SCCM Pod-538: Leading With Purpose: Career Growth and Well-Being
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Hello and welcome to the Society of Critical Care Medicine's podcast. I'm your host, Kyle Enfield. Today, I'll be speaking with Dr. Jenny Duncan, MD, and Dr. Raquel Cabral, PhD, CPH, from our Leadership, Empowerment, and Development program to discuss career development through a well-being lens.

Dr. Duncan is a professor of pediatric critical care medicine at Washington University School of Medicine, where she is the director of wellness for graduate medical education. Dr. Duncan also serves on the faculty council for the Association of Pediatric Program Directors Leadership and Educational Academic Development Program.

a leadership development program for pediatric educators. Dr. Cabral is a staff psychologist for graduate medical education at Washington University School of Medicine in St. Louis, Missouri. Prior to her current position, she served as the director of health promotion, the founding director of the Women and Gender Equity Resource Center, and the director for campus recreation at Florida Atlantic University in Boca Raton, Florida. Her research interests include innovative strategies for supporting well-being and promoting diversity, equity, and inclusion.

Dr. Duncan and Dr. Cabral, thank you so much for taking time out of your day to talk with me. Before we really dive into this topic, I wanted to see if you had any disclosures you wanted to report. I have no disclosures. I have no disclosures either.

I think one of the places I'd like to start out is well-being has become a little bit of a buzzword in our modern lexicon. If one of you could, and maybe we'll start with Dr. Carell, talk about when you're using in the setting of career development, what you mean by well-being.

When I think about well-being in the area of career development, I think it definitely has become a buzzword, like you're saying. And I think often what we associate with well-being is a state of happiness and contentment and ease. And I actually find that well-being in career development is more about satisfaction in our work.

And I think that if we're truly invested in our work and we're doing work that matters and is meaningful to us, we are likely to go through a whole spectrum of emotions in that setting. And so to assume that I am constantly in a place where everything is balanced and happy and comfortable is incorrect when we're thinking about well-being. Because if you care about something and things don't go the way that you expect them to, the appropriate emotion in that setting is some disappointment or some sadness.

Or if there's something that you're really passionate about and you're witnessing an injustice, the appropriate emotion in that setting is going to be some anger. So I think it's overall not necessarily a pleasant experience, but one that leads to personal satisfaction and meaning. I think it's building a rich and meaningful career life.

That makes a lot of sense. And I think it takes it away from some of the other ways that well-being is used currently in the modern lexicon. I think it would be helpful for everyone who's going to be listening to this podcast to talk a little bit about how and why you got into this space. And maybe I could ask Dr. Duncan to lead off that conversation.

Sure. So I was previously the associate program director and then the program director for our fellowship in pediatric critical care. And in my time as program director, you know, my passion was really around career development and mentoring these trainees and training.

just encountered along the way various challenges for our trainees in different aspects of their life that were really interfering with their ability to either invest in their work as trainees or to, you know, feel energized enough to be at work during the day. And we were really lacking in resources at that time. And so I communicated

came into my well-being role because I had developed over time the sort of passion for trying to develop resources and think about how well-being fits into making people really have a holistic approach to career development and happened to be in the right place at the right time when our institution developed this role as the director of well-being for GME. And so I moved into that role really to be able to build a program that would help us invest in that way for our trainees.

So, you know, traditionally, career development in academic medicine, for sure, has sort of focused on the pillars of patient care, education and research. And it's

In many ways, we have raised those people who are almost single-mindedly pursuing those pursuits to near fame, if not really seeing that as a path to promotion and development. I wonder if you could discuss a little bit what's important about addressing well-being in your career and what the benefits are for the individual.

I guess I would say you aren't really going to be able to invest optimally in any of those different pillars if you don't have an optimal sense of well-being for whatever that looks like for you. And I think well-being needs are going to vary from individual to individual, but to

really have that sense of satisfaction in what you're doing, you have to cultivate that. And so attending to your various needs so that you can be present in the lab and really invested in the research and excited about the results that you get or be at the bedside and be able to have some time during the day where you connect again with the reason that you went into medicine, that meaning and that purpose.

And often what we find is that people who are not attending to their various needs, whatever they may be, are frustrated or angry about the fact that we have documentation requirements and we have a frustrating EMR. And they're not able to really make those connections with the things in their career that matter.

drove them into medicine or drove them into research. And so I think it's important that we think about this holistically in terms of attending to all of our needs, because it will make us better and happier. I shouldn't say happier since Raquel just said it's not just about happiness, but more satisfied with the work that we're doing.

To be fair, I think happiness is a great emotion and I hope we all have lots of it in our lives. But it's also unfair to expect that if you're in a career that you're deeply invested in, that is the only emotion you will feel. But I'm all for happiness. I wonder if you could explain a little bit more about what you mean by well-being needs. It sounds like you are using that as an umbrella term to describe specific things that are unique to an individual.

Yeah, and I think that those needs do vary from individual to individual. And so, right, our approach to sort of thinking about well-being resources is to try to have a menu of resources to help support the individual needs. And so, you know, if you have a family, it may be that you need to be able to invest in some of the things that are important to your family life and the relationships

there. And if we can make that easier through providing resources, whatever those may be, maybe those are resources to be able to help you get home a little bit earlier, to sort of fix some things in our system that will allow you to get home earlier, or maybe they are resources so that you can access better childcare or elder care or other things that you need. Then the

that will help to attend to that well-being need. Maybe what you really need is to feel more connected with the people around you, or you want to be connected with people outside of your training program or your particular division because you already know those people, but you haven't really found a common interest. And so that's a separate well-being need. And so

figuring out ways to promote those connections, people that might have similar interests would be helping to address that need. So I think it varies. And so we think about, you know, some people talk about the wellness wheel and there's different domains of wellbeing. So attending to that, and many of those are outside of the workplace, but a lot of them are actually relevant in the workplace as well. What are the connections that you have in the workplace? What are things that maybe get in the way of you really having time at the bedside with your patients that you want to, those types of things?

So it sounds in some part is both unique to the individual, but also based on the decisions that they're making at the time and sort of helping them figure out what the resources they might need to embrace the values that they have or the specific needs.

things that are unique to them along with their career. I wonder if you might be able to sort of explore that concept of how you bring in your personal with your professional, because I know at least when I was a resident that at times it felt like we had to draw a hard line between those two areas of our lives. And how do you align them better?

Yeah, I think that that's a really good question. And I agree with you that when I was a resident, it did seem like there was a hard line there. And I think you mentioned the importance of aligning values. And I think that that can be a really helpful way about thinking about how you align the decisions that you make in your personal life and your professional life so that they are all more closely in touch with those values. I love

love listening to Raquel talk about values and values-based decision-making. So I'm going to toss this over to her to maybe address a little bit further. Yeah, I'm happy to talk about that. I've appreciated the shift in recent years that is less focused on work-life balance, where there's this separation, there's this assumption that you've got your work and you've got your life and these two shall never meet, but we have to keep them even. And I don't think that's realistic. You are one person.

who exists in both contexts. And so the way your work is going is going to impact your life outside of work and the way things are going in your life outside of work are also going to impact the way that things are going at work. I've never seen a resident who is struggling in anything outside of work who isn't also struggling at work.

So I think it's really important to see a person as a whole being. And I think in doing that, I think considering people's values are really important. So values, I'm going to take a little while to do a little psychological defining of what I mean when I say values. Values are deeply held desires for who we want to be and how we want to show up in the world.

I think values sometimes get conflated with goals. Goals are outcome oriented. And I think we're very good in our society at focusing on goals and trying to reach goals. Goals can be accomplished or we can fail at a goal. We can have a certain outcome that we're looking for that may or may not come to reality. Values are not that.

Values are really the way we want to show up in our lives. So for example, let's say that I have a goal of being a loving person. And one of the things, one of the goals that I have as a loving person is to get married and have a family. I may or may not be able to accomplish that goal. There are other factors that depend on that, but I can show up

in my life in a way that's loving. And I can be loving towards my friends and I can be loving towards my family members. And I may even be loving towards my patients in a way that's caring and kind. And that is a value that I'm able to have in my life. So I think it's incredibly valuable to identify the things that matter to us in our lives so that we are showing up in all areas of our lives with those things that we care about. Maslach and

lighter recently, I think it was about 2022, wrote a book called The Burnout Challenge. And they identified six different areas that impact people's burnout. Workload is one that we often talk about and people are aware of control, how much control we have over the work that we're doing, the rewards, how we're getting compensated, what kind of recognition is given at work.

the sense of community, fairness, and values are the six things that they looked at. A lot of these pieces are not ones that we can necessarily control. We may not be able to control our workload. We may not be able to control our schedule. We may even have to follow certain guidelines, but how we do things, that's where our values come into place. And I think that that's why values are so important when we think about longevity of your career, because if the way you're showing up at work and the

things you're doing at work matter with who you really want to be as a person, that's going to be much more sustainable long-term than if you are living in a way that's inconsistent with your values, you're going to burn out pretty quickly. That's really interesting given the sort of focus that we've seen, particularly following the pandemic on burnout within the healthcare, about the importance of bringing your values with you to work. Can you give us some examples of how

a resident or a new physician can really think about that when they're making decisions about their career? Oh, absolutely. I do this all the time with my clients and really enjoy this. When you're thinking about what matters to you, it can be as small as what matters to me in this rotation. So for example, several years ago, I had a client that was going into their senior month rotation where they were going to be in charge of everything. And it was kind of a first experience for them. They were kind of nervous about it.

So we sat and had a conversation about what would make this resident reflect at the end of the rotation and look back and be like, I did that really well. Notice again that it's not like it went really well. There were no issues. All the outcomes were good. It was more of like, I am proud of the way that I handled that.

And what would that have looked like for her? And I don't remember the specifics of it, but I want to say that she identified that helping the interns grow was really important to her. And so that was her value, was growth and development of others. And so we thought of several behaviors that would be in alignment with

that. And so that's the also the really cool thing about values is that there's a lot of flexibility and how you might do this. So for her, there was this piece of there was one intern that she knew was having some difficulties. And so her focus was how can I be kind in the feedback that I give this intern so that I can help them to

develop. For other folks, let's say that they are in residency looking at applying for jobs. I think it's really helpful to say, what kind of working environment do I like to work in? Am I somebody who values competition? In which case, I'm going to want a different set of colleagues than somebody who values collaboration. I'm going to be looking for something to

Am I somebody who values innovation, where I want to be at a place that's taking risks and open to me making mistakes? Or am I somebody who's more safety-oriented, where I just want a group that follows the guidelines and sticks to that very strictly? And if you take somebody, for example, who's very focused on patient care and

what they really want is to be able to spend as much time as possible with their patients. And you put them in a setting where that is not a lot of what they're doing, even though there might be other perks in that setting, that's going to burn out that person. Now, if you take somebody who's, which also happens, you take somebody who's very research oriented and does not enjoy the clinical work

quite as much and you're making the bulk of their time be patient facing, that's going to burn them out. And so I think one of the things that's really helpful with value, especially as you're considering going in, looking at the values of an organization and how much that matches your personal values. But as you're somebody looking to bring folks into your group, I think it's also really important to consider what kind of work do we do? What kind of work does this person enjoy doing and do naturally? And how does that fit with what they value?

You will always get a bigger bang for your buck if you've got somebody who's on a personal level invested with the types of things that your organization is doing or the way your organization does things. Does that make sense? Yeah, that makes total sense. And it sounds like there's two levels to that. And one of them is at the individual level to really identify sort of what...

They are interested in what kind of person they are. I know you guys are in the graduate medical education space. And do you find that people come to your office, residence, et cetera, and really know what their own values are? Or do you find that many people come in and don't...

quite really know how to articulate that yet? I think often people don't know how to articulate that yet. We haven't given them a lot of language around that, but I think there are lots of things that are good indicators of something that somebody values. There are also exercises that you can do. I mean, you can Google a values card sort or just a list of values and kind of rank them and take a look at which ones resonate with you and which ones don't. But when somebody's struggling with this, one of the activities that I will sometimes ask them to do is to think about moments at work

that were particularly sweet, like those moments that really stuck with you and you felt energized and excited and like, this is why I do this work. Usually those moments have some kind of evidence of something that you care about. And this is very individual. I'm a geek and I get very excited about spreadsheets and it is a really stupid thing. And I also know that there are other people who do not get excited about spreadsheets at all. But if you need a data task and you want to give it to me, oh my gosh, I'm going to love that.

And I can tell you about that. Those are the moments where I'm completely lost in my work. Time will pass and I haven't even noticed it. For me, there are also certain types of cases that I really enjoy. Clients where all of a sudden I look up in the clock and I'm like, oh my gosh, our session is over because this is something that I'm really invested in. And if you ask most people, they're able to identify some moments at work that were like that. If they're having a hard time with that,

The flip side of that is to think about moments at work that were particularly painful or difficult. Those moments also highlight something that somebody deeply cares about and matters to them, usually a value that wasn't present in that situation. Does that make sense? Yeah, I was not thinking about it that way, but I thought you were going to say the exact opposite, but that's great. Yeah, so you can identify, oh, I appreciate attention to detail, and this is one of those times where I had to sacrifice that for the sake of efficiency, which I'm less about, those kinds of things, for example.

It seems to me that there are inherently barriers in our world that can make some of this difficult. You mentioned the EMR and sort of documentation and how it's kind of easy to get wrapped up in those things. What advice do you give to trainees when they bring those as frustrations or pain points to the office?

I do wonder what Dr. Duncan would say to that. She has been on both the program director side and now on this side. Program directors are a source for everyone to complain to. So I'm sure she's heard that. And I guess I do wonder what she would say to the resident of, you know, I'm really struggling with this and it doesn't align with my values. And I feel like I can't spend as much time with patients because all I have to do is make sure that the HMP is done within 24 hours and not

up to date before they can go for a procedure or some other sort of what seems sometimes like a bureaucratic point? Yeah, no, I think it's a it's a fair question. And we address this in a variety of different ways. When we go to give talks for programs, we'll get asked to give talks on different topics. And I usually try to address upfront that sometimes people don't actually want people to come talk about burnout or well being because really, the problem is in our system. And they get frustrated that you know, somebody is coming to try to tell them how to fix something in themselves and

So what I try to do up front is say, like, we have to acknowledge that the system has a lot of challenges. And I'm a program director, certainly willing to listen and see if this person has some suggestions for ways that we might go about this differently, if we can provide some

resources or think about other more efficient ways to create our templates for our H&P, those types of improvements, and recognize that there are some requirements on our system that we simply aren't going to fix right now. Maybe our healthcare system will change in the future, but our giant national healthcare system problems, and we also have our local system problems that are larger usually than any single program is going to be able to fix. So with that in mind, trying to sort of get them to focus on like

what are the things that are most important to you? And why is it that you went into medicine? And how can we help connect you with even small amounts of time in those areas? So are there ways we can shave even a few minutes off of the time you're putting into that H&P so that you can spend a few minutes at the bedside? Or are there other ways that don't really take very much time at all that will give you an opportunity to sort of connect with the work that you're doing? So, you know,

One of my favorites that I've taken is that she at the end of her clinic, resident clinic will ask every resident, who did you help today? So it's one simple question, but help them sort of reflect on the fact that in this super challenging clinic with lots of people who have major socioeconomic challenges and opiate addiction that can be really hard to get through, there's usually somebody that the resident can connect with and say that they've helped. And that kind of gets back to that, like,

What's the purpose of you being here? How can you find meaning in the work that you've done? I had a surgery chair who shared with his residents that one of the things he tries to do is once a week, spend 10 minutes at the end of the day going back to some patient's bedside and just having a short conversation to help sort of make that connection with a patient. He's very intentional about it.

But what are the ways that you can build those things in, even in the midst of our often challenging and frustrating system so that you can maintain that connection? And that can tie to what's important to you. What are your values? So that's sort of the advice I would give. The other thing I guess I would just add to that as a program leader, thinking about that, it doesn't take a lot of time.

So there's data that shows when people spend just 20% of their time in something that they find really meaningful, that's protective of burnout. So it's not like they have to spend 100% of their time doing that bedside, you know, patient communication. It's just this small amount of time in the areas that they find really meaningful can make a big difference.

I wanted to come back to that leadership question because we were talking a little bit earlier about aligning sort of value and meeting with your work and how different people will have different things that they value and the importance of leaders understanding that when someone joins, you know, does that person's values really fit the values of our organization? I wonder if, Dr. Cabral, you would sort of speak to that and then maybe follow along, Dr. Duncan, in what ways do those of us in lower leadership positions

levels also practice sort of well-being-centered skills when we are maybe just a leader of a small team or a resident who's just leading an intern and a student? Yeah, absolutely. I think leadership opportunities in medicine are available across the board. And I'll let Dr. Duncan expand on that a little bit more. But as a leader, I think there are multiple layers of values that I think are important for us to know in those situations. First, there's the values of the organization. There are also the values that you bring as an individual and things that you care about.

which I think is helpful for the people who work with you to also be aware of, because this is how I like to show up in the world. So if I'm a very creative person and I value creativity, I think it's helpful for my team to know that I'm going to look for creative approach to things. But I think having conversations with folks when they first start out and asking them things about like, what was your best day at work? Or what are the things that you normally struggle with? What are the kind of tasks that

that you enjoy kind of looking at what areas are missing in your team and where you can plug somebody in means a lot to people, but also kind of recognizing what their values might be in areas outside of work and being able to follow up with that. That fosters a lot of connection and a sense of caring. And I think that in order to be

a really effective leader, it is important for us to know the folks that we're working with. And it doesn't mean that you have to know every detail of their life. Have them have a sense that you care about them. Then when you're having to have complicated conversations or difficult things, they know that you care because you've recognized the things that they value and you've tried to support that throughout. So I think there are several layers in which we end up involving values as we lead folks.

I love, Raquel, that you didn't say, you know, a leader should sort of take out the list of values and ask their people to reflect on them, but instead are asking questions to really like get to know the person, but through those questions can begin to identify those values and the things that are important to the people that are working for them. And so it's not really about like, here, I want you to list your values for me so that we can help you figure out, you know, what you should do more like really demonstrating that caring and getting to know them that helps to set that foundation for

and can lead to really meaningful relationships that are going to allow teams to work really well together. I'll add to that. If you watch people, you can fairly easily start to notice what makes them tick. Some of the colleagues that you've worked with for a long time, you know what their thing is. And those are usually areas that are well-developed in terms of values and things that they care about.

Yeah.

Yes, for sure. I always like to talk about the fact that we all lead in some way or another. And so we have like those big L leaders that are, you know, the executives or our chairs and division chiefs, but our residents are leaders of teams. Even if you're an intern, you are often, you know, leading some medical students on your team in some way, and you're showing up

as a potential leader for nursing staff or other staff in the hospital. And if you're, you know, a junior faculty member, you're leading a whole team of residents and medical students, or maybe you're leading a team in clinic, and that might include the nursing staff. So

there's lots of different ways that we can show up as leaders. And I think the key there in terms of like being well-being centered as leaders are some of the things that Dr. Cabral was just talking about, which are really that foundation of caring about people. So there's this great framework that's been published by Tate Shanafelt, who's the chief wellness officer at Stanford. The article is about well-being centered leadership, and it's a framework that's a triangle with a

foundation and then a peak. But at the foundation is really about that foundation of caring about people. It starts with caring about yourself. You do have to attend to your own self-care needs. There's data that leaders who are more burned out tend to get lower leadership scores when they're rated by their team. And leaders, for example, that talk about the fact that they only got three hours of sleep last night are generally rated more poorly by their team members. So your self-care is important.

But really that inviting of sharing and trying to understand what's important to your people and demonstrating that caring is the foundation. And then the next level is really about fostering relationships between team members and thinking about how you can help people to work well together and thinking about how you can create collaborations for folks

that maybe have similar interests and bring teams together. And then the peak is really about sort of helping people be more aspirational and inspiring them to move forward. And without those foundations of building those relationships, building that trust, demonstrating that curiosity as a leader, it's harder to get to the more aspirational goals. So

you know, in the clinic as a junior faculty member, taking that time to get to know the new interns that just started and where they've come from, what's important to them, why they went into medicine, what day they can reflect on maybe from medical school that was most impactful for them might be a question they could ask. And getting to know them in that clinic as sort of the foundation of learning about them and helping them then navigate

the challenges that come up or career decisions that might come up in the future, I think is really important. In many ways, you're saying if we make it about people and what matters to them, by focusing on them, we're going to allow them to achieve their best, which really just works for all of us to be better. And I think that's a great message that a lot of leaders can take to heart.

And there's data on this stuff too. It's fairly old and kind of consistent data, but Gallup many years ago did a survey on employee engagement. And among the top three factors of what leads to engaged employees is when people get to do what they do best online.

On a regular basis. And so, like you said, it's both good for the individual and people are likely to be much more satisfied that way, but it's also really good for the company and how engaged of an employee you have, which is also going to help with employee retention and what you can get in terms of productivity out of somebody. Well, that is all amazing. Is there anything that you wish we had covered today that you think is important to this topic?

You know, the only other thing I guess I would add to this in terms of things that leaders can think about, I guess I touched on it very peripherally, is how they can build that sense of community within their groups. And, you know, this may not be as relevant for a team that's rotating on for a week through the ICU, but I think you can try to get people to share. But, you know, if you're a division chief,

or a medical director of a clinic where you've got staff that's working more longitudinally, that sense of building community, or even just within a department. I think we do know that there is a, we've heard about the epidemic of isolation from our surgeon general. And I can say this, you know, while COVID might have made this worse, I think that is a significant issue for us. Raquel hears about this all the time from people that come in just feeling very isolated and

So thinking about ways to promote those connections. And so one good example that I like to share is something that was done by Colin West at Mayo Clinic that he's published on where he developed these compass groups. And they're small groups of faculty that get together every few weeks. The Mayo Clinic pays money towards a meal. They have a discussion topic that they...

spend any amount of time that they want. They could spend the whole hour on it. They could spend 10 minutes and then just build that community. But they've shown a significant impact in terms of reducing burnout and promoting better professional satisfaction. So that may not be the way that works for every organization, but we know that promoting that community and connection between colleagues can make a difference. And I think that's something leaders can be thoughtful about in terms of trying to support the well-being of the people on their teams.

That sounds like an awesome idea. And I think the concept of bringing community together is one that we know is important for our organizations and for individuals as well. Dr. Duncan, Dr. Cabral, I really appreciate your time today. This concludes another episode of the Society of Critical Care Medicine's podcast. If you're listening on your favorite podcast app and you like what you heard, consider rating and leaving a review. For the Society of Critical Care Medicine podcast, I'm Kyle Enfield.

The information discussed in this podcast was provided by the Society of Critical Care Medicine's Leadership, Empowerment, and Development Lead Committee. Find other professional development topics and more in the SCCM Resource Library. Kyle B. Enfield, MD, is an Associate Professor of Medicine in the Division of Pulmonary and Critical Care at the University of Virginia. He received his undergraduate degree from the University of Oklahoma.

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