Navigating the Game of Residency

Dr. Frances Mei Hardin: Today we have with us guest Colin Royal. Colin Royal is an e-commerce manager, digital marketing strategist, and SEO specialist. Born and Oregon, but raised in Boston. He’s an avid sports enthusiast and experienced street debater. As a Wake Forest graduate, he’s an impassioned Demon Deacon. And he’s also my husband. For full disclosure, he is the favorite parent to, our main coon, Edley, and the second favorite parent to our dog, Beignet. We lived together all five years of my ent residency, so Colin had front row seats to the genuine nightmare job that is being a surgery resident. And he spent those five years with me dissecting, strategizing, and coming up with new ways all the time to survive residency. And, yes, we’re recording in the same house right now, but just from our respective offices. Hey, Colin, thanks for joining us.

Colin Royal: Yeah, I was going to ask if we’re allowed to say what our setup is. I find it interesting our dog is with you. Despite both of us wearing matching sweatshirts with his face on it, he still chose you, so it’s disappointing.

Dr. Frances Mei Hardin: And if Edley could pick, like, if your door was open, Edley would be, like, walking across your keyboard right now, causing chaos, disconnect you off the. You know, hopefully she understands why she had to be kept out of this.

Colin Royal: Yeah, she’s not allowed.

Colin created Collins Corner to help residents deal with workplace challenges

Dr. Frances Mei Hardin: so I want to introduce everybody to Colin’s corner, and so I need to give you a little bit of context for that. You may not have heard of Collins Corner. Well, in 2020, during the pandemic, like many others, we decided to get into great shape. So we made this commitment. We agreed we were going to start running again. One thing about me, I am not a runner. And so when we got in this routine of doing two to 3 miles at a time, at least five days a week, that was a huge adjustment for me. And even when I got good at it, I was still just, like, wheezing the whole time. Another thing about me is that I can usually very readily talk for long stretches of time uninterrupted. And Colin knows that about me. In this instance, he recognized that I could not hold conversations during runs, and he immediately took advantage of it and created what is now known as Colin’s corner. And so we’d have these 20 or 30 minutes lectures on whatever topic he chose for the day. It would range from World War I history to some biography of an old president. I’ll spare you more of those. But there were a few topics on Collins Corner that actually really started to pique my interest. Those ones that were super useful were where he started talking about workplace strategy and the principles that help one understand how to exist and play within an organization. And one of the best theories is centered on the office, which is one of my comfort tv shows. And we’ll talk about that today as well. And like many residents, I had never really worked in a traditional office setting. And so I didn’t know much about how organizational dynamics interplayed, with my role at the hospital, nor how I could use them to my advantage. So we’ll get into some of those interesting ideas today. And I realize for those of you out there who are like old president history buffs, I don’t mean to offend. I’m sure that stuff is interesting to know, Colin included, but that’s not what we’re here for.

Colin Royal: you know, I don’t even know that I consider myself a huge old president history buff, but I think with your unique stem high school and upbringing, we had to fill in some history gaps for you. So definitely, took a big spot, I feel like where this was kind of born out of, obviously residency and medical training, everything has all its own unique challenges, but a lot of the stuff that you would come home with were kind of typical workplace challenges. and having not really worked in an office setting or a corporate job, I feel like these were a lot of things that were just kind of foreign to you. And to me it was things I dealt with for ten years and didn’t necessarily have a specific language to kind of talk about. So I wanted to go out and find sort of a shared language that we could create and be able to talk through some of this stuff where you would start to hit on, okay, I see these patterns over and over again and these are ways that I can kind of adjust or deal with some of the smaller, nuanced things that don’t necessarily have direct impact on my residency, but create massive headaches day to day.

I started talking to you about the idea of agile methodology

I mean, the first thing we talked about was, what we called mental agility. so basically we put this together. I started talking to you about just the idea of agile methodology, which is really sort of kind of older now at this point, a software development technique, software developer. But obviously this type of thing comes up a lot in the type of work I do. it’s basically a project management approach to breaking down, sort of a long term project. old school was just, okay, we want to get from point a to point b. Let’s trudge through it. the agile methodology is more of breaking down a project into these sort of discrete phases. you invite continuous feedback and collaboration, sort of cross functionally, so that when you make mistakes, you make them early, and you’re able to learn from those, quickly, identify, the issues and solve them well before you kind of get to that end result.

Dr. Frances Mei Hardin: Yeah, I really loved that. And, well, number one, a huge plug for the shared language piece of it, because there’s so much that one of us has learned and then brought to the other person and said, hey, read this or listen to this, because this way we’ll get some new language, for what we’re trying to describe. And so with mental agility, and again, like, even agility in corporations and things like that, when it was introduced, I was kind of like m. I like those words. I like mental agility. I haven’t heard of this before. All right, you’re saying it could make me faster, sleeker, a better physician. Okay, I’m interested. And so, like I said, that piqued my interest. One example of application, though, that I think is so interesting is that I will use the personal example of not being good at receiving feedback. And that was definitely something that I learned as an intern, as a junior resident, because I was receiving feedback that just said, bad at receiving feedback. And of course, that’s not even super actionable. Then it’s on you to figure out, okay, well, how can I receive feedback better and then take it and implement it better? Because that’s definitely everyone’s goal. That’s what I wanted to do better, but I didn’t know how. And what’s so interesting is that when I heard about mental agility, I was like, okay, I kind of like this. I could put my teeth in this. Of course, that’s just a different way at coming at problems such as not receiving feedback very well, because this is something where I was able to say, not I’m bad at receiving feedback, I want to receive feedback better, but I was able to come at it from the standpoint of I would do anything to improve my mental agility and be able to weave that into my practice in the workspace and be able to demonstrate that. And so one way in which to do so, to actually walk the walk here, would be that you prioritize taking eagerly all the feedback that you get, whether from staff, your senior residents, attendings, co residents, seriously contemplating it, and actions that can be taken and then acting on those. Of course, residents receive so much feedback, both formal and informal throughout the days and weeks, and you’re sleep deprived and you’re often hungry and you kind of get one bathroom break, especially in those early years. And so I do think that by approaching it with some new language and kind of like a fun spin was a much more pleasant and effective way to get to the end goal of receiving feedback better. Because, again, it’s not like, punitive, it’s not like, hey, you’re bad at receiving feedback, take feedback better. That didn’t mean much to me. Whereas be agile in the workspace. Really did.

Colin Royal: Yeah. And I think one of the keys there too, is breaking down that broader goal of getting better at taking feedback, because that’s really hard. I mean, how do you just even measure that? Right? So it was more of, okay, it’s going to probably take me a long time to really be great at this skill. But first, what I can do is work on being less reactive when I first hear it. So that’s one step. And I’m going to read various techniques on breathing, techniques or whatever it is to slow down my heart rate when I’m hearing this feedback initially, that’s going to set me up for success as we continue the conversation. And that’s something you can practice and that’s something you can break down. And you can ask someone at the end of an exchange, you can say, hey, did I look like I was going to freak out when I heard that? Or did you think I was pretty cool? Common, collected, and you can get feedback and you can kind of practice that and you can do it in the mirror. and then you just kind of move on step by step, until all of a sudden you’ve broken it down into enough pieces where it wasn’t that hard to get to it, it was probably a lot of smaller, uncomfortable moments. But now, at the end of this, you are good at receiving feedback. And it wasn’t this just huge, amorphous goal that was unattainable?

Dr. Frances Mei Hardin: Yes, absolutely.

The Gervais principle is based on the office

And so the next one that we’ll move into this is kind of the meat of what we wanted to talk about. It’s called the Gervais principle. like I said, based on one of my favorite comfort shows, which is the office. The US version.

Colin Royal: Yeah. Okay, so the mental agility stuff is a pretty good lead into this because, know, we’re talking about. All right, here’s how, you know, Bob and weave and sort of gain skills and do better throughout. But, when you are staring down the face of something as crazy as residency or this huge hospital or healthcare system. How do you even fit within that? And what is gaining all these skills even really going to do for you? So, yeah, this is a fun one. obviously, just being centered around the office, gives a lot of good context and makes it a little bit more fun to talk to or talk about. So, yeah, this is called the Gervais principle. is developed by a guy named Venkatesh Rao. he has a site called Ribbon Farm. He’s, I don’t know, a consultant, think tank type guy. Very smart, very interesting guy. he does a lot of stuff like this, but he put this together, actually while the office was live. So this is pretty old at this point. It’s called the Gervais principle because, Ricky Gervais created the UK version. So it’s after him, basically. But essentially he set out to create the sort of theory of organizations and the people within them. and he modeled it after the office, which happens to be a pretty good setup, in terms, know, you’ve got all these different hierarchies and you’ve got all these kind of wacky characters within it. but they do sort of fall neatly into certain rungs when you start to look at it. So basically the theory is that, organizations create this, what he called, like individualistic darwinism. so it’s basically this dog eat dog capitalism, that you kind of can’t escape when you’re inside of this organization here unless you leave. So, within that you essentially have three levels of employees. I’ll explain these terms because they all sound bad on the surface. Some of them are mostly bad, but the three levels are sociopaths, clueless and losers. So quick definition sociopath doesn’t mean that you’re an actual sociopath. Oftentimes it probably does, but, it’s essentially the people at the top, right? So they’re the ones who kind of force an organization to carry on despite itself, right? They’re the decision makers. The clueless are, the middle managers. They’re the middlemen. The classic company man, like unfailingly loyal, might have been high performing, but they’re stuck in the middle. They’re the ones who have to kind of take it from the top and then deliver the bad news. And then the final group are the losers. So the losers, they’re not losers in like a social sense, but they’re losers in an economic sense. So they have essentially entered into a bad economic agreement. Oftentimes they’re probably the coolest within an organization. So it really has nothing to do with your social standing. It just means that you have given up this high earning potential to collect a steady paycheck. So you might be at a really profitable company, but you don’t see any of those profits. You just get your regular paycheck. Maybe you get a small percent raise a year, you get your insurance covered, and you’re kind of happy to take that deal. Losers have entered into this agreement willingly or unwillingly. there are sometimes obviously, social or sort of economic factors where you can’t take that risk. To go for the hiring potential, you just have to, take your steady paycheck. And certainly in the case of residency here, you literally don’t have a choice. If you want to be an attending physician, you have to go through residency. So they’re the actual producers, right? They’re the kind of laborers within an organization, basically how these people interact. So the sociopaths, like I said, are at the top. they have the highest level of freedom. So they can come in and out. They’re the know, moving around from company to company. Very easy to sort of enter and exit whatever they want in the office setting. The kind of classic example is so, you know, he comes in and out of mifflin, what, like two or three times, starts his own company, comes back, he’s at the top. He’s a decision maker. High level freedom there. The clueless, like I said, are those middle managers. They’re often, like, former high achieving losers. so main example in office is obviously Michael Scott. He was a high performing salesperson at one point, right? And there’s that classic kind of now meme of know, shaking the guy’s hand when he’s getting, know, with this bewildered look on his face. He doesn’t even know why he’s getting promoted. Right. That’s part of the kind of clues thing. And then the losers, these are basically everyone else on the show for the most part. So it’s Jim Stanley. Kevin Ryan is kind of an interesting one here. They rarely have loyalty to the organization as a whole, but they’re probably loyal to each other. Right. There’s probably some, strong ties there. Everyone. If your own coworker is not your best friend, you probably know someone who would say that. Something like that. But, yeah. So that’s kind of the framework for this.

Gervais suggests looking at residency as its own specific job

and we can kind of talk through what it means for this, but in this scenario, and sort of how we talked about it back when you were in residency, residents are essentially the losers in this scenario, you’ve entered into a bad economic agreement. You’ve given up three to seven potentially more years of very high earning potential, to make minimum wage, basically working 100 hours, weeks. It is a unique scenario, obviously, because there is this sort of carrot at the end of the stick. Right. When you finish residency, you could become a high earner. But realistically, most people who enter into this, they probably could have left college at 21, 22, taken a job at a consulting firm, been working for ten years by the time they finished residency, and already have a million in the bank. Right? So it’s not a get rich quick scheme. becoming a doctor, it can be lucrative down the line.

Dr. Frances Mei Hardin: What I really liked about the Gervais principle and hearing about it on our runs was basically that by having this framework to better understand organizational structure and kind of the interplay between different players. Number one, as a resident physician who was really struggling, like, midway through a five year ent residency, it gave me the opportunity to remember that this is a job. That part is huge, because when you’re in the thick of it, it’s just your life, right? Like, you spend pretty much every waking hour at the hospital. Everybody you talk to is at the hospital, and you forget that this is a job that you wake up and you attend. You forget that you’re a person going to a job and that, of course, the organization has its own dynamics that you could exploit if you really understood your role in it. And the fact that it’s kind of a game which we’ll come back to. But I really appreciated that reminder because just even starting to think about things this way, and of course we’ll get into things like power talk later on. But it really started to open my eyes and it felt like starting to come up for air a little bit, because if this is a job and this isn’t just a direct extension of me, when you’re a resident, sometimes it feels like, where do you end? And the job begins? Things like that. So, I really liked that. And then not only that, but like I mentioned, I thought that the office was like a really fun sitcom when I was younger. I didn’t think, oh, there are so many truths in this that are representative of each of those players and the overall game.

Colin Royal: Honestly, I had never really thought of the office that way either. So it is really interesting. We kind of initially read through this stuff to just see, oh, wow, over and over and over again. You can just kind of pinpoint pretty classic truths to various characters or situations within it. But, yeah, I think that’s a good point, because, one of the obviously weird things about residency is so much of what you do is barely tied to becoming a physician, right? Like, they are these separate jobs. If, someone was to just design. I mean, obviously everyone at this point knows, right, that the history of residency, and it goes way, way back. But if someone nowadays was to design a training program to make someone a surgeon, there’d be a lot more learning and just, attending surgeries or procedures or clinic visits or whatever. You guys are hospital employees. Like, residents are hospital employees. You’re filling in this huge gap, and then there’s learning on top of it. So looking at residency as its own specific job versus, oh, this is like the true path to becoming a doctor, I, think is pretty important to even kind of keep your sanity when you’re within it.

Dr. Frances Mei Hardin: And he’s referring to even tasks like, for those of you who don’t know, sometimes residents are involved in patient transport from point a of the hospital to point b. And that’s because sometimes residents will get it done faster than transport because they’re often understaffed. Another task, going down to the mailroom looking for mail, looking for the latest instrument that was supposed to be replaced via mail, and you’ve already pre op the patient, and the case is rolling soon, and the attending sends you down to the mailroom to go hunt down this very specific object. So that’s number two, number three, doing ivs and things like that. So there is a lot that we do and get really excellent as, especially as a senior. Make the call schedule, make the daily schedule. I mean, we really are.

Colin Royal: Big one. I mean, that’s a huge time suck there.

Dr. Frances Mei Hardin: And at some spots, that’s more of like an administrative job and not put on the residents. But in our case, that was 100% on the residents. And so that would add maybe five to 10 hours of additional work per week, depending on how fast you are at it.

Colin Royal: Yeah, it’s kind of crazy, but yeah. So, basically the way, sort of through the lens of the gervais principle to look at this is if you sort of accept that residents are at the bottom of the ladder here, right. You’ve made this bad agreement. You’re stuck in it. It is what it is. you basically have three options. So you can do the bare minimum, you can do less than the bare minimum, or you can overachieve. And that’s pretty much what it comes down to. It sounds pretty simple, but we’ll kind of walk through it. So really, the logical thing would be to do the bare minimum. And again, you have to think about this. Residency is a job, right? So we’re not talking about, oh, you should learn the bare minimum, but in terms of the actual amount of work that’s being done, you are getting paid the bare minimum. So it would make sense to work at that level. Right? At the bare minimum. if you do more, if you way overachieve, you are not going to get a raise. Literally, you cannot. It’s government mandated, and it’s the best way to just shoot right into the clueless class. No offense to those who have done this, and we know people who have done a chief year, but the idea of a chief year is, pretty brutal from an economic standpoint. Right. you are chief of the losers. You’ve given up sort of an extra year to stay a resident. obviously there are plenty of reasons why people do it, but again, from an economic standpoint, kind of rough. and they’re not going to give the underachieving resident the chief year position.

Dr. Frances Mei Hardin: Right.

Colin Royal: That’s going to be one of the best residents. They offer that up, boom, you’re shot into kind of Michael Scott territory. Now, if you do less than the bare minimum, it’s very risky, right. You are either going to get fired or you’re going to get a promotion into the sociopath class. and that seems counterintuitive, but basically, just think about it, right? You probably know someone in your residency or in another one that they were just kind of a bad resident. Right. They didn’t do a lot of what they were supposed to do. Maybe they had a bad reputation within the resident class, yet the program director loved them, or some really high up attending, or the department chair just seemed to really like them, and they got brought into a lot of stuff and they cruised through and they graduated, no problem. m. It kind of doesn’t seem to make sense. Right. And you just chalk it up to, oh, favoritism or whatever. but honestly, it could kind of relate back to this type of stuff.

Ryan says he does less than the bare minimum in surgical residency

Dr. Frances Mei Hardin: Well, and it happens to, you know, Ryan on the.

Colin Royal: Yeah, yeah, exactly. So Ryan’s kind of the most classic example. I mean, he truly does less than the bare minimum. Right. It’s kind of the ongoing joke is that he literally never makes a sale as a salesman. yet he’s the one who gets promoted up into, the executive level class despite, frankly, being a bad employee. But he got on the radar of those kind of sociopath groups by essentially sustaining this high pressure situation, which is doing less than the bare minimum because your job is on the line the whole time. you sort of expose the inherent unfairness of the system. Right. And there’s fewer systems inherently more unfair than residency or even just sort of us healthcare in general. Right. So these chairs of departments, like, they might talk a big game, but you know that they understand that residency is kind of a rough gig, and this isn’t very fun. And if you can really sort of showcase that, you get it and you’re not going to do more than you have to do. That’s a good way to sort of get on those people’s radar.

Dr. Frances Mei Hardin: Yeah. And I like the Dr. Death example as well, because for anyone who has read about him or watched that show, about his career, what is interesting and what I immediately kind of jumped to is I was like, okay, I’d like to know what his residency was like. What kind of resident was this guy? Obviously not a great surgeon, and certainly, like, many horrible stories and outcomes from his practice, but it’s like every physician, whether they remember or not or are willing to admit it or not, they were once a resident. And so as I was reading different long forms about him, when his story came out, they talked about his residency training and that he was under some scrutiny as a resident. His surgical skills were not strong, his surgical numbers were not strong, and it looked like they had even let him do additional research time, and things like that. And just eventually, he waited them out. Enough time passed. He did some lucrative projects for the hospital, and he graduated, like, in decent standing. And it’s one thing to say, well, the other members of the department really respected him or not. That has pretty much no bearing on whether or not a person gets graduated. And I think that in his case, it really illustrates that bare minimum to less than minimum amount of surgical experience, surgical expertise, particularly in surgical residency, yet that didn’t prevent him from getting out there and getting licensed and credentialed and everything.

Colin Royal: Yeah, that’s kind of the key piece of it, is that, in that example specifically, I don’t remember exactly what, but he had either created a product or something that that hospital system then owned, and they were making money off, or he had done some big research project, and they got a lot of grant money or something. Right. That was financially, incentivizing them to keep him on. but you don’t want to be like Dr. Death, but, that sort of idea and principle holds kind of true in terms of looking out for yourself. Right. So what can a resident kind of do with this information? Obviously, just like having this language and kind of understanding and what you were saying, francis may just remembering that this is a job, right. Like this is not sort of end all, be all. Even if your true calling is to become a physician, the residency experience is quite different. But knowing that you are kind of allowed to slack off in areas that are not going to benefit you. Right. Like you’re working tons of hours as a resident. if you try to be the best resident and you spend all of your time doing extra notes, really in detail, great notes, because you’ve heard that this one attending likes it, but you’re not planning on specializing in the thing that that attending does. Honestly, it’s kind of a waste of time, right. Because you might be the best resident, but that’s not going to make you the best doctor moving forward. So figure out what your priorities are and use whatever extra time you have for those kind of high risk, high reward types of payoff that might be cozying up to, the attending in your department that specializes, in the thing that you want to do. Right. this is groundbreaking stuff. Right. Try to figure out what you want to do and learn from it. But seriously, taking some of that time that might be spent doing other sort of resident tasks, you still got to do them, Right. Or else you might legitimately get fired. But you can kind of do the bare minimum there, deal with the pressure sort of internally that maybe some residents don’t like you that much, but that’s okay. You’re looking out for yourself. You’re trying to get through this game. and you’re spending extra time doing research with that other attending. Or if you want to do private practice, you find the one who came from private practice and you make friends with them and figure out what their.

Colin: Avoid conflicts with the clueless class and other losers during residency

Dr. Frances Mei Hardin: Process, you know, obviously I feel like I got to make the disclaimer now we’re talking. know, Colin’s not a, you, know, there’s all sorts of implications and I would never say know, be a complete sociopath, know, screw over your team or your, like, we’re not saying that at all. Although I think very interestingly Vekatesh Rao, he’s written some other pieces that I really love and one of them is called be slightly evil. And it is almost this thought which I think is rooted in something very true, which is that you can’t give 100% to everything. I think a lot of physicians, a lot of surgeons, we are perfectionists. And so every single thing, all the time does need to be perfect. Like the. Or needs to run on time. All these consults have to be seen within the 30 minutes time limit in the Ed. If a junior resident or say, like, you’re in a car wreck and you hit the 35 minutes mark, it’s like, is that the end of the world? I think that what’s really tough during residency, or at least what happened to me, is that I could not tell the difference anymore between what was a big deal and what wasn’t a big deal. And here’s the other part, is you can’t run on everything’s a big deal all the time because you will just die. That’s not a way to make it through residency. I think that people will find that they do burn out or that legitimately, their personhood and even life can be at risk. So there is a level of just really smart, valuable strategy to, trying to protect yourself from being in one of those kinds of situations. And one thing that I will mention real quick here is that that does involve avoiding conflicts with the clueless class and other losers. This is all game. It doesn’t matter. Getting into fights with other members of the loser class. No one in this situation has clout or power. So it just all kind of goes nowhere, and it doesn’t help you. And for most of us, there’s a lot of wear and tear that comes with conflict or feeling like, okay, well, I got into it with somebody at work. It’s much better to just stay out of the weeds, and you can even be like, okay, sounds good, you win. But at the end of the day, clueless and loser class members just can’t really win. And having that fundamental understanding helps you to just kind of take that all a little bit less seriously, even if it feels serious.

Colin Royal: Yeah. right. I mean, that’s kind of the main takeaway. And we’ll get into how you can deal with some of that stuff, because obviously, you can’t avoid every fight. You’re not a buddhist monk who can just sort of take the abuse over and over again and not deal with it. But, yeah, to be clear, I am not advocating for people to be sociopaths in the office. Examples. Right. The main two are David Wallace and Ryan. They both flame out horribly and are deeply miserable. So being a true sociopath, it’s potentially a good way to get rich, but it’s not a great life path. what you do want to do is what you mentioned, right? Sort of. That be slightly evil, probably. I would say, most people would watch the office and say, best case was you’re Jim. You know, toiled away. He got the girl. know, he eventually started his own company and kind of followed his passion. but if you look at Jim compared to Kevin, Jim gets it the whole time, right. He has opportunities. He just kind of decides not to take them. But he doesn’t take anything in the office seriously. Right. That’s why he’s always staring at the camera, messing with, dwight or really not taking Michael seriously. he’s staying out of the weeds, but I think he’s one of the best sales guys there, right? He ends up being the manager, and he kind of moves his way up. So it’s not that he’s like a bad sales guy and he’s not doing his job. He just doesn’t take it that seriously. so there is that sort of separation of your resources. Right? Like, here’s my real life, here’s my job.

Dr. Frances Mei Hardin: Yeah.

During residency, we learned about power talk, posture talk and baby talk

And then this is my favorite part where we’ll get into power talk, posture talk, and baby talk. And what I love about these, this is awesome. This really helped me a lot. During residency, we needed to lay down all those definitions because these new terms for the different convos that you can have, they do require an understanding of what the different groups are.

Colin Royal: Yeah. So I’ll do kind of quick definitions again, just to lay these out. So basically have four methods of conversation here. this is how these different groups relate to each other. so power talk, would be sort of the in group language of the sociopaths. So this is how they talk to each other. Posture talk is language spoken by the clueless to everyone else. They think that it’s power talk, but it’s all posture, right? So posture talk, baby talk is spoken by losers and sociopaths to the clueless. this is Jim talking to Michael. he’s playing the game, right? It sounds to the clueless like posture talk, power talk, but it’s not. The other person is in on it. They are baby talking them. and then the fourth is game talk. This is within the loser class. So there’s a whole other language, right, that happens within the people that work on the ground floor. we won’t really talk about that because that doesn’t apply so much to, what we’re trying to get across here. And then you’ll notice there’s kind of a missing piece there. The sociopaths and the losers just kind of rarely talk. if they do, it’s very straightforward. It’s a sociopath. department chair gathering a meeting and saying to all the residents, we’re covering this new hospital. That’s it, move on. I’m taking questions or not. there’s no sort of hidden subtext or meaning to those. How often do you see the department chair just talking directly to the intern? Right? Very rarely. it’s just going to be pretty surface level type of stuff. A good example of power talk. hopefully many people who are listening to this have watched the office and are somewhat familiar with it. I’ll kind of describe the scene a little bit. So even if you don’t know exactly what I’m talking about, it makes sense. but basically there’s a point where, Michael is having this kind of illicit relationship with Jan, his boss. And David Wallace kind of brings Jim out and he’s trying to get some information from them. And he basically says, hey, what’s up with Michael and Jan? and Jim, rather than just saying, oh, this is what’s going on, he just kind of laughs and he says, I wouldn’t even know where to begin. And that’s it. And Michael Wallace says, oh, okay. And then they just shoot basketball together. Right? So that sounds like nothing, right? That just sounds, you know, Jim was uncomfortable, know, didn’t want to say anything. But really, there’s a lot of layers to it. basically in that conversation, Jim is know, I’m confirming what you’re right, with this kind of laugh and pause and saying, I don’t even know where to start. I’m confirming that something is going on. You should look into this. But I’m not going to outright say it, right? I’m not going to be liable, I’m not going to get called in and say for them to be like, jim is the guy who said that this relationship was happening. Definitely not going to get involved in that. And the third piece is, he has information that, you know, this high up executive wants, so why would he give it up for free, right? So maybe David Wallace kind of offers something for it or hints. Know, he might get a promotion if he lets in on this now. Okay, now we’re talking. Now maybe I’ll give you some more information. But, that is like very fluent power talk that happened there. It also sort of signals to the other sociopath that I get it. I know what we’re doing here, right? Like, I’m not stupid enough to just sort of blab. You can picture if that conversation happened between him and Michael. Michael Scott would just tell David Wallace everything, right? He wouldn’t know to sort of hold back. There are obviously tons of examples of Michael being horrible at power talk. One of them is when he’s trying to negotiate for a raise with Jan, right? He just does not get it. And she’s trying to sort of introduce some nuance, and he know can’t understand it and kind of freaks out. So kind know, at its core, power talk, it contains these multiple layers, but that’s not necessarily what defines it, right. Because something as simple as like sarcasm also has multiple layers, but that can kind of be spoken by anyone. That would be sort of game talk. Basically the core definition of power talk is that it contains stakes, right? So there are power shifts happening within that individual conversation because there are real stakes at play. You know, in that David Wallace Jim example, Michael Scott might get fired, jan might get fired, right? There’s serious stakes that these people are going to get in real trouble. And Jim has that know, there’s, there’s constant give and take in terms of who’s going to say what, who’s going to offer up, kind of their stakes at a time. And you can only engage in power talk if you have those stakes. So if you have no table stakes, it’s always going to be posture talk, right? when you are getting yelled at by a senior resident and they’re saying, we’re going to fire you, that senior resident probably can’t fire you, right. He can maybe launch a years long smear campaign to potentially get you fired down the line. But he has no real power. So them saying that, that’s posture Talk, right. Because there are no actual stakes in that conversation. and the proper way to respond to that would be with this baby talk, right. Because you understand that, okay, this person talking to me, they are not in real power here. There are not stakes in this conversation. This is just someone kind of all bark, no bite. So I’m going to respond in kind with baby talk. I’m going to make it seem like I’m taking this seriously. I’m not going to blow them off, right. If you blow off Michael Scott, he goes nuts and he freaks out and his ego is hurt and he tries to do anything to sort of get the power back. so you’re going to play along, you’re going to let them win in a lot of cases, right? Oh, totally get that.

Using posture talk can create illusion that there are stakes in a conversation

No, I don’t want to get fired. I would be so scared of you firing me, right? I mean, very dumbed down example but, this is sort of the reason why having this organizational knowledge is very important. So you sort of know who you’re talking to and sort of the ways in which you can, engage in that conversation correctly.

Dr. Frances Mei Hardin: Totally baby talk. If you use it in response, it does make them think that you’re in on it and that you’re taking the conversation seriously and that you are also buying in to the illusion that they’ve created that there are stakes. So this allows them to keep up that illusion that they have power and there’s real stakes here, but it also can prevent that loser from being dragged into a real mess or just like meeting extra meetings at work. And one example that comes to mind for me is, I remember when I was a senior resident, one of my juniors were staying together at their computers and he received a phone call from an attendee who was just super peeved about a, ah, disposition plan, something like that, from call. It was not, a big deal in terms of what happened or didn’t, that didn’t affect outcome, affect care or anything. Just maybe like if the timeline of follow up was maybe a couple of days off from what the attending wanted and what the junior had done. And I could actually hear the attending yelling at him through the phone, just at the computer next to me. And that resident, he was just cool as a cucumber. He’s sitting there. He was like, that sounds good, sir. He was like, I got it. He was like, I agree with you, I understand. He was the epitome of this type of conversation where there’s posture talk from above this attending, and it was an attending who just kind of objectively didn’t have a lot of power or clout in the department or anything like that. this resident physician, in the typical gym way, he wasn’t taking it extremely seriously, but obviously he had to let on as if, okay, there’s no reason I wouldn’t take this seriously. Your posture talking at me. Et then. But at the end of that phone call, which was like two and a half minutes, he was clean, he was free, he was like moved on with his day. Like, no know. Whereas, like Colin mentioned, if you do alert the person who is in the clueless class using posture talk at you, if you alert them to the fact, hey, man, like, this is what’s really happening. that is going to turn into a lot of meetings that you probably don’t want to have. So I like to think about how gracefully that was interplayed in that exchange that I witnessed.

Colin Royal: Yeah, I feel like most things we were, strategizing for was just like, how to avoid more meetings. that’s kind of the main goal of all this.

Dr. Frances Mei Hardin: Yes, that’s the number one rule.

Colin Royal: Yeah. no, but, that is a good point. especially when you’re dealing with people that are in residency, right? These are all doctors. These are very smart people. They’re very accomplished. There’s going to be a lot of egos at play here, and I think a lot of people might even hear this and say, well, I’m not going to stand for being yelled at by this person. Right. How can I live with myself taking this abuse and just saying, yes, sir. Of, like, I’ll do that. Just think, michael Scott’s yelling at me right now, right? Would you get yelled at by Michael Scott and think, oh, my. Like, I’ve just got cut down to my core. Like, I cannot believe that I’m taking this abuse? You’d say, no, this is a literal baby yelling at me. Just an absolute clueless person. They don’t know what they’re talking about. They don’t understand the game. I’ll humor them. Right. That’s just a way to reframe it in your mind that you can walk away from that day. Even if you got screamed at all day, you can say, wow, what a weird day. Just got yelled at by a clown. Who cares?

Dr. Frances Mei Hardin: Yes, there’s a lot of depth to the Gervais principle. It’s very lengthy, it’s very fun to think about and chop up. But, we wanted to introduce that today as well as, like I said, importantly, just thinking about the power talk versus posture talk versus baby talk. One last thing I will mention about power talk today is that you can’t practice it. And yes, there are ways around that. There are ways to approximate it, but it is tough because power talk is something that, until you are in that conversation, that has stakes, and it’s people with real power, like interacting, it is hard to approximate. And so the question would be like, well, how do I get this skill that is very challenging to practice? but anyway, that’s for another day. Power talk, it is something that every physician will run into, maybe less so, during residency, but by the time that you’re a senior resident or chief, certainly early career attendings like, power talk is a very important, type of conversation that everyone will have another example of. Just some shared language that can be really helpful. And in terms of, like, as a physician, having other people keep you honest and things like that. I recently read the courage to be disliked. And I really loved it. They talk about adlerian psychology, kind of like the third little stepsister to freudian and young schools of psychology. And one of the main tenets is the importance of recognizing the separation of tasks. So by focusing very singularly on your own tasks and not those of others, you can decrease your own mental load. And again, as a surgeon, that is music to my ears. If you told me that eating five black licorice a day decreased my mental load, I would eat 50 black licorice a day. Because it’s just so critical, that you can focus on what is important to you and that you can keep out the noise or getting distracted down some kind of spiral. So the principle of this is that when you do feel yourself like ruminating on or worrying about or planning for x or y or z thing, you ask yourself, whose task is this? And so r1 life example would be like if I’m at home and I’m just walking around and I am starting to ruminate and I’m like spiraling about a conversation that was had at work, not really about what I said, but specifically, and this is something I like to ruminate on, is how the other person responded. Did they like it? Did they understand? Know, what did they feel about what I said? And Colin will literally just interrupt me to say that is not your know, I made him read the book after I finished it and loved it. but it’s such a great reminder and a healthy way to limit your own mental load. Because what the point of this principle, is, is just that what I say in conversation, how I carry myself and how I present my ideas, those are all my own tasks. Like, absolutely, I’m 100% responsible for all that. However, how the other party feels about what I’ve said, that actually is their task. That’s not my own task. And I did find this to be like a pretty effective way to cut down mental load like 20% in a week by just saying, okay, well, I’m very focused on my own tasks, and I’m not going to get too bogged down in the weeds with other people’s tasks.

Colin Royal: Yeah, this is a really good post residency type of philosophy because I feel like we’ve now spent a while kind of unlearning a lot of the residency stuff where as a resident you’re just responsible for so much stuff. And you literally are, there’s going to be maybe ten attendings at one point calling you to ask about different patients or different things going on. So you kind of do have to, in some ways, a little bit be responsible for other people’s tasks just to get through a day. but now you don’t have to do that anymore, so it’s like just pulling all these layers back. and I do love having a nice phrase to just kind of something.

Dr. Frances Mei Hardin: Like, easy to remember, just a good mantra.

Colin and I have been watching The Bachelor since college

and then the last thing that we wanted to touch on really quickly is how our years of watching and studying the bachelor has also kind of helped to strategize how to win the game of residency. my first season ever was when my mom got me into it in college, and so I saw Ashley h. The dentist when she was bachelorete. And I’ve been watching since then, and Colin and I started dating right before Nick vile’s bachelor season came out. And so kind of a weird intro to the show. That was an unusual season. but we’ve been watching ever since, and we’ve even gone back and done some of the hits, like Jason Mace next season, and, you know, had to hit all the classics. But we like the show. We’ve learned a lot from watching it, talking about it.

Colin says the bachelor rules are similar to residency rules

I wanted Colin to know his bachelor rules, of the road, especially as they pertain to physicians.

Colin Royal: Yeah, I think the main thing is just having watched this, you just see on almost every season, there is some sort of in house fighting, and it’s usually the 10th and 11th place person are in a fight, right. Because they’re both kind of feeling threatened. and sometimes they’re going after one of the top people. This is the best part. The most interesting ones is when there’s a front runner, and then they get targeted by these kind of, like, last place people, and they either have two options. They can kind of be a villain and just sort of sit there and say, yeah, they don’t really like me that much, and they don’t worry about it. Right. They have a good time with the lead, and, they just kind of go off and do their own thing in the house or then get pulled into that drama. And then all of a sudden, now they’re spending the majority of their time talking to the lead about the drama. They’re going to get called in for cross examination. The amount of depositions that happen in the bachelor where so and so gets called in to rat on someone else, it’s awesome.

Dr. Frances Mei Hardin: But it’s kind of like residency also.

Colin Royal: Yeah, 100%. usually the lead will kind of have, like, a mole within it. They recognize early, like, this person’s going to tell me what’s going on in here. They love the drama, so I’ll get my information from them. But at the end of the day, you never, ever win if you get pulled into the weeds. I don’t think we’ve ever seen, a winning contestant who was, like, legitimately. Not that they weren’t involved in drama, but that they themselves did not get involved. Like, usually the lead, at some point, someone’s going to complain about them, they’re going to accuse them of something, but as long as they don’t get pulled in the weeds, they just kind of act above it and they say, hey, that’s not my task. Right. I don’t need to deal with these people. That still allows them to kind of stay on the straight and narrow and potentially win the game of residency or bachelor or whatever it is. but I think it’s really applicable to residency because there’s just so much bs that goes on in the background, and it’s really easy to get bogged down and kind of take your eye off the prize.

Dr. Frances Mei Hardin: Yeah. The person who throws somebody else’s blazer into the pool at a group date, that person never wins. And obviously, I’d be lying if I said it never occurred to me to throw somebody’s blazer in a pool, from my experience in residency. But it’s like that person, they’re just dragging themselves down, and so it’s a good reminder.

Colin Royal: Yeah. And all that happens is that even if the lead really likes that front runner who’s now in the drama, now, all of a sudden they hear front runner’s name plus drama. And even if they’re like, I don’t really believe it. Now, every week they just hear that overnight and they start thinking, when we get off this show, are they just going to get involved in drama all the like? I might really like them, but, I don’t know. They seem like a bad egg, having done nothing. That’s just now their association, because they’re willing to engage in that, and it kind of causes some worry.

Next week, we will have Dr. Kimberly Koo on the podcast to discuss motherhood

Dr. Frances Mei Hardin: Thanks for joining us this week, Colin. It’s been really fun to chat theory with you.

Colin Royal: Yeah, had a blast. I will come, down and see you in a minute here.

Dr. Frances Mei Hardin: Next week, we will have Dr. Kimberly Koo, an oncologist, on the podcast to discuss motherhood as a physician both during training and as an attending and now partner in her practice, she is a passionate advocate for female physicians and women rising in the workplace. Follow me on Instagram at at Francesmay, Md. And at rethinking residency, visit my website, rethinkingresidency.com, to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I can’t wait to connect with you on next week’s episode of promising, young M Surgeon.