Since I began promoting myself as a coach I have received a lot of curiosity from medical colleagues around what I do and why. I hope this podcast answers some of this. Its 30 minutes and discusses the history of coaching and what I believe coaching has to offer medicine. Comments and suggestions welcome!
Click on this link - Coaching In Medicine
free use image from Pixabay
It's that time of year again. New residents coming into programs and senior residents graduating. I have been reading all the "Tips for New Docs" on twitter and this made me reflect on advice that I would give my graduating residents. Here are my pearls - Hope that you find them useful
Not long ago I facilitated a small group session on "crucial conversations" as part of the USaskEM's non-medical expert CanMEDS curriculum. From what I read (and my experience reinforces this) we tend to avoid conflict in the ER. Your workplace is probably no different. Unfortunately, our avoidance to take on challenging interpersonal situations contributes to ongoing inappropriate behaviour which itself creates even more workplace conflict. This topic is so important that people have written books on "difficult" or "crucial conversations".
Courageous conversations are actually an important form of collegiality
The main reason we avoid conflict is fear. It takes courage to do what is right and face the blow-back and so I think we need to redefine these conversations as "courageous". My experiences also have taught me that it is also "collegial" to have them. My hope is that, by reframing the concept, we may begin to shift our approach from disengagement to dialogue - because ultimately we are all professionals on the same side. So read on - comments welcome!
Emotions in the Workplace:
What defines a courageous conversation?
Signs and Symptoms you’re in (or about to have) a courageous conversation:
Why courageous conversations do not happen enough:
Why it is important to know about and have courageous conversations in healthcare:
How we undermine meaningful dialogue:
SILENCE = purposefully withholding information from the dialogue.
Start having courageous conversations by creating inner shifts:
Guiding principles of courageous collegiality:
My 4-p’s of Courageous Collegiality:
How to measure your success:
I would like to acknowledge the authors and resources below without which I could not have learned about this. The picture at the beginning of the blog is free-use media from the web.
Resources | References:
Patterson, Grenny, McMillan & Switzler 2002 . Crucial Conversations: Tools for Talking when Stakes are High . McGraw Hill. [Below is a link, which outlines some of the major points of the book by Jim Force]
Judy Ringer blog post on difficult conversations:
Janine Bowen article on Emotions in Organisations:
Crucial Conversations for Dummies Cheats:
Business Lit blog article
ERmentor on EI:
I created this slide as part of a talk I gave at the University of Saskatchewan's Emergency Medicine winter retreat. I thought that I'd share it and some reflections here.
During the talk I used my own personal experience as a burning-out PGY3 resident struggling with issues of fatigue and low sense of accomplishment, self doubt, compromised relationships, lack of wellness and a decreased sense of purpose. Sound familiar?
It's only a few years after the fact looking back on things that i realized that I was burnt out, unwell, unaware and living in a horrible environment! I wish I knew then what I knew now. The diagram above represents what in coaching circles we refer to as the 'Logical Levels of Self' [adapted from the work of anthropologist Gregory Bateson].
Struggling Nadim was stuck at the bottom of this pyramid - questioning the choices he had made to get him to this point. He was perseverating on the negatives and oblivious to how far he'd gotten off his wellness track. He was living in a noisy apartment with construction noise all day and into the night - impeding his ability to sleep. He was also struggling with the cultural expectations of being the eldest son in an ethnic family.
“I am stressed and exhausted. I feel like I can’t accomplish anything. I feel like a failure”
“I should be smarter and more efficient. I don’t have what it takes ... maybe I need to work more shifts so that I can get better | smarter | tougher”
Little did he know that he unwittingly built this basement that he was living in piece-by-piece with his beliefs, blindspots and lack of introspection and self-awareness.
While he had some idea of his skills and capabilities, he really didn't know his strengths or inner resources. He had never learned how to deal with his emotions or to have courageous conversations. He had never learned to deal with his inner critic. At some point in time he may have had a vague sense of what was important to him, but like most people he’s never really sat down and reflected deeply on this. Fast-forward to where he is right now – questioning his sense of self, his ability and role in life.
I wish I had the chance to coach this young man. I hope that all future Nadim's won't even need a professional coach, because this stuff will become 'baseline knowledge' in medicine. In order to build your life from the inside out ... you first need a 'home inspection' of your Logical Levels pyramid:
Get to know your basement:
Understanding your pyramid begins with spend some time looking at the basement you've created. You need to have a good realistic grasp of your environment. While it's important to understand some negative aspects [such as the ambient noise and how it was affecting Nadim above] I want you to shift the focus onto all of the positive things. Appreciate where you are and the good things you've accomplished. Get a good sense of the tasks in your life that require prioritizing. The most important of these is self-care.
Understand your capabilities:
Everyone I have coached is universally blind to some of their strengths. You got here somehow - reflect on what it takes to make you achieve. Look at other areas of your life where you have more agency - this will make you more aware your strengths.
Learn how to deal with your inner-critic:
Everyone I have coached is also hampered by negative self-talk. Your inner critic has served a valuable function in your life, but if you want to excel you need to be in the driver's seat. Acknowledge these thoughts, but choose to accept or refute them.
Learn how to deal with people - including yourself:
Read up on emotional intelligence and courageous conversations. Reflect on situations that made you emotional. Ask yourself why? What does it say about what you value? How might you do things different? [Hint: go easy on yourself - you're only human]
If you want a better basement start from the top:
You might not know your purpose in life, but you still need to ask yourself some tough questions. Understanding what you are about and what you value takes time. Sometimes what you think you value is just a 'surrogate' marker for something else. Think deeply. Strip away the layers so that you have a list of your core values. Challenge your firmly held beliefs - why do you believe these 'facts'? I read a book called The Four Agreements. The biggest pearl I found in there was that we inherit many of beliefs from our well-meaning parents. We never had informed consent about these. If you could clear the slate and go to an app store of beliefs today- which ones would you download? Your purpose should start to become more clear to you as you reflect on these things.
Once you've done all the mental footwork the rest comes easier - you just need to nudge yourself forward. Align your actions with the things that you value. Play to your strengths and start winning :)
Depressed doctor: www.medscape.com article
Call to action: www.overpass.co.uk
Just watched a very interesting TED TALK by Amy Cuddy on body language. Watch the TED TALK here. Amy's research shows that just 2 minutes of creating a powerful presence using your body posture actually leads to a powerful presence of body and mind. She showed that by assuming a powerful posture subjects not only increased salivary testosterone [more power] and reduced cortisol [less stress], they put themselves out there, excelled at a high stress interview and were more likely to be selected by blinded observers. Her last pearl was that practising powerful poses leads to becoming more powerfully present over time.
The talk inspired me to think of how one could apply this wisdom in two common high-pressure situations in emergency medicine and residency training - code | simulation scenarios and oral exams.
My residents will tell you that I teach them to find some way of getting into the right head space before simulation scenarios and oral exams. The goal is to fashion a powerful presence while being stress-resilient. I believe that Amy's wisdom provides another avenue for this.
So next time you're feeling a bit overwhelmed before a code | simulation scenario or oral exam, try 2 minutes of a powerful pose [or assuming a powerful pose during the scenario] - see if you can create a more impactful presence. If it works - practise it! Comments welcome
Over the years I have come to realize that my medical community is pretty small. Because of this fact - people [that I have never met] have opinions of me. This is my reputation and it didn't happen by accident.
We all know about those docs in the hospital that "throw tantrums in the O.R." or "always have bad consults". We garner these reputations with our personal interactions, our written communications, the committees that we sit on, the lectures that we give, students that we teach and with how we practise our medicine.
You are not immune - . There are perceptions out there about you. These perceptions could be good or bad , but they will affect how people interact with you. They will affect how people judge you. The good news is that, over time – one’s good deeds overshadow the bad – it’s the pattern of behavior that defines our reputation. The first thing that you can do to create this reputation is to think of yourself as your own personal brand name.
“Regardless of age, regardless of position, regardless of the business we happen to be in, all of us need to understand the importance of branding. We are CEOs of our own companies: Me Inc. … our most important job is to be head marketer for the brand called You"
The Art of Personal Branding
1) Brand yourself by:
2) Package yourself by:
I've blogged before on personal branding - if you haven't read it please do. As I was creating this website I had to think about my personal philosophy. Most educators at some point reflect on their educational philosophy. It's important because it helps guide how you approach teaching and learning, but I think it's worthwhile to think more broadly. Here's a neat article that goes over some of the points below [ehow link]:
What might this look like?
Words that embody what I am about: hard work, achievement, mentoring, sharing, giving, life-long learning, being involved, paying it foreward.
Check out my Landing page to see how I did. For those who are embarking on creating their own websites here's some tips on what your landing page should look like [article link]
Having a powerful personal philosophy will help align your actions with your values. Everything you do should come back to "what am I about?". If you can distill this into one word - even better! I am still reflecting on my one word - as a Meducator I think it will also have to work as an acronym :)