Episode Transcript
Interviewer: This is The Scope Radio live from Learn Serve Lead at the AAMC. Today we're talking about pathways. Pathways in academic medicine. Pathways can connect, advance, empower, transform and inspire. And today we're going to learn about pathways for medical students from Tom Hurtado. He's a senior director of student affairs and the co-director of the RealMD program. And we've got some medical students here and we're going to talk about pathways to leadership. So Tom, let's frame this up here. First of all, leadership is a concept for med students, not something necessarily they're learning in their anatomy classes. That's why you feel it's important. Otherwise, why is it so important?
Tom Hurtado: Well, I think first, Scot, it is super important because medical schools struggle to deliver leadership development content, and I think they're making a lot of effort but it's a challenge. It's a challenge to fit it into the curriculum. It's a challenge to make it relevant. I think it's a challenge on so many levels and I think we need to hear student perspective about it. I think that's where we're going to learn and where we're going to co-create a better form of leadership development for our learners.
Interviewer: And I've noticed here at the AAMC a theme that you've got to talk to the people that you're trying to create these pathways for to find out what works for them, whether it's students, whether it's patients. Why is leadership such an important skill for doctors?
Tom Hurtado: Well, in every way you're part of the health care team, but you're a leader in the health care team. You're someone that people are looking to. And not only that, I think in a career you're also leading your own life, and I think you have to be aware, have self-awareness and have an ability to navigate both of those spaces.
Interviewer: Right, to provide better patient care, better outcomes, you've got this team that you need to be able to lead. So Tom, what are we going to talk about with these students today?
Tom Hurtado: Well, we're going to get student perspective. We had a great opportunity at this Learn Serve Lead conference to do a panel and to talk about student perspective and a resident perspective on leadership development, talking about what's working, talking about what isn't working maybe as well, and learning from that perspective, which I think that is where the magic is. That's what I like to say, that student perspective, that is where the magic is. So with that, let's jump to Nick. Nick Kieran, who is a fourth-year from Thomas Jefferson University. And Nick was kind of behind the whole idea of the panel that we did. And so Nick, I just want to ask, why do you care about leadership and why did you want to do this panel at this conference?
Nick Kieran: I think that one of the things I've really learned in med school is that knowing medical information is really only half the job of being a doctor. I would say maybe even the most important part is being able to manage the team members. As a med student, when we're rounding, we spend hours talking about patients. The senior doctor often stands in the background and doesn't say anything about patient care until there's a disagreement. When the nurse has a different opinion from the resident and then the pharmacist brings up a concern about the medications, it's really the senior physician who comes in and identifies a way to solve all of the problems, keep people on the same team because they have to see 15 other patients that day. And by doing all of that, I think that the physician really becomes a leader in a way that without it patient care really would sacrifice.
Tom Hurtado: Yeah, so I think of you right as you started medical school almost four years ago, kind of hard to believe it goes by real fast, when did the light turn on for you that medical school was more than knowledge and skills and that you needed to have these leadership development experiences? When did that happen?
Nick Kieran: Yeah, I think it was as soon as I entered the hospital. At least at my medical school, about the first two years are all sort of the textbook, the lecture learning, and that's really memorizing information. And then the second that I stepped into the hospital, that was when I realized that there were all of these softer skills that you're expected to know about how to lead a team, how to be productive. And that's when I identified that some people were really, really good at it and some people definitely struggled, and I identified that it's something I hope I'm good at, but that at least three years into my medical school when I was really in the hospital, I hadn't been taught that yet and I was soon going to be the one that had to be part of a team leader.
Tom Hurtado: All right, let's go over to Noah Danesh who is at USC and is a second year medical student. And you were also part of the panel and I guess I would love to get your take, Noah, on why leadership development matters to you and maybe start giving us some ideas of experiences that you have had that have been meaningful.
Noah Danesh: Right. Thanks Tom. Nick, I think, did a great job of talking about how fundamental it is to have leadership in medical education and why it's such a valuable aspect of patient care. For me, so I'm a second year, so I'm earlier in my school process in medical school, and I think even in our first week of medical school at USC, we're fortunate enough to go into the hospital, and going in there and seeing how the medical environment is so busy, so chaotic, and how there's so many attributes that are required to really help ground those interactions and ensure that the patient experience is really what it needs to be. I think once seeing that so early on started framing my thinking. And early on then I started realizing that, "Oh, as a medical student, that's going to be me in a few years, so I need to have that experience."
And at USC, I think they do a great job of incubating that experience with the attributes that we want to approach. So I think one of the big ones is the responsibility. And I mentioned this during the panel yesterday that responsibility we at USC talk about being one of the most fundamental aspects of leadership, and throughout the different opportunities we have at USC, responsibility is kind of at the core of that. One thing that I think is unique is the OSR position of AAMC that I have. And for people who don't know, that's basically each school can have some representatives to the AAMC. And in that role, I've had the opportunity to learn with students about what challenges they're having and bring that back to both administration and to other schools to navigate ways that we can find solutions.
So I think being able to really be jumping into that position, I think USC said, "You can go ahead and get started," and that not having the lead time of, "Oh, warm up and get to this," and really having you immediately get started I think was what is so good about some of the opportunities we have. It's that get started, go and start exploring.
Tom Hurtado: Yeah, I mean often medical students have these feelings of being an imposter, and yet I think it's refreshing to say, "Go jump in and learn and be a part of this." Why do you think medical schools have such a hard time teaching and engaging students in leadership, Noah?
Noah Danesh: That's a fantastic question. I think the conversation of buy-in for leadership programs is really fundamental, and especially in third and fourth years when students have less time it gets even more challenging. But maybe for the first or second year experience that I can speak to, I think one of the things is how busy students can be and then what value sets they put in certain things. I think they expect that with step one exam coming up, that should be their main focus and that these other soft skills that are required for leadership can sort of be developed later and we can off put that for a later time. And when I speak to other students and they're like, "Oh Noah, why are you doing this now?" or they're like, "Oh, I'm going to figure that stuff out later." I say, "Well, I understand and I understand when it's busy, but my perspective is that being able to early on get experiences that develop over the four years, having that long-term experience is really fundamental."
I was at the LSL, Learn Serve Lead conference last year and just being able to start so early at that and having a great group of mentors, both at my school and beyond, have allowed me to over time hone my skills. And even since the last year I've had dramatic changes in perspectives on leadership, medical education, et cetera. So the more I've seen that, the more it's reinforced my understanding that getting involved early and having that opportunity to jump in early and grow with a program and grow with an experience that you're a part of is really important.
Tom Hurtado: Yeah. I love what you said about medical students having a tendency to push some of these things out, "It's not on the test or the quiz that I'm studying for right now, so I'm going to push it out." And how with these leadership development things, it's not a light switch that you just turn on all of a sudden and be like, "Well, I've gained the knowledge and skills and so now I'm just going to flip this switch on and my leadership abilities will just magically appear." And so I appreciate how you're saying, as learners, we have to carve out that time. We have to make it a priority because the system won't do that for us, right? On the other hand, buy-in is tough because the quality maybe isn't there and we talked a lot about this yesterday. So I do want give Greg Memmott from the University of Utah and an MS2, a second-year medical student, an opportunity to talk about this. Why is buy-in so important and how have you even in your role started to create buy-in and help other medical students buy in?
Greg Memmott: I think for me, buy-in matters a lot because it's taking the power from the people that are trying to give you information and giving it to the student. Tom, we talked about the quote I love yesterday where I think it was Ben Franklin, but it's students are matches to be lit, not vessels to be filled, and if you can help someone, I love it. And I feel like if you can help someone understand what ignites them, excites them, gets them excited to get out of bed in the morning, you won't have to worry about encouraging or motivating or inspiring because they have it. It's intrinsic at that point. Just like Noah was saying too, that's really hard. Because for medical students, the next hoop in front of you is always so much closer than the personal development side of things.
But I think when we can show people that improving yourself improves your relationships, improves your environment, then wanting to work on those things becomes a lot more intrinsic and where you start pushing for that more. I think for me, I'm a part of the RealMD program at the University of Utah, which has been great. It's the opt-in portion of leadership development. And I think for me, it's given me the opportunity to see what other students have done that's excited them, the opportunity to follow in their footsteps on some things, but also kind of forge my own path on others. And that for me has been awesome because it isn't a curriculum-based thing. It's not like you have to check off all these boxes. I love these areas of leadership and professional development and I want to learn more and get better at those things.
Tom Hurtado: Yeah. Can you talk more about what aspects of RealMD have been a light, helped ignite you just in who you are? Is it an experience that comes to mind that like, "Oh, this really helped me figure out some of my leadership"?
Greg Memmott: I think for me, the biggest thing, I love working with different people. I used to train EMTs and that kind of thing, and I love that aspect of it of helping people figure out what works for them. And especially with University of Utah, we just started a new curriculum and I think people have felt a little off-balance by that at times. So I think getting to work as a facilitator where I'm trying to help connect them with their purpose and figure out what drives them, that's kind of helped me ignite my own passion for that too more. So just different meetings with classmates, whether that's a formal gathering or a side conversation, working to build kind of a scaffolding around what we're doing to help support people has really been the biggest thing for me.
Interviewer: Hey Tom, I wanted to jump in and ask. For our listeners, the RealMD program is kind of a formalized pathway. We're talking about pathways that can lead to some opportunity or some new skills. Explain a little bit what that program is because I know you're the co-director of it, so you should know something. And I'd also like to find out from the med students what pathways, if there are any pathways or formal programs at their institutions.
Tom Hurtado: So RealMD is a super unique thing for our school. It started about seven and a half years ago and it's really been created with students. That was the first part, but it is a leadership development, professional identity formation and career exploration program. It's an acronym that stands for Relationships, Excellence, Authenticity and Leadership. But I think I said earlier, there's magic in working with students and the students helped us create what it is. So seven and a half years ago, we started with some lunch sessions that allowed physicians to sort of take off their armor and talk about their authentic journeys into the physicians and the professionals and who they are and whatever that nonlinear path looked like.
And then we created a coaching program that has now grown into something that's full blown with faculty, and the students also created a workbook that helps facilitate self-reflection as you're going through each step of the process. So yeah, I could talk a lot about it, but ultimately anything good that happened about it came from students like Greg who stepped in and said, "These are the kind of things that I need. These are the kind of content pieces that I need." And so yeah, it's really exciting to see it continuing and growing the way that it is.
Interviewer: So it sounds like it took a leader at the institution to recognize this is something that needs to happen, and then you went to the students and said, "How can we best make this happen for you?" And you just let them develop it.
Tom Hurtado: Yeah.
Interviewer: The scope increased over time. It started out very simple, and now it's got some pretty cool components to it.
Tom Hurtado: Well, and I'll say this from our students and I want to jump right back to them, but that we have to intentionally carve out space and let students fill that space with the content that matters to them, especially when you're talking about your personal professional development, your idea of who you are, what you care about, what your why is, and then building your leadership and all of those interpersonal skills to accomplish your why on top of it. That's where real leadership happens, because there's a need to acquire those skills. It's not preemptively going out to attain these skills and then figure out your why and then see what happens. It's about, no, let's get to the core. Let's light it up like Greg said, and then let's build the leadership on top of it.
I want to talk to Nick again because what I loved about this conference and this panel was that we heard from several institutions and there's really amazing things happening at each of them. So Nick, talk about what you mentioned about programs that really sort of lit you up and made you excited about your own leadership journey at your school.
Nick Kieran: Yeah, yeah. And I'm lucky because our school has a number of different opportunities. We have student-led leadership programs. Actually one just started a couple of weeks ago because there really is a desire for it in the medical student community. But there was one opportunity that I talked about from our school called the Student Leadership Forum that I think was unique and hands-on in a way that really got students engaged and helped them that leadership skills are important because I think that's sometimes a barrier is that we aren't always told that these skills are going to be helpful in the future.
And this was a group where the dean selects about 18 students to serve on this sort of small leadership forum where once a month we have these meetings where we either get lectures or we have group discussions, or I think most importantly we do hands-on practice where we actually learn about leadership skills like delegation, like giving an elevator style pitch, something that we have to sort of think on our feet and adapt quickly, how to give bad news. Being able to do all of these things and then the next day be in the hospital and see physicians that do this well or do it poorly, I think that's really what has motivated me even more to now come here to do this panel, to understand that leadership development is really important and I think is something that medical students need more of.
Tom Hurtado: Thank you for that. I love this program that you talked about, and I think that it's something, once again, special happening at your school that is helping a lot of students practice and engage and also have leadership modeled by people who have been there. Noah, you talked about things as well. What about a mentoring track and why don't you give us the rundown on things that have been really compelling for you that you've experienced, and then also something that could use a little improvement.
Noah Danesh: At USC, we are lucky, we have a lot of opportunities. Yesterday during the panel we spoke about the three aspects of leadership curriculum. We have the formal curriculum, co-curricular and hidden. And I think at USC we do a good job at having the three of those and engaging students in each of them to the level that they want. One of the programs I spoke about during our panel was the Track Mentor Program at USC, and what this is in effect fourth-year students that are selected to lead a group of students that are a part of a track, which is the order of core clerkships that students are a part of. And this allows, I think, in many ways providing opportunities for all the stakeholders involved in the program.
The fourth-year students have the opportunity to gain the responsibility of walking students through the challenges of a core clerkships, the nuances that exist between specialties, and having it at a peer level allows the student relationship to connect and people to be more open with open forum of discussion with what they want to talk about. For the M4s, they get that strong ability to lead and develop a program and run it the way they want to with the institutional support and the connections that they need for that. For the M2 and M3s, while they're not in the leadership aspect of that curriculum, they're also not only getting the benefits of a peer mentor, they're also seeing a role model up there of leadership traits and how they can aspire to be one of those students.
So I think Track Mentor is something that's somewhat unique at USC and has provided a lot of different benefits. Now maybe we'll speak on the other side of things that are improving. So we have a longitudinal one-year course in the pre-clerkship phase at USC, the EPIC course which is Empowerment through Professional Identity Cultivation. And while this course isn't explicitly a leadership course, it trains students in the fundamental attributes of leadership, conflict resolution, taking responsibility, teamwork and how to approach different aspects of the medical field. You mentioned earlier that physicians are leaders regardless of what state they're in, whether they're in the patient care team, whether they're part of a public health system in academic medicine.
So training students in these attributes is really important in having them be the physicians that we want people to be, the empathetic physicians we want them to be that we lead teams through challenging situations. But it's an evolution of a course that's been very well integrated into USC for many years. And I think this is something I want to highlight is that it is a good example of what happens when you listen to students, improve with student feedback. Every year the course is different in some ways, sessions are added, sessions are removed, overall structures can be adjusted. And that's based on not only specific evaluations that occur after every session, but focus groups that are held.
Our directors of this program are really open and they want students to come talk and they don't say, "Do you have any feedback?" They say, "Please give us what feedback do you have and how can we improve this?" And I think that's a great aspect of the program's development. And one thing that we have been talking to them about improving is in the EPIC program we have an interdisciplinary education, but instead of having the dental students, medical students, pharmacy students, OT, et cetera, work on real patients, we work with mock patients and mock scenarios and we don't have that socialization phase and we don't get to, in this aspect, go to the patients and work with a real patient with an interdisciplinary team.
So we brought that up with the faculty and they heard us, and they're now working on figuring out ways that that can be incorporated. I think the rapid pace of them quickly hearing, figuring out ways, and then coming back to us, I think that's the key. They didn't listen to us the first time. They went back, they started thinking about it, then they came back to us and said, "What do you think about what we're doing?" I think that is so fundamental when we're talking about improving medical education.
Tom Hurtado: Yeah. Tuning in, for sure, and noticing and then reacting quickly in a way that usually there's some actionable way to change it. And certainly, I agree with you, having more deeper interpersonal interactions rather than a simulation is certainly going to help more in leadership. Greg, you talked about RealMD, but why don't you talk about some of the things that you mentioned that maybe need some improvement, still kind of a work in progress?
Greg Memmott: I think the big thing we're working on right now is our house model. We started a new curriculum for the University of Utah about two years ago. I'm the first graduating class from it, but in that, each year is split up into six different houses. And the goal is each house has students from each year to provide intergenerational mentoring and that kind of thing. And we've had a hard time just for the first couple of years to take off, because you've got these new students who started with the model, and then you've got all of these older students who didn't start with the model but are also so incredibly busy, which makes it really difficult to engage and kind of grow off of that.
So we've seen some improvement, kind of like Noah was saying where it's a growing program, and I think by the time all four years have gone through the program, their whole medical school, it'll be a lot different than it is today. But just getting it where enough of the students have a buy-in, that they're mentoring, building relationships, attending events, that kind of thing. So definitely a work in progress.
Tom Hurtado: Yeah. Growing those communities can be a challenge. Well, I've loved this conversation. I certainly love the panel working, with all of you, and most importantly, hearing directly from student leaders out in the field about what is working, what maybe could improve and how to do it. As institutions who are trying to train the future physicians, we have to put a stake in the ground around leadership development and create space. And often we want to fill that space, that's our inclination. We've got to incorporate and leverage student perspective and co-create leadership development and react when they give us feedback and really tune in to what they need. That's our job, and I'm excited about the future of helping our students become the leaders that they certainly deserve to be.