Mastering Soft Skills in Surgery

Interpersonal Effectiveness: Mastering Soft Skills in Surgery

Today we’ll discuss interpersonal effectiveness skills and giving and receiving feedback

Dr. Frances Mei Hardin: Welcome to this week’s episode of Promising Young Surgeon. Today we’ll be discussing first, interpersonal effectiveness skills, and then we’ll have Anna Brandt join us to discuss fixed versus growth mindsets and giving and receiving feedback. So when I was in medical school and residency, all I really focused on was building up, you know, my knowledge base, doing Uworld questions and later, board vital questions, you know, time suture knots while watching Netflix every night as a third year medical student and then as a resident, still studying surgical anatomy and reading about surgical technique, working on getting my hands perfect. By the end of residency, though, what I realized that I hadn’t been taught and what really allows you to get ahead and be successful is interpersonal effectiveness skills. If you’re anything like me, when you’re young and hungry, you do not think about the softer life skills, at least not seriously. And so, you know, again, they don’t teach interpersonal effectiveness really formally in undergrad or in medical school. But as I mentioned, by the end of residency training and then certainly really every day in my career, as now an ent attending, I have a great appreciation for the importance of these skills. It’s not just even about handling issues that may arise directly for me, but the reality is that often physicians are leaders of teams in healthcare. And so there could be situations where you’re helping two other people come to an agreement and an effective path forward. So there’s a lot of applications for these skills. And one thing that I know, I probably sound like a broken record, I do say this a lot, but if you talk to someone or you encounter someone who’s naturally, really charismatic, or they’ve been someone who’s just always been comfortable around people their whole life, you may think, okay, well, they just have it and I don’t, and you just have it or you don’t. But the important thing to know is that these skills are concrete and learnable. You know, again, the charisma myth. The myth is that you’re born with it, whereas charisma is absolutely like a learnable skill. And so what we’re focusing on today are interpersonal effectiveness skills. This is one of four pillars of dialectic behavioral therapy, or DBT. And of course, as we’ve talked about before, I am not a DBT expert. I am not a clinical psych PhD or DBT certified or anything like that. But I, am a surgeon who sees the very applicable nature of these skills to what we do as physicians and surgeons every day. So do you ever feel like you have a hard time getting what you want or need from people or you feel like your responses are often misunderstood by others. Sometimes we don’t know what actions to take or how to communicate effectively. So interpersonal effectiveness skills are three evidence based concepts that equip you with the ability to increase your own chances of having an effective or successful interaction. The three that we go over today are ah, fast, give, and dear man. These are acronyms. Picture them in all caps. Dear man focuses on how to ask for what you want or need and increases the chances that your request will be granted. The fast skill is about how to communicate your boundaries to maintain or increase your sense of self respect. And the give skill is how to communicate in a manner that leads to positive and reciprocal relationships. So these skills help the other person feel good about you when they interact with you. Anytime that you are going to be kind of looking at this framework and a situation arises and you say, okay, how am I going to tackle this situation? Well, in terms of choosing the right skill to apply, you do first need to clarify your priorities. So how important are each of these? Following three. Number one, getting what you want or obtaining a goal. Number two, maintaining the relationship. Number three, maintaining your self respect. So we’ll walk through these and we will go through some scenarios as well. We’ll start with dear man. The first part of dear man, the D e, a r, is all about what to say when you’re asking for what you need or you’re making a request.

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Dr. Frances Mei Hardin: So describe the situation. Use factual, observable statements. Express how you feel about the situation. Assert yourself by asking for what you want or need, or you may need to say no. Clearly r reinforce or reward the other person. Tell them what’s in it for them if they were to grant your request. The second part of dear man, the man, focuses on how to say the dear part. So mindful. Make good eye contact. Don’t get distracted or stray from what you want to ask for. Stay focused on the interaction at hand. Use the broken record strategy, repeating your request as many times as needed to ensure that the other person is clear about your request. You know, the example that I like to use for this one, the broken record strategy, is that as an ent, we are responders to airway emergencies in the hospital. And I have been in, you know, especially if it’s in an unusual spot in the hospital. Like, of course, if something happens in an or suite, like, okay, that’s a good place for something to happen because they’re fully stocked and or suites are equipped for that type of thing. But I was responding to a unusual location, you know, like a back hallway of a hospital. there were no scalpels available. There were none around. The staff there didn’t carry scalpels on them. Like, understandably, that was just not something that often came up. And so in asking for an eleven blade, which is a type of scalpel, I used the broken record strategy. You know, this is a very critical scenario where we just need specific, ah, life saving equipment. So you can just repeat yourself respectfully but firmly over and over again. you know, and within a minute, like somebody had gotten it. But I did not stray or veer from that request. You know, it was that level of importance. Like, there was nothing else I really needed. And I didn’t chop it up different ways. I just kind of kept saying, you know, I need an eleven blade for surgical airway. Can somebody please get me an eleven blade on loop until it was. Until it was done. A of man appear confident even when you’re not. Use a confident tone of voice. No stammering, no whispering, no looking away. N negotiate. Be willing to give and get. Offer and ask for other solutions to the problem. Reduce your request. Say no, but offer something that is within your limits. Focus on what will work and be willing to take no for an answer, or be willing to not have your request granted.

Senior resident needs to ask junior resident to update patient list daily

Let’s walk through a dear man scenario. Imagine that you are the senior resident and you need to ask your junior resident to update the patient list, at the end of each workday. In this hypothetical scenario, let’s say that updating the list daily is a clear, defined responsibility of the junior resident and it has not been getting done. How do you approach discussing this with your junior resident? Describe d use clear and concrete terms to describe what you want. Stating only facts. It’s not an expression of your feelings. So, for example, say, let’s touch base about the list. It needs to be updated every day before we head out. Express how you’re feeling using I statements. Take accountability. I noticed that it hasn’t been updated the past few days. Ask for your need. Do not beat around the bush. And people are not mind readers. I would like you to confirm that the list has been updated each afternoon before we head out. Reinforce, make sure the other person knows why they should grant your request. Because relationships are built on reciprocity. I appreciate you and all that you do for our patients. Keeping the list updated daily makes our whole team look good and it allows us to provide excellent continuity of care.

Give or the relationship effectiveness skill increases the chance that other person will have positive feelings

Moving on, to give or the relationship effectiveness skill. Again, this one increases the chance that the other person will have positive feelings about you after an interaction. It’s helpful for building new relationships with others or, for instance, maintaining a positive and reciprocal relationship with a colleague. Gentle. Be nice and prioritize kindness and consideration for the other person. Act interested even when youre not pay attention to the other person. When youre talking to them. Maintain good eye contact. Ask follow up questions that

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signal that youre interested in what they have to say. Validate. Show that you understand the other persons feelings and thoughts about the situation. Try to see it from the other persons point of view, and then say or act on what you see. For instance, I realize that this is hard for you, and I see that you are busy, and you can always consider going to a private place if the person’s uncomfortable talking in public. E maintain an easy manner. Use a little humor. Smile. Ease the person along. Be lighthearted. Use a soft sell over a hard sell. I think that many of us can think of formative role models or mentors that we’ve had over the years who do have that easy manner. You know, people just like to work with them. People just want to make things run smoothly for them, you know, because they have this easy manner. They’re, they’re light hearted. They bring some of that lightheartedness to work. It’s. It’s wonderful to work with those people, you know.

Self respect effectiveness helps you maintain your sense of self respect

Now we’ll move on to fast or self respect effectiveness. This one I really love, because I do think that a lot of people in healthcare can benefit from practicing kind of this framework and, and, setting their own boundaries. What this skill does is help you maintain your sense of self respect. We often don’t know what our boundaries are until they’re crossed. Some signs of boundary violations are, when we feel frustrated, angry, or resentful of others or the situation fast allows you to balance your needs while being mindful of others so that you are not aggressive. Passive or passive aggressive. So these skills are helping you communicate assertively. I do like to kind of define each of those other quadrants here. So passive, inhibiting your own wants and needs and being over accommodating to others. That’s very common, certainly early on in the journey to becoming a physician or a surgeon. Passive aggressive, expressing your own wants and needs indirectly and in such a way that you avoid responsibility. Aggressive. Expressing your own wants and needs in a way that disregards the rights of others. And so what we want to be, in contrast to all those, is assertive, which is where there’s expression of your own wants and needs clearly and in a way that is respectful to others.

Do not over apologize. Many of us are over apologizing all of the time

All right, let’s walk through it. So f be fair to yourself and the other person. Remember to validate your own feelings and wishes while also acknowledging the feelings and wishes of others. A. Do not over apologize. Don’t apologize for having preferences, for making requests, or for being alive. You know, I think the commonest, the most obvious example of this to me is when the shadower or the medical student follows the resident into the bathroom. It is pretty funny, objectively, you know, we’ve all done it. I mean, I followed men into the men’s restroom, and I followed women into the women’s restroom totally on accident, just because, you know, you get in this rhythm of kind of tailing the person for the day or week or month, whatever it may be. But again, there’s just kind of this sense that, you know, we probably over apologize if we accidentally do that. Like, I think if, when I have done that in the past, I probably give, like, eight sorrys and then I just trip, trip over my own feet and then, like, duck behind a corner. You know, there. There’s kind of a better way to let these things roll off our shoulders. So another example of not over apologizing is, you know, sometimes when you’re the learner or you’re, like, lower in the hierarchy in a situation and someone, let’s say that, you know, they dropped something, you weren’t even touching them. You weren’t even touching the thing. You’re like 6ft away from them just being like, sorry. It’s like, that’s an admission of guilt, and you’re not guilty. You were 6ft away from when it happened. So there’s also that type of dynamic at play. But I really, I harp on this one because it’s important. No apologies for having an opinion or for disagreeing with someone. Don’t look ashamed with your eyes down or your body slumped. S stick to your values. Do not sell out your values or your integrity. T be truthful. Don’t lie. Don’t act helpless when you are not. Don’t exaggerate or make up excuses. I really like this example because I think that we all run into versions of this pretty much at every stage of our careers. You’re a busy PGY two, which means a second year resident and an attending approaches you about joining a research study that they’re working

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on. you have already had a publication this year, and you’re working on a few other projects at the time. Of the proposition. In this scenario, you don’t have the time or energy to take on additional projects right now. How do you respond to the attending without creating conflict, yet maintaining self respect and boundaries on your time? F be fair to yourself and others. Be direct. Thank you for the opportunity. I already have a few projects currently ongoing and would not be able to join on this study. Avoid unnecessary, apologies. Many of us are over apologizing all of the time. This is a generally unhelpful practice. Apologizing for mistakes that are not our own or apologizing for things that are not mistakes can reflect unnecessary guilt. You do not need to apologize for being at a point in your career where an additional research study does not make sense for you. Sticking to your values s protection of your time and boundaries is a value that you may hold. You will always have limited, finite time and you determine how you will distribute that towards research. And finally, be truthful. Avoid exaggerating, making excuses or lying. Take ownership of your values and decisions and express them in a confident manner. Do not say yes and then ghost.

Anna Brant is an instructional designer at Metro Health in northeast Ohio

All right, today we are so excited to have Anna Brandt with us, and I’d like to give a quick introduction to her before we get into discussion today. As an instructional designer at the Metro Health Hospital system in northeast Ohio, Anna Brant supports employees with the design and delivery of learning activities, including live activities and enduring material. Prior to joining Metro Health in 2022, she received a master’s degree in childhood education from Lehman College and a master’s degree in higher education from the University of Pennsylvania, while also working in various k twelve and higher education roles. This included teaching middle school math and science, working at nonprofits focused on college access and success, and providing holistic support to college students at Penn and Oberlin College. Her interest in medicine stems from being the daughter of a family medicine physician and a general surgeon. Outside of work, Anna enjoys spending time with family and friends, traveling, running, and going on adventures with her dog, Rollo. Anna, thank you so much for joining me today. I’m really excited to learn practical and effective tools that directly translate, you know, into our work at the hospital.

Anna Brandt: Thank you so much for having me and for that kind introduction. I’m excited to be here and dive in on that topic.

First, I would love to discuss fixed versus growth mindsets

Dr. Frances Mei Hardin: First, I would love to discuss fixed versus growth mindsets, and I did want to give a, quick introduction kind of broadly for people before we get into it. So again, this is, this is at a very high level, but just someone with a growth mindset views intelligence, abilities, and talents as learnable and capable of improvement through effort. On the other hand, someone with a fixed mindset views those same traits as inherently stable and unchangeable over time. And so I’d love, you know, to just jump right into it with you. I know that you have a lot of expertise on this topic, provide a lot of workshops, and, you know, really training for physicians.

Anna Brandt: Yeah. So this is a topic that I became, more familiar with when I was working with college students at Oberlin College. it’s a concept, as you mentioned, that was pioneered by doctor Carol Dweck, who is a psychologist at Stanford University. And I really got interested in it because I was finding that, you know, as you can imagine, a lot of the students at Oberlin College are high achievers, and I think a lot of times, we’re coming into college with that, more of that fixed mindset. And I will note that, you know, a lot of times, we aren’t one or the other. It’s usually on a spectrum. Right. So we’re kind of shifting back and forth. But I was noticing that a lot of the students were kind of more towards the fixed mindset side. And so, you know, all growing up, these are people who are at the top of their class. They maybe haven’t gotten below a b ever in school. And so let’s say they got a d on an exam. In a lot of situations, it was almost like an identity crisis, because I’m the smart one. I have these abilities, I have this intelligence. And so a lot of the discussion around growth and fixed mindset, I think, really resonated with that, group, because they’re just so used to thinking a certain way. And it was, I think, an opportunity for them to self reflect and think about how this has impacted their lives in different ways.

Um, shifting over to the healthcare realm, I think, again,

shifting over to the healthcare realm,

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I think, again, you’re kind of in a space where there’s a lot of high achievers. to get into medical school, you’ve got to do really well in school. To get into residency, you have to do really well in medical school, and then it kind of just continues forward. And so I think a lot of those same feelings and situations, are also happening at the healthcare level that I was seeing at Oberlin. So that’s kind of how I first got interested in it and how it’s kind of been playing out in some of the discussions that I’ve been having at Metrohealth.

Dr. Frances Mei Hardin: Yeah, that totally makes sense. And I really like that, you know, this is bigger than just physicians or physicians to be or anything. that makes perfect sense to me that this is something that really hits home for a lot of high achievers at whatever point along their life journey, career that they do have to face it. And that may look very different. You know, I’m sure for all of us individually, I guess, that I’d love to hear about, like, fixed versus growth mindset.

How does this directly relate to resident physicians in a fixed mindset versus growth mindset

Okay, so we’ve introduced it, but how does this directly relate to, like, resident physicians and what are just examples of, like, a resident doctors in a fixed mindset versus a growth mindset?

Anna Brandt: Yeah. So I think one thing that I’ve noticed, too, is that this is kind of closely intertwined with imposter phenomenon, or imposter syndrome, as it’s kind of more commonly known. You know, I think a lot of times with imposter phenomena, we have this fear of being found out or this fear that I’m not as capable as people think I am, or I don’t actually deserve to be here. And it was a mistake that I was admitted to this program. And because of that, we often are more on the fixed mindset side of the spectrum because we don’t want to put ourselves in situations where we’re going to get critiqued, or we’re going to get feedback, or we’re stepping out of our comfort zone in some way. We’re kind of trying to stay on the sidelines. so I think a lot of times when we’re on the more fixed mindset side of the spectrum, we don’t really respond to feedback much at all because we’re kind of discounting it. We also might not want to put in more effort towards learning a new skill, because, again, if we’re on the fixed mindset side of the spectrum, either I’m good at it or I’m not good at it. So what’s the point in trying harder? Because just a fixed trade, right? So we may avoid effort or avoid challenges. and also a lot of times we can be, jealous or kind of threatened by the success of others, because, again, if I don’t feel that I can ever improve in some way and these people around me are excelling, I might have this fear that I’ll never get to that level. And so I kind of shy away in that sense, too. So I think it’s, as a whole, a lot of shying away, a lot of kind of staying on the sidelines because of that fear of being found out, because of that fear of, maybe I’m going to find out that I’m not as intelligent or talented as I thought I was.

Dr. Frances Mei Hardin: Yeah. And that totally makes sense in terms of how it ties into identity, like you said, because then it’s almost like, well, if that’s true and if I’m defective in some way, then, you know, that’s almost like an identity death to learn that information or what have you.

When we face setbacks, we should view them as learning opportunities, right

And so, I guess, from another light, what is an example of the resident physician or the doctor who’s in the growth mindset who isn’t keeping themselves small or shying away, keeping their world small? I mean, it’s sad. When you were describing the fixed mindset, I was like, it breaks your heart because, like, that’s keeping your world really small.

Anna Brandt: Right, right. And, I mean, no shame. I think we’ve all been in a fixed mindset side of the spectrum at some point in life. I think especially if we’re in new situations where we’re kind of stepping out of our comfort zone in some way, shape or form, it can be easy to kind of go into that side. But growth mindset, I would say it’s something where, you know, I put myself in the running for a leadership position. maybe I want to pursue the chief residency position, or I want to pursue a fellowship program. That maybe is a stretch for me. so recognizing that, I think a lot of times, when it comes to a setback, let’s say I apply for a fellowship, and I fail at getting in, I think we view ourselves as a failure, even though this is not a personal reflection of me necessarily, but I think we really can internalize it. So instead of viewing it as I’m a failure, it’s okay. You know, maybe that wasn’t the right fit for me. what other programs or opportunities could allow me to continue to grow in this area? And, you know, any setback is that easy. So I think it’s, you know, normal to be bummed out, but instead of really internalizing it and kind of spiraling, viewing it as a learning opportunity, and I know it’s

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Anna Brandt: harder in a medical setting because there are people’s lives at stake in a lot of these situations. So, I think that’s also where activities like simulation can be really helpful because we’re able to kind of take risks, try out new things. and if we make a mistake, there’s not necessarily a real patient involved, and we have that more of a safe space to kind of debrief and learn from those opportunities. Because ideally, when we can frame setbacks as learning opportunities, that’s where we can continue to grow and improve. Right. As opposed to a setback as a personal reflection of me and my abilities.

Dr. Frances Mei Hardin: Totally. I really agree with that. And. And I love. I think that that has implications for the culture of medicine, though, and really importantly for the culture of medical training, because you’re right. And the technological advances and the ability to do simulations, like, particularly for surgical trainees like this, is huge. That’s incredible that that is a major asset. And I agree about it. Hopefully, the bigger and bigger role that it can play for people as they learn. But here’s the other thing that is so simple, and it’s free to do, and you don’t even need fancy equipment or technology to do it, but it’s almost like, for the culture to really be where we acknowledge our own learning journey, right? Like, if we more openly acknowledge, I tell people all the time, I did not come out of the womb knowing this. I mean, and frankly, with more complex head and neck anatomy and ent, many of us struggle even through medical school with it, you know, the ear anatomy, I mean, they are not playing with that stuff. Like, it’s. And it’s not super intuitive. You could be like a, wonderful memorizer and avid reader your whole life. And then the ear anatomy, some of that 3d stuff, it will, you know, it’ll challenge you. And so I just do think that even this interplays with even imposter syndrome, right? Because I think that part of imposter syndrome that could be tamped down, like, we could turn the knob on that way down by just saying, oh, I didn’t show up here knowing this. Like, so if you show up here and you didn’t know this, that’s not really on you. That happened to all of us. But what happens is when people, or, especially teachers, act like, okay, this is obvious. And, like, I’ve always known it. Like, I knew it at five years old. I don’t know why you don’t know it now. It’s just, I think it feeds some of those suboptimal kind of attitudes towards self and towards learning, for sure.

Anna Brandt: And I think that, to your point, a lot of being able to create a culture where a growth mindset can thrive is also on the attending side. Right? Like you said, being able to be vulnerable and say, hey, this was hard for me, too, at one point. That’s normal that it’s not, you know, clicking right away. but I think it’s difficult. I think especially sometimes there’s other elements, like gender at play, where, you know, I want to be respected. And I, you know, I think a lot of times residents will put attendings on a pedestal and say they’re just experts at this and they always have been. And on the attending side, it could, it could, you know, be someone nice in some ways to say, like, wow, they really respect me. but I think that vulnerability that you were referencing really does go a long way and really helps people feel more comfortable, you know, putting in the effort, stepping out of their comfort zone, taking on new challenges, because they recognize that it’s normal for things to not click right away. And even if I’m not getting it perfectly right the first time, it doesn’t mean that with dedication, with effort, with hard work that I can improve in this area.

Taking time to celebrate effort and progress can go a long way in medicine

And I think another point that you were kind of touching upon is, I think really, this kind of goes into feedback as well, really taking the time to celebrate effort and progress. I think a lot of times in medicine, we focus on the outcomes, you know, was this done correctly? Yes or no? or did you pass the boards? Yes or no? And there’s not a lot of focus on the progress and, the journey to get to that point. So being able to kind of step back and to your point, also self reflect on the learner side or on the resident side and say, wow, if I look back to my first year of residency compared to where I am now, look at how much I’ve grown in these different areas, and I think that’s hard to do when we’re so busy and overwhelmed and exhausted. You know, it’s harder to take time to step back and actually, you know, note those things. But really recognizing the growth that you’ve made can go a long way. And if you can’t do that yourself, maybe also touching base with a mentor that you have who can really help illuminate that for you. Because I think a lot of times we may be harder on ourselves than we would to a lot of people in our lives. So sometimes we might also need to get other feedback from mentors and other people that we respect to help us illuminate that progress that we’ve made, too.

Dr. Frances Mei Hardin: It’s something that can be cultivated by

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Dr. Frances Mei Hardin: people in leadership positions. So attendings, even senior residents, because when they’re modeling that behavior, it’s almost proof of concept. Because if I’m looking at, say, a chief resident, they are a phenomenal surgeon. They lead the team. I’m so in awe of their clinical acumen and all this. And then they tell me, look, you’re doing a good job. You’re just an intern. You’re just a two. I think that you’re doing great. I was in your position as a two, and I still became me now, like, that’s such a wonderful lesson for people to hear and internalize. I don’t think that it’s as common as one would hope or as I would hope, you know, in the medical education landscape today.

Anna Brandt: I agree. I agree. I think it’s something to strive towards.

Dr. Frances Mei Hardin: I do think that I wanted to go back to and highlight. I totally agree with you because you mentioned, like, no shame or judgment about the fixed mindset. And, 1 million% I agree with you. I was that resident, like, certainly when I was a, junior and when I was going through my darkest parts of residency, I had just this extremely limited, limiting growth. I, apologize. Not growth. I had a extremely limited, limiting, fixed mindset. And so I do know what that feels like now, being on the other side of it. I know how rich and how, you know, really impactful, the opposite the growth mindset can be. And I did want to share, so, you know, but without having had that old fixed mindset, I wouldn’t be here today. Like, the podcast wouldn’t exist, rethinking residency wouldn’t exist, or anything like that.

Post traumatic growth mindset was identified in the 1990s by psychologists

And I did want to touch on and kind of get your opinion on this other specific concept, which is the post traumatic growth mindset that I’ve read about, and I want to just share one little piece of writing about it. So, this phenomenon was identified in the 1990s by psychologists Richard Tedeschi and Lawrence Calhoun. Based on their research, the pair described five categories of growth that occur over time. One, survivors of trauma recognize and embrace new opportunities. They forge stronger relationships with loved ones, as well as with victims who suffered the same way. They cultivate inner strength through the knowledge that they have overcome tremendous hardship, they gain a deeper appreciation for life, and their relationship to religion and spirituality changes and evolves.

Anna Brandt: Wow, that’s really powerful.

Dr. Frances Mei Hardin: Have you seen much of this phenomenon, you know, through your work and the high achievers you’ve worked with?

Anna Brandt: I definitely think there is a level of power that can come from going through difficult experiences. I think, again, sometimes we also might need someone walking alongside us who can help us illuminate that power for us, because I think, when you go through a really traumatic situation, you’re just sometimes focusing on getting through the next day and kind of minute by minute. again, having someone who can help, help you see the journey that you’ve been on help you see the growth that you’ve made over time. and I think it does also, really, to your point, make you appreciate things in a different way. And also, sometimes there’s just confidence. When you were first were saying that, it was reminding me of, my first job out of college was teaching middle school in the Bronx, which loved my students, but it was definitely a whirlwind. and I think it was one of those things that forevermore, I can tell myself I can do hard things. Right. Or similarly, I’ve run a marathon before, and I think an experience like that, you kind of have this mindset, like, hey, I can do hard things. So I imagine, I haven’t obviously gone through residency, but I imagine residency is probably a similar situation where when you’re on the other side of it, you can kind of have that confidence, like, hey, I can do hard things. I think it doesn’t always happen right away. I think, again, especially when you’re in it or kind of just coming out of the other side, you’re just still trying to kind of process what that experience was for yourself. but I could that all of that research, the findings that they. That they found, make sense to me because I think it does give you a different perspective on things moving forward when you go through a difficult situation, situation, whatever that might be.

Dr. Frances Mei Hardin: And my experience is absolutely congruent with what you’re saying, which is that it was not made alone. that journey was not in a vacuum, you know? And it also, by the way, it didn’t just happen magically when I graduated either. There was a lot of therapy, reading, you know, self reflection, hypnosis, meditation. Like, I mean, there was everything, there were a

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Dr. Frances Mei Hardin: billion cold plunges, like everything in the book. so it. Yeah, it was very effortful. But I do. I do certainly believe in this type of a phenomenon. When you can get to the other side again, not by, like, luck and not by just the passage of time, but actually with effort, which that feeds back into, you know, the full growth mindset.

Anna Brandt: Right?

Dr. Frances Mei Hardin: Like, you. You can change your position, you can advance your position, you can change your perspective for the better, everything like that.

Anna Brandt: For sure.

I wanted to get your advice for anyone who feels like they are in fixed mindset

Dr. Frances Mei Hardin: I wanted to get your advice for anyone listening who feels like they are in the fixed mindset. Like, I think we very well defined fixed versus growth mindset. What are any tools or tricks or anything that somebody can use to jump from one to the other to move from fixed to growth mindset? Because that’s not easy.

Anna Brandt: Mm Yeah, I would say there’s there’s a few different things that come to mind. I think one is, again, connecting with a mentor, whoever that might be for you. It could be a peer, it could be a co worker, it could be an attending that you have. It could be a professor you had in college, it could be a family member, you know, whoever that is to you that you respect and admire and who knows you well and can. Because, again, I think a lot of times we’re harder on ourselves than we would be to anyone else in our life. And so someone who can kind of give you that different perspective, help you see the growth that you’ve made over time, encourage you to pursue new opportunities. I know, for example, sometimes when I’ve looked at job descriptions, I might, you know, have 90% of the things that are on the job description. And because of the 10% that I don’t have, I might just not apply. Right. Whereas if I send that to a mentor of mine, they might say, oh, my gosh, this is right up your alley. Like, you should definitely apply. so someone who can kind of be your cheerleader in that way, I think a lot of times, too, there’s this concept, metacognition, thinking about your thinking. I think the more that I’ve talked about this concept of growth versus fixed mindset with people and talked about imposter feminine with people, it’s helped me, become more aware of my own self talk. And, you know, I’m able to now hear myself a little bit better than maybe I was ten plus years ago. And if I hear myself being really harsh to myself, then I sometimes just check myself and say, would I say that to my friend or would I say that to another resident in this program? And usually the answer is no. And so then I might just say, okay, how can I talk to myself as I would talk to a friend who’s going through this situation? yeah, that’s usually the one that I really try to harp on myself is, how would I talk to a friend who’s saying this right now? Because a lot of times you wouldn’t say, oh, my gosh, yeah, you’re so stupid. I can’t believe you made that mistake. You’re the worst. But that’s kind of often how we talk to ourselves. so being able to kind of just think about your thinking, notice how you’re talking to yourself, and just take that moment to say, okay, how would I talk to a friend who’s in this situation?

Dr. Frances Mei Hardin: I think that that is incredible. And I would file that under really a, self compassion practice, you know, and. But, but rather than just being, like, telling somebody who’s in distress, ah, show yourself some self compassion and, like, you know, kicking them out the door. Like, I love that because it’s very concrete. That is such a good test, you know, so we can call it the friend test, whatever you want. I really think of, one of my favorite books is the untethered soul, and he writes about basically, like, the crazy roommate test. And, it’s very similar, you know, it’s almost like, a play on what you’re describing. And so I’ll kind of describe the crazy roommate for those who maybe will resonate either with the friend self compassion tack or this other one, which is, you know, if you had a crazy roommate and, you know, you guys are sharing a flat or what have you, and they’re just chirping you all the time, like, legitimately. Like, they just follow you around. They’re like, your outfit looks dumb today. Like, I don’t know. You look dumb. Hair is bad. Outfits a zero. You know, all this stuff, it’s like, would you put great stock in what your crazy roommate, quote unquote, is saying to you? And it’s like, that is one way to think about the voice inside your head, especially if it’s one of these that has this, you know, extraordinarily, like, harsh, negative narration running all the time. There’s chirping you 100% of the time. Like, it’s funny and sometimes helpful to think of them as the crazy roommate. And it’s just like, okay, well, you know, whatever. Like, that’s her. She’s always saying, like, the craziest stuff. Does it have any real bearing on the real world? Like, not enormously.

Anna Brandt: Right? Yeah. I almost view it as these two different voices on my shoulders. And I have to, talk back to the other one, the crazy roommate, or,

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Anna Brandt: you know, my own self that’s just kind of chirping in my ear and saying those sorts of things. For sure. Yeah. And sometimes, sorry. Sometimes you need to see it written down too. Like, I know that, again, I mentioned teaching middle school. Tough situation. Very rewarding, but difficult. And I would just keep kind of a running log of every day. I would try to find one thing that went well. It could be a student gave me a hug, or a student who had been struggling on this one topic really had that light bulb moment. You know, 50 other things in my head could have not gone well that I was hoping would have gone well. But really just trying to find even the smallest thing to celebrate. I think once you kind of continue to make that a practice, similarly to kind of doing a gratitude journal, where they’re more that you kind of make this a practice to kind of note these things, it could just be one, two, three things a day. It kind of shifts your perspective, and you’re able to celebrate those wins in a more natural way, as opposed to fixating on all the things that aren’t going as well as you had hoped.

Dr. Frances Mei Hardin: Mm And I will make a plug for the journal I use is the five minutes a day, you know, intelligent change journal. I’ve used it for years and years, and I like their layout. It’s clean. It’s easy enough for a resident or a physician to have it on their bedside table. I can’t say that I successfully completed every day, but, you know, I’ll have seasons of life where maybe I do hit 90 days in a row, and that’s a really wonderful time. And that’s enough to even change the way that I do have some of these thought patterns and change them for the better, change them towards gratitude and things like that, where even if it’s not a day that I complete the journal. Okay, well, the day starts and closes with still a reflection on, you know, these items we’re grateful for. So I really love that.

Giving and receiving feedback is something a lot of us struggle with

And I want to transition now to build off of something you mentioned earlier. But basically, having a growth mindset is a key to learning from feedback and not viewing it as a personal attack. And so one of the other topics that I know you teach on frequently, you know, provide workshops on is giving and receiving feedback.

Anna Brandt: Yeah. I would say, of all the topics that I’ve done workshops on at, metro health, this is the most requested one. So I think it also just kind of goes to show that feedback is something that a lot of us struggle with no matter what department we’re in or what role we’re in. And it makes sense. Right. Feedback is a little scary, whether we’re on the person who’s the side of the person who’s giving feedback or the side of the person who’s receiving feedback. Like you mentioned, I think on the receiving side, if we have that fixed mindset, we might view this. Let’s say that I’m getting a piece of constructive criticism. I might view that as maybe I’m not meant to be in this role.

Dr. Frances Mei Hardin: Right.

Anna Brandt: I might kind of spiral. But on the flip side, on the giving side, you know, we don’t want to hurt people’s feelings, we might have a fear of retaliation. there might be different power dynamics at play. And so, you know, I think also we just aren’t often taught how to give feedback, so we don’t really know where to start. So I think it makes sense that this is a popular topic that’s requested. and it’s been helpful for me to kind of do more research on about how to actually go about this process, because, again, I think it’s something that’s not taught very often. so I think on the side of giving feedback, some things that could be helpful to keep in mind. The acronym that I use that I find helpful to remember is cats. so the first part of that is clear. So making the feedback clear enough that I know what you want me to do moving forward. Right. So if. If the feedback is so vague that I don’t even really know what you mean, I can’t change my practice, right. So really trying to make it as clear as possible, the a then is actionable. So I think a lot of times we might say, oh, you did a great job of this at this, and then we kind of leave it there, but really trying to take that extra step to help someone get a sense of what I can do moving forward. so whether that’s an area that I can prove upon and how I can do that. So, for example, sometimes we’ll say, read more, you know, but what sort of things would you like me to read? What sort of topics do you feel like I could really benefit from diving deeper into? but on the flip side, too, maybe we’re doing something well. So maybe, for example, we communicate really well with our patients. Maybe there’s opportunities for me to help teach my other residents in the program or, you know, present at a conference or whatever it might be. How can I continue to share those skills that I have in a way that’s going to help others improve as well? So clear, actionable, timely. So timely. goes with the research that

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Anna Brandt: shows that a lot of times that real time feedback can really be powerful, you know, as fresh in the moment, and we can kind of learn as we’re maybe doing a procedure right after we see a patient. having said that, I always kind of throw a caveat in there, that there may be times where we are very emotional or we’re exhausted or you’re just having a tough day. For whatever reason, that may not have anything to do with work. Maybe, just checking in with ourselves and really getting a sense of whether this is the right time and place to give feedback that, kind of goes along with also being mindful of setting where, you know, do I want to have this conversation in a private space as opposed to in front of this whole group? Maybe there are times where we want to learn as a group, and that makes sense, but maybe there’s other times where a one on one conversation would make more sense. And it doesn’t always have to be in an office either. Right? Like, maybe we go have a meal in the cafeteria and chat about something that happened. so that’s another thing to keep in mind, and then the s is specific. So really trying to give as much as you can specific examples of what someone’s doing well or what they can improve upon based on things that you’ve seen. I think sometimes we can get in the hearsay game of, oh, I heard this happen, but if we did not witness it, then that’s not maybe an appropriate thing for us to comment on. So, really trying to make it specific based on examples and behaviors that we’ve observed, and also really trying to use language that’s not judgmental.

When did you receive feedback in a helpful way or in a non effective way

So, I think for some people, and I think we were actually talking about maybe doing this activity ourselves, that, usually at the beginning of these sessions, I have people reflect on. Okay, when is the time you receive feedback that you felt like was done in a helpful way, and what do you feel like made it a helpful experience? And then on the flip side, when was the time that you received feedback in a non effective way? What do you think contributed to that experience? And sometimes things that will come up are things where people are told things like, you’re not teachable, or you’re just never going to get it. You know, just statements that I would say are rather harsh. so I think really trying to be mindful of using that nonjudgmental language that, you know, maybe you really are having a thought that someone is not teachable, which is unfortunate, but maybe you’re having that thought, but really trying to be specific of, you know, what about the situation made it appear that this person wasn’t learning from the opportunity, and what could they do moving forward? Whether it’s reading more, you know, going into the simulation lab and doing more simulation to practice something, you know, what could they do to try to move forward in a situation? So, yeah, clear, actual, timely, specific are kind of the key points that we talk about a lot.

Dr. Frances Mei Hardin: No, I love that. And I would kind of argue, you know, rather than jumping to this person’s unteachable. I actually think that it says a lot about the teacher, that they would kind of, you know, go there. And often they can go there, like, pretty quickly. when I think of things, that feedback, that has been very helpful to me. yes. You know, kind of like leading with lightheartedness and, you know, empathy and also, again, that whole understanding, like, hey, you’re on a journey. Like, you’re a young learner. So I totally, like, it’s not as if I expect you to be as good as me today. I’ve been doing this for ten years, or I’ve been doing this for 20 years, whatever it may be. You know, I don’t expect you to be here, but let’s talk about, like, I want you to get here, so how can we. You know, that that’s no worries. How can we get you there? That has always. That’s kind of my preferred way of receiving feedback, and that is how I try to give feedback. I have no problem saying that I do not receive feedback very well. Like, not because I cause a scene or anything, but just because I think my brain does not receive the information, quite literally, if I am afraid. So kind of like the fear and intimidation tax. They just. Well, I mean, they work on me. They make me fearful and intimidated. They just don’t help me receive any kind of feedback or learn or improve. Like, it’s, you know, and that’s not uncommon. I don’t think that I’m alone. There are maybe people who. That’s one of their preferred learning styles and modes of communication, but it is absolutely not mine. And even when I think back to, like, when I was a junior resident. What? At one point, we had this chief who was just, like, really, like, a pretty overt bully. Like, he never gave, specific or constructive feedback, although he would sometimes pop up just to be like, why are you here? Like, you’re not doing a good job. Why are you in

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Dr. Frances Mei Hardin: the doctor’s lounge? It’d be like, 12:30 p.m. on a weekday. Like, and you just have, you know, you’d be going to get lunch from clinic. He’d be like, why are you in here? You’re never working. It’s like, what do you mean? I just. I walked over here from clinic. I’m going to eat, like, six fig newtons, and then I’ll walk back to clinic. Like, what do you mean? Why am I here? I became afraid to go to the doctor’s lounge and, like, go get my fig newtons. And so, But what’s funny is he then wrote in my evaluations that I was bad at receiving feedback. And it’s just funny because I definitely have had to improve over the past decade, 1 million% in terms of receiving feedback. Like, that’s also true. But just in his case, specifically, knowing all the feedback I got from him and then him saying, like, she’s not taking it well, it is. It’s a little ironic, because what he meant is that I don’t take insults and intimidation that well, which is a true fact about me, you know, like, so it’s just interesting. That’s a really extreme example, I think, of, like, the feedback provider and the feedback receiver not speaking the same language and not living on the same planet.

Anna Brandt: Yeah, no, I think you make a good point. That reminds me of research, too, showing that we receive feedback best when it’s coming from someone who we trust and respect. And sounds like that relationship that you had was maybe not falling in that bucket. And I think that also is important to consider because, you know, I think that goes along with setting up, a culture of feedback within a department that’s based in trust and respect. And I know from listening to some of your prior episodes that that can be hard. And if that’s not established, then we can give and receive feedback all we want, but it’s not really going to be as effective because that baseline trust and respect is not there. And so that might be a sign that that’s something we might need to focus on, spend more time on than maybe we would anticipate instead of just kind of going through the motions. Because, again, if that. That culture is not established, then we’re not really going to be able to reach our full potential, because the feedback that we’re getting is not going to be, to your point, we’re not really going to be able to receive it and do something with it.

Dr. Frances Mei Hardin: Yeah. And it reminds me almost of that old advice. There’s, like, the adage, like, don’t take advice from someone who you would not want to be like. And honestly, I think that’s pretty good advice. And I take that to heart. And so, yes, it made, you know, at times when there was a significant value difference between others in my residency program and myself, that was the friction, and that made it difficult to receive feedback. But, you know, I really appreciate that. I love. I love cats. And so it’s an easy mnemonic to remember.

Anna Brandt: You know, it’s a good remember, too. Yeah.

Dr. Frances Mei Hardin: So that’s perfect.

I think talking to yourself can help fix growth mindset

I. I just want to finish by asking if there any pearls that you want to leave us with, like, you know, some mantras that you’ve seen really work or, or they’re short enough and pithy enough to help people.

Anna Brandt: Yeah. I think cats is the one when it comes to giving feedback that I really try to hold on to. I think when it comes to, again, fixing growth mindset, it’s just, for me, at least talking to yourself as you would talk to a friend, that’s kind of the one that I try to remember. and also know that, again, part of why I feel like I’m able to be more reflective and be able to kind of monitor my thoughts is because I’m talking about it with other people on a frequent basis. So I think the more we’re able to really be open and honest and have these sorts of discussions, the easier it tends to get. It’s something that, it is kind of a learned skill. It is something that you kind of have to practice. Just, I know you mentioned that it takes time to be able to kind of self reflect in that way. so know that if it doesn’t happen tomorrow, that’s normal. But I think the more you can kind of have these conversations with people and the more you can kind of take that moment to pause and listen to how you’re speaking to yourself, that’s usually been helpful for me, at least.

Dr. Frances Mei Hardin: That’s perfect. And, you know, I do think that one mantra that all reminds me of is just, you are not your thoughts. Right? So you guys, like, you are not your thoughts. And that didn’t make sense to me for years and years, you know, as I was barreling along. But now, like I even alluded to earlier, I do, you know, I think I have the crazy roommate kind of issue. And so. But I’m not the crazy roommate. The crazy roommate sometimes is in my thoughts, you know? But again, that’s not me. And so I do love the metacognition that you kind of brought up for us and everything.

Anna Brandt: I think just kind of similarly, if you fail, you’re not a failure, right. I think just trying to realize that, you know, depersonalizing it and, yeah, whether it’s the crazy roommate talking at you or, or whoever

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Anna Brandt: is kind of what setback you’re going through, recognizing that just because you fail, we all fail. Failure doesn’t mean failing doesn’t mean that you are a failure.

Dr. Frances Mei Hardin: Absolutely. Well, thank you so much again for joining us today, Anna. next week, we will have maylies, Przezinski on the podcast to learn about the science and theory behind hypnosis and the massive benefits of therapy for healthcare workers. Follow me on Instagram at francesmei, Md. And 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 cannot wait to connect with you on the next episode of Promising Young Surgeon.

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