to give you time to care for yourself, just as well as you care for your patients.
- While at work you can practice self-care. Take 2 minutes to practice relaxation breathing. Take 1 minute to show yourself or another person gratitude. Take 5 minutes before you start writing your notes for the day to listen to relaxing music or a mindful podcast. Take 3 minutes to share three good things that happened in the day with your family or colleagues. Take 5-10 minutes to do chair yoga. Take a self-compassion break.
- Implement a 5-minute wellness break into your group’s daily function with some of the previous mentioned examples. This will allow you to care for and nurture yourself, while also caring for and nurturing others in an environment that cultivates your wellness goals.
As a hospitalist, I can attest that I did not show myself self-compassion nearly as often as I showed compassion to others. I am my own worst critic and my training taught me to suffer in silence, and not seek out others who are experiencing the same thing for fear of being perceived as weak, inadequate, or flawed.
This false notion that we need to always be tough, strong, and without emotion in order to be taken seriously, to advance, or be held in high regard is rubbish and only perpetuated by accepting it. In order to change the culture of medicine, we have to change the way we think and behave. I have practiced self-compassion exercises and it has enhanced my perspective to see that many of us are going through varying degrees of the same thing. It has shown me the positive effects on my inner being and my life. If you are ready to try something new that will benefit your psychological and emotional well-being, and help you through pain, suffering, struggles, and crisis, you have nothing to lose. Be the change, and show yourself self-compassion.
In summary, self-compassion is an attitude of warmth, curiosity, connection, and care. Learning to become more self-compassionate is a process of moving from striving to change our experience and ourselves toward embracing who we are already.9 The practice of self-compassion is giving ourselves what we need in the moment. Even if we are not ready, or it is too painful to fully accept or embrace, we can still plant the seeds that will, with time and patience, grow and bloom.
When we are mindful of our struggles, when we respond to ourselves with compassion, kindness, and give ourselves support in times of difficulty, we learn to embrace ourselves and our lives, our inner and outer imperfections, and provide ourselves with the strength needed to thrive in the most precarious and difficult situations. With self-compassion, we give the world the best of us, instead of what is left of us.
Dr. Williams is vice president of the Hampton Roads chapter of the Society of Hospital Medicine. She is a hospitalist at Sentara Careplex Hospital in Hampton, Va., where she also serves as vice president of the medical executive committee.
References
1. Sanchez-Reilly S et al. Caring for oneself to care for others: Physicians and their self-care. J Community Support Oncol. 2013;11(2):75-81. doi: 10.12788/j.suponc.0003.
2. Neff K. Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self Identity. 2010;2(2):85-101. doi: 10.1080/15298860309032.
3. Neff K et al. The forest and the trees: Examining the association of self-compassion and its positive and negative components with psychological functioning. Self Identity. 2018;17(6):627-45. doi: 10.1080/15298868.2018.1436587.
4. Zessin U et al. The relationship between self-compassion and well-being: A meta-analysis. Appl Psychol Health Well-Being. 2015;7(3):340-64. doi: 10.1111/aphw.12051.
5. Warren R et al. Self-criticism and self-compassion: Risk and resilience. Current Psychiatry. 2016 Dec;15(12):18-21,24-28,32.
6. Neff K. The Five Myths of Self-Compassion. Greater Good Magazine. 2015 Sep 30. https://greatergood.berkeley.edu/article/item/the_five_myths_of_self_compassion.
7. Neff KD and Germer CK. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. 2013 Jan;69(1):28-44. doi: 10.1002/jclp.21923.
8. Neff K. Self-Compassion Guided Meditations and Exercises. https://self-compassion.org/category/exercises/#exercises.
9. Germer C and Neff KD. Mindful Self-Compassion (MSC), in “The handbook of mindfulness-based programs.” (London: Routledge, 2019, pp. 357-67).
Residency programs readjust during COVID
Hospitalist-honed agility proves invaluable
It could be argued that hospital medicine in the United States was made vital by a major infectious disease epidemic – the HIV/AIDS crisis – said Emily Gottenborg, MD, a hospitalist and program director of hospitalist training at the University of Colorado at Denver, Aurora. Certainly, it was born out of the need for change, for physicians who could coordinate complex patient care plans and serve as the “quarterbacks” of the hospital. “As a result, we have always been very nimble and ready to embrace change,” said Dr. Gottenborg.
That hospitalist-honed agility and penchant for innovation has proven to be invaluable during the current COVID-19 pandemic as hospital medicine–focused residency programs have been forced to pivot quickly and modify their agendas. From managing the pandemic’s impact on residents’ day-to-day experiences, to carefully balancing educational needs and goals, program leaders have worked tirelessly to ensure that residents continue to receive excellent training.
The overarching theme across U.S.-based residency programs is that the educational changes and challenges during the COVID-19 pandemic have often been one and the same.
Service versus education
At the beginning of the pandemic, trainees at the University of Pittsburgh Medical Center were limited in seeing COVID patients in order to curb exposure. But now that COVID appears to be the new normal, “I think the question becomes: ‘How do we incorporate our trainees to take care of COVID patients since it seems it will be staying around for a while?’ ” said Rachna Rawal, MD, a hospitalist and clinical assistant professor of medicine at UPMC.
This dilemma highlights the conflict between service and education. Residents have been motivated and eager to help, which has been beneficial whenever there is a surge. “At the same time, you want to preserve their education, and it’s a very difficult balance at times,” said Dr. Rawal. It’s also challenging to figure out the safest way for residents to see patients, as well as how to include medical students, since interns and residents serve as important educational resources for them.
Keeping trainees involved with daily virtual conferences rather than in-person interactions raises the question of whether or not the engagement is equivalent. “It’s harder to keep them accountable when they’re not in person, but it’s also not worth the risk given the COVID numbers at times,” Dr. Rawal said. The goal has become to make sure residents stay safe while still feeling that they are getting a good education.
A balancing act
“I think early on, there was a lot of pride in what we were doing, that we were on the front line managing this thing that was emerging,” said Daniel Ricotta, MD, a hospitalist and associate program director of the internal medicine residency at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, both in Boston. “And now I think people are starting to feel a little bit weary.”
It has been demanding trying to manage ongoing educational needs through this time. “At the end of the day, residents are still trainees and have to be trained and educated. They’re not just worker bees taking care of patients,” Dr. Ricotta said. Residents need a well-rounded clinical experience – “they can’t just take care of COVID patients and then be able to graduate as general internists,” he said – but that becomes onerous when the hospital is full of patients with COVID.
Along with balancing residents’ clinical immersion, Dr. Ricotta said there has been the challenge of doing “the content-based teaching from didactics that occur in the context of clinical work, but are somewhat separated when you need to limit the number of people in the rooms and try to keep as many people at home as possible when they’re not taking care of patients in order to limit their level of risk.” Adjusting and readjusting both of these aspects has had a major impact on residents’ day-to-day education.
“A big part of residency is community,” noted Dr. Ricotta, but the sense of community has been disrupted because some of the bonding experiences residents used to do outside the hospital to build that community have necessarily gone by the wayside. This particularly affects interns from around the country who are meeting each other for the first time. “We actually had a normal intern orientation this year, but last year, when everything was virtual, we were trying to find ways to bridge relationships in a way that was safe and socially distanced,” he said.
Improving quality
UC Denver is unique in that they have a 3-year program specifically for hospital medicine residents, said Dr. Gottenborg. Right away, “our residents rose to the challenge and wanted to be part of the workforce that helps care for this critical population of [COVID] patients.” The residents were able to run the ICUs and take care of COVID patients, but in exchange, they had to give up some of their elective rotation time.
One aspect of the UC Denver hospital medicine residency program is participation in projects that focus on how to improve the health care system. Over the past year, the residents worked on one project in particular that focused on restructuring the guidelines for consulting physical therapists. Since many patients end up needing a physical therapist for a variety of reasons, a full hospital puts increased strain on their workload, making their time more precious.
“[The project] forced us to think about the right criteria to consult them,” explained Dr. Gottenborg. “We cut down essentially all the inappropriate consults to PT, opening their time. That project was driven by how the residents were experiencing the pandemic in the hospital.”
Learning to adapt
“The training environment during this pandemic has been tumultuous for both our residents and medical students,” said Alan M. Hall, MD, associate professor of internal medicine and pediatrics and assistant dean of curriculum integration at the University of Kentucky, Lexington. Along with treating patients with COVID-19, he said trainees have also had to cope with anxiety about getting the virus themselves or inadvertently bringing it home to their families.
Like most medical schools, University of Kentucky students were shifted away from clinical rotations and into alternative and online education for a time. When they returned to in-person education, the students were initially restricted from seeing patients with confirmed or suspected COVID-19 in order to reduce their personal risk and to conserve personal protective equipment.
This especially impacted certain rotations, such as pediatrics. Because respiratory symptoms are common in this population, students were greatly limited in the number of new patients they could see. Now they are given the option to see patients with COVID-19 if they want to.
“Our residents have had to adapt to seemingly endless changes during this pandemic,” Dr. Hall said. For example, at the beginning of the surge, the internal medicine residents trained for a completely new clinical model, though this ultimately never needed to be implemented. Then they had to adjust to extremely high census numbers that continue to have an effect on almost all of their rotations.
Conversely, the pediatrics residents saw far fewer inpatients last winter than they typically would. This made it more difficult for them to feel comfortable when census numbers increased with common diagnoses like bronchiolitis. “However, those respiratory viruses that were hibernating last winter caused an unusual and challenging summer surge,” Dr. Hall said.
The biggest challenge though “is knowing that there is not a perfect solution for this global pandemic’s effect on medical education,” said Dr. Hall. “We can’t possibly perfectly balance the safety of our learners and their families with the dangers of COVID-19.”
Leadership discussions
As a residency program leader, Dr. Ricotta said there are conversations about multiple topics, including maintaining a safe learning environment; providing important aspects of residency training; whether to go back to full in-person teaching, keep doing virtual teaching, or implement a hybrid model; and how to help residents understand the balance between their personal and professional lives, especially in terms of safety.
“They have to their lives outside of the hospital, but we also are trying to instill ... what their responsibility is to society, to their patients, and to each other,” said Dr. Ricotta.
A more recent discussion has been about how to manage the COVID vaccine boosters. “We can’t have everyone getting vaccines at the same time because they might have symptoms afterward, and then be out sick – you’re missing half your workforce,” Dr. Ricotta said. But staggering residents’ booster shots created yet another dilemma around deciding who received the booster sooner rather than later.
The biggest consideration for Dr. Gottenborg’s leadership team was deciding whether to use their residents to help with the COVID surges or keep them in a traditional residency experience. While the residents wanted to be part of the pandemic response, there were many factors to consider. Ultimately, they came up with a balance between the amount of time residents should spend taking care of COVID patients while also assuring that they leave the program with all the skills and experiences they need.
Though Dr. Hall works more closely with medical students than residents, he sees the challenges and effects as being similar. Creating harmony between a safe learning environment and students’ educational goals has been the topic of endless discussions. This includes decisions as to whether or not students should be involved in person in certain activities such as large classroom didactics, written exams, seeing patients in clinical settings, and small group discussions.
Recruitment effects
When it comes to recruiting during a global pandemic, the experiences and predictions are mixed. Dr. Hall believes virtual interviews are making recruitment easier, but in turn, the fact that they are virtual also makes it harder for the applicant to get a good feel for the program and the people involved in it.
Dr. Ricotta reported that recruitment numbers have been fairly steady at Beth Israel Deaconess over the last few years. “In addition to the critical care physicians, hospital medicine was really the front line of this pandemic and so in some ways, we gained some recognition that we may not have had otherwise,” said Dr. Ricotta. He believes this has the benefit of attracting some residents, but at the same time, it could potentially scare others away from what they perceive as a demanding, grueling job. “I think it has been mixed. It’s dependent on the person.”
At UC Denver, Dr. Gottenborg said they are seeing a rapid rise in the number of applications and interest in their programs. Still, “I think this could go both ways,” she acknowledged. With the focus on hospital medicine in the media, medical students are more aware of the specialty and what it involves. “I think the sense of mission is really exemplified and everyone is talking about it,” she said. This is evident in the arrival this summer of the first new class of interns since the pandemic. “They’re incredibly passionate about the work,” said Dr. Gottenborg.
However, there is also the notable increase in physician burnout since the pandemic started. That this has been regularly featured in the media leaves Dr. Gottenborg to wonder if prospective residents will shy away from hospital medicine because they believe it is an area that leads to burnout. “I hope that’s not the case,” she said.
“I would actually argue [recruitment] is easier,” said Dr. Rawal. Like Dr. Hall, she sees virtual interviews as a big benefit to prospective trainees because they don’t have to spend a large amount of money on travel, food, and other expenses like they did before, a welcome relief for residents with significant debt. “I think that is one very big positive from the pandemic,” she said. Her trainees were advised to make a final list and consider going to see the top two or three in person, but “at this point, there’s really no expectation to go see all 15 places that you look into.”
Dr. Rawal also pointed out that recruitment is affected by whether or not trainees are expected to see COVID patients. “I know in some places they aren’t and in some places they are, so it just depends on where you are and what you’re looking for,” she said.
Shifts in education
It remains to be seen if all the educational changes will be permanent, though it appears that many will remain. Dr. Hall hopes that virtual visits to provide care to patients who have difficulty getting to physical clinics will continue to be a focus for hospital medicine trainees. “For medical students, I think this will allow us to better assess what content can best be delivered in person, synchronously online, or asynchronously through recorded content,” he said.
Dr. Ricotta predicts that virtual conferences will become more pervasive as academic hospitals continue to acquire more community hospitals, especially for grand rounds. “The virtual teaching that occurred in the residency program because it’s required by the [Accreditation Council for Graduate Medical Education] has, I think, informed how academic centers do ongoing faculty development, professional development, and obviously education for the residents,” Dr. Ricotta said. “I think virtual teaching is here to stay.” This includes telehealth training, which had not been a widespread part of residency education before now.
Trainees have been given tools to handle high patient censuses and learned a whole new set of communication skills, thanks to the pandemic, said Dr. Rawal. There has been a focus on learning how to advocate for the vaccine, along with education on situations like how to have conversations with patients who don’t believe they have COVID, even when their tests are positive. “Learning to handle these situations and still be a physician and provide appropriate care regardless of the patient’s views is very important. This is not something I learned in my training because it never came up,” she said.
Dr. Gottenborg has been impressed by the resident workforce’s response across all specialties throughout these difficult days. “They were universally ready to dive in and work long hours and care for these very sick patients and ultimately share their experiences so that we could do it better as these patients continue to flow through our systems,” she said. “It has been very invigorating.”
The pandemic has also put a spotlight on the importance of being flexible, as well as various problems with how health care systems operate, “which, for people in our field, gets us both excited and gives us a lot of work to do,” said Dr. Gottenborg. “Our residents see that and feel that and will hopefully continue to hold that torch in hospital medicine.”
In spite of everything, Dr. Rawal believes this is an exhilarating time to be a trainee. “They’re getting an opportunity that none of us got. Usually, when policies are made, we really don’t see the immediate impact.” But with recent mandates like masks and social distancing, “the rate of change that they get to see things happen is exciting. They’re going to be a very exciting group of physicians.”
Hospitalist-honed agility proves invaluable
Hospitalist-honed agility proves invaluable
It could be argued that hospital medicine in the United States was made vital by a major infectious disease epidemic – the HIV/AIDS crisis – said Emily Gottenborg, MD, a hospitalist and program director of hospitalist training at the University of Colorado at Denver, Aurora. Certainly, it was born out of the need for change, for physicians who could coordinate complex patient care plans and serve as the “quarterbacks” of the hospital. “As a result, we have always been very nimble and ready to embrace change,” said Dr. Gottenborg.
That hospitalist-honed agility and penchant for innovation has proven to be invaluable during the current COVID-19 pandemic as hospital medicine–focused residency programs have been forced to pivot quickly and modify their agendas. From managing the pandemic’s impact on residents’ day-to-day experiences, to carefully balancing educational needs and goals, program leaders have worked tirelessly to ensure that residents continue to receive excellent training.
The overarching theme across U.S.-based residency programs is that the educational changes and challenges during the COVID-19 pandemic have often been one and the same.
Service versus education
At the beginning of the pandemic, trainees at the University of Pittsburgh Medical Center were limited in seeing COVID patients in order to curb exposure. But now that COVID appears to be the new normal, “I think the question becomes: ‘How do we incorporate our trainees to take care of COVID patients since it seems it will be staying around for a while?’ ” said Rachna Rawal, MD, a hospitalist and clinical assistant professor of medicine at UPMC.
This dilemma highlights the conflict between service and education. Residents have been motivated and eager to help, which has been beneficial whenever there is a surge. “At the same time, you want to preserve their education, and it’s a very difficult balance at times,” said Dr. Rawal. It’s also challenging to figure out the safest way for residents to see patients, as well as how to include medical students, since interns and residents serve as important educational resources for them.
Keeping trainees involved with daily virtual conferences rather than in-person interactions raises the question of whether or not the engagement is equivalent. “It’s harder to keep them accountable when they’re not in person, but it’s also not worth the risk given the COVID numbers at times,” Dr. Rawal said. The goal has become to make sure residents stay safe while still feeling that they are getting a good education.
A balancing act
“I think early on, there was a lot of pride in what we were doing, that we were on the front line managing this thing that was emerging,” said Daniel Ricotta, MD, a hospitalist and associate program director of the internal medicine residency at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, both in Boston. “And now I think people are starting to feel a little bit weary.”
It has been demanding trying to manage ongoing educational needs through this time. “At the end of the day, residents are still trainees and have to be trained and educated. They’re not just worker bees taking care of patients,” Dr. Ricotta said. Residents need a well-rounded clinical experience – “they can’t just take care of COVID patients and then be able to graduate as general internists,” he said – but that becomes onerous when the hospital is full of patients with COVID.
Along with balancing residents’ clinical immersion, Dr. Ricotta said there has been the challenge of doing “the content-based teaching from didactics that occur in the context of clinical work, but are somewhat separated when you need to limit the number of people in the rooms and try to keep as many people at home as possible when they’re not taking care of patients in order to limit their level of risk.” Adjusting and readjusting both of these aspects has had a major impact on residents’ day-to-day education.
“A big part of residency is community,” noted Dr. Ricotta, but the sense of community has been disrupted because some of the bonding experiences residents used to do outside the hospital to build that community have necessarily gone by the wayside. This particularly affects interns from around the country who are meeting each other for the first time. “We actually had a normal intern orientation this year, but last year, when everything was virtual, we were trying to find ways to bridge relationships in a way that was safe and socially distanced,” he said.
Improving quality
UC Denver is unique in that they have a 3-year program specifically for hospital medicine residents, said Dr. Gottenborg. Right away, “our residents rose to the challenge and wanted to be part of the workforce that helps care for this critical population of [COVID] patients.” The residents were able to run the ICUs and take care of COVID patients, but in exchange, they had to give up some of their elective rotation time.
One aspect of the UC Denver hospital medicine residency program is participation in projects that focus on how to improve the health care system. Over the past year, the residents worked on one project in particular that focused on restructuring the guidelines for consulting physical therapists. Since many patients end up needing a physical therapist for a variety of reasons, a full hospital puts increased strain on their workload, making their time more precious.
“[The project] forced us to think about the right criteria to consult them,” explained Dr. Gottenborg. “We cut down essentially all the inappropriate consults to PT, opening their time. That project was driven by how the residents were experiencing the pandemic in the hospital.”
Learning to adapt
“The training environment during this pandemic has been tumultuous for both our residents and medical students,” said Alan M. Hall, MD, associate professor of internal medicine and pediatrics and assistant dean of curriculum integration at the University of Kentucky, Lexington. Along with treating patients with COVID-19, he said trainees have also had to cope with anxiety about getting the virus themselves or inadvertently bringing it home to their families.
Like most medical schools, University of Kentucky students were shifted away from clinical rotations and into alternative and online education for a time. When they returned to in-person education, the students were initially restricted from seeing patients with confirmed or suspected COVID-19 in order to reduce their personal risk and to conserve personal protective equipment.
This especially impacted certain rotations, such as pediatrics. Because respiratory symptoms are common in this population, students were greatly limited in the number of new patients they could see. Now they are given the option to see patients with COVID-19 if they want to.
“Our residents have had to adapt to seemingly endless changes during this pandemic,” Dr. Hall said. For example, at the beginning of the surge, the internal medicine residents trained for a completely new clinical model, though this ultimately never needed to be implemented. Then they had to adjust to extremely high census numbers that continue to have an effect on almost all of their rotations.
Conversely, the pediatrics residents saw far fewer inpatients last winter than they typically would. This made it more difficult for them to feel comfortable when census numbers increased with common diagnoses like bronchiolitis. “However, those respiratory viruses that were hibernating last winter caused an unusual and challenging summer surge,” Dr. Hall said.
The biggest challenge though “is knowing that there is not a perfect solution for this global pandemic’s effect on medical education,” said Dr. Hall. “We can’t possibly perfectly balance the safety of our learners and their families with the dangers of COVID-19.”
Leadership discussions
As a residency program leader, Dr. Ricotta said there are conversations about multiple topics, including maintaining a safe learning environment; providing important aspects of residency training; whether to go back to full in-person teaching, keep doing virtual teaching, or implement a hybrid model; and how to help residents understand the balance between their personal and professional lives, especially in terms of safety.
“They have to their lives outside of the hospital, but we also are trying to instill ... what their responsibility is to society, to their patients, and to each other,” said Dr. Ricotta.
A more recent discussion has been about how to manage the COVID vaccine boosters. “We can’t have everyone getting vaccines at the same time because they might have symptoms afterward, and then be out sick – you’re missing half your workforce,” Dr. Ricotta said. But staggering residents’ booster shots created yet another dilemma around deciding who received the booster sooner rather than later.
The biggest consideration for Dr. Gottenborg’s leadership team was deciding whether to use their residents to help with the COVID surges or keep them in a traditional residency experience. While the residents wanted to be part of the pandemic response, there were many factors to consider. Ultimately, they came up with a balance between the amount of time residents should spend taking care of COVID patients while also assuring that they leave the program with all the skills and experiences they need.
Though Dr. Hall works more closely with medical students than residents, he sees the challenges and effects as being similar. Creating harmony between a safe learning environment and students’ educational goals has been the topic of endless discussions. This includes decisions as to whether or not students should be involved in person in certain activities such as large classroom didactics, written exams, seeing patients in clinical settings, and small group discussions.
Recruitment effects
When it comes to recruiting during a global pandemic, the experiences and predictions are mixed. Dr. Hall believes virtual interviews are making recruitment easier, but in turn, the fact that they are virtual also makes it harder for the applicant to get a good feel for the program and the people involved in it.
Dr. Ricotta reported that recruitment numbers have been fairly steady at Beth Israel Deaconess over the last few years. “In addition to the critical care physicians, hospital medicine was really the front line of this pandemic and so in some ways, we gained some recognition that we may not have had otherwise,” said Dr. Ricotta. He believes this has the benefit of attracting some residents, but at the same time, it could potentially scare others away from what they perceive as a demanding, grueling job. “I think it has been mixed. It’s dependent on the person.”
At UC Denver, Dr. Gottenborg said they are seeing a rapid rise in the number of applications and interest in their programs. Still, “I think this could go both ways,” she acknowledged. With the focus on hospital medicine in the media, medical students are more aware of the specialty and what it involves. “I think the sense of mission is really exemplified and everyone is talking about it,” she said. This is evident in the arrival this summer of the first new class of interns since the pandemic. “They’re incredibly passionate about the work,” said Dr. Gottenborg.
However, there is also the notable increase in physician burnout since the pandemic started. That this has been regularly featured in the media leaves Dr. Gottenborg to wonder if prospective residents will shy away from hospital medicine because they believe it is an area that leads to burnout. “I hope that’s not the case,” she said.
“I would actually argue [recruitment] is easier,” said Dr. Rawal. Like Dr. Hall, she sees virtual interviews as a big benefit to prospective trainees because they don’t have to spend a large amount of money on travel, food, and other expenses like they did before, a welcome relief for residents with significant debt. “I think that is one very big positive from the pandemic,” she said. Her trainees were advised to make a final list and consider going to see the top two or three in person, but “at this point, there’s really no expectation to go see all 15 places that you look into.”
Dr. Rawal also pointed out that recruitment is affected by whether or not trainees are expected to see COVID patients. “I know in some places they aren’t and in some places they are, so it just depends on where you are and what you’re looking for,” she said.
Shifts in education
It remains to be seen if all the educational changes will be permanent, though it appears that many will remain. Dr. Hall hopes that virtual visits to provide care to patients who have difficulty getting to physical clinics will continue to be a focus for hospital medicine trainees. “For medical students, I think this will allow us to better assess what content can best be delivered in person, synchronously online, or asynchronously through recorded content,” he said.
Dr. Ricotta predicts that virtual conferences will become more pervasive as academic hospitals continue to acquire more community hospitals, especially for grand rounds. “The virtual teaching that occurred in the residency program because it’s required by the [Accreditation Council for Graduate Medical Education] has, I think, informed how academic centers do ongoing faculty development, professional development, and obviously education for the residents,” Dr. Ricotta said. “I think virtual teaching is here to stay.” This includes telehealth training, which had not been a widespread part of residency education before now.
Trainees have been given tools to handle high patient censuses and learned a whole new set of communication skills, thanks to the pandemic, said Dr. Rawal. There has been a focus on learning how to advocate for the vaccine, along with education on situations like how to have conversations with patients who don’t believe they have COVID, even when their tests are positive. “Learning to handle these situations and still be a physician and provide appropriate care regardless of the patient’s views is very important. This is not something I learned in my training because it never came up,” she said.
Dr. Gottenborg has been impressed by the resident workforce’s response across all specialties throughout these difficult days. “They were universally ready to dive in and work long hours and care for these very sick patients and ultimately share their experiences so that we could do it better as these patients continue to flow through our systems,” she said. “It has been very invigorating.”
The pandemic has also put a spotlight on the importance of being flexible, as well as various problems with how health care systems operate, “which, for people in our field, gets us both excited and gives us a lot of work to do,” said Dr. Gottenborg. “Our residents see that and feel that and will hopefully continue to hold that torch in hospital medicine.”
In spite of everything, Dr. Rawal believes this is an exhilarating time to be a trainee. “They’re getting an opportunity that none of us got. Usually, when policies are made, we really don’t see the immediate impact.” But with recent mandates like masks and social distancing, “the rate of change that they get to see things happen is exciting. They’re going to be a very exciting group of physicians.”
It could be argued that hospital medicine in the United States was made vital by a major infectious disease epidemic – the HIV/AIDS crisis – said Emily Gottenborg, MD, a hospitalist and program director of hospitalist training at the University of Colorado at Denver, Aurora. Certainly, it was born out of the need for change, for physicians who could coordinate complex patient care plans and serve as the “quarterbacks” of the hospital. “As a result, we have always been very nimble and ready to embrace change,” said Dr. Gottenborg.
That hospitalist-honed agility and penchant for innovation has proven to be invaluable during the current COVID-19 pandemic as hospital medicine–focused residency programs have been forced to pivot quickly and modify their agendas. From managing the pandemic’s impact on residents’ day-to-day experiences, to carefully balancing educational needs and goals, program leaders have worked tirelessly to ensure that residents continue to receive excellent training.
The overarching theme across U.S.-based residency programs is that the educational changes and challenges during the COVID-19 pandemic have often been one and the same.
Service versus education
At the beginning of the pandemic, trainees at the University of Pittsburgh Medical Center were limited in seeing COVID patients in order to curb exposure. But now that COVID appears to be the new normal, “I think the question becomes: ‘How do we incorporate our trainees to take care of COVID patients since it seems it will be staying around for a while?’ ” said Rachna Rawal, MD, a hospitalist and clinical assistant professor of medicine at UPMC.
This dilemma highlights the conflict between service and education. Residents have been motivated and eager to help, which has been beneficial whenever there is a surge. “At the same time, you want to preserve their education, and it’s a very difficult balance at times,” said Dr. Rawal. It’s also challenging to figure out the safest way for residents to see patients, as well as how to include medical students, since interns and residents serve as important educational resources for them.
Keeping trainees involved with daily virtual conferences rather than in-person interactions raises the question of whether or not the engagement is equivalent. “It’s harder to keep them accountable when they’re not in person, but it’s also not worth the risk given the COVID numbers at times,” Dr. Rawal said. The goal has become to make sure residents stay safe while still feeling that they are getting a good education.
A balancing act
“I think early on, there was a lot of pride in what we were doing, that we were on the front line managing this thing that was emerging,” said Daniel Ricotta, MD, a hospitalist and associate program director of the internal medicine residency at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, both in Boston. “And now I think people are starting to feel a little bit weary.”
It has been demanding trying to manage ongoing educational needs through this time. “At the end of the day, residents are still trainees and have to be trained and educated. They’re not just worker bees taking care of patients,” Dr. Ricotta said. Residents need a well-rounded clinical experience – “they can’t just take care of COVID patients and then be able to graduate as general internists,” he said – but that becomes onerous when the hospital is full of patients with COVID.
Along with balancing residents’ clinical immersion, Dr. Ricotta said there has been the challenge of doing “the content-based teaching from didactics that occur in the context of clinical work, but are somewhat separated when you need to limit the number of people in the rooms and try to keep as many people at home as possible when they’re not taking care of patients in order to limit their level of risk.” Adjusting and readjusting both of these aspects has had a major impact on residents’ day-to-day education.
“A big part of residency is community,” noted Dr. Ricotta, but the sense of community has been disrupted because some of the bonding experiences residents used to do outside the hospital to build that community have necessarily gone by the wayside. This particularly affects interns from around the country who are meeting each other for the first time. “We actually had a normal intern orientation this year, but last year, when everything was virtual, we were trying to find ways to bridge relationships in a way that was safe and socially distanced,” he said.
Improving quality
UC Denver is unique in that they have a 3-year program specifically for hospital medicine residents, said Dr. Gottenborg. Right away, “our residents rose to the challenge and wanted to be part of the workforce that helps care for this critical population of [COVID] patients.” The residents were able to run the ICUs and take care of COVID patients, but in exchange, they had to give up some of their elective rotation time.
One aspect of the UC Denver hospital medicine residency program is participation in projects that focus on how to improve the health care system. Over the past year, the residents worked on one project in particular that focused on restructuring the guidelines for consulting physical therapists. Since many patients end up needing a physical therapist for a variety of reasons, a full hospital puts increased strain on their workload, making their time more precious.
“[The project] forced us to think about the right criteria to consult them,” explained Dr. Gottenborg. “We cut down essentially all the inappropriate consults to PT, opening their time. That project was driven by how the residents were experiencing the pandemic in the hospital.”
Learning to adapt
“The training environment during this pandemic has been tumultuous for both our residents and medical students,” said Alan M. Hall, MD, associate professor of internal medicine and pediatrics and assistant dean of curriculum integration at the University of Kentucky, Lexington. Along with treating patients with COVID-19, he said trainees have also had to cope with anxiety about getting the virus themselves or inadvertently bringing it home to their families.
Like most medical schools, University of Kentucky students were shifted away from clinical rotations and into alternative and online education for a time. When they returned to in-person education, the students were initially restricted from seeing patients with confirmed or suspected COVID-19 in order to reduce their personal risk and to conserve personal protective equipment.
This especially impacted certain rotations, such as pediatrics. Because respiratory symptoms are common in this population, students were greatly limited in the number of new patients they could see. Now they are given the option to see patients with COVID-19 if they want to.
“Our residents have had to adapt to seemingly endless changes during this pandemic,” Dr. Hall said. For example, at the beginning of the surge, the internal medicine residents trained for a completely new clinical model, though this ultimately never needed to be implemented. Then they had to adjust to extremely high census numbers that continue to have an effect on almost all of their rotations.
Conversely, the pediatrics residents saw far fewer inpatients last winter than they typically would. This made it more difficult for them to feel comfortable when census numbers increased with common diagnoses like bronchiolitis. “However, those respiratory viruses that were hibernating last winter caused an unusual and challenging summer surge,” Dr. Hall said.
The biggest challenge though “is knowing that there is not a perfect solution for this global pandemic’s effect on medical education,” said Dr. Hall. “We can’t possibly perfectly balance the safety of our learners and their families with the dangers of COVID-19.”
Leadership discussions
As a residency program leader, Dr. Ricotta said there are conversations about multiple topics, including maintaining a safe learning environment; providing important aspects of residency training; whether to go back to full in-person teaching, keep doing virtual teaching, or implement a hybrid model; and how to help residents understand the balance between their personal and professional lives, especially in terms of safety.
“They have to their lives outside of the hospital, but we also are trying to instill ... what their responsibility is to society, to their patients, and to each other,” said Dr. Ricotta.
A more recent discussion has been about how to manage the COVID vaccine boosters. “We can’t have everyone getting vaccines at the same time because they might have symptoms afterward, and then be out sick – you’re missing half your workforce,” Dr. Ricotta said. But staggering residents’ booster shots created yet another dilemma around deciding who received the booster sooner rather than later.
The biggest consideration for Dr. Gottenborg’s leadership team was deciding whether to use their residents to help with the COVID surges or keep them in a traditional residency experience. While the residents wanted to be part of the pandemic response, there were many factors to consider. Ultimately, they came up with a balance between the amount of time residents should spend taking care of COVID patients while also assuring that they leave the program with all the skills and experiences they need.
Though Dr. Hall works more closely with medical students than residents, he sees the challenges and effects as being similar. Creating harmony between a safe learning environment and students’ educational goals has been the topic of endless discussions. This includes decisions as to whether or not students should be involved in person in certain activities such as large classroom didactics, written exams, seeing patients in clinical settings, and small group discussions.
Recruitment effects
When it comes to recruiting during a global pandemic, the experiences and predictions are mixed. Dr. Hall believes virtual interviews are making recruitment easier, but in turn, the fact that they are virtual also makes it harder for the applicant to get a good feel for the program and the people involved in it.
Dr. Ricotta reported that recruitment numbers have been fairly steady at Beth Israel Deaconess over the last few years. “In addition to the critical care physicians, hospital medicine was really the front line of this pandemic and so in some ways, we gained some recognition that we may not have had otherwise,” said Dr. Ricotta. He believes this has the benefit of attracting some residents, but at the same time, it could potentially scare others away from what they perceive as a demanding, grueling job. “I think it has been mixed. It’s dependent on the person.”
At UC Denver, Dr. Gottenborg said they are seeing a rapid rise in the number of applications and interest in their programs. Still, “I think this could go both ways,” she acknowledged. With the focus on hospital medicine in the media, medical students are more aware of the specialty and what it involves. “I think the sense of mission is really exemplified and everyone is talking about it,” she said. This is evident in the arrival this summer of the first new class of interns since the pandemic. “They’re incredibly passionate about the work,” said Dr. Gottenborg.
However, there is also the notable increase in physician burnout since the pandemic started. That this has been regularly featured in the media leaves Dr. Gottenborg to wonder if prospective residents will shy away from hospital medicine because they believe it is an area that leads to burnout. “I hope that’s not the case,” she said.
“I would actually argue [recruitment] is easier,” said Dr. Rawal. Like Dr. Hall, she sees virtual interviews as a big benefit to prospective trainees because they don’t have to spend a large amount of money on travel, food, and other expenses like they did before, a welcome relief for residents with significant debt. “I think that is one very big positive from the pandemic,” she said. Her trainees were advised to make a final list and consider going to see the top two or three in person, but “at this point, there’s really no expectation to go see all 15 places that you look into.”
Dr. Rawal also pointed out that recruitment is affected by whether or not trainees are expected to see COVID patients. “I know in some places they aren’t and in some places they are, so it just depends on where you are and what you’re looking for,” she said.
Shifts in education
It remains to be seen if all the educational changes will be permanent, though it appears that many will remain. Dr. Hall hopes that virtual visits to provide care to patients who have difficulty getting to physical clinics will continue to be a focus for hospital medicine trainees. “For medical students, I think this will allow us to better assess what content can best be delivered in person, synchronously online, or asynchronously through recorded content,” he said.
Dr. Ricotta predicts that virtual conferences will become more pervasive as academic hospitals continue to acquire more community hospitals, especially for grand rounds. “The virtual teaching that occurred in the residency program because it’s required by the [Accreditation Council for Graduate Medical Education] has, I think, informed how academic centers do ongoing faculty development, professional development, and obviously education for the residents,” Dr. Ricotta said. “I think virtual teaching is here to stay.” This includes telehealth training, which had not been a widespread part of residency education before now.
Trainees have been given tools to handle high patient censuses and learned a whole new set of communication skills, thanks to the pandemic, said Dr. Rawal. There has been a focus on learning how to advocate for the vaccine, along with education on situations like how to have conversations with patients who don’t believe they have COVID, even when their tests are positive. “Learning to handle these situations and still be a physician and provide appropriate care regardless of the patient’s views is very important. This is not something I learned in my training because it never came up,” she said.
Dr. Gottenborg has been impressed by the resident workforce’s response across all specialties throughout these difficult days. “They were universally ready to dive in and work long hours and care for these very sick patients and ultimately share their experiences so that we could do it better as these patients continue to flow through our systems,” she said. “It has been very invigorating.”
The pandemic has also put a spotlight on the importance of being flexible, as well as various problems with how health care systems operate, “which, for people in our field, gets us both excited and gives us a lot of work to do,” said Dr. Gottenborg. “Our residents see that and feel that and will hopefully continue to hold that torch in hospital medicine.”
In spite of everything, Dr. Rawal believes this is an exhilarating time to be a trainee. “They’re getting an opportunity that none of us got. Usually, when policies are made, we really don’t see the immediate impact.” But with recent mandates like masks and social distancing, “the rate of change that they get to see things happen is exciting. They’re going to be a very exciting group of physicians.”
Hospitalist movers and shakers – December 2021
Narine Sargsyan, MD, recently was named the 2021 Alton Memorial Hospital (Alton, Ill.) Chairman’s Award winner. Serving as BJC Medical Group’s hospitalist medical director and hospital department chief of medicine, Dr. Sargsyan won the award based on the nominations of her fellow physicians.
The Chairman’s Award goes to an Alton Memorial staff member acknowledged for contributions to the facility and the community, including promotion and execution of outstanding customer service. Dr. Sargsyan has been a point person for Alton’s treatment of patients during the COVID-19 pandemic, recruiting new hospitalists to treat hospital inpatients. She also served on a committee selecting the inaugural resident class for the Southern Illinois University School of Medicine’s Family Residency program.
Alice Tang, DO, recently was named chief medical officer at Sentara Northern Virginia Medical Center (Woodbridge, Va.). The former medical director at Sentara Lake Ridge Hospital also directed the stroke program at Sentara Northern Virginia Medical Center, so she is familiar with her new facility.
The hospital medicine veteran specialized in emergency medicine and earned her health care MBA from George Washington University. Dr. Tang said her goal as CMO is to enhance the care environment while simultaneously raising the level of the care given by Sentara providers.
Faisal Keen, MD, has been named 2021 Physician of the Year at Sarasota Memorial Hospital’s Sarasota (Fla.) campus. The award winner was selected by a panel of SMH physician leaders.
Dr. Keen has been a hospitalist at SMH Sarasota for the past 6 years.
In presenting Dr. Keen with the award, the staff paid particular compliment to the care he provided to the facility’s hundreds of COVID-19 patients throughout the pandemic. At one point during the surge, Dr. Keen worked 30 shifts during a single month. Among the praises he received during the award presentation were those for his efforts in hurricane preparedness and helping physicians at SMH utilize technology in their patient care.
Jeffrey Crowder, MSPA, PA-C, recently became the first physician assistant to be named chief of hospitalist service at Maine Veterans Affairs Medical Center (Augusta, Me.). He is the first PA to hold the position at any Maine VA hospital. Mr. Crowder held the role in an acting position for the previous year, helping Maine VA Augusta navigate the COVID-19 pandemic.
Mr. Crowder will oversee 13 physicians and 9 PAs in providing care to Maine’s veterans. Included in the facility are intensive care and medical surgery units. Mr. Crowder’s group is responsible for part-time coverage at the 60-bed Togus Community Living Center.
Southeast Iowa Regional Medical Center (West Burlington, Iowa) has expanded its hospitalist program, adding the service to its Fort Madison campus. The health system’s hospitalist program was initiated at SEIRMC’s West Burlington campus back in 2010. That facility now includes 12 full-time and five part-time hospitalist physicians.
OB Hospitalist Group (Greenville, S.C.) has been acquired by Kohlberg & Company LLC (Mount Kisco, N.Y.), giving the nation’s largest dedicated obstetric hospitalist provider a new stakeholder. OBHG hopes to expand its services, which already include 200 hospital partners across 34 states.
OBHG’s network of providers includes more than 1,100 clinicians, with sites normally featuring an OB emergency department with a practicing ob.gyn. on site around the clock. Kohlberg & Company was founded in 1987 and has organized nine private equity funds, raising $12 billion of equity capital.
Narine Sargsyan, MD, recently was named the 2021 Alton Memorial Hospital (Alton, Ill.) Chairman’s Award winner. Serving as BJC Medical Group’s hospitalist medical director and hospital department chief of medicine, Dr. Sargsyan won the award based on the nominations of her fellow physicians.
The Chairman’s Award goes to an Alton Memorial staff member acknowledged for contributions to the facility and the community, including promotion and execution of outstanding customer service. Dr. Sargsyan has been a point person for Alton’s treatment of patients during the COVID-19 pandemic, recruiting new hospitalists to treat hospital inpatients. She also served on a committee selecting the inaugural resident class for the Southern Illinois University School of Medicine’s Family Residency program.
Alice Tang, DO, recently was named chief medical officer at Sentara Northern Virginia Medical Center (Woodbridge, Va.). The former medical director at Sentara Lake Ridge Hospital also directed the stroke program at Sentara Northern Virginia Medical Center, so she is familiar with her new facility.
The hospital medicine veteran specialized in emergency medicine and earned her health care MBA from George Washington University. Dr. Tang said her goal as CMO is to enhance the care environment while simultaneously raising the level of the care given by Sentara providers.
Faisal Keen, MD, has been named 2021 Physician of the Year at Sarasota Memorial Hospital’s Sarasota (Fla.) campus. The award winner was selected by a panel of SMH physician leaders.
Dr. Keen has been a hospitalist at SMH Sarasota for the past 6 years.
In presenting Dr. Keen with the award, the staff paid particular compliment to the care he provided to the facility’s hundreds of COVID-19 patients throughout the pandemic. At one point during the surge, Dr. Keen worked 30 shifts during a single month. Among the praises he received during the award presentation were those for his efforts in hurricane preparedness and helping physicians at SMH utilize technology in their patient care.
Jeffrey Crowder, MSPA, PA-C, recently became the first physician assistant to be named chief of hospitalist service at Maine Veterans Affairs Medical Center (Augusta, Me.). He is the first PA to hold the position at any Maine VA hospital. Mr. Crowder held the role in an acting position for the previous year, helping Maine VA Augusta navigate the COVID-19 pandemic.
Mr. Crowder will oversee 13 physicians and 9 PAs in providing care to Maine’s veterans. Included in the facility are intensive care and medical surgery units. Mr. Crowder’s group is responsible for part-time coverage at the 60-bed Togus Community Living Center.
Southeast Iowa Regional Medical Center (West Burlington, Iowa) has expanded its hospitalist program, adding the service to its Fort Madison campus. The health system’s hospitalist program was initiated at SEIRMC’s West Burlington campus back in 2010. That facility now includes 12 full-time and five part-time hospitalist physicians.
OB Hospitalist Group (Greenville, S.C.) has been acquired by Kohlberg & Company LLC (Mount Kisco, N.Y.), giving the nation’s largest dedicated obstetric hospitalist provider a new stakeholder. OBHG hopes to expand its services, which already include 200 hospital partners across 34 states.
OBHG’s network of providers includes more than 1,100 clinicians, with sites normally featuring an OB emergency department with a practicing ob.gyn. on site around the clock. Kohlberg & Company was founded in 1987 and has organized nine private equity funds, raising $12 billion of equity capital.
Narine Sargsyan, MD, recently was named the 2021 Alton Memorial Hospital (Alton, Ill.) Chairman’s Award winner. Serving as BJC Medical Group’s hospitalist medical director and hospital department chief of medicine, Dr. Sargsyan won the award based on the nominations of her fellow physicians.
The Chairman’s Award goes to an Alton Memorial staff member acknowledged for contributions to the facility and the community, including promotion and execution of outstanding customer service. Dr. Sargsyan has been a point person for Alton’s treatment of patients during the COVID-19 pandemic, recruiting new hospitalists to treat hospital inpatients. She also served on a committee selecting the inaugural resident class for the Southern Illinois University School of Medicine’s Family Residency program.
Alice Tang, DO, recently was named chief medical officer at Sentara Northern Virginia Medical Center (Woodbridge, Va.). The former medical director at Sentara Lake Ridge Hospital also directed the stroke program at Sentara Northern Virginia Medical Center, so she is familiar with her new facility.
The hospital medicine veteran specialized in emergency medicine and earned her health care MBA from George Washington University. Dr. Tang said her goal as CMO is to enhance the care environment while simultaneously raising the level of the care given by Sentara providers.
Faisal Keen, MD, has been named 2021 Physician of the Year at Sarasota Memorial Hospital’s Sarasota (Fla.) campus. The award winner was selected by a panel of SMH physician leaders.
Dr. Keen has been a hospitalist at SMH Sarasota for the past 6 years.
In presenting Dr. Keen with the award, the staff paid particular compliment to the care he provided to the facility’s hundreds of COVID-19 patients throughout the pandemic. At one point during the surge, Dr. Keen worked 30 shifts during a single month. Among the praises he received during the award presentation were those for his efforts in hurricane preparedness and helping physicians at SMH utilize technology in their patient care.
Jeffrey Crowder, MSPA, PA-C, recently became the first physician assistant to be named chief of hospitalist service at Maine Veterans Affairs Medical Center (Augusta, Me.). He is the first PA to hold the position at any Maine VA hospital. Mr. Crowder held the role in an acting position for the previous year, helping Maine VA Augusta navigate the COVID-19 pandemic.
Mr. Crowder will oversee 13 physicians and 9 PAs in providing care to Maine’s veterans. Included in the facility are intensive care and medical surgery units. Mr. Crowder’s group is responsible for part-time coverage at the 60-bed Togus Community Living Center.
Southeast Iowa Regional Medical Center (West Burlington, Iowa) has expanded its hospitalist program, adding the service to its Fort Madison campus. The health system’s hospitalist program was initiated at SEIRMC’s West Burlington campus back in 2010. That facility now includes 12 full-time and five part-time hospitalist physicians.
OB Hospitalist Group (Greenville, S.C.) has been acquired by Kohlberg & Company LLC (Mount Kisco, N.Y.), giving the nation’s largest dedicated obstetric hospitalist provider a new stakeholder. OBHG hopes to expand its services, which already include 200 hospital partners across 34 states.
OBHG’s network of providers includes more than 1,100 clinicians, with sites normally featuring an OB emergency department with a practicing ob.gyn. on site around the clock. Kohlberg & Company was founded in 1987 and has organized nine private equity funds, raising $12 billion of equity capital.
What does it mean to be a trustworthy male ally?
“If you want to be trusted, be trustworthy” – Stephen Covey
A few years ago, while working in my office, a female colleague stopped by for a casual chat. During the course of the conversation, she noticed that I did not have any diplomas or certificates hanging on my office walls. Instead, there were clusters of pictures drawn by my children, family photos, and a white board with my “to-do” list. The only wall art was a print of Banksy’s “The Thinker Monkey,” which depicts a monkey with its fist to its chin similar to Rodin’s famous sculpture, “Le Penseur.”
When asked why I didn’t hang any diplomas or awards, I replied that I preferred to keep my office atmosphere light and fun, and to focus on future goals rather than past accomplishments. I could see her jaw tense. Her frustration appeared deep, but it was for reasons beyond just my self-righteous tone. She said, “You know, I appreciate your focus on future goals, but it’s a pretty privileged position to not have to worry about sharing your accomplishments publicly.”
What followed was a discussion that was generative, enlightening, uncomfortable, and necessary. I had never considered what I chose to hang (or not hang) on my office walls as a privilege, and that was exactly the point. She described numerous episodes when her accomplishments were overlooked or (worse) attributed to a male colleague because she was a woman. I began to understand that graceful self-promotion is not optional for many women in medicine, it is a necessary skill.
This is just one example of how my privilege as a male in medicine contributed to my ignorance of the gender inequities that my female coworkers have faced throughout their careers. My colleague showed a lot of grace by taking the time to help me navigate my male privilege in a constructive manner. I decided to learn more about gender inequities, and eventually determined that I was woefully inadequate as a male ally, not by refusal but by ignorance. I wanted to start earning my colleague’s trust that I would be an ally that she could count on.
Trustworthiness
I wanted to be a trustworthy ally, but what does that entail? Perhaps we can learn from medical education. Trust is a complex construct that is increasingly used as a framework for assessing medical students and residents, such as with entrustable professional activities (EPAs).1,2 Multiple studies have examined the characteristics that make a learner “trustworthy” when determining how much supervision is required.3-8 Ten Cate and Chen performed an interpretivist, narrative review to synthesize the medical education literature on learner trustworthiness in the past 15 years,9 developing five major themes that contribute to trustworthiness: Humility, Capability, Agency, Reliability, and Integrity. Let’s examine each of these through the lens of male allyship.
Humility
Humility involves knowing one’s limits, asking for help, and being receptive to feedback.9 The first thing men need to do is to put their egos in check and recognize that women do not need rescuing; they need partnership. Systemic inequities have led to men holding the majority of leadership positions and significant sociopolitical capital, and correcting these inequities is more feasible when those in leadership and positions of power contribute. Women don’t need knights in shining armor, they need collaborative activism.
Humility also means a willingness to admit fallibility and to ask for help. Men often don’t know what they don’t know (see my foibles in the opening). As David G. Smith, PhD, and W. Brad Johnson, PhD, write in their book, “Good Guys,” “There are no perfect allies. As you work to become a better ally for the women around you, you will undoubtedly make a mistake.”10 Men must accept feedback on their shortcomings as allies without feeling as though they are losing their sociopolitical standing. Allyship for women does not mean there is a devaluing of men. We must escape a “zero-sum” mindset. Mistakes are where growth happens, but only if we approach our missteps with humility.
Capability
Capability entails having the necessary knowledge, skills, and attitudes to be a strong ally. Allyship is not intuitive for most men for several reasons. Many men do not experience the same biases or systemic inequities that women do, and therefore perceive them less frequently. I want to acknowledge that men can be victims of other systemic biases such as those against one’s race, ethnicity, gender identity, sexual orientation, religion, or any number of factors. Men who face inequities for these other reasons may be more cognizant of the biases women face. Even so, allyship is a skill that few men have been explicitly taught. Even if taught, few standard or organized mechanisms for feedback on allyship capability exist. How, then, can men become capable allies?
Just like in medical education, men must become self-directed learners who seek to build capability and receive feedback on their performance as allies. Men should seek allyship training through local women-in-medicine programs or organizations, or through the increasing number of national education options such as the recent ADVANCE PHM Gender Equity Symposium. As with learning any skill, men should go to the literature, seeking knowledge from experts in the field. I recommend starting with “Good Guys: How Men Can Be Better Allies for Women in the Workplace10 or “Athena Rising: How and Why Men Should Mentor Women.”11 Both books, by Dr. Smith and Dr. Johnson, are great entry points into the gender allyship literature. Seek out other resources from local experts on gender equity and allyship. Both aforementioned books were recommended to me by a friend and gender equity expert; without her guidance I would not have known where to start.
Agency
Agency involves being proactive and engaged rather than passive or apathetic. Men must be enthusiastic allies who seek out opportunities to mentor and sponsor women rather than waiting for others to ask. Agency requires being curious and passionate about improving. Most men in medicine are not openly and explicitly misogynistic or sexist, but many are only passive when it comes to gender equity and allyship. Trustworthy allyship entails turning passive support into active change. Not sure how to start? A good first step is to ask female colleagues questions such as, “What can I do to be a better ally for you in the workplace?” or “What are some things at work that are most challenging to you, but I might not notice because I’m a man?” Curiosity is the springboard toward agency.
Reliability
Reliability means being conscientious, accountable, and doing what we say we will do. Nothing undermines trustworthiness faster than making a commitment and not following through. Allyship cannot be a show or an attempt to get public plaudits. It is a longitudinal commitment to supporting women through individual mentorship and sponsorship, and to work toward institutional and systems change.
Reliability also means taking an equitable approach to what Dr. Smith and Dr. Johnson call “office housework.” They define this as “administrative work that is necessary but undervalued, unlikely to lead to promotion, and disproportionately assigned to women.”10 In medicine, these tasks include organizing meetings, taking notes, planning social events, and remembering to celebrate colleagues’ achievements and milestones. Men should take on more of these tasks and advocate for change when the distribution of office housework in their workplace is inequitably directed toward women.
Integrity
Integrity involves honesty, professionalism, and benevolence. It is about making the morally correct choice even if there is potential risk. When men see gender inequity, they have an obligation to speak up. Whether it is overtly misogynistic behavior, subtle sexism, use of gendered language, inequitable distribution of office housework, lack of inclusivity and recognition for women, or another form of inequity, men must act with integrity and make it clear that they are partnering with women for change. Integrity means being an ally even when women are not present, and advocating that women be “at the table” for important conversations.
Beyond the individual
Allyship cannot end with individual actions; systems changes that build trustworthy institutions are necessary. Organizational leaders must approach gender conversations with humility to critically examine inequities and agency to implement meaningful changes. Workplace cultures and institutional policies should be reviewed with an eye toward system-level integrity and reliability for promoting and supporting women. Ongoing faculty and staff development programs must provide men with the knowledge, skills, and attitudes (capability) to be strong allies. We have a long history of male-dominated institutions that are unfair or (worse) unsafe for women. Many systems are designed in a way that disadvantages women. These systems must be redesigned through an equity lens to start building trust with women in medicine.
Becoming trustworthy is a process
Even the best male allies have room to improve their trustworthiness. Many men (myself included) have a LOT of room to improve, but they should not get discouraged by the amount of ground to be gained. Steady, deliberate improvement in men’s humility, capability, agency, reliability, and integrity can build the foundation of trust with female colleagues. Trust takes time. It takes effort. It takes vulnerability. It is an ongoing, developmental process that requires deliberate practice, frequent reflection, and feedback from our female colleagues.
Dr. Kinnear is associate professor of internal medicine and pediatrics in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center and University of Cincinnati Medical Center. He is associate program director for the Med-Peds and Internal Medicine residency programs.
References
1. Ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013 Mar;5(1):157-8. doi: 10.4300/JGME-D-12-00380.1.
2. Ten Cate O. Entrustment decisions: Bringing the patient into the assessment equation. Acad Med. 2017 Jun;92(6):736-8. doi: 10.1097/ACM.0000000000001623.
3. Kennedy TJT et al. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008 Oct;83(10 Suppl):S89-92. doi: 10.1097/ACM.0b013e318183c8b7.
4. Choo KJ et al. How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis. J Hosp Med. 2014 Mar;9(3):169-75. doi: 10.1002/jhm.2150.
5. Hauer KE et al. How clinical supervisors develop trust in their trainees: A qualitative study. Med Educ. 2015 Aug;49(8):783-95. doi: 10.1111/medu.12745.
6. Sterkenburg A et al. When do supervising physicians decide to entrust residents with unsupervised tasks? Acad Med. 2010 Sep;85(9):1408-17. doi: 10.1097/ACM.0b013e3181eab0ec.
7. Sheu L et al. How supervisor experience influences trust, supervision, and trainee learning: A qualitative study. Acad Med. 2017 Sep;92(9):1320-7. doi: 10.1097/ACM.0000000000001560.
8. Pingree EW et al. Encouraging entrustment: A qualitative study of resident behaviors that promote entrustment. Acad Med. 2020 Nov;95(11):1718-25. doi: 10.1097/ACM.0000000000003487.
9. Ten Cate O, Chen HC. The ingredients of a rich entrustment decision. Med Teach. 2020 Dec;42(12):1413-20. doi: 10.1080/0142159X.2020.1817348.
10. Smith DG, Johnson WB. Good guys: How men can be better allies for women in the workplace: Harvard Business School Publishing Corporation 2020.
11. Johnson WB, Smith D. Athena rising: How and why men should mentor women: Routledge 2016.
“If you want to be trusted, be trustworthy” – Stephen Covey
A few years ago, while working in my office, a female colleague stopped by for a casual chat. During the course of the conversation, she noticed that I did not have any diplomas or certificates hanging on my office walls. Instead, there were clusters of pictures drawn by my children, family photos, and a white board with my “to-do” list. The only wall art was a print of Banksy’s “The Thinker Monkey,” which depicts a monkey with its fist to its chin similar to Rodin’s famous sculpture, “Le Penseur.”
When asked why I didn’t hang any diplomas or awards, I replied that I preferred to keep my office atmosphere light and fun, and to focus on future goals rather than past accomplishments. I could see her jaw tense. Her frustration appeared deep, but it was for reasons beyond just my self-righteous tone. She said, “You know, I appreciate your focus on future goals, but it’s a pretty privileged position to not have to worry about sharing your accomplishments publicly.”
What followed was a discussion that was generative, enlightening, uncomfortable, and necessary. I had never considered what I chose to hang (or not hang) on my office walls as a privilege, and that was exactly the point. She described numerous episodes when her accomplishments were overlooked or (worse) attributed to a male colleague because she was a woman. I began to understand that graceful self-promotion is not optional for many women in medicine, it is a necessary skill.
This is just one example of how my privilege as a male in medicine contributed to my ignorance of the gender inequities that my female coworkers have faced throughout their careers. My colleague showed a lot of grace by taking the time to help me navigate my male privilege in a constructive manner. I decided to learn more about gender inequities, and eventually determined that I was woefully inadequate as a male ally, not by refusal but by ignorance. I wanted to start earning my colleague’s trust that I would be an ally that she could count on.
Trustworthiness
I wanted to be a trustworthy ally, but what does that entail? Perhaps we can learn from medical education. Trust is a complex construct that is increasingly used as a framework for assessing medical students and residents, such as with entrustable professional activities (EPAs).1,2 Multiple studies have examined the characteristics that make a learner “trustworthy” when determining how much supervision is required.3-8 Ten Cate and Chen performed an interpretivist, narrative review to synthesize the medical education literature on learner trustworthiness in the past 15 years,9 developing five major themes that contribute to trustworthiness: Humility, Capability, Agency, Reliability, and Integrity. Let’s examine each of these through the lens of male allyship.
Humility
Humility involves knowing one’s limits, asking for help, and being receptive to feedback.9 The first thing men need to do is to put their egos in check and recognize that women do not need rescuing; they need partnership. Systemic inequities have led to men holding the majority of leadership positions and significant sociopolitical capital, and correcting these inequities is more feasible when those in leadership and positions of power contribute. Women don’t need knights in shining armor, they need collaborative activism.
Humility also means a willingness to admit fallibility and to ask for help. Men often don’t know what they don’t know (see my foibles in the opening). As David G. Smith, PhD, and W. Brad Johnson, PhD, write in their book, “Good Guys,” “There are no perfect allies. As you work to become a better ally for the women around you, you will undoubtedly make a mistake.”10 Men must accept feedback on their shortcomings as allies without feeling as though they are losing their sociopolitical standing. Allyship for women does not mean there is a devaluing of men. We must escape a “zero-sum” mindset. Mistakes are where growth happens, but only if we approach our missteps with humility.
Capability
Capability entails having the necessary knowledge, skills, and attitudes to be a strong ally. Allyship is not intuitive for most men for several reasons. Many men do not experience the same biases or systemic inequities that women do, and therefore perceive them less frequently. I want to acknowledge that men can be victims of other systemic biases such as those against one’s race, ethnicity, gender identity, sexual orientation, religion, or any number of factors. Men who face inequities for these other reasons may be more cognizant of the biases women face. Even so, allyship is a skill that few men have been explicitly taught. Even if taught, few standard or organized mechanisms for feedback on allyship capability exist. How, then, can men become capable allies?
Just like in medical education, men must become self-directed learners who seek to build capability and receive feedback on their performance as allies. Men should seek allyship training through local women-in-medicine programs or organizations, or through the increasing number of national education options such as the recent ADVANCE PHM Gender Equity Symposium. As with learning any skill, men should go to the literature, seeking knowledge from experts in the field. I recommend starting with “Good Guys: How Men Can Be Better Allies for Women in the Workplace10 or “Athena Rising: How and Why Men Should Mentor Women.”11 Both books, by Dr. Smith and Dr. Johnson, are great entry points into the gender allyship literature. Seek out other resources from local experts on gender equity and allyship. Both aforementioned books were recommended to me by a friend and gender equity expert; without her guidance I would not have known where to start.
Agency
Agency involves being proactive and engaged rather than passive or apathetic. Men must be enthusiastic allies who seek out opportunities to mentor and sponsor women rather than waiting for others to ask. Agency requires being curious and passionate about improving. Most men in medicine are not openly and explicitly misogynistic or sexist, but many are only passive when it comes to gender equity and allyship. Trustworthy allyship entails turning passive support into active change. Not sure how to start? A good first step is to ask female colleagues questions such as, “What can I do to be a better ally for you in the workplace?” or “What are some things at work that are most challenging to you, but I might not notice because I’m a man?” Curiosity is the springboard toward agency.
Reliability
Reliability means being conscientious, accountable, and doing what we say we will do. Nothing undermines trustworthiness faster than making a commitment and not following through. Allyship cannot be a show or an attempt to get public plaudits. It is a longitudinal commitment to supporting women through individual mentorship and sponsorship, and to work toward institutional and systems change.
Reliability also means taking an equitable approach to what Dr. Smith and Dr. Johnson call “office housework.” They define this as “administrative work that is necessary but undervalued, unlikely to lead to promotion, and disproportionately assigned to women.”10 In medicine, these tasks include organizing meetings, taking notes, planning social events, and remembering to celebrate colleagues’ achievements and milestones. Men should take on more of these tasks and advocate for change when the distribution of office housework in their workplace is inequitably directed toward women.
Integrity
Integrity involves honesty, professionalism, and benevolence. It is about making the morally correct choice even if there is potential risk. When men see gender inequity, they have an obligation to speak up. Whether it is overtly misogynistic behavior, subtle sexism, use of gendered language, inequitable distribution of office housework, lack of inclusivity and recognition for women, or another form of inequity, men must act with integrity and make it clear that they are partnering with women for change. Integrity means being an ally even when women are not present, and advocating that women be “at the table” for important conversations.
Beyond the individual
Allyship cannot end with individual actions; systems changes that build trustworthy institutions are necessary. Organizational leaders must approach gender conversations with humility to critically examine inequities and agency to implement meaningful changes. Workplace cultures and institutional policies should be reviewed with an eye toward system-level integrity and reliability for promoting and supporting women. Ongoing faculty and staff development programs must provide men with the knowledge, skills, and attitudes (capability) to be strong allies. We have a long history of male-dominated institutions that are unfair or (worse) unsafe for women. Many systems are designed in a way that disadvantages women. These systems must be redesigned through an equity lens to start building trust with women in medicine.
Becoming trustworthy is a process
Even the best male allies have room to improve their trustworthiness. Many men (myself included) have a LOT of room to improve, but they should not get discouraged by the amount of ground to be gained. Steady, deliberate improvement in men’s humility, capability, agency, reliability, and integrity can build the foundation of trust with female colleagues. Trust takes time. It takes effort. It takes vulnerability. It is an ongoing, developmental process that requires deliberate practice, frequent reflection, and feedback from our female colleagues.
Dr. Kinnear is associate professor of internal medicine and pediatrics in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center and University of Cincinnati Medical Center. He is associate program director for the Med-Peds and Internal Medicine residency programs.
References
1. Ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013 Mar;5(1):157-8. doi: 10.4300/JGME-D-12-00380.1.
2. Ten Cate O. Entrustment decisions: Bringing the patient into the assessment equation. Acad Med. 2017 Jun;92(6):736-8. doi: 10.1097/ACM.0000000000001623.
3. Kennedy TJT et al. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008 Oct;83(10 Suppl):S89-92. doi: 10.1097/ACM.0b013e318183c8b7.
4. Choo KJ et al. How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis. J Hosp Med. 2014 Mar;9(3):169-75. doi: 10.1002/jhm.2150.
5. Hauer KE et al. How clinical supervisors develop trust in their trainees: A qualitative study. Med Educ. 2015 Aug;49(8):783-95. doi: 10.1111/medu.12745.
6. Sterkenburg A et al. When do supervising physicians decide to entrust residents with unsupervised tasks? Acad Med. 2010 Sep;85(9):1408-17. doi: 10.1097/ACM.0b013e3181eab0ec.
7. Sheu L et al. How supervisor experience influences trust, supervision, and trainee learning: A qualitative study. Acad Med. 2017 Sep;92(9):1320-7. doi: 10.1097/ACM.0000000000001560.
8. Pingree EW et al. Encouraging entrustment: A qualitative study of resident behaviors that promote entrustment. Acad Med. 2020 Nov;95(11):1718-25. doi: 10.1097/ACM.0000000000003487.
9. Ten Cate O, Chen HC. The ingredients of a rich entrustment decision. Med Teach. 2020 Dec;42(12):1413-20. doi: 10.1080/0142159X.2020.1817348.
10. Smith DG, Johnson WB. Good guys: How men can be better allies for women in the workplace: Harvard Business School Publishing Corporation 2020.
11. Johnson WB, Smith D. Athena rising: How and why men should mentor women: Routledge 2016.
“If you want to be trusted, be trustworthy” – Stephen Covey
A few years ago, while working in my office, a female colleague stopped by for a casual chat. During the course of the conversation, she noticed that I did not have any diplomas or certificates hanging on my office walls. Instead, there were clusters of pictures drawn by my children, family photos, and a white board with my “to-do” list. The only wall art was a print of Banksy’s “The Thinker Monkey,” which depicts a monkey with its fist to its chin similar to Rodin’s famous sculpture, “Le Penseur.”
When asked why I didn’t hang any diplomas or awards, I replied that I preferred to keep my office atmosphere light and fun, and to focus on future goals rather than past accomplishments. I could see her jaw tense. Her frustration appeared deep, but it was for reasons beyond just my self-righteous tone. She said, “You know, I appreciate your focus on future goals, but it’s a pretty privileged position to not have to worry about sharing your accomplishments publicly.”
What followed was a discussion that was generative, enlightening, uncomfortable, and necessary. I had never considered what I chose to hang (or not hang) on my office walls as a privilege, and that was exactly the point. She described numerous episodes when her accomplishments were overlooked or (worse) attributed to a male colleague because she was a woman. I began to understand that graceful self-promotion is not optional for many women in medicine, it is a necessary skill.
This is just one example of how my privilege as a male in medicine contributed to my ignorance of the gender inequities that my female coworkers have faced throughout their careers. My colleague showed a lot of grace by taking the time to help me navigate my male privilege in a constructive manner. I decided to learn more about gender inequities, and eventually determined that I was woefully inadequate as a male ally, not by refusal but by ignorance. I wanted to start earning my colleague’s trust that I would be an ally that she could count on.
Trustworthiness
I wanted to be a trustworthy ally, but what does that entail? Perhaps we can learn from medical education. Trust is a complex construct that is increasingly used as a framework for assessing medical students and residents, such as with entrustable professional activities (EPAs).1,2 Multiple studies have examined the characteristics that make a learner “trustworthy” when determining how much supervision is required.3-8 Ten Cate and Chen performed an interpretivist, narrative review to synthesize the medical education literature on learner trustworthiness in the past 15 years,9 developing five major themes that contribute to trustworthiness: Humility, Capability, Agency, Reliability, and Integrity. Let’s examine each of these through the lens of male allyship.
Humility
Humility involves knowing one’s limits, asking for help, and being receptive to feedback.9 The first thing men need to do is to put their egos in check and recognize that women do not need rescuing; they need partnership. Systemic inequities have led to men holding the majority of leadership positions and significant sociopolitical capital, and correcting these inequities is more feasible when those in leadership and positions of power contribute. Women don’t need knights in shining armor, they need collaborative activism.
Humility also means a willingness to admit fallibility and to ask for help. Men often don’t know what they don’t know (see my foibles in the opening). As David G. Smith, PhD, and W. Brad Johnson, PhD, write in their book, “Good Guys,” “There are no perfect allies. As you work to become a better ally for the women around you, you will undoubtedly make a mistake.”10 Men must accept feedback on their shortcomings as allies without feeling as though they are losing their sociopolitical standing. Allyship for women does not mean there is a devaluing of men. We must escape a “zero-sum” mindset. Mistakes are where growth happens, but only if we approach our missteps with humility.
Capability
Capability entails having the necessary knowledge, skills, and attitudes to be a strong ally. Allyship is not intuitive for most men for several reasons. Many men do not experience the same biases or systemic inequities that women do, and therefore perceive them less frequently. I want to acknowledge that men can be victims of other systemic biases such as those against one’s race, ethnicity, gender identity, sexual orientation, religion, or any number of factors. Men who face inequities for these other reasons may be more cognizant of the biases women face. Even so, allyship is a skill that few men have been explicitly taught. Even if taught, few standard or organized mechanisms for feedback on allyship capability exist. How, then, can men become capable allies?
Just like in medical education, men must become self-directed learners who seek to build capability and receive feedback on their performance as allies. Men should seek allyship training through local women-in-medicine programs or organizations, or through the increasing number of national education options such as the recent ADVANCE PHM Gender Equity Symposium. As with learning any skill, men should go to the literature, seeking knowledge from experts in the field. I recommend starting with “Good Guys: How Men Can Be Better Allies for Women in the Workplace10 or “Athena Rising: How and Why Men Should Mentor Women.”11 Both books, by Dr. Smith and Dr. Johnson, are great entry points into the gender allyship literature. Seek out other resources from local experts on gender equity and allyship. Both aforementioned books were recommended to me by a friend and gender equity expert; without her guidance I would not have known where to start.
Agency
Agency involves being proactive and engaged rather than passive or apathetic. Men must be enthusiastic allies who seek out opportunities to mentor and sponsor women rather than waiting for others to ask. Agency requires being curious and passionate about improving. Most men in medicine are not openly and explicitly misogynistic or sexist, but many are only passive when it comes to gender equity and allyship. Trustworthy allyship entails turning passive support into active change. Not sure how to start? A good first step is to ask female colleagues questions such as, “What can I do to be a better ally for you in the workplace?” or “What are some things at work that are most challenging to you, but I might not notice because I’m a man?” Curiosity is the springboard toward agency.
Reliability
Reliability means being conscientious, accountable, and doing what we say we will do. Nothing undermines trustworthiness faster than making a commitment and not following through. Allyship cannot be a show or an attempt to get public plaudits. It is a longitudinal commitment to supporting women through individual mentorship and sponsorship, and to work toward institutional and systems change.
Reliability also means taking an equitable approach to what Dr. Smith and Dr. Johnson call “office housework.” They define this as “administrative work that is necessary but undervalued, unlikely to lead to promotion, and disproportionately assigned to women.”10 In medicine, these tasks include organizing meetings, taking notes, planning social events, and remembering to celebrate colleagues’ achievements and milestones. Men should take on more of these tasks and advocate for change when the distribution of office housework in their workplace is inequitably directed toward women.
Integrity
Integrity involves honesty, professionalism, and benevolence. It is about making the morally correct choice even if there is potential risk. When men see gender inequity, they have an obligation to speak up. Whether it is overtly misogynistic behavior, subtle sexism, use of gendered language, inequitable distribution of office housework, lack of inclusivity and recognition for women, or another form of inequity, men must act with integrity and make it clear that they are partnering with women for change. Integrity means being an ally even when women are not present, and advocating that women be “at the table” for important conversations.
Beyond the individual
Allyship cannot end with individual actions; systems changes that build trustworthy institutions are necessary. Organizational leaders must approach gender conversations with humility to critically examine inequities and agency to implement meaningful changes. Workplace cultures and institutional policies should be reviewed with an eye toward system-level integrity and reliability for promoting and supporting women. Ongoing faculty and staff development programs must provide men with the knowledge, skills, and attitudes (capability) to be strong allies. We have a long history of male-dominated institutions that are unfair or (worse) unsafe for women. Many systems are designed in a way that disadvantages women. These systems must be redesigned through an equity lens to start building trust with women in medicine.
Becoming trustworthy is a process
Even the best male allies have room to improve their trustworthiness. Many men (myself included) have a LOT of room to improve, but they should not get discouraged by the amount of ground to be gained. Steady, deliberate improvement in men’s humility, capability, agency, reliability, and integrity can build the foundation of trust with female colleagues. Trust takes time. It takes effort. It takes vulnerability. It is an ongoing, developmental process that requires deliberate practice, frequent reflection, and feedback from our female colleagues.
Dr. Kinnear is associate professor of internal medicine and pediatrics in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center and University of Cincinnati Medical Center. He is associate program director for the Med-Peds and Internal Medicine residency programs.
References
1. Ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013 Mar;5(1):157-8. doi: 10.4300/JGME-D-12-00380.1.
2. Ten Cate O. Entrustment decisions: Bringing the patient into the assessment equation. Acad Med. 2017 Jun;92(6):736-8. doi: 10.1097/ACM.0000000000001623.
3. Kennedy TJT et al. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008 Oct;83(10 Suppl):S89-92. doi: 10.1097/ACM.0b013e318183c8b7.
4. Choo KJ et al. How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis. J Hosp Med. 2014 Mar;9(3):169-75. doi: 10.1002/jhm.2150.
5. Hauer KE et al. How clinical supervisors develop trust in their trainees: A qualitative study. Med Educ. 2015 Aug;49(8):783-95. doi: 10.1111/medu.12745.
6. Sterkenburg A et al. When do supervising physicians decide to entrust residents with unsupervised tasks? Acad Med. 2010 Sep;85(9):1408-17. doi: 10.1097/ACM.0b013e3181eab0ec.
7. Sheu L et al. How supervisor experience influences trust, supervision, and trainee learning: A qualitative study. Acad Med. 2017 Sep;92(9):1320-7. doi: 10.1097/ACM.0000000000001560.
8. Pingree EW et al. Encouraging entrustment: A qualitative study of resident behaviors that promote entrustment. Acad Med. 2020 Nov;95(11):1718-25. doi: 10.1097/ACM.0000000000003487.
9. Ten Cate O, Chen HC. The ingredients of a rich entrustment decision. Med Teach. 2020 Dec;42(12):1413-20. doi: 10.1080/0142159X.2020.1817348.
10. Smith DG, Johnson WB. Good guys: How men can be better allies for women in the workplace: Harvard Business School Publishing Corporation 2020.
11. Johnson WB, Smith D. Athena rising: How and why men should mentor women: Routledge 2016.
Hospitalist movers and shakers - November 2021
Vineet Chopra, MD, MSc, FHM, recently became chair of the Department of Medicine at the University of Colorado School of Medicine, Aurora. He had previously been the chief of the Division of Hospital Medicine at the University of Michigan Health system. He assumed his new role in October 2021.
Dr. Chopra, who specializes in research and mentorship in patient safety, helped create innovations in care delivery at the University of Michigan, including direct care hospitalist services at VA Ann Arbor Health Care and two other community hospitals.
In his safety-conscious research, Dr. Chopra focuses on preventing complications created within the hospital environment. He also is the first hospitalist to be named deputy editor of the Annals of Internal Medicine. He has written more than 250 peer-reviewed articles. Among the myriad awards he has received, Dr. Chopra recently earned the Kaiser Permanente Award for Clinical Teaching at the UM School of Medicine.
Steve Phillipson, MD, FHM, has been named regional director of hospital medicine at Aspirus Health (Wausau, Wisc.). Dr. Phillipson will oversee the hospitalist programs at 17 Aspirus hospitals in Wisconsin and Michigan.
Dr. Phillipson has worked with Aspirus since 2009, with stints in the emergency department and as a hospitalist. As Aspirus Wausau Hospital director of medicine, he chaired the facility’s COVID-19 treatment team.
Hackensack (N.J.) Meridian University Medical Center has hired Patricia (Patti) L. Fisher, MD, MHA, to be the institution’s chief medical officer. Dr. Fisher joined the medical center from Central Vermont Medical Center where she served as chief medical officer and chief safety officer, with direct oversight of hospital risk management, operations of all hospital-based services, IS services and quality including patient safety and regulatory compliance.
As a board-certified hospitalist, Dr. Fisher also served as clinical assistant professor in the Department of Family Medicine at the University of Vermont, Burlington. Dr. Fisher earned her medical degree from The University of Texas in Houston and completed residency through Forbes Family Practice Residency in Pittsburgh.
Martin Chaney, MD, has been chosen by the Maury Regional Health Board of Trustees to serve as interim chief executive officer. He was formerly the chief medical officer at MRH, which is based in Columbia, Tenn. Dr. Chaney began his new role in October, replacing Alan Watson, the CEO since 2012.
Dr. Chaney has spent 18 of his 25 years in medicine with MRH, where most recently he has focused on clinical quality, physician recruitment, and establishing and expanding the hospital medicine program.
Hyung (Harry) Cho, MD, SFHM, has been placed on Modern Healthcare’s Top 25 Innovators list for 2021, getting recognized for innovation and leadership in creating value and safety initiatives in New York City’s public health system. Dr. Cho became NYC Health + Hospitals’ first chief value officer in 2019, and his programs have created an estimated $11 million in savings per year by preventing unnecessary testing and treatment that can lead to patient harm.
A member of the Society of Hospital Medicine’s editorial advisory board, Dr. Cho is also SHM’s hospitalist liaison with the COVID-19 Real-Time Learning Network, which collaborates with the Centers for Disease Control and Prevention and the Infectious Diseases Society of America.
Raymond Kiser, MD, a hospitalist and nephrologist at Columbus (Ind.) Regional Health, has been named the Douglas J. Leonard Caregiver of the Year. The award is given by the Indiana Hospital Association to health care workers whose care is considered exemplary by both peers and patients.
Dr. Kiser has been with CRH for 7 years, including stints as associate chief medical officer and chief of staff.
Justin Buchholz, DO, has been elevated to medical director of the hospitalist teams at Regional Medical Center (Alamosa, Colo.) and Conejos County Hospital (La Jara, Colo.). Dr. Buchholz has been a full-time hospitalist and assistant medical director at Parkview Medical Center (Pueblo, Colo.) for the past 3 years. He also worked on a part-time basis seeing patients at the Regional Medical Center.
Dr. Buchholz completed his residency at Parkview Medical Center and was named Resident of the Year in his final year with the internal medicine program.
Kenneth Mishark, MD, SFHM, a hospitalist with the Mayo Clinic Hospital (Tucson, Ariz.), will serve on the board of directors for Anigent, a drug diversion-prevention company based in Chesterfield, Mo. He will be charged with helping Anigent better serve health systems with its drug-diversion software.
Dr. Mishark is vice-chair of diversion prevention across the whole Mayo Clinic. A one-time physician in the United States Air Force, Dr. Mishark previously has been the Mayo Clinic’s Healthcare Information Coordination Committee chair.
Core Clinical Partners (Tulsa, Okla.) has announced it will join with Hillcrest HealthCare System (Tulsa, Okla.) to provide hospitalist services to Hillcrest’s eight sites across Oklahoma. The partnership will begin at four locations in December 2021, and four others in March 2022.
In expanding its services, Core Clinical Partners will create 70 new physician positions, as well as a systemwide medical director. Core will manage hospitalist operations at Hillcrest Medical Center, Hillcrest Hospital South, Hillcrest Hospital Pryor, Hillcrest Hospital Claremore, Bailey Medical Center, Hillcrest Hospital Cushing, Hillcrest Hospital Henryetta, and Tulsa Spine and Specialty Hospital.
Vineet Chopra, MD, MSc, FHM, recently became chair of the Department of Medicine at the University of Colorado School of Medicine, Aurora. He had previously been the chief of the Division of Hospital Medicine at the University of Michigan Health system. He assumed his new role in October 2021.
Dr. Chopra, who specializes in research and mentorship in patient safety, helped create innovations in care delivery at the University of Michigan, including direct care hospitalist services at VA Ann Arbor Health Care and two other community hospitals.
In his safety-conscious research, Dr. Chopra focuses on preventing complications created within the hospital environment. He also is the first hospitalist to be named deputy editor of the Annals of Internal Medicine. He has written more than 250 peer-reviewed articles. Among the myriad awards he has received, Dr. Chopra recently earned the Kaiser Permanente Award for Clinical Teaching at the UM School of Medicine.
Steve Phillipson, MD, FHM, has been named regional director of hospital medicine at Aspirus Health (Wausau, Wisc.). Dr. Phillipson will oversee the hospitalist programs at 17 Aspirus hospitals in Wisconsin and Michigan.
Dr. Phillipson has worked with Aspirus since 2009, with stints in the emergency department and as a hospitalist. As Aspirus Wausau Hospital director of medicine, he chaired the facility’s COVID-19 treatment team.
Hackensack (N.J.) Meridian University Medical Center has hired Patricia (Patti) L. Fisher, MD, MHA, to be the institution’s chief medical officer. Dr. Fisher joined the medical center from Central Vermont Medical Center where she served as chief medical officer and chief safety officer, with direct oversight of hospital risk management, operations of all hospital-based services, IS services and quality including patient safety and regulatory compliance.
As a board-certified hospitalist, Dr. Fisher also served as clinical assistant professor in the Department of Family Medicine at the University of Vermont, Burlington. Dr. Fisher earned her medical degree from The University of Texas in Houston and completed residency through Forbes Family Practice Residency in Pittsburgh.
Martin Chaney, MD, has been chosen by the Maury Regional Health Board of Trustees to serve as interim chief executive officer. He was formerly the chief medical officer at MRH, which is based in Columbia, Tenn. Dr. Chaney began his new role in October, replacing Alan Watson, the CEO since 2012.
Dr. Chaney has spent 18 of his 25 years in medicine with MRH, where most recently he has focused on clinical quality, physician recruitment, and establishing and expanding the hospital medicine program.
Hyung (Harry) Cho, MD, SFHM, has been placed on Modern Healthcare’s Top 25 Innovators list for 2021, getting recognized for innovation and leadership in creating value and safety initiatives in New York City’s public health system. Dr. Cho became NYC Health + Hospitals’ first chief value officer in 2019, and his programs have created an estimated $11 million in savings per year by preventing unnecessary testing and treatment that can lead to patient harm.
A member of the Society of Hospital Medicine’s editorial advisory board, Dr. Cho is also SHM’s hospitalist liaison with the COVID-19 Real-Time Learning Network, which collaborates with the Centers for Disease Control and Prevention and the Infectious Diseases Society of America.
Raymond Kiser, MD, a hospitalist and nephrologist at Columbus (Ind.) Regional Health, has been named the Douglas J. Leonard Caregiver of the Year. The award is given by the Indiana Hospital Association to health care workers whose care is considered exemplary by both peers and patients.
Dr. Kiser has been with CRH for 7 years, including stints as associate chief medical officer and chief of staff.
Justin Buchholz, DO, has been elevated to medical director of the hospitalist teams at Regional Medical Center (Alamosa, Colo.) and Conejos County Hospital (La Jara, Colo.). Dr. Buchholz has been a full-time hospitalist and assistant medical director at Parkview Medical Center (Pueblo, Colo.) for the past 3 years. He also worked on a part-time basis seeing patients at the Regional Medical Center.
Dr. Buchholz completed his residency at Parkview Medical Center and was named Resident of the Year in his final year with the internal medicine program.
Kenneth Mishark, MD, SFHM, a hospitalist with the Mayo Clinic Hospital (Tucson, Ariz.), will serve on the board of directors for Anigent, a drug diversion-prevention company based in Chesterfield, Mo. He will be charged with helping Anigent better serve health systems with its drug-diversion software.
Dr. Mishark is vice-chair of diversion prevention across the whole Mayo Clinic. A one-time physician in the United States Air Force, Dr. Mishark previously has been the Mayo Clinic’s Healthcare Information Coordination Committee chair.
Core Clinical Partners (Tulsa, Okla.) has announced it will join with Hillcrest HealthCare System (Tulsa, Okla.) to provide hospitalist services to Hillcrest’s eight sites across Oklahoma. The partnership will begin at four locations in December 2021, and four others in March 2022.
In expanding its services, Core Clinical Partners will create 70 new physician positions, as well as a systemwide medical director. Core will manage hospitalist operations at Hillcrest Medical Center, Hillcrest Hospital South, Hillcrest Hospital Pryor, Hillcrest Hospital Claremore, Bailey Medical Center, Hillcrest Hospital Cushing, Hillcrest Hospital Henryetta, and Tulsa Spine and Specialty Hospital.
Vineet Chopra, MD, MSc, FHM, recently became chair of the Department of Medicine at the University of Colorado School of Medicine, Aurora. He had previously been the chief of the Division of Hospital Medicine at the University of Michigan Health system. He assumed his new role in October 2021.
Dr. Chopra, who specializes in research and mentorship in patient safety, helped create innovations in care delivery at the University of Michigan, including direct care hospitalist services at VA Ann Arbor Health Care and two other community hospitals.
In his safety-conscious research, Dr. Chopra focuses on preventing complications created within the hospital environment. He also is the first hospitalist to be named deputy editor of the Annals of Internal Medicine. He has written more than 250 peer-reviewed articles. Among the myriad awards he has received, Dr. Chopra recently earned the Kaiser Permanente Award for Clinical Teaching at the UM School of Medicine.
Steve Phillipson, MD, FHM, has been named regional director of hospital medicine at Aspirus Health (Wausau, Wisc.). Dr. Phillipson will oversee the hospitalist programs at 17 Aspirus hospitals in Wisconsin and Michigan.
Dr. Phillipson has worked with Aspirus since 2009, with stints in the emergency department and as a hospitalist. As Aspirus Wausau Hospital director of medicine, he chaired the facility’s COVID-19 treatment team.
Hackensack (N.J.) Meridian University Medical Center has hired Patricia (Patti) L. Fisher, MD, MHA, to be the institution’s chief medical officer. Dr. Fisher joined the medical center from Central Vermont Medical Center where she served as chief medical officer and chief safety officer, with direct oversight of hospital risk management, operations of all hospital-based services, IS services and quality including patient safety and regulatory compliance.
As a board-certified hospitalist, Dr. Fisher also served as clinical assistant professor in the Department of Family Medicine at the University of Vermont, Burlington. Dr. Fisher earned her medical degree from The University of Texas in Houston and completed residency through Forbes Family Practice Residency in Pittsburgh.
Martin Chaney, MD, has been chosen by the Maury Regional Health Board of Trustees to serve as interim chief executive officer. He was formerly the chief medical officer at MRH, which is based in Columbia, Tenn. Dr. Chaney began his new role in October, replacing Alan Watson, the CEO since 2012.
Dr. Chaney has spent 18 of his 25 years in medicine with MRH, where most recently he has focused on clinical quality, physician recruitment, and establishing and expanding the hospital medicine program.
Hyung (Harry) Cho, MD, SFHM, has been placed on Modern Healthcare’s Top 25 Innovators list for 2021, getting recognized for innovation and leadership in creating value and safety initiatives in New York City’s public health system. Dr. Cho became NYC Health + Hospitals’ first chief value officer in 2019, and his programs have created an estimated $11 million in savings per year by preventing unnecessary testing and treatment that can lead to patient harm.
A member of the Society of Hospital Medicine’s editorial advisory board, Dr. Cho is also SHM’s hospitalist liaison with the COVID-19 Real-Time Learning Network, which collaborates with the Centers for Disease Control and Prevention and the Infectious Diseases Society of America.
Raymond Kiser, MD, a hospitalist and nephrologist at Columbus (Ind.) Regional Health, has been named the Douglas J. Leonard Caregiver of the Year. The award is given by the Indiana Hospital Association to health care workers whose care is considered exemplary by both peers and patients.
Dr. Kiser has been with CRH for 7 years, including stints as associate chief medical officer and chief of staff.
Justin Buchholz, DO, has been elevated to medical director of the hospitalist teams at Regional Medical Center (Alamosa, Colo.) and Conejos County Hospital (La Jara, Colo.). Dr. Buchholz has been a full-time hospitalist and assistant medical director at Parkview Medical Center (Pueblo, Colo.) for the past 3 years. He also worked on a part-time basis seeing patients at the Regional Medical Center.
Dr. Buchholz completed his residency at Parkview Medical Center and was named Resident of the Year in his final year with the internal medicine program.
Kenneth Mishark, MD, SFHM, a hospitalist with the Mayo Clinic Hospital (Tucson, Ariz.), will serve on the board of directors for Anigent, a drug diversion-prevention company based in Chesterfield, Mo. He will be charged with helping Anigent better serve health systems with its drug-diversion software.
Dr. Mishark is vice-chair of diversion prevention across the whole Mayo Clinic. A one-time physician in the United States Air Force, Dr. Mishark previously has been the Mayo Clinic’s Healthcare Information Coordination Committee chair.
Core Clinical Partners (Tulsa, Okla.) has announced it will join with Hillcrest HealthCare System (Tulsa, Okla.) to provide hospitalist services to Hillcrest’s eight sites across Oklahoma. The partnership will begin at four locations in December 2021, and four others in March 2022.
In expanding its services, Core Clinical Partners will create 70 new physician positions, as well as a systemwide medical director. Core will manage hospitalist operations at Hillcrest Medical Center, Hillcrest Hospital South, Hillcrest Hospital Pryor, Hillcrest Hospital Claremore, Bailey Medical Center, Hillcrest Hospital Cushing, Hillcrest Hospital Henryetta, and Tulsa Spine and Specialty Hospital.
Resident physician work-hour regulations associated with improved physician safety and health
Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted a consecutive work-hour restriction of 16 hours for first-year residents. Reports of these changes have focused on patient safety, resident education, and resident well-being. The impact on resident safety had not been addressed.
Study design: Prospective cohort study.
Setting: U.S. Academic institutions training resident physicians.
Synopsis: This study compared first-year resident physicians from 2002 to 2007 (pre-implementation) and 2014 to 2017 (post-implementation). In all, 5,680 pre-implementation residents and 9,596 post-implementation residents consented to the study. With the 2011 ACGME restriction, the risk of motor vehicle crash decreased 24% (relative risk [RR] .76; .67-.85), and percutaneous injury risk decreased more than 40% (RR .54; .48-.61). Although weekly work hours were significantly higher pre-implementation, self-reported hours involved in patient care were similar for both groups.
While this large, well-powered study suggests extended work-hour restrictions for resident physicians improve their safety, the study is limited by self-reporting of resident physicians. As the ACGME has re-introduced extended duration shifts for first-year resident physicians, hospitalists should advocate for objective physician safety studies in relation to extended-hour shifts.
Bottom line: The 2011 ACGME work-hour reform for first-year physicians improved their safety and health.
Citation: Weaver MD et al. The association between resident physician work-hour regulations and physician safety and health. Am J Med. 2020 July;133(7):e343-54.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted a consecutive work-hour restriction of 16 hours for first-year residents. Reports of these changes have focused on patient safety, resident education, and resident well-being. The impact on resident safety had not been addressed.
Study design: Prospective cohort study.
Setting: U.S. Academic institutions training resident physicians.
Synopsis: This study compared first-year resident physicians from 2002 to 2007 (pre-implementation) and 2014 to 2017 (post-implementation). In all, 5,680 pre-implementation residents and 9,596 post-implementation residents consented to the study. With the 2011 ACGME restriction, the risk of motor vehicle crash decreased 24% (relative risk [RR] .76; .67-.85), and percutaneous injury risk decreased more than 40% (RR .54; .48-.61). Although weekly work hours were significantly higher pre-implementation, self-reported hours involved in patient care were similar for both groups.
While this large, well-powered study suggests extended work-hour restrictions for resident physicians improve their safety, the study is limited by self-reporting of resident physicians. As the ACGME has re-introduced extended duration shifts for first-year resident physicians, hospitalists should advocate for objective physician safety studies in relation to extended-hour shifts.
Bottom line: The 2011 ACGME work-hour reform for first-year physicians improved their safety and health.
Citation: Weaver MD et al. The association between resident physician work-hour regulations and physician safety and health. Am J Med. 2020 July;133(7):e343-54.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted a consecutive work-hour restriction of 16 hours for first-year residents. Reports of these changes have focused on patient safety, resident education, and resident well-being. The impact on resident safety had not been addressed.
Study design: Prospective cohort study.
Setting: U.S. Academic institutions training resident physicians.
Synopsis: This study compared first-year resident physicians from 2002 to 2007 (pre-implementation) and 2014 to 2017 (post-implementation). In all, 5,680 pre-implementation residents and 9,596 post-implementation residents consented to the study. With the 2011 ACGME restriction, the risk of motor vehicle crash decreased 24% (relative risk [RR] .76; .67-.85), and percutaneous injury risk decreased more than 40% (RR .54; .48-.61). Although weekly work hours were significantly higher pre-implementation, self-reported hours involved in patient care were similar for both groups.
While this large, well-powered study suggests extended work-hour restrictions for resident physicians improve their safety, the study is limited by self-reporting of resident physicians. As the ACGME has re-introduced extended duration shifts for first-year resident physicians, hospitalists should advocate for objective physician safety studies in relation to extended-hour shifts.
Bottom line: The 2011 ACGME work-hour reform for first-year physicians improved their safety and health.
Citation: Weaver MD et al. The association between resident physician work-hour regulations and physician safety and health. Am J Med. 2020 July;133(7):e343-54.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Mentoring is key to growing women’s leadership in medicine
Men may think they are supportive of women in the workplace, but if you ask women, they say there is a discrepancy, according to W. Brad Johnson, PhD, a clinical psychologist and professor at the United States Naval Academy in Annapolis, Md.
“We may think we are acting as allies to women because we believe in it, but it may not be showing up in the execution,” he said in a presentation at the virtual Advance PHM Gender Equity Conference.
Although women currently account for the majority of medical school students, they make up only 16% of the population of medical school deans, 18% of department chairs, and 25% of full professors, according to 2019 data from the Association of American Medical Colleges, Dr. Johnson said.
The “missing ingredient” in increasing the number of women in medical faculty positions is that women are less mentored. Some barriers to mentorship include men’s concerns that women will take offers of mentorship the wrong way, but “it is incredibly rare for women to make a false accusation” of harassment in a mentorship situation, said Dr. Johnson.
Dr. Johnson offered some guidance for how men can become better allies for women in the workplace through interpersonal allyship, public allyship, and systemic allyship.
Interpersonal allyship and opportunities for mentoring women in medicine start by building trust, friendship, and collegiality between men and women colleagues, Dr. Johnson explained.
He provided some guidance for men to “sharpen their gender intelligence,” which starts with listening. Surveys of women show that they would like male colleagues to be a sounding board, rather than simply offering to jump in with a fix for a problem. “Show humility,” he said, don’t be afraid to ask questions, and don’t assume that a colleague wants something in particular because she is a woman.
“A lot of men get stuck on breaking the ice and getting started with a mentoring conversation,” Dr. Johnson said. One way to is by telling a female colleague who gave an outstanding presentation, or has conducted outstanding research, that you want to keep her in your organization and that she is welcome to talk about her goals. Women appreciate mentoring as “a constellation” and a way to build support, and have one person introduce them to others who can build a network and promote opportunities for leadership. Also, he encouraged men to be open to feedback from female colleagues on how they can be more supportive in the workplace. Sincerity and genuine effort go a long way towards improving gender equity.
Public allyship can take many forms, including putting women center stage to share their own ideas, Dr. Johnson said. Surveys of women show that they often feel dismissed or slighted and not given credit for an idea that was ultimately presented by a male colleague, he noted. Instead, be a female colleague’s biggest fan, and put her in the spotlight if she is truly the expert on the topic at hand.
Women also may be hamstrung in acceding to leadership positions by the use of subjective evaluations, said Dr. Johnson. He cited a 2018 analysis of 81,000 performance evaluations by the Harvard Business Review in which the top positive term used to describe men was analytical, while the top positive term used to describe women was compassionate. “All these things go with pay and promotions, and they tend to disadvantage women,” he said.
Dr. Johnson provided two avenues for how men can effectively show up as allies for women in the workplace.
First, start at the top. CEOs and senior men in an organization have a unique opportunity to set an example and talk publicly about supporting and promoting women, said Dr. Johnson.
Second, work at the grassroots level. He encouraged men to educate themselves with gender equity workshops, and act as collaborators. “Don’t tell women how to do gender equity,” he said, but show up, be present, be mindful, and be patient if someone seems not to respond immediately to opportunities for mentoring or sponsorship.
“Claiming ally or mentor status with someone from a nondominant group may invoke power, privilege, or even ownership” without intention, he said. Instead, “Always let others label you and the nature of the relationship [such as ally or mentor].”
For more information about allyship, visit Dr. Johnson’s website, workplaceallies.com.
Men may think they are supportive of women in the workplace, but if you ask women, they say there is a discrepancy, according to W. Brad Johnson, PhD, a clinical psychologist and professor at the United States Naval Academy in Annapolis, Md.
“We may think we are acting as allies to women because we believe in it, but it may not be showing up in the execution,” he said in a presentation at the virtual Advance PHM Gender Equity Conference.
Although women currently account for the majority of medical school students, they make up only 16% of the population of medical school deans, 18% of department chairs, and 25% of full professors, according to 2019 data from the Association of American Medical Colleges, Dr. Johnson said.
The “missing ingredient” in increasing the number of women in medical faculty positions is that women are less mentored. Some barriers to mentorship include men’s concerns that women will take offers of mentorship the wrong way, but “it is incredibly rare for women to make a false accusation” of harassment in a mentorship situation, said Dr. Johnson.
Dr. Johnson offered some guidance for how men can become better allies for women in the workplace through interpersonal allyship, public allyship, and systemic allyship.
Interpersonal allyship and opportunities for mentoring women in medicine start by building trust, friendship, and collegiality between men and women colleagues, Dr. Johnson explained.
He provided some guidance for men to “sharpen their gender intelligence,” which starts with listening. Surveys of women show that they would like male colleagues to be a sounding board, rather than simply offering to jump in with a fix for a problem. “Show humility,” he said, don’t be afraid to ask questions, and don’t assume that a colleague wants something in particular because she is a woman.
“A lot of men get stuck on breaking the ice and getting started with a mentoring conversation,” Dr. Johnson said. One way to is by telling a female colleague who gave an outstanding presentation, or has conducted outstanding research, that you want to keep her in your organization and that she is welcome to talk about her goals. Women appreciate mentoring as “a constellation” and a way to build support, and have one person introduce them to others who can build a network and promote opportunities for leadership. Also, he encouraged men to be open to feedback from female colleagues on how they can be more supportive in the workplace. Sincerity and genuine effort go a long way towards improving gender equity.
Public allyship can take many forms, including putting women center stage to share their own ideas, Dr. Johnson said. Surveys of women show that they often feel dismissed or slighted and not given credit for an idea that was ultimately presented by a male colleague, he noted. Instead, be a female colleague’s biggest fan, and put her in the spotlight if she is truly the expert on the topic at hand.
Women also may be hamstrung in acceding to leadership positions by the use of subjective evaluations, said Dr. Johnson. He cited a 2018 analysis of 81,000 performance evaluations by the Harvard Business Review in which the top positive term used to describe men was analytical, while the top positive term used to describe women was compassionate. “All these things go with pay and promotions, and they tend to disadvantage women,” he said.
Dr. Johnson provided two avenues for how men can effectively show up as allies for women in the workplace.
First, start at the top. CEOs and senior men in an organization have a unique opportunity to set an example and talk publicly about supporting and promoting women, said Dr. Johnson.
Second, work at the grassroots level. He encouraged men to educate themselves with gender equity workshops, and act as collaborators. “Don’t tell women how to do gender equity,” he said, but show up, be present, be mindful, and be patient if someone seems not to respond immediately to opportunities for mentoring or sponsorship.
“Claiming ally or mentor status with someone from a nondominant group may invoke power, privilege, or even ownership” without intention, he said. Instead, “Always let others label you and the nature of the relationship [such as ally or mentor].”
For more information about allyship, visit Dr. Johnson’s website, workplaceallies.com.
Men may think they are supportive of women in the workplace, but if you ask women, they say there is a discrepancy, according to W. Brad Johnson, PhD, a clinical psychologist and professor at the United States Naval Academy in Annapolis, Md.
“We may think we are acting as allies to women because we believe in it, but it may not be showing up in the execution,” he said in a presentation at the virtual Advance PHM Gender Equity Conference.
Although women currently account for the majority of medical school students, they make up only 16% of the population of medical school deans, 18% of department chairs, and 25% of full professors, according to 2019 data from the Association of American Medical Colleges, Dr. Johnson said.
The “missing ingredient” in increasing the number of women in medical faculty positions is that women are less mentored. Some barriers to mentorship include men’s concerns that women will take offers of mentorship the wrong way, but “it is incredibly rare for women to make a false accusation” of harassment in a mentorship situation, said Dr. Johnson.
Dr. Johnson offered some guidance for how men can become better allies for women in the workplace through interpersonal allyship, public allyship, and systemic allyship.
Interpersonal allyship and opportunities for mentoring women in medicine start by building trust, friendship, and collegiality between men and women colleagues, Dr. Johnson explained.
He provided some guidance for men to “sharpen their gender intelligence,” which starts with listening. Surveys of women show that they would like male colleagues to be a sounding board, rather than simply offering to jump in with a fix for a problem. “Show humility,” he said, don’t be afraid to ask questions, and don’t assume that a colleague wants something in particular because she is a woman.
“A lot of men get stuck on breaking the ice and getting started with a mentoring conversation,” Dr. Johnson said. One way to is by telling a female colleague who gave an outstanding presentation, or has conducted outstanding research, that you want to keep her in your organization and that she is welcome to talk about her goals. Women appreciate mentoring as “a constellation” and a way to build support, and have one person introduce them to others who can build a network and promote opportunities for leadership. Also, he encouraged men to be open to feedback from female colleagues on how they can be more supportive in the workplace. Sincerity and genuine effort go a long way towards improving gender equity.
Public allyship can take many forms, including putting women center stage to share their own ideas, Dr. Johnson said. Surveys of women show that they often feel dismissed or slighted and not given credit for an idea that was ultimately presented by a male colleague, he noted. Instead, be a female colleague’s biggest fan, and put her in the spotlight if she is truly the expert on the topic at hand.
Women also may be hamstrung in acceding to leadership positions by the use of subjective evaluations, said Dr. Johnson. He cited a 2018 analysis of 81,000 performance evaluations by the Harvard Business Review in which the top positive term used to describe men was analytical, while the top positive term used to describe women was compassionate. “All these things go with pay and promotions, and they tend to disadvantage women,” he said.
Dr. Johnson provided two avenues for how men can effectively show up as allies for women in the workplace.
First, start at the top. CEOs and senior men in an organization have a unique opportunity to set an example and talk publicly about supporting and promoting women, said Dr. Johnson.
Second, work at the grassroots level. He encouraged men to educate themselves with gender equity workshops, and act as collaborators. “Don’t tell women how to do gender equity,” he said, but show up, be present, be mindful, and be patient if someone seems not to respond immediately to opportunities for mentoring or sponsorship.
“Claiming ally or mentor status with someone from a nondominant group may invoke power, privilege, or even ownership” without intention, he said. Instead, “Always let others label you and the nature of the relationship [such as ally or mentor].”
For more information about allyship, visit Dr. Johnson’s website, workplaceallies.com.
FROM THE ADVANCE PHM GENDER EQUITY CONFERENCE
Hospitals must identify and empower women leaders
Many potential leaders in academic medicine go unidentified, and finding those leaders is key to improving gender equity in academic medicine, said Nancy Spector, MD, in a presentation at the virtual Advance PHM Gender Equity Conference.
“I think it is important to reframe what it means to be a leader, and to empower yourself to think of yourself as a leader,” said Dr. Spector, executive director for executive leadership in academic medicine program at Drexel University, Philadelphia.
“Some of the best leaders I know do not have titles,” she emphasized.
Steps to stimulate the system changes needed to promote gender equity include building policies around the life cycle, revising departmental and division governance, and tracking metrics at the individual, departmental, and organizational level, Dr. Spector said.
Aligning gender-equity efforts with institutional priorities and navigating politics to effect changes in the gender equity landscape are ongoing objectives, she said.
Dr. Spector offered advice to men and women looking to shift the system and promote gender equity. She emphasized the challenge of overcoming psychological associations of men and women in leadership roles. “Men are more often associated with agentic qualities, which convey assertion and control,” she said. Men in leadership are more often described as aggressive, ambitious, dominant, self-confident, forceful, self-reliant, and individualistic.
By contrast, “women are associated with communal qualities, which convey a concern for compassionate treatment of others,” and are more often described as affectionate, helpful, kind, sympathetic, sensitive, gentle, and well spoken, she noted.
Although agentic traits are most often associated with effective leadership, in fact, “the most effective contemporary leaders have both agentic and communal traits,” said Dr. Spector.
However, “if a woman leader is very communal, she may be viewed as not assertive enough, and it she is highly agentic, she is criticized for being too domineering or controlling,” she said.
To help get past these associations, changes are needed at the individual level, leader level, and institutional level, Dr. Spector said.
On the individual level, women seeking to improve the situation for gender equity should engage with male allies and build a pipeline of mentorship and sponsorship to help identify future leaders, she said.
Women and men should obtain leadership training, and “become a student of leadership,” she advised. “Be in a learning mode,” and then think how to apply what you have learned, which may include setting challenging learning goals, experimenting with alternative strategies, learning about different leadership styles, and learning about differences in leaders’ values and attitudes.
For women, being pulled in many directions is the norm. “Are you being strategic with how you serve on committees?” Dr. Spector asked.
Make the most of how you choose to share your time, and “garner the skill of graceful self-promotion, which is often a hard skill for women,” she noted. She also urged women to make the most of professional networking and social capital.
At the leader level, the advice Dr. Spector offered to leaders on building gender equity in their institutions include ensuring a critical mass of women in leadership track positions. “Avoid having a sole woman member of a team,” she said.
Dr. Spector also emphasized the importance of giving employees with family responsibilities more time for promotion, and welcoming back women who step away from the workforce and choose to return. Encourage men to participate in family-friendly benefits. “Standardize processes that support the life cycle of a faculty member or the person you’re hiring,” and ensure inclusive times and venues for major meetings, committee work, and social events, she added.
Dr. Spector’s strategies for institutions include quantifying disparities by using real time dashboards to show both leading and lagging indicators, setting goals, and measuring achievements.
“Create an infrastructure to support women’s leadership,” she said. Such an infrastructure could include not only robust committees for women in science and medicine, but also supporting women to attend leadership training both inside and outside their institutions.
Dr. Spector noted that professional organizations also have a role to play in support of women’s leadership.
“Make a public pledge to gender equity,” she said. She encouraged professional organizations to tie diversity and inclusion metrics to performance reviews, and to prioritize the examination and mitigation of disparities, and report challenges and successes.
When creating policies to promote gender equity, “get out of your silo,” Dr. Spector emphasized. Understand the drivers rather than simply judging the behaviors.
“Even if we disagree on something, we need to work together, and empower everyone to be thoughtful drivers of change,” she concluded.
Dr. Spector disclosed grant funding from the Department of Health & Human Services, the Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute. She also disclosed receiving monetary awards, honoraria, and travel reimbursement from multiple academic and professional organization for teaching and consulting programs. Dr. Spector also cofunded and holds equity interest in the I-PASS Patient Safety Institute, a company created to assist institutions in implementing the I-PASS Handoff Program.
Many potential leaders in academic medicine go unidentified, and finding those leaders is key to improving gender equity in academic medicine, said Nancy Spector, MD, in a presentation at the virtual Advance PHM Gender Equity Conference.
“I think it is important to reframe what it means to be a leader, and to empower yourself to think of yourself as a leader,” said Dr. Spector, executive director for executive leadership in academic medicine program at Drexel University, Philadelphia.
“Some of the best leaders I know do not have titles,” she emphasized.
Steps to stimulate the system changes needed to promote gender equity include building policies around the life cycle, revising departmental and division governance, and tracking metrics at the individual, departmental, and organizational level, Dr. Spector said.
Aligning gender-equity efforts with institutional priorities and navigating politics to effect changes in the gender equity landscape are ongoing objectives, she said.
Dr. Spector offered advice to men and women looking to shift the system and promote gender equity. She emphasized the challenge of overcoming psychological associations of men and women in leadership roles. “Men are more often associated with agentic qualities, which convey assertion and control,” she said. Men in leadership are more often described as aggressive, ambitious, dominant, self-confident, forceful, self-reliant, and individualistic.
By contrast, “women are associated with communal qualities, which convey a concern for compassionate treatment of others,” and are more often described as affectionate, helpful, kind, sympathetic, sensitive, gentle, and well spoken, she noted.
Although agentic traits are most often associated with effective leadership, in fact, “the most effective contemporary leaders have both agentic and communal traits,” said Dr. Spector.
However, “if a woman leader is very communal, she may be viewed as not assertive enough, and it she is highly agentic, she is criticized for being too domineering or controlling,” she said.
To help get past these associations, changes are needed at the individual level, leader level, and institutional level, Dr. Spector said.
On the individual level, women seeking to improve the situation for gender equity should engage with male allies and build a pipeline of mentorship and sponsorship to help identify future leaders, she said.
Women and men should obtain leadership training, and “become a student of leadership,” she advised. “Be in a learning mode,” and then think how to apply what you have learned, which may include setting challenging learning goals, experimenting with alternative strategies, learning about different leadership styles, and learning about differences in leaders’ values and attitudes.
For women, being pulled in many directions is the norm. “Are you being strategic with how you serve on committees?” Dr. Spector asked.
Make the most of how you choose to share your time, and “garner the skill of graceful self-promotion, which is often a hard skill for women,” she noted. She also urged women to make the most of professional networking and social capital.
At the leader level, the advice Dr. Spector offered to leaders on building gender equity in their institutions include ensuring a critical mass of women in leadership track positions. “Avoid having a sole woman member of a team,” she said.
Dr. Spector also emphasized the importance of giving employees with family responsibilities more time for promotion, and welcoming back women who step away from the workforce and choose to return. Encourage men to participate in family-friendly benefits. “Standardize processes that support the life cycle of a faculty member or the person you’re hiring,” and ensure inclusive times and venues for major meetings, committee work, and social events, she added.
Dr. Spector’s strategies for institutions include quantifying disparities by using real time dashboards to show both leading and lagging indicators, setting goals, and measuring achievements.
“Create an infrastructure to support women’s leadership,” she said. Such an infrastructure could include not only robust committees for women in science and medicine, but also supporting women to attend leadership training both inside and outside their institutions.
Dr. Spector noted that professional organizations also have a role to play in support of women’s leadership.
“Make a public pledge to gender equity,” she said. She encouraged professional organizations to tie diversity and inclusion metrics to performance reviews, and to prioritize the examination and mitigation of disparities, and report challenges and successes.
When creating policies to promote gender equity, “get out of your silo,” Dr. Spector emphasized. Understand the drivers rather than simply judging the behaviors.
“Even if we disagree on something, we need to work together, and empower everyone to be thoughtful drivers of change,” she concluded.
Dr. Spector disclosed grant funding from the Department of Health & Human Services, the Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute. She also disclosed receiving monetary awards, honoraria, and travel reimbursement from multiple academic and professional organization for teaching and consulting programs. Dr. Spector also cofunded and holds equity interest in the I-PASS Patient Safety Institute, a company created to assist institutions in implementing the I-PASS Handoff Program.
Many potential leaders in academic medicine go unidentified, and finding those leaders is key to improving gender equity in academic medicine, said Nancy Spector, MD, in a presentation at the virtual Advance PHM Gender Equity Conference.
“I think it is important to reframe what it means to be a leader, and to empower yourself to think of yourself as a leader,” said Dr. Spector, executive director for executive leadership in academic medicine program at Drexel University, Philadelphia.
“Some of the best leaders I know do not have titles,” she emphasized.
Steps to stimulate the system changes needed to promote gender equity include building policies around the life cycle, revising departmental and division governance, and tracking metrics at the individual, departmental, and organizational level, Dr. Spector said.
Aligning gender-equity efforts with institutional priorities and navigating politics to effect changes in the gender equity landscape are ongoing objectives, she said.
Dr. Spector offered advice to men and women looking to shift the system and promote gender equity. She emphasized the challenge of overcoming psychological associations of men and women in leadership roles. “Men are more often associated with agentic qualities, which convey assertion and control,” she said. Men in leadership are more often described as aggressive, ambitious, dominant, self-confident, forceful, self-reliant, and individualistic.
By contrast, “women are associated with communal qualities, which convey a concern for compassionate treatment of others,” and are more often described as affectionate, helpful, kind, sympathetic, sensitive, gentle, and well spoken, she noted.
Although agentic traits are most often associated with effective leadership, in fact, “the most effective contemporary leaders have both agentic and communal traits,” said Dr. Spector.
However, “if a woman leader is very communal, she may be viewed as not assertive enough, and it she is highly agentic, she is criticized for being too domineering or controlling,” she said.
To help get past these associations, changes are needed at the individual level, leader level, and institutional level, Dr. Spector said.
On the individual level, women seeking to improve the situation for gender equity should engage with male allies and build a pipeline of mentorship and sponsorship to help identify future leaders, she said.
Women and men should obtain leadership training, and “become a student of leadership,” she advised. “Be in a learning mode,” and then think how to apply what you have learned, which may include setting challenging learning goals, experimenting with alternative strategies, learning about different leadership styles, and learning about differences in leaders’ values and attitudes.
For women, being pulled in many directions is the norm. “Are you being strategic with how you serve on committees?” Dr. Spector asked.
Make the most of how you choose to share your time, and “garner the skill of graceful self-promotion, which is often a hard skill for women,” she noted. She also urged women to make the most of professional networking and social capital.
At the leader level, the advice Dr. Spector offered to leaders on building gender equity in their institutions include ensuring a critical mass of women in leadership track positions. “Avoid having a sole woman member of a team,” she said.
Dr. Spector also emphasized the importance of giving employees with family responsibilities more time for promotion, and welcoming back women who step away from the workforce and choose to return. Encourage men to participate in family-friendly benefits. “Standardize processes that support the life cycle of a faculty member or the person you’re hiring,” and ensure inclusive times and venues for major meetings, committee work, and social events, she added.
Dr. Spector’s strategies for institutions include quantifying disparities by using real time dashboards to show both leading and lagging indicators, setting goals, and measuring achievements.
“Create an infrastructure to support women’s leadership,” she said. Such an infrastructure could include not only robust committees for women in science and medicine, but also supporting women to attend leadership training both inside and outside their institutions.
Dr. Spector noted that professional organizations also have a role to play in support of women’s leadership.
“Make a public pledge to gender equity,” she said. She encouraged professional organizations to tie diversity and inclusion metrics to performance reviews, and to prioritize the examination and mitigation of disparities, and report challenges and successes.
When creating policies to promote gender equity, “get out of your silo,” Dr. Spector emphasized. Understand the drivers rather than simply judging the behaviors.
“Even if we disagree on something, we need to work together, and empower everyone to be thoughtful drivers of change,” she concluded.
Dr. Spector disclosed grant funding from the Department of Health & Human Services, the Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute. She also disclosed receiving monetary awards, honoraria, and travel reimbursement from multiple academic and professional organization for teaching and consulting programs. Dr. Spector also cofunded and holds equity interest in the I-PASS Patient Safety Institute, a company created to assist institutions in implementing the I-PASS Handoff Program.
FROM THE ADVANCE PHM GENDER EQUITY CONFERENCE
Hospitalist movers and shakers – September 2021
Chi-Cheng Huang, MD, SFHM, was recently was named one of the Notable Asian/Pacific American Physicians in U.S. History by the American Board of Internal Medicine. May was Asian/Pacific American Heritage Month. Dr. Huang is the executive medical director and service line director of general medicine and hospital medicine within the Wake Forest Baptist Health System (Winston-Salem, N.C.) and associate professor at Wake Forest School of Medicine.
Dr. Huang is a board-certified hospitalist and pediatrician, and he is the founder of the Bolivian Children Project, a non-profit organization that focuses on sheltering street children in La Paz and other areas of Bolivia. Dr. Huang was inspired to start the project during a year sabbatical from medical school. He worked at an orphanage and cared for children who were victims of physical abuse. The Bolivian Children Project supports those children, and Dr. Huang’s book, When Invisible Children Sing, tells their story.
Joshua Lenchus, DO, RPh, SFHM, has been elected president of the Florida Medical Association. It is the first time in its history that the FMA will have a DO as its president. Dr. Lenchus is a hospitalist and chief medical officer at the Broward Health Medical Center in Fort Lauderdale, Fla.
Mark V. Williams, MD, MHM, will join Washington University School of Medicine and BJC HealthCare, both in St. Louis, as professor and chief for the Division of Hospital Medicine in October 2021. Dr. Williams is currently professor and director of the Center for Health Services Research at the University of Kentucky and chief quality officer at UK HealthCare, both in Lexington.
Dr. Williams was a founding member of the Society of Hospital Medicine, one of the first two elected members of the Board of SHM, its former president, founding editor of the Journal of Hospital Medicine, and principal investigator for Project BOOST. He established the first hospitalist program at a public hospital (Grady Memorial in Atlanta) in 1998, and later became the founding chief of the Division of Hospital Medicine in 2007 at Northwestern University School of Medicine in Chicago. At the University of Kentucky, he established the Center for Health Services Research and the Division of Hospital Medicine in 2014.
At Washington University, Dr. Williams will be tasked with translating the division of hospital medicine’s scholarly work, innovation, and research into practice improvement, focusing on developing new systems of health care delivery that are patient-centered, cost effective, and provide outstanding value.
Jordan Messler, MD, SFHM, has been named the new chief medical officer at Glytec (Waltham, Mass.), where he has worked as executive director of clinical practice since 2018. Dr. Messler will be tasked with leading strategy and product development while also supporting efforts in quality care, customer relations, and delivery of products.
Glytec provides insulin management software across the care continuum and is touted as the only cloud-based software provider of its kind. Dr. Messler’s background includes expertise in glycemic management. In addition, he still works as a hospitalist at Morton Plant Hospitalist Group (Clearwater, Fla.).
Dr. Messler is a senior fellow with SHM and is physician editor of SHM’s official blog The Hospital Leader.
Tiffani Maycock, DO, recently was named to the Board of Directors for the American Board of Family Medicine. Dr. Maycock is director of the Selma Family Medicine Residency Program at the University of Alabama at Birmingham, where she is an assistant professor in the department of family medicine.
Dr. Maycock helped create hospitalist services at Vaughan Regional Medical Center (Selma, Ala.) – Selma Family Medicine’s primary teaching site – and currently serves as its hospitalist director and on its Medical Executive Committee. She has worked at the facility since 2017.
Preetham Talari, MD, SFHM, has been named associate chief of quality safety for the Division of Hospital Medicine at the University of Kentucky’s UK HealthCare (Lexington, Ky.). Dr. Talari is an associate professor of internal medicine in the Division of Hospital Medicine at the UK College of Medicine.
Over the last decade, Dr. Talari’s work in quality, safety, and health care leadership has positioned him as a leader in several UK Healthcare committees and transformation projects. In his role as associate chief, Dr. Talari collaborates with hospital medicine directors, enterprise leadership, and medical education leadership to improve the system’s quality of care.
Dr. Talari is the president of the Kentucky chapter of SHM and is a member of SHM’s Hospital Quality and Patient Safety Committee.
Adrian Paraschiv, MD, FHM, is being recognized by Continental Who’s Who as a Trusted Internist and Hospitalist in the field of Medicine in acknowledgment of his commitment to providing quality health care services.
Dr. Paraschiv is a board-certified Internist at Garnet Health Medical Center in Middletown, N.Y. He also serves in an administrative capacity as the Garnet Health Doctors Hospitalist Division’s Associate Program Director. He is also the Director of Clinical Informatics. Dr. Paraschiv is certified as the Epic physician builder in analytics, information technology, and improved documentation.
DCH Health System (Tuscaloosa, Ala.) recently selected Capstone Health Services Foundation (Tuscaloosa) and IN Compass Health Inc. (Alpharetta, Ga.) as its joint hospitalist service provider for facilities in Northport and Tuscaloosa. Capstone will provide the physicians, while IN Compass will handle staffing management of the hospitalists, as well as day-to-day operations and calculating quality care metrics. The agreement is slated to begin on Oct. 1, 2021, at Northport Medical Center, and on Nov. 1, 2021, at DCH Regional Medical Center.
Capstone is an affiliate of the University of Alabama and oversees University Hospitalist Group, which currently provides hospitalists at DCH Regional Medical Center. Its partnership with IN Compass includes working together in recruiting and hiring physicians for both facilities.
UPMC Kane Medical Center (Kane, Pa.) recently announced the creation of a virtual telemedicine hospitalist program. UPMC Kane is partnering with the UPMC Center for Community Hospitalist Medicine to create this new mode of care.
Telehospitalists will care for UPMC Kane patients using advanced diagnostic technique and high-definition cameras. The physicians will bring expert service to Kane 24 hours per day utilizing physicians and specialists based in Pittsburgh. Those hospitalists will work with local nurse practitioners and support staff and deliver care to Kane patients.
Wake Forest Baptist Health (Winston-Salem, N.C.) has launched a Hospitalist at Home program with hopes of keeping patients safe while also reducing time they spend in the hospital. The telehealth initiative kicked into gear at the start of 2021 and considered the first of its kind in the region.
Patients who qualify for the program establish a plan before they leave the hospital. Wake Forest Baptist Health paramedics makes home visits and conducts care with a hospitalist reviewing the visit virtually. Those appointments continue until the patient does not require monitoring.
The impetus of creating the program was the COVID-19 pandemic, however, Wake Forest said it expects to care for between 75-100 patients through Hospitalist at Home at any one time.
Chi-Cheng Huang, MD, SFHM, was recently was named one of the Notable Asian/Pacific American Physicians in U.S. History by the American Board of Internal Medicine. May was Asian/Pacific American Heritage Month. Dr. Huang is the executive medical director and service line director of general medicine and hospital medicine within the Wake Forest Baptist Health System (Winston-Salem, N.C.) and associate professor at Wake Forest School of Medicine.
Dr. Huang is a board-certified hospitalist and pediatrician, and he is the founder of the Bolivian Children Project, a non-profit organization that focuses on sheltering street children in La Paz and other areas of Bolivia. Dr. Huang was inspired to start the project during a year sabbatical from medical school. He worked at an orphanage and cared for children who were victims of physical abuse. The Bolivian Children Project supports those children, and Dr. Huang’s book, When Invisible Children Sing, tells their story.
Joshua Lenchus, DO, RPh, SFHM, has been elected president of the Florida Medical Association. It is the first time in its history that the FMA will have a DO as its president. Dr. Lenchus is a hospitalist and chief medical officer at the Broward Health Medical Center in Fort Lauderdale, Fla.
Mark V. Williams, MD, MHM, will join Washington University School of Medicine and BJC HealthCare, both in St. Louis, as professor and chief for the Division of Hospital Medicine in October 2021. Dr. Williams is currently professor and director of the Center for Health Services Research at the University of Kentucky and chief quality officer at UK HealthCare, both in Lexington.
Dr. Williams was a founding member of the Society of Hospital Medicine, one of the first two elected members of the Board of SHM, its former president, founding editor of the Journal of Hospital Medicine, and principal investigator for Project BOOST. He established the first hospitalist program at a public hospital (Grady Memorial in Atlanta) in 1998, and later became the founding chief of the Division of Hospital Medicine in 2007 at Northwestern University School of Medicine in Chicago. At the University of Kentucky, he established the Center for Health Services Research and the Division of Hospital Medicine in 2014.
At Washington University, Dr. Williams will be tasked with translating the division of hospital medicine’s scholarly work, innovation, and research into practice improvement, focusing on developing new systems of health care delivery that are patient-centered, cost effective, and provide outstanding value.
Jordan Messler, MD, SFHM, has been named the new chief medical officer at Glytec (Waltham, Mass.), where he has worked as executive director of clinical practice since 2018. Dr. Messler will be tasked with leading strategy and product development while also supporting efforts in quality care, customer relations, and delivery of products.
Glytec provides insulin management software across the care continuum and is touted as the only cloud-based software provider of its kind. Dr. Messler’s background includes expertise in glycemic management. In addition, he still works as a hospitalist at Morton Plant Hospitalist Group (Clearwater, Fla.).
Dr. Messler is a senior fellow with SHM and is physician editor of SHM’s official blog The Hospital Leader.
Tiffani Maycock, DO, recently was named to the Board of Directors for the American Board of Family Medicine. Dr. Maycock is director of the Selma Family Medicine Residency Program at the University of Alabama at Birmingham, where she is an assistant professor in the department of family medicine.
Dr. Maycock helped create hospitalist services at Vaughan Regional Medical Center (Selma, Ala.) – Selma Family Medicine’s primary teaching site – and currently serves as its hospitalist director and on its Medical Executive Committee. She has worked at the facility since 2017.
Preetham Talari, MD, SFHM, has been named associate chief of quality safety for the Division of Hospital Medicine at the University of Kentucky’s UK HealthCare (Lexington, Ky.). Dr. Talari is an associate professor of internal medicine in the Division of Hospital Medicine at the UK College of Medicine.
Over the last decade, Dr. Talari’s work in quality, safety, and health care leadership has positioned him as a leader in several UK Healthcare committees and transformation projects. In his role as associate chief, Dr. Talari collaborates with hospital medicine directors, enterprise leadership, and medical education leadership to improve the system’s quality of care.
Dr. Talari is the president of the Kentucky chapter of SHM and is a member of SHM’s Hospital Quality and Patient Safety Committee.
Adrian Paraschiv, MD, FHM, is being recognized by Continental Who’s Who as a Trusted Internist and Hospitalist in the field of Medicine in acknowledgment of his commitment to providing quality health care services.
Dr. Paraschiv is a board-certified Internist at Garnet Health Medical Center in Middletown, N.Y. He also serves in an administrative capacity as the Garnet Health Doctors Hospitalist Division’s Associate Program Director. He is also the Director of Clinical Informatics. Dr. Paraschiv is certified as the Epic physician builder in analytics, information technology, and improved documentation.
DCH Health System (Tuscaloosa, Ala.) recently selected Capstone Health Services Foundation (Tuscaloosa) and IN Compass Health Inc. (Alpharetta, Ga.) as its joint hospitalist service provider for facilities in Northport and Tuscaloosa. Capstone will provide the physicians, while IN Compass will handle staffing management of the hospitalists, as well as day-to-day operations and calculating quality care metrics. The agreement is slated to begin on Oct. 1, 2021, at Northport Medical Center, and on Nov. 1, 2021, at DCH Regional Medical Center.
Capstone is an affiliate of the University of Alabama and oversees University Hospitalist Group, which currently provides hospitalists at DCH Regional Medical Center. Its partnership with IN Compass includes working together in recruiting and hiring physicians for both facilities.
UPMC Kane Medical Center (Kane, Pa.) recently announced the creation of a virtual telemedicine hospitalist program. UPMC Kane is partnering with the UPMC Center for Community Hospitalist Medicine to create this new mode of care.
Telehospitalists will care for UPMC Kane patients using advanced diagnostic technique and high-definition cameras. The physicians will bring expert service to Kane 24 hours per day utilizing physicians and specialists based in Pittsburgh. Those hospitalists will work with local nurse practitioners and support staff and deliver care to Kane patients.
Wake Forest Baptist Health (Winston-Salem, N.C.) has launched a Hospitalist at Home program with hopes of keeping patients safe while also reducing time they spend in the hospital. The telehealth initiative kicked into gear at the start of 2021 and considered the first of its kind in the region.
Patients who qualify for the program establish a plan before they leave the hospital. Wake Forest Baptist Health paramedics makes home visits and conducts care with a hospitalist reviewing the visit virtually. Those appointments continue until the patient does not require monitoring.
The impetus of creating the program was the COVID-19 pandemic, however, Wake Forest said it expects to care for between 75-100 patients through Hospitalist at Home at any one time.
Chi-Cheng Huang, MD, SFHM, was recently was named one of the Notable Asian/Pacific American Physicians in U.S. History by the American Board of Internal Medicine. May was Asian/Pacific American Heritage Month. Dr. Huang is the executive medical director and service line director of general medicine and hospital medicine within the Wake Forest Baptist Health System (Winston-Salem, N.C.) and associate professor at Wake Forest School of Medicine.
Dr. Huang is a board-certified hospitalist and pediatrician, and he is the founder of the Bolivian Children Project, a non-profit organization that focuses on sheltering street children in La Paz and other areas of Bolivia. Dr. Huang was inspired to start the project during a year sabbatical from medical school. He worked at an orphanage and cared for children who were victims of physical abuse. The Bolivian Children Project supports those children, and Dr. Huang’s book, When Invisible Children Sing, tells their story.
Joshua Lenchus, DO, RPh, SFHM, has been elected president of the Florida Medical Association. It is the first time in its history that the FMA will have a DO as its president. Dr. Lenchus is a hospitalist and chief medical officer at the Broward Health Medical Center in Fort Lauderdale, Fla.
Mark V. Williams, MD, MHM, will join Washington University School of Medicine and BJC HealthCare, both in St. Louis, as professor and chief for the Division of Hospital Medicine in October 2021. Dr. Williams is currently professor and director of the Center for Health Services Research at the University of Kentucky and chief quality officer at UK HealthCare, both in Lexington.
Dr. Williams was a founding member of the Society of Hospital Medicine, one of the first two elected members of the Board of SHM, its former president, founding editor of the Journal of Hospital Medicine, and principal investigator for Project BOOST. He established the first hospitalist program at a public hospital (Grady Memorial in Atlanta) in 1998, and later became the founding chief of the Division of Hospital Medicine in 2007 at Northwestern University School of Medicine in Chicago. At the University of Kentucky, he established the Center for Health Services Research and the Division of Hospital Medicine in 2014.
At Washington University, Dr. Williams will be tasked with translating the division of hospital medicine’s scholarly work, innovation, and research into practice improvement, focusing on developing new systems of health care delivery that are patient-centered, cost effective, and provide outstanding value.
Jordan Messler, MD, SFHM, has been named the new chief medical officer at Glytec (Waltham, Mass.), where he has worked as executive director of clinical practice since 2018. Dr. Messler will be tasked with leading strategy and product development while also supporting efforts in quality care, customer relations, and delivery of products.
Glytec provides insulin management software across the care continuum and is touted as the only cloud-based software provider of its kind. Dr. Messler’s background includes expertise in glycemic management. In addition, he still works as a hospitalist at Morton Plant Hospitalist Group (Clearwater, Fla.).
Dr. Messler is a senior fellow with SHM and is physician editor of SHM’s official blog The Hospital Leader.
Tiffani Maycock, DO, recently was named to the Board of Directors for the American Board of Family Medicine. Dr. Maycock is director of the Selma Family Medicine Residency Program at the University of Alabama at Birmingham, where she is an assistant professor in the department of family medicine.
Dr. Maycock helped create hospitalist services at Vaughan Regional Medical Center (Selma, Ala.) – Selma Family Medicine’s primary teaching site – and currently serves as its hospitalist director and on its Medical Executive Committee. She has worked at the facility since 2017.
Preetham Talari, MD, SFHM, has been named associate chief of quality safety for the Division of Hospital Medicine at the University of Kentucky’s UK HealthCare (Lexington, Ky.). Dr. Talari is an associate professor of internal medicine in the Division of Hospital Medicine at the UK College of Medicine.
Over the last decade, Dr. Talari’s work in quality, safety, and health care leadership has positioned him as a leader in several UK Healthcare committees and transformation projects. In his role as associate chief, Dr. Talari collaborates with hospital medicine directors, enterprise leadership, and medical education leadership to improve the system’s quality of care.
Dr. Talari is the president of the Kentucky chapter of SHM and is a member of SHM’s Hospital Quality and Patient Safety Committee.
Adrian Paraschiv, MD, FHM, is being recognized by Continental Who’s Who as a Trusted Internist and Hospitalist in the field of Medicine in acknowledgment of his commitment to providing quality health care services.
Dr. Paraschiv is a board-certified Internist at Garnet Health Medical Center in Middletown, N.Y. He also serves in an administrative capacity as the Garnet Health Doctors Hospitalist Division’s Associate Program Director. He is also the Director of Clinical Informatics. Dr. Paraschiv is certified as the Epic physician builder in analytics, information technology, and improved documentation.
DCH Health System (Tuscaloosa, Ala.) recently selected Capstone Health Services Foundation (Tuscaloosa) and IN Compass Health Inc. (Alpharetta, Ga.) as its joint hospitalist service provider for facilities in Northport and Tuscaloosa. Capstone will provide the physicians, while IN Compass will handle staffing management of the hospitalists, as well as day-to-day operations and calculating quality care metrics. The agreement is slated to begin on Oct. 1, 2021, at Northport Medical Center, and on Nov. 1, 2021, at DCH Regional Medical Center.
Capstone is an affiliate of the University of Alabama and oversees University Hospitalist Group, which currently provides hospitalists at DCH Regional Medical Center. Its partnership with IN Compass includes working together in recruiting and hiring physicians for both facilities.
UPMC Kane Medical Center (Kane, Pa.) recently announced the creation of a virtual telemedicine hospitalist program. UPMC Kane is partnering with the UPMC Center for Community Hospitalist Medicine to create this new mode of care.
Telehospitalists will care for UPMC Kane patients using advanced diagnostic technique and high-definition cameras. The physicians will bring expert service to Kane 24 hours per day utilizing physicians and specialists based in Pittsburgh. Those hospitalists will work with local nurse practitioners and support staff and deliver care to Kane patients.
Wake Forest Baptist Health (Winston-Salem, N.C.) has launched a Hospitalist at Home program with hopes of keeping patients safe while also reducing time they spend in the hospital. The telehealth initiative kicked into gear at the start of 2021 and considered the first of its kind in the region.
Patients who qualify for the program establish a plan before they leave the hospital. Wake Forest Baptist Health paramedics makes home visits and conducts care with a hospitalist reviewing the visit virtually. Those appointments continue until the patient does not require monitoring.
The impetus of creating the program was the COVID-19 pandemic, however, Wake Forest said it expects to care for between 75-100 patients through Hospitalist at Home at any one time.