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Standing Ovation


Is this really happening? That’s what I was thinking as my mind quickly ran a differential of the possible explanations for the 80 people before me, positioned erectly, hands audibly moving together and apart. This had never happened to me before. Was this some sort of group yoga stretch aimed at quelling DVT formation, perhaps a pre-determined signal alerting security to have me removed for hitting an unconscionable level of boredom, or, most likely, a synchronized form of mass exit (my talks are accustomed to a certain level of attrition)? Beyond these possibilities lies just one alternative: I actually was receiving a standing ovation.

First, let me dispense with one ever-important technicality. The ovation, coming at the close of the recent four-day Academic Hospitalist Academy held outside Atlanta, was more rightly intended for the efforts of the entire eight-member faculty than me alone. I just happened to be giving the closing session.

The fact of the matter is that as a faculty member for this program, which aimed to provide early-career development for junior academic hospitalists, I, too, was in awe at the tremendous, unparalleled work of the faculty: Drs. Brad Sharpe, Vikas Parekh, Andy Auerbach, Jeff Wiese, Shobi Chheda, Bob Centor, and Jen Myers.

Yet there I was, just moments after uttering a few closing comments, being showered with praise, each clap further pumping my chest fuller with pride. It was then, with a deflating wheeze, that I realized what was happening—they weren’t clapping for me, or even the rest of the faculty. It turns out the more obvious cause for their enthusiasm had been staring me in the face the whole time. Or, more to the point, the faces staring back at me were reflecting my numerous missteps that this course had ensured they’d never make. And that was very ovation-worthy.

It’s tempting to feel that our residency training should prepare us for our jobs. However, the reality is that while residency prepares us reasonably well to practice clinic medicine,it does very little to prepare us for the wide-ranging rigors of medical practice.

Take-Home Points

Clapping excitedly at table No. 4 was a young first-year hospitalist from a major academic medical center. Looking at her, I could tell she would not, like I had, make the mistake of waiting too long to find a mentor. It wasn’t until my fourth year in academics that I found a mentor. That was four years of unproductive wandering, chasing dead ends, grabbing at wrong straws. So after multiple sessions covering the importance and means of finding mentors, as well as the role of mentees, it was clear that this young hospitalist would build her career foundation on more firm footing.

Applauding from table No. 7 was a second-year hospitalist from a community teaching hospital with aspirations of making a splash on the national hospitalist scene. Unlike my early fruitless attempts to get involved outside of my institution, the session on the importance of peer and national networking provided his quiver with several time-honored arrows that took me years to acquire.

The eyes of a hospitalist at table No. 8 foretold the story of a young faculty member who wouldn’t struggle with the process of promotion, as I had. After sitting through talks that lifted the veil on both the inner workings of an academic medical center and the mysteries by which said centers promote their members, she had a head start on ensuring her academic success.

Table No. 3 offered several hospitalists who wouldn’t make the errors I’ve made—repeatedly—with e-mail, phone conversations and running a meeting. A presentation on the basics of communications ensured that they wouldn’t send those irretrievable e-missives carrying unintentional messages or waste hours trying to cover in e-mail what would be better solved over the phone or in a face-to-face meeting.

A person at table one patted me on the shoulder, the glint in his eye signaling that the sessions on how to run a teaching team and be a more effective teacher at both the bedside and at the chalkboard would help him avoid the lower teaching scores that plagued my early academic years.

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Focus on Fundamentals

I could go on, but the point is that while my fellow faculty and I reveled in the pleasure of a standing ovation, the truth is that the clapping had less to do with us or how we imparted information and more to do with the fact that we had shared with them the ingredients of their future success, something they actively longed for—a means to enhance their career success and satisfaction.

Mind you, none of these revelations were shocking; indeed, most are mundane and straightforward. However, the reality is that more often than not we just need help getting started—a little enzymatic push in the right direction. The fact that these needs were finally being met was evident in every heartfelt clap of the hands.

Lest you think these lessons are only important for us academic eggheads, I’d submit to you that the same, or at least similarly important, points are just as critical for young community hospitalists.

In fact, hospitalists and the field of HM are all very young; most of us are in desperate need of career guidance. And I’d go so far as to say the success of our field depends on meeting these needs as much or more than our ability to improve the quality of healthcare. The reality is that without sated, successful, career-oriented hospitalists, there can be no HM movement to improve the quality of care.

It’s tempting to feel that our residency training should prepare us for our jobs. However, the reality is that while residency prepares us reasonably well to practice clinic medicine, it does very little to prepare us for the wide-ranging rigors of medical practice. And while it’s easy to dismiss early-career development as touchy-feely nonsense, we do so at our own peril.

That message is written in the conflicts that abound within our HM groups and our hospitals, the burnout and low satisfaction that fuel our high turnover rate, and the unfulfilled careers that litter the HM landscape. It’s a message that threatens our beloved specialty—a message that all the clapping couldn’t drown out. TH

Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.

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