Leadership and Professional Development

Leadership & Professional Development: A Letter to the Future Teaching Physician

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© 2020 Society of Hospital Medicine

“No one cares how much you know, until they know how much you care.”

—Theodore Roosevelt (attributed)

Like many early career clinician-educators, you are likely embarking on your teaching role with excitement and trepidation. Excitement accompanies the opportunity to develop the next generation of physicians. Trepidation arises from a fear of insufficient knowledge. This concern is understandable but misplaced: great teachers are great because of their emotional intelligence, not their medical intelligence. These five principles will help you establish an optimal learning environment.

Small-Talk before Med-Talk. “What do you like to do outside of the hospital?” “Where is your favorite place to eat?” These questions indicate that your interest in learners transcends clinical work. Leaders who are more relationship- than task-oriented achieve greater group cohesion and more team learning. Exemplary inpatient attending physicians use learners’ first names and get to know them on a personal level to signal that they care as much about the person as they do about the performance.1

Be Available. Medical educators balance supervision and autonomy while trainees engage in high-stakes decisions. The best teachers get this right by signaling “I have faith in you” and “I’m always available.” Clinician-educator Kimberly Manning, MD portrayed this balance in a recent Twitter thread. The resident called: “I am sorry to bother you.” Dr. Manning responded, “Never be sorry.” The resident was concerned about a patient with new abdominal pain but reassured Dr. Manning that she did not need to return to the hospital. She returned anyway. She assessed the patient and had nothing to add to the resident’s outstanding management. As the patient recovered from his operation for a perforated ulcer, Dr. Manning reflected, “On a perfect Saturday afternoon, I chose to return to the hospital. To make not one decision or write one single order. But instead to stand beside my resident and intentionally affirm her.”

Build from the Ground Up. Asking questions is the teacher’s core procedure. Strive to master the true Socratic method of starting with an elemental inquiry and then leading a conversation that poses questions of increasing difficulty until you reach the limits of the learner’s understanding. This method reinforces their hard-earned knowledge and sets the stage for growth. “What would be your first test to evaluate tachycardia?” Once the correct answer is firmly in hand, explore the margin of their knowledge. “Which regular, narrow complex tachycardias stop with adenosine?”

Never Judge. Never endorse an incorrect response—but do not disparage it either. A trainee must learn that their answer was wrong but should not feel defeated or embarrassed. Use judgment regarding whether constructive feedback should be delivered in public or in private.

I recall answering a question incorrectly in medical school. The attending responded, “How many years did you take off before starting third year?” I had not taken any time off. The attending was a phenomenal clinician but a lousy teacher. A master teacher would have accessed a foothold and built my knowledge without judgment.

Remain Humble. One of the most liberating phrases you will deploy as a teacher is “I don’t know.” Its utterance demonstrates the honesty and humility you hope to instill in learners. Be on the lookout for the many times your trainees will know more than you.

Recently my team evaluated a patient with blunted facial expression, bradykinesia, and a resting hand tremor. I disclosed to my team: “I don’t know the key maneuvers to distinguish the Parkinson plus syndromes from Parkinson disease.” The medical student had spent one year studying patients with neurodegenerative diseases (I learned this during the “small-talk before med-talk” phase). I invited him to demonstrate the neurologic exam, which he did admirably. That day I did not know the subject well, and we all learned because I freely admitted it.

Being a physician is the greatest job in the world. If you leverage your EQ (emotional quotient) as much as your IQ (intelligence quotient), your learners will conclude the same.


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