Michelle Kittleson, MD (@MKittlesonMD) drops pearls from her new book, Mastering the Art of Patient Care, around how to be a leader and navigate transitions in health profession education. She shares relatable anecdotes and valuable tips on how to prepare for leadership, navigate uncertainty, and build your mentor cabinet.
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Dr Michelle Kittleson is Professor of Medicine at Cedars-Sinai and Director of Education in Heart Failure and Transplantation at the Smidt Heart Institute. Dr. Kittleson is Deputy Editor of the Journal of Heart and Lung Transplantation, on writing committees for the 2020 Hypertrophic Cardiomyopathy Guidelines and the 2022 HF Guidelines, and on the Board of Directors for the Heart Failure Society of America. Her essays have appeared in the New England Journal of Medicine, Annals of Internal Medicine, and JAMA Cardiology and poems in JAMA and Annals of Internal Medicine. Her book, Mastering the Art of Patient Care, is available from Springer publishing.
Leadership is an important role for medical providers. Dr Kittleson suggests that having the initiative and motivation to grow and improve is the first step. Learning from your own experiences, your mentors, and the mistakes of others can move you forward.
Recognize that it is scary to move into a new role, and Dr. Kittleson says it’s understandable; it should feel initially scary. Make a plan where you can transform your fears into a concrete action plan. Prepare. The more you are prepared, the better you can implement your plan with your team.
Based on expert opinion from Dr. Kittleson, preparation upfront is key for everything, but especially for rounds. Consider how you want rounds to be structured and share clear expectations of that structure. Dr Kittleson suggests focusing on efficiency in rounds. Presentations start with a one liner and move straight to the plan by system; this allows for dedicated time to discuss the management plan, the most important aspect for each patient.
Pre-rounding helps streamline rounds because the senior resident/fellow/attending doesn’t have to use time during rounds to confirm the accuracy of what the learner shared. The rounds leader can instead focus on the learner’s presentation and management reasoning. The team leader doesn’t necessarily have to go bedside to see the patient, but information in the electronic medical record (EMR) can be extremely helpful for pre-rounding: review vitals, new orders, nursing notes from overnight, etc. Pre-rounding allows the leader to prepare their teaching plan early and devote more time to teaching when actually on rounds.
Have a systematic approach to the assessment and plan. Presentations start with a one liner and move straight to the plan by system.
It is important to be able to talk through disagreements and come to a place of consensus where the patients, trainees, and attending physicians all benefit. Dr. Kittleson recommends normalizing the elephant in the room, with enthusiasm and kindness. E.g. “I sense that you don’t agree with me, and I think that’s great, because I love to debate medical issues. Tell me where you’re coming from. Let’s see where we can talk about it some more and make sense of this issue.” By normalizing healthy debate and discussion, trainees learn that respectful disagreement is possible; rounds become a safe and brave space where everyone is learning without fear and people feel comfortable asking questions. It’s mutually beneficial: the rounds leader can comprehend a medical topic better by having to explain their reasoning and the evidence, and the team may come up with something the team leader hadn’t thought about, ultimately leading to better patient care.
Dr. Kittleson shares an anecdote about when she was a fellow, she would answer night calls with “what is your emergency?” One time when she called her childrens’ pediatrician after hours, the on-call clinician answered with “How can I help?” She learned from this that being rude will not stop people from calling, it just makes the call more unpleasant. Dr. Kittleson teaches that when you start out from a place of openness and kindness, it allows for a more productive and thoughtful conversation.
Dr Kittleson highlights the power of defending your team. She recommends talking to the person who is not respecting a team member directly, especially if it is someone you supervise. If you have a concern about how a staff member who is not in your chain of command is treating one of your trainees, talk with that person’s supervisor and ask the best way to deal with the situation. If there is disrespect coming from another physician in a different department, similarly, go to their supervisor.
When you see a learner or team member struggling or overwhelmed with whatever duties they have in front of them, rather than offering to help, make a concrete plan to step in and help.
Transitioning to be a 3rd year medical student, 2nd year resident, first-year fellow, or new attending is hard! These are new roles requiring new skill sets with increasing levels of responsibility/leadership. Although it can be stressful, the best way to mitigate these transitions is to start with a plan. Once you make your plan, envision what is involved in success. Remember, you can always look to your past (successful) experiences and trusted mentors whenever you need help (Deb 2021).
A mentor is a role model, someone you admire. When advancing in your career, it is important to establish a cabinet of mentors to support you in different situations. A mentor may be most valuable to you in different scenarios, such as discussing challenging clinical scenarios, nuanced medical topics, interpersonal issues, work-life balance, or research endeavors.
How to Establish Mentors
Focus on optimal patient care. Figure out what is and what is not negotiable. When you encounter a situation where there is a non-negotiable situation, give an explanation as to why that situation cannot be handled differently. In negotiable situations, you can give your trainees some leeway by having them develop a contingency plan. If you don’t get X result by Y time, you will do Z.
A great leader can do their supervisees’ jobs as well as they can, they just don’t do it because they have taken on leadership roles. A great physician leader provides excellent patient care and understands what it’s like to be a “foot soldier”.
Listeners will appreciate the nuances of leadership skill development in medical education, specifically as it applies to role transitions and teaching on a team.
After listening to this episode listeners will…
Dr. Kittleson reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Kittleson, M. Heublein M, Kryzhanovskaya E. Ong J. “#33 Leading the Way: Navigating Transitions in Medical Education”. The Curbsiders Teach Podcast. https://thecurbsiders.com/teach. May 30, 2023.
Writer: John Ong, DO
CME: John Ong, DO
Infographic: Charlotte Chaiklin, MD
Cover Art: Charlotte Chaiklin, MD
Hosts: Era Kryzhanovskaya MD; Molly Heublein MD; John Ong DO
Show Notes: John Ong DO; Era Kryzhanovskaya MD
Editor: (audio) podpaste (written materials) Molly Heublein MD
Guest: Michelle Kittleson MD
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