Letters to the Editor
Mind–Body Medicine Training: A Pathway to Inclusive Excellence in Medical Education? To the Editor: I read with great interest the Innovation Report by Talisman and colleagues1 in the June 2015 issue of Academic Medicine. The authors present excellent perspectives on the impact of mind–body medicine (MBM) training on professional identity development in health care faculty, with a special emphasis on self-awareness and perceived stress. Quantitative analysis resulted in significantly lower scores on stress indices and increased scores on a mindfulness inventory. Qualitative analysis revealed themes of professional identity, self-care, and mindful awareness. The authors, however, have missed a potentially powerful application of this work in promoting diversity and inclusion, which medical education must address at all levels.2 Of particular interest is Talisman and colleagues’ qualitative finding that many participants experienced a broadened sense of community. No mention of ethnic and racial diversity is found in this study. The potential of MBM training to facilitate cultural competency and humble communication among faculty and administrators is therefore not addressed by the authors. However, minority faculty, administrators, medical students, and the patients they are training to serve are likely to be affected by a persistent lack of inclusiveness, with inclusiveness being defined by an increased sense of belonging to the broader community. These negative experiences have been found to impede faculty professional development and mentorship.3,4 This study makes an excellent contribution to the changing climate of medical education. Affecting positive indications of the professional identity of minority faculty and other health care administrators using the mechanisms found in this study (communication, connections, and community; empathy, active listening, self-confidence, and improved self-care) may very well be an effective way to significantly increase, not only inclusiveness, but the inclusive excellence of our medical training institutions. However, there is much
292
more to investigate, quantify, qualify, and disseminate in this very important area of medical education. Disclosures: None reported. Shawn L. Garrison, PhD Assistant professor, Department of Psychiatry, Morehouse School of Medicine, Atlanta, Georgia; [email protected].
References 1 Talisman N, Harazduk N, Rush C, Graves K, Haramati A. The impact of mind–body medicine facilitation on affirming and enhancing professional identity in health care professions faculty. Acad Med. 2015;90:780– 784. 2 Rodríguez JE, Campbell KM, Mouratidis RW. Where are the rest of us? Improving representation of minority faculty in academic medicine. South Med J. 2014;107:739–744. 3 Hassouneh D, Lutz KF, Beckett AK, Junkins EP, Horton LL. The experiences of underrepresented minority faculty in schools of medicine. Med Educ Online. 2014;19:24768. 4 Tempski P, Santos IS, Mayer FB, et al. Relationship among medical student resilience, educational environment and quality of life. PLoS One. 2015;10:e0131535.
Should We Normalize Failure? To the Editor: Most physicians carry the self-image of being high achievers. In college, we were students at the top of our class. During residency, we begin to recognize that mistakes are inevitable: medication dosing errors, incorrect documentation, and complications from invasive procedures. Most of us, with enough clinical practice, experience all of these. But, how many of us accept that failure and mistakes are normal? With the rise of social media, interactions are brief and perspectives are skewed. We see select images of our friends, acquaintances, and colleagues: photographs of vacations, graduations, celebrations, and successes. We do not see the sadness and guilt over the loss of patients, growing debt, and spousal arguments. What are the costs of hiding our failures and the consequences of burying our mistakes? Recent tragedies1,2 on my medical school campus have compelled me to pause, reflect, and wonder about what truly matters. Would circumstances be different for all of us if our professional culture learned to embrace “narrative humility”3 instead of perpetuating a culture of pride
and bravado during medical training? Peer relationships set standards for acceptable behavior. In order to truly support each other, perhaps we should normalize failure. I am thankful to Tsevat and colleagues3 for reminding us of the importance of “narrative humility” and the potential “dangers to doing narrative work.” Openness about our failures may come with regret and vulnerability; however, the real danger is in hiding our stories from the people who are able to support us the most. Let us normalize failure, dissolve isolation, deepen relationships, temper fears, and, ultimately, build a community of more resilient and compassionate physicians. Disclosures: None reported. Cynthia H. Ho, MD Assistant professor of clinical medicine and pediatrics, Departments of Internal Medicine and Pediatrics, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine, Los Angeles, California; [email protected].
References 1 Help find Derek. http://helpfindderek.com. Accessed May 5, 2015. 2 University of Southern California. Memorial honors faculty physician Yoshimasa “Yoshi” Makino, 38. HSC News. January 9, 2015. http:// hscnews.usc.edu/faculty-physician-yoshimasayoshi-makino-38. Accessed May 5, 2015. 3 Tsevat RK, Sinha AA, Gutierrez KJ, DasGupta S. Bringing home the health humanities: Narrative humility, structural competency, and engaged pedagogy. Acad Med. 2015;90:1462–1465.
In Reply to Ho: We were delighted to read Dr. Cynthia Ho’s thoughtful letter, in which she suggests that medical culture adopt a stance of “narrative humility” in order to “normalize failure, dissolve isolation, deepen relationships, temper fears, and, ultimately, build a community of more resilient and compassionate physicians.” In his classic story “The Use of Force,” physician–writer William Carlos Williams1 creates a powerful model for physician self-reflexivity that takes into account mistakes, regrets, and less-thanprofessional impulses. He writes: The child’s mouth was already bleeding … and she was screaming in wild hysterical shrieks. Perhaps I should have desisted and come back.… No doubt it would have been better. But … feeling that I must get a diagnosis now or never
Academic Medicine, Vol. 91, No. 3 / March 2016
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
Mind–Body Medicine Training: A Pathway to Inclusive Excellence in Medical Education? To the Editor: I read with great interest the Innovation Report by Talisman and colleagues1 in the June 2015 issue of Academic Medicine. The authors present excellent perspectives on the impact of mind–body medicine (MBM) training on professional identity development in health care faculty, with a special emphasis on self-awareness and perceived stress. Quantitative analysis resulted in significantly lower scores on stress indices and increased scores on a mindfulness inventory. Qualitative analysis revealed themes of professional identity, self-care, and mindful awareness. The authors, however, have missed a potentially powerful application of this work in promoting diversity and inclusion, which medical education must address at all levels.2 Of particular interest is Talisman and colleagues’ qualitative finding that many participants experienced a broadened sense of community. No mention of ethnic and racial diversity is found in this study. The potential of MBM training to facilitate cultural competency and humble communication among faculty and administrators is therefore not addressed by the authors. However, minority faculty, administrators, medical students, and the patients they are training to serve are likely to be affected by a persistent lack of inclusiveness, with inclusiveness being defined by an increased sense of belonging to the broader community. These negative experiences have been found to impede faculty professional development and mentorship.3,4 This study makes an excellent contribution to the changing climate of medical education. Affecting positive indications of the professional identity of minority faculty and other health care administrators using the mechanisms found in this study (communication, connections, and community; empathy, active listening, self-confidence, and improved self-care) may very well be an effective way to significantly increase, not only inclusiveness, but the inclusive excellence of our medical training institutions. However, there is much
292
more to investigate, quantify, qualify, and disseminate in this very important area of medical education. Disclosures: None reported. Shawn L. Garrison, PhD Assistant professor, Department of Psychiatry, Morehouse School of Medicine, Atlanta, Georgia; [email protected].
References 1 Talisman N, Harazduk N, Rush C, Graves K, Haramati A. The impact of mind–body medicine facilitation on affirming and enhancing professional identity in health care professions faculty. Acad Med. 2015;90:780– 784. 2 Rodríguez JE, Campbell KM, Mouratidis RW. Where are the rest of us? Improving representation of minority faculty in academic medicine. South Med J. 2014;107:739–744. 3 Hassouneh D, Lutz KF, Beckett AK, Junkins EP, Horton LL. The experiences of underrepresented minority faculty in schools of medicine. Med Educ Online. 2014;19:24768. 4 Tempski P, Santos IS, Mayer FB, et al. Relationship among medical student resilience, educational environment and quality of life. PLoS One. 2015;10:e0131535.
Should We Normalize Failure? To the Editor: Most physicians carry the self-image of being high achievers. In college, we were students at the top of our class. During residency, we begin to recognize that mistakes are inevitable: medication dosing errors, incorrect documentation, and complications from invasive procedures. Most of us, with enough clinical practice, experience all of these. But, how many of us accept that failure and mistakes are normal? With the rise of social media, interactions are brief and perspectives are skewed. We see select images of our friends, acquaintances, and colleagues: photographs of vacations, graduations, celebrations, and successes. We do not see the sadness and guilt over the loss of patients, growing debt, and spousal arguments. What are the costs of hiding our failures and the consequences of burying our mistakes? Recent tragedies1,2 on my medical school campus have compelled me to pause, reflect, and wonder about what truly matters. Would circumstances be different for all of us if our professional culture learned to embrace “narrative humility”3 instead of perpetuating a culture of pride
and bravado during medical training? Peer relationships set standards for acceptable behavior. In order to truly support each other, perhaps we should normalize failure. I am thankful to Tsevat and colleagues3 for reminding us of the importance of “narrative humility” and the potential “dangers to doing narrative work.” Openness about our failures may come with regret and vulnerability; however, the real danger is in hiding our stories from the people who are able to support us the most. Let us normalize failure, dissolve isolation, deepen relationships, temper fears, and, ultimately, build a community of more resilient and compassionate physicians. Disclosures: None reported. Cynthia H. Ho, MD Assistant professor of clinical medicine and pediatrics, Departments of Internal Medicine and Pediatrics, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine, Los Angeles, California; [email protected].
References 1 Help find Derek. http://helpfindderek.com. Accessed May 5, 2015. 2 University of Southern California. Memorial honors faculty physician Yoshimasa “Yoshi” Makino, 38. HSC News. January 9, 2015. http:// hscnews.usc.edu/faculty-physician-yoshimasayoshi-makino-38. Accessed May 5, 2015. 3 Tsevat RK, Sinha AA, Gutierrez KJ, DasGupta S. Bringing home the health humanities: Narrative humility, structural competency, and engaged pedagogy. Acad Med. 2015;90:1462–1465.
In Reply to Ho: We were delighted to read Dr. Cynthia Ho’s thoughtful letter, in which she suggests that medical culture adopt a stance of “narrative humility” in order to “normalize failure, dissolve isolation, deepen relationships, temper fears, and, ultimately, build a community of more resilient and compassionate physicians.” In his classic story “The Use of Force,” physician–writer William Carlos Williams1 creates a powerful model for physician self-reflexivity that takes into account mistakes, regrets, and less-thanprofessional impulses. He writes: The child’s mouth was already bleeding … and she was screaming in wild hysterical shrieks. Perhaps I should have desisted and come back.… No doubt it would have been better. But … feeling that I must get a diagnosis now or never
Academic Medicine, Vol. 91, No. 3 / March 2016
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
