Episode 105: Passing the Torch

Speaker 1: You are listening to Your Practice Made Perfect; support protection and advice for practicing medical professionals, brought to you by SVMIC.

J. Baugh: Hello everyone, and welcome to this episode of Your Practice Made Perfect. My name is J. Baugh and I'll be your host for today's episode. Today we're going to talk about mentoring medical students, and to help us discuss this topic we have with us Dr. Greg Hood. Dr. Hood, welcome.

Dr. Hood: Thank you very much. Delighted to be here.

J. Baugh: Well, it's good to have you here. We're looking forward to hearing your thoughts about a topic that's as important as mentoring medical students. Before we get into that, how about if you give us a little brief introduction of yourself and what you're doing now?

Dr. Hood: Certainly, I'm a general internist in private practice in Lexington, Kentucky. And I've worked extensively with the American College of Physicians and other medical specialties on a wide variety of issues, that including supporting and mentoring the generations that follow us.

J. Baugh: Well, I know that you've spent quite a bit of time mentoring medical students. And I'm wondering how did that start for you, and how long have you been mentoring medical students?

Dr. Hood: Well, it's a very good question. And I think it's something that we all play a role in, even if we don't realize it, even back to the time when we're residents ourselves and have medical students that are rotating with us on our teams. I was very blessed to be Chief Resident in the year after my residency. And had the greater educational mission arranging the educational topics for every noontime conference, as well as working with the teams and the individual students, both on the wards and in the continuity clinics. And I really had a tremendous residency in San Diego at one of the private hospitals, and loved the director that I had trained under and the program.

And, so even in my first few years in practice, would go back and help teach and mentor the house staff and the medical students. From there, it's been something that I've been blessed from time to time to have the opportunity to work with students, both in my office as well as some online, as they work through their processes of deciding who they are going to become and the paths that their careers are going to take.

J. Baugh: Well, it sounds like that you've been mentoring medical students for a good portion of your career. And I'm wondering, why is it that you feel that it's so important to be able to mentor medical students?

Dr. Hood: I think it's very important and I think it's a duty of conscience for each of us as physicians. As we look at the advances, even that continue to be made today in medical science, we have to understand that we're really standing on the shoulders of those that have come before us. And, it's really imperative with the challenges that our profession faces from so many different angles and society as a whole, that we maintain what is special and unique about being a physician, and has been so for generations and is still so in our generation. I think it's essential that we impart that understanding in a way that has meaning and a true basis and true connection to the generations that are coming up and following us.

J. Baugh: So when you have a new medical student that you're getting ready to mentor, do you have a mentoring template for each student or is each student different? And how do you determine the best way to provide the best lessons and so forth for each student?

Dr. Hood: Well, I think it was Jimmy Johnson when he took over the Dallas Cowboys and he met with the team that he'd inherited, and he said, "I promise, I'm going to treat every one of you differently." And I think we have to do that when we work with each student, because each of them are unique individuals. So having guiding principles is important, a way that you want to project an understanding of duty to patients and to profession and of professionalism, and the things that for each mentor help in their resonance of how they've defined themselves. But we have to understand the uniqueness that is each medical student, each one comes from a different background with different life experiences, many of which already tell compelling stories. And many of which tell nontraditional stories. When you look at the breadth of human experience, you can't really be an effective teacher if you take just a stamped cookie-cutter approach.

And so what I try and do when I can, I meet with the medical student prior to actually starting to see patients with them shadowing or participating, or ultimately seeing patients independently and speaking to me, to find out a little more about them and their interests. And of course, we can't be all things to all people, but we can open doors that facilitate them taking steps forward and exploring who they think they are, who they want to be, and as they find what resonates for them. So each student has a bit of a tailored approach, but it's also important that we do show what we've found to be best practices so that we can be something for them to perhaps emulate. I certainly know that I have things that I do even today in my practice that I learned from emulating mentors that I had in medical school and residency.

J. Baugh: You mentioned a few minutes ago about a cookie-cutter approach. I could see from your perspective that if you went down that road, it would be easier for you to do a cookie-cutter approach, but I can also see that it would be much more effective to not do it that way. Because as you said, medical students have a wide variety of backgrounds and stories in their lives. And so I can see why you would want to take a more individualistic approach in mentoring medical students, even though that might be the more difficult way to go about it. Let me ask you this question. What is unique about mentoring a medical student in an office setting?

Dr. Hood: Well, I think it gets actually very well though. But part of the point you were just making, as a mentor if you're not going to tailor your approach and make what you do with each student or resident unique and interesting, then why are you doing it? If you're going to treat every one of them exactly the same, then where's the excitement or the interest in that? And part of what I find the medical students and residents really crave about the office experience, is that they see a different world than just what they see in the hospital. And that's very important because there is such a diversity of our patients and of the problems they may come in with.

I have a student with me now, and every visit is different. We may go and treat hypertension and being proactive about risk of dementia and stroke with one patient. The next patient is a cat bite. The next patient is a urinary tract infection. The next patient is a general anxiety disorder. They get the education, but they don't get the feel for the diversity of what happens with patients and how you shift gears and have to be adaptive and responsive as a physician.

And being in the office setting, which is so varied in the visits that happen, it does really help them see that, and help them feel and stoke the fires in themselves that led them to choose this path of fire that hopefully doesn't ever get extinguished. But when you sit and you're doing didactics and you're receiving lectures over and over, and you're admitting problems that maybe are very redundant on a specialty service, you can lose sight of or wonder if that variety is really out there. So, they really do have a different world when they come here than being in the hospital, although there are a lot of unique patient cases in the hospital as well, certainly.

And it's important that those of us who practice in an outpatient or an inpatient and outpatient basis, that we demonstrate this because our profession with physicians as outpatient providers is really under great pressure. It's very difficult for economists and business people and general public, to understand how very special it is to bring a physician's training and experience in a relationship that has continuity such as we offer in our practice. That continuity and that bond and that understanding over time really make a difference.

I had a patient that I saw with a medical student recently, that because I've taken care of this patient for almost 20 years, it was very simple to know what was happening and why it wasn't what the face value presentation would make it seem like for somebody who didn't have continuity, or was seeing them in a fragmented care model. So, it really helps them understand why this profession is valuable to the patients, but particularly to themselves.

J. Baugh: Well, it sounds like the medical students that you're mentoring are learning quite a bit by being able to be with you while you're seeing patients. I'm wondering in your experience, has the practice of mentoring medical students changed since you were in training and the roles were reversed, where you used to be the medical student who was being mentored and now you're the one who is doing the mentoring? Has that changed much in your experience in that period of time?

Dr. Hood: Well, I certainly have a greater understanding. It would mystify me a bit when I was being mentored and I would have my book learning of, well, this patient just said this, and that means we have these questions we have to answer and these things we have to worry about. And my mentor would kind of go in a different, customized, very precise direction, and then it would all work out fine. And the difference was he already knew enough about the person that it changed the pretest probabilities in his mind of what might be going on.

So, it's a nice luxury to be on the other side of that equation. And certainly, we've seen over the decades as I've been doing this, the technology has changed quite a bit. The interfaces with the electronic health records, the ability to pull up studies, or to double-check drug interactions. All the technology has changed, but the spirit of learning, and really important I think for those who consider mentoring, the energy and curiosity that the students have and still bring can be so invigorating and sustaining for the mentor. It really is refreshing for the mentor, rewarding for the student or resident as they have an affirmation of their intellectual and spiritual curiosities.

J. Baugh: So with the medical students that you have mentored recently, what are some of the common hurdles that you're seeing in today's world for a medical student?

Dr. Hood: Well, certainly those considerations have to start with finances. And I think in general, much of the current generation of medical students and residents are certainly more aware and in good cases, more focused on the financial impacts. And they have to be because we've seen residents that have $400,000 in educational debt, and that's just such a burden on the soul and it can be limiting in their career choices as they think about what they do. So that is a big hurdle that's incontrovertible, particularly when people are looking at specialties that may not be the most financially compensated in our healthcare system.

But the fragmentation is a challenge. Certainly, there are problems with overwork, and it's important that patients be cared for well by health staff that are able to think and aren't asleep on their feet. But we do see quite a bit with the work hour restrictions and the way that schedules have been changed to accommodate hospitalist services and nocturnalist services. That it's very difficult for the medical students to see what my wife and I saw when we were in medical school and in our residencies, as you would look at acute critical illness and the way things would progress over 12 or 16 or 30 hours. They really don't have an opportunity to see that. They'll see a snapshot of those 30 hours.

And in another patient, they'll see a snapshot of a different set of time. But to be intimately involved as the treating provider on a case like that throughout a day and an overnight and you really come to understand that cadence. That's a very difficult hurdle for the medical students now, because it's just not in their experience.

But I think there's also a lot that's been removed in hurdles. And I think removing those hurdles gives these health staff and medical students the opportunity to really participate, not just in a more supportive environment, but one that more fosters asking the questions. When you have such a paternalistic and hierarchical approach that we were subjected to, there were a lot of questions that we probably could have learned the answers to earlier, and been better medical students and been further ahead as residents and physicians, if we had the sort of environment now that encourages asking questions and really being more full participants.

So, hurdles are always going to exist. There's a reason life is a four letter word. But, there are opportunities in this. And just because there are hurdles, doesn't mean that there are other hurdles that haven't gone away, and certainly doesn't mean that they're insurmountable. And that's where a role in having a mentor and one who's open to be asked questions and to give perspective, can help students to overcome and really reach their full potential.

J. Baugh: So in your experience in mentoring medical students, I'm wondering if you've ever intentionally or not intentionally influenced a change in specialty for students in the past? And if so, could you give us maybe an example of where that's happened?

Dr. Hood: Oh, certainly. As an internist, it's not unusual to have a medical student or a resident who's considering their subspecialties within medicine and their paths in fellowship, and influencing in those regards is pretty common. But I did have in the last couple of years a student that came in that was convinced that he wanted to be an OB/GYN, which is a great choice, and I didn't consciously dissuade him from that. But as he worked with me and followed me, he gained such an appreciation of the variety in internal medicine. And there's probably an overused statement, but has that Sherlock Holmes sort of approach to deducing problems and synthesizing solutions that he really found that he craved a greater breadth than limiting to OB/GYN would provide. Which isn't all that limiting, they do a tremendous variety of things. But he just found that internal medicine was going to resonate more fully with his interests, and did change his residency plans as a result.

J. Baugh: So when you're mentoring students, what is it that you hope for them to take away from that experience in having you mentor them as a medical student?

Dr. Hood: I would say first and foremost, that there is a future. It's easy with the intensity and breadth of the readings and studying, and the long hours in the library, and all the didactics to lose sight that there is a place where this choice of schooling and education leads. And that there is a way to craft for each student, each physician that they're becoming, their own vision for their career and their lives and that they can make this meaningful and they can even make it fun. We forget that word all too often in lives, particularly in a career path that is all about delayed gratification and service and subsuming our needs to the immediate needs of the case we're caring for. Life is intended to be enjoyed within balance. And there are things about this career that are rewarding in ways that are very difficult to find in most other careers.

But if we don't have a way that this is meaningful and rewarding for each of us and find some ways to make things interesting, unique, and fun, then that's where really that fire can ebb and even sometimes be extinguished. And that's a great tragedy, particularly given all the sacrifice that's required to get into medical school and then to succeed there and beyond.

J. Baugh: Right. So as we begin to draw this podcast to a close, do you have any advice that you would give to the young students who are about to enter into a mentoring program? And do you have any advice that you would give to a more experienced physician who is considering beginning the process of mentoring medical students?

Dr. Hood: The main thing I would say to the student is to beware the unasked question. Whether it's uncertainty or a lack of confidence or questioning of roles, there is a tendency that oftentimes goes just a little too far to hold students back in asking what they really have on their mind or what they don't understand. And obviously some mentoring relationships are going to flow more easily than others, or have greater depth or fulfillment, but these are people that have invested that they want to help you. And you never know, just as we started, as a mentor, don't assume a background or don't treat the students as all the same. As a mentee, as you get a sense for who you're mentoring under and what their strengths and interests are, if there are questions that you have that you think they could answer, finding the appropriate time and the appropriate way to ask those questions can lead you to answers that you hadn't considered before and can help make the path further.

And as far as the mentors go, it is a challenge as fast-paced as the world is now and with HIPAA and liability and that sort of thing, it can be difficult to take that leap to start or to continue a mentoring relationship. But being honest with yourself about how this can work in your practice and where the most conducive timing can be, usually with the training programs can find something that fits fairly well. And patients are generally much more accepting of that shadowing role. They understand that this is a calling and that we have to teach it forward.

So it's worth taking the leap. And I suppose like those commercials that have been on TV recently talking about adoption, that you don't have to be a perfect parent to be a parent that fulfills a need. There's a need for mentoring, and there's a need for these students to be able to understand what it means that they chose the path of becoming a physician. And if we that our physicians don't share in their understanding of that, then how do we expect our profession to continue in the wonderful ways that have sustained it for millennia?

J. Baugh: Well, Dr. Hood, I want to thank you for all of the work that you're doing in mentoring medical students today. And I also want to thank you for spending some time to talk to us about this very important topic.

Dr. Hood: My pleasure. Thank you very much.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect with your host J. Baugh. Listen to more episodes, subscribe to the podcast, and find show notes at SVMIC.com/podcast. 

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