GUEST POST: Happy Graduation and in the words of Dr. Seuss, "Oh the Places You'll Go!"

Dr Candice Chen (pictured here) writes: Oh the places you'll go. To be completely honest, when I got into medical school, I had no real idea of what I wanted to do with my life. I just knew I wanted to do something. I did a pediatrics residency and still I knew I wanted to do something more. I did a community pediatrics fellowship and still there had to be something more. Well, still uncertain what that something was, I became clinical faculty at an academic center and the options seemed to stretch out and blur in front of me. I enjoyed taking care of patients but how could I make a bigger difference?

About 6 months in to my new faculty position, a mentor from my fellowship offered me a 50% time position on a project looking at the social mission of medical education. I paused – clinical medicine is what I knew and honestly, studying medical education isn’t where I thought I was headed. But the pause was brief and I at least recognized the opportunity for something more.

And this is what happened (highlights):

• We worked on 2 pieces of legislation that passed with the Affordable Care Act.
• We published an article ranking medical schools on their social mission output that sparked wide public interest and was featured in articles in the Washington Post and the New York Times
• I joined another project looking at medical education in Sub-Saharan Africa that has resulted in international travel and work with international medical education experts

And the lessons I learned are:

1. Be open to opportunities. I’m not saying every opportunity is the right one, but change is scary and don’t let fear keep you from trying something new. On the issue of whether medical education was the right issue for me, once I was into the work it quickly became clear that we were focused on the role of medical education in meeting the health care needs of the nation - about how to achieve access and equity for everyone. It was exactly the issue I wanted to work on.
2. A good mentor can make the biggest difference. It took me a while to find the right person and develop the right relationship, but, to be completely clear, my highlights reel is a direct result of being in the right place at the right time, with the right mentor. He was willing to put me forward and that is the characteristic in a mentor that I didn’t realize was important until I found it.
3. While we can’t necessarily do it all, we can do a lot. There are choices we all have to make along the way. I’m down to 1 day a week seeing patients, and that’s not what I thought my career would look like. But I’m glad to have that time and now I work to maintain it.

So the oddest thing to me now is when students or residents come to me for career advice. I don’t feel like I should be in a place yet to give this advice. But those are the lessons I tell them. And I’m amazed by the people who come to me for advice. They have more experience and vision than I ever had at that time – I, who walked around with a big question mark above my head for years.

But I’m not writing this for those individuals necessarily. Rather, to all of you who don’t know yet what you want to do, just that you want to do something more, I hope you hold on to that feeling because, well, you never know the places you'll go.

ABOUT OUR GUEST POST CONTRIBUTOR:
Dr Candice Chen received her MD from Baylor College of Medicine and her MPH from GWU, with a concentration in Community Oriented Primary Care. In addition to serving her patients in southeast Washington, DC, she conducts ongoing research on medical education (here and abroad) and on developing a socially responsible physician workforce. And I can attest that she is an incredibly socially responsible physician and person herself... I was fortunate to work side by side with Candice Chen at a community health center a few years back.

So much peer reviewed literature on mothers... have a free to be happy day!

Update for May 2013:  The number of articles in PubMed with "mother" in the title?  A quick search reveals 12,925.  (If you include "mother" in full text we're up to 154,295).  And yet we are more than a given quantity of peer reviewed articles.  And at times we transcend the evidence.

Whether you have 1 mom or you have 2 moms or you have anyone you refer to as mom, then make sure to give her a hug, a call, a text, some FaceTime or Skype...  Give a reminder that this week also kicks off Women's Health Week.  Maybe give her a present.  And some of you will perhaps visit her grave and live on to exemplify the principles she'd always modeled, and she is remembered, today and every day.

And we say thank you, with love.

Some of us, or some of our parents, were raised on Free to Be You and Me so we know that "mommies are people, people with children" who can be doctors and almost anything they want to be.  Are you who you want to be?

Further points to consider on gender, parenting, and the physician workforce:

• The percentage of women entering medical school has declined since its peak in 2003.
• The AAP has a policy highlighting a commitment to preventing sexual harassment in the workplace and educational setting.
• The AMA opposes gender-based questioning during residency interviews for the purpose of sexual discrimination.
• The AMA opposes requiring residents to repeat a year of training upon returning from leave under the Family and Medical Leave Act (FMLA). 
• For more, see the Women Physicians Congress: Policy Compendium (see H-420.961 and 420.966 and 420.967 and 420.987 and 420.996 and more)
• Does your residency program sponsor parental leave with --or without-- pay?  Are there childcare facilities onsite at your workplace and/or other support for women and men to raise children?

We thank the many female physicians (some are also mothers) and the many male physicians (some are also fathers) who came before us, paving the way for these and other rights.  So that we are free to be all we want to be.  Even --especially-- if that means we grow up to be people with children who are also people providing healthcare for other people's children. 

Top 10 reasons pediatricians are educators (why we teach you)

1. We get to teach kids, parents, families, trainees, and medical students
2. We get to learn from all of the above (plus nurses and other health professionals, of course)
3. Education, it does your body (and mind) good. Like milk (particularly breastmilk).
4. We need booster doses to strengthen what we have learned along the way, and the questions our students, residents, and fellows ask us helps to keep us strong.
5. We ask and answer a lot of questions. 
6. Neither field (pediatrics, nor medical education) pays the big bucks, so we do both because we love both.
7. We aim to help our patients be healthy enough to learn.
8. We are lifelong active learners ourselves and are comfortable with feedback (giving and getting).
9. We like to facilitate learning through milestones.
10. When we teach and learn, we all grow.

Educating is an "entrustable" professional activity!

There are many more reasons, what did I leave out?   Comment below:

Top 10 things (milestones?) I learned at a pediatric educators' conference this year

Our annual conference of pediatric medical student education leaders (COMSEP) had the added bonus of teaming up with the pediatric residency program leaders (APPD) this year.   In Nashville, where music and med ed mix melodically.  And once again, I depart the conference feeling energized to educate and grateful for opportunity.

Here are just some of the things I learned (or am reflecting further upon):

 

1. There are actually milestones for dancing at professional meetings. 
2. With a little prompting, we can get well over 100 pediatric educators to tweet the meeting and use a hashtag and a QR code to get an app (or at least they're trying).
3. From our Miller/Sarkin keynote speaker, Kevin Eva: The purpose of assessment is improvement. Expertise needs continual reinvestment.  And good medicine does not involve just going through a series of checklists, we need to put it all together.
4. We are educating (and learning from) generation i as in iPad, iPhone, internet, interactivity, I want to share something...
5. That if you ask a bunch of people, "how many jelly beans are in this jar?" each individual answer will be wrong, but the average of all their responses are right. Together we can find answers.  Teamwork.
6. There is a lot of fried food (including pickles) amidst the country music scene in Nashville.
7. Omphaloskepsis is the contemplation of one's navel as an aid in meditation or reflection.
8. Mentor, volunteer (lean in?), listen, teach, and learn.  Pediatric medical education is a rewarding career path with outstandingly sincere, helpful,  and dedicated individuals who come together for the children and all learners.
9. The how and why of fostering reflective practice across the continuum.
10. LEAD stands for Leadership in Educational Academic Development.  And LEARN stands for Longitudinal Educational Assessment Research Network. 

Here's what I learned at last year's meeting.

And, looking forward to many more.  Before you go to your next conference please check out this post.

Mentoring and Mentee-ing

Did I just make up the word mentee-ing? 

As I prep for an upcoming workshop at the combined Council on Medical Student Education in Pediatrics (COMSEP) and Association of Pediatric Program Directors (APPD) meeting* (led by Cori Green at Cornell and a great set of pediatric colleagues) I'm thinking about mentoring and, well, mentee-ing.

To be the mentee is an important part of the relationship.  Come to the arrangement ready to learn and grow.  Think about your goals for the research, the project, the mentorship, and the menteeship (another coined word?). 


Some issues may arise in the mentor-mentee relationship.  Do you recognize any?

• The vanishing mentee
• The vanishing mentor
• The proposal that needs a lot of work
• Lack of focus
• Style differences
• Time pressures
• Excuses
• ____________, ____________, and _____________  (fill in the blanks)

And yet, every one of these is an opportunity for learning, for providing and receiving feedback from mentor to mentee and vice versa.  An opportunity to do the critical but sometimes underrecognized prepwork, and in the words of Sheryl Sandberg, to lean in to the arrangement you have with your mentor or mentee.

It may be a rocky road to success.  And occasionally, you may need to give your mentor some well-timed well-crafted feedback as well.  But before you write a hate letter, take a deep breath and get some perspective on navigating these complex relationships.  Try these "Love Letters: An Anthology of Constructive Relationship Advice Shared Between Junior Mentees and Their Mentors" from JGME Sept 2012. Fortunately, my own mentors (yes, you can have several, including peer-mentors) have been outstandingly helpful.

*Tweet with us (with your mentor/mentee!) at the #COMSEP2013 and #APPD2013 meeting and check out @COMSEPediatrics

ABCs

Thinking about the ABCs:

• Airway
• Breathing
• Circulation (i.e. chest compression)

Or CAB, as per the updated AHA guidelines: Compression, Airway, Breathing.

And then, a pediatric resident provided me with a pediatric update in continuity clinic the other day.  He told me that the new ABC is really: 

• Airway
• Breastfeeding
• Circulation

Getting back to basics, and helpful in ways too numerous to count.

GUEST POST: The Finest Gifts: Finding Balance and Relationships in Pediatrics – A Junior Resident Perspective

Pediatric resident Dr Shazeen Suleman writes:

Last month, I was surprised with a gift from a family I had cared for. On a day I had felt particularly beaten down, it was a wonderful reminder of the appreciation of many families. The card still sits on my fridge, so I can read the words daily, as does a plastic bracelet with the name of the patient and “Together We Can.”

However, one part of the gift remains unopened.

In addition to the lovely, heartfelt card and symbol of strength and hope, this particular family had generously given me a beautiful crystal piece of jewelry. I didn’t have the opportunity to even express my thanks in person – the family had simply left gifts for all the staff who had helped them at the main nursing station on a particular ward.

In speaking with a mentor earlier this week, I realized why I hadn’t opened that part of the gift: it felt uncomfortable. To dissect why I – and I’m sure many other residents – may feel this way requires a bit of an exploration into navigating relationships in medicine, particularly when in training. In particular, it seems to be of greater issue in pediatric medicine than other specialties, again highlighting some of the specific challenges we face.

As a medical student, I loved being able to be the “frontline” staff member, the person who spent the most amount of time with a patient and their family. This was partly due to the fact that it took me a lot longer to get through a history and physical for complex problems, and also partly due to the fewer other responsibilities I had. In spending time with families, our relationships grew; we would often be the team members who would uncover the crucial, “non-medical” psychosocial elements that contributed significantly to their treatment and recovery. It was empowering to both myself and the patient to have an open, trusting relationship and for very this reason, relationships are a central tenet in social pediatrics, recognizing that for the most vulnerable, trust is essential for providing good care.

In July, I began my pediatrics residency at a large tertiary center in Canada, and again often found myself as the most junior member of my team. Whether on the general pediatrics ward or in the NICU, I often spent hours talking to patients and their families about their concerns, fears and interests. However – I wasn’t just their student now, I was their doctor. I wrote their prescriptions, made their referrals, went over their discharge instructions, and counseled them on home management. Our relationships often grew even closer and sometimes, the doctor-patient boundary felt more like a line in the sand. Parents often ask me where I went to medical school, when I’d be finished with my residency, what I’m planning to do. These friendly questions were what confused me; instead of their doctor, I sometimes felt like their friend.

Relationships help you advocate for, empower, and care for your patients. However, they can also negatively affect you and the care you provide. In medical school, I remember learning about transference and counter-transference. Transference is what happens when you feel the emotions from your patient, for example, if a patient reminds you of your friend or family member.  Countertransference is what happens when your feelings then dictate how you feel toward the patient. This might mean feeling happy around certain patients and dreading seeing others. It might even be the sadness you experience when something negative happens to a patient you were caring for, that you carry home with you. Gifts are another manifestation of countertransference and transference, representing emotion in tangible form which in turn, affects your relationship with your patient. In a world where we must still be able to provide objective care for those around us, countertransference and transference are challenges that we as junior medical team members may often struggle with the most, particularly since we are the ones that spend the most time with the patients and families.

My greater challenge now is managing these relationships and how they affect me. I love knowing that I’ve been able to connect with my patients’ families on a meaningful level, that they know how sincerely I care for them. However, I need to be able to manage the emotions that come with that and balance my feelings with the professional values of objectivity and equality. As a junior resident, it’s been helpful to know that I’m not alone; senior residents, fellows and staff have all had similar experiences. Any time colleagues share a particular clinical encounter, they’re sharing a relationship with you and the impact it had. By reflecting on my emotions and actions individually and with my peers, I’m better able to understand myself and my own emotional needs, and in turn, continue to provide my patients with my whole attention without compromise.

My unopened gift remains in its box. The family had already gifted me with something much more valuable: a meaningful relationship and the validation that care, concern and connection have so much impact on our patient’s lives. Equally important, they have helped me realize that there is a fine balance between connecting and professionalism, as giving too much of myself can conversely negatively affect my patients. In the end, I strive to constantly reflect on how I feel so that I can strike this careful balance, and advocate for my patients.

ABOUT OUR GUEST POST CONTRIBUTOR: Shazeen is a first year pediatrics resident in Toronto, Ontario, Canada. She has a strong interest in medical education, reflective practice, social pediatrics and early childhood development. For more, you can follow her on Twitter @shazeen_s