Early-career hospitalists must learn to navigate multiple roles—clinician, educator, coach, leader, and colleague, to name a few. Complementary to mentorship and experiential learning, select professional-development books can help early-career hospitalists acquire the necessary skills to fulfill their myriad responsibilities. In this article, we share lessons from four such books that helped us achieve success and satisfaction in early-career practice.
Dr. Nelson’s pick:
Essentialism1 by Greg McKeown
Dr. Nelson
TAKE HOME: Prioritize the few opportunities that are truly important to you; gracefully say no to those unaligned with your goals.
As hospitalists, we’re afforded a variety of career opportunities outside our clinical duties. Common advice for an early-career hospitalist is to routinely say yes, so you develop a reputation as a “go-to” person for projects. Essentialism argues that you should only say yes to the right opportunities for you.
Essentialism advocates for the transition from the “undisciplined pursuit of more” to the “disciplined pursuit of less.” To become Essentialists, we must appreciate our right to choose and recognize the reality of tradeoffs—we cannot do it all. First, we should systematically evaluate a variety of opportunities to help “discern the vital few from the trivial many.” This process helps clarify our sense of purpose and define our highest point of contribution. Then, we can begin to eliminate options that are unaligned with our career goals. Lastly, we must be proactive, remove obstacles, celebrate small wins, develop routines, and maintain focus to execute our essential pursuits.
As a second-year hospitalist, I was asked to lead a clinician-wellness task force. This position was unfunded and would require weekly meetings in person across multiple hospitals. Having explored multiple opportunities in my first year, I knew this role would detract from my passion for medical-education projects. Essentialism equipped me with the confidence to say no gracefully and protect my essential pursuit.
Dr. Saunders’ pick:
Make It Stick2 by Peter Brown, Henry Roediger III, and Mark McDaniel
Dr. Saunders
TAKE HOME: Meaningful learning is hard; however, we can use skills derived from cognitive learning theory to help us durably learn as well as teach others.
In hospital medicine, lifelong learning is essential given the wide breadth of knowledge needed in our daily lives. At times, we use study habits that create a false sense of learning such as cramming, highlighting, or re-reading. Make It Stick draws on cognitive psychology to offer concrete ways to enhance durable, long-lasting learning.
To start, one needs to “Embrace the fact that significant learning is often, or even usually, somewhat difficult. You will experience setbacks. These are signs of effort, not of failure. Setbacks come with striving and striving builds expertise…knowing this is so, makes the difficulties worth tackling.” The authors offer three key study strategies that can enhance our learning: retrieval practice (self-quizzing), spaced practice (studying information during multiple periods), and interleaving (studying more than one concept at a time).
As hospitalists, our job also includes teaching others—our peers, residents, medical students, multidisciplinary colleagues, and patients. Make It Stick provides recommendations for improving our teaching such as creating desirable difficulties and acknowledging the rationale for these challenges.
My lesson from Make It Stick is that meaningful and durable learning can be hard. However, there are techniques we can use not only to augment our own lifelong learning but also to enhance our teaching of others—skills that are fundamental to hospitalists.
Dr. Scott’s pick:
Crucial Accountability3 by Kerry Patterson, Joseph Grenny, Ron McMillan, Al Switzler, and David Maxfield
Dr. Scott
TAKE HOME: When unmet expectations occur, we should be curious and not judgmental as we work together to assess and solve the problem.
When I became a teaching attending, one piece of advice prevailed, “Set clear expectations.” I want to suggest an addendum, “And then talk about unmet expectations.”
Crucial Accountability provides the “tools for resolving violated expectations, broken commitments, and bad behavior.” The authors challenge the idea that these subjects are taboo. Instead, they claim that skillfully addressing unmet expectations leads to higher team efficiency and overall well-being. Crucial Accountability provides three steps for addressing unmet expectations: assume the best, reflect on mutual purpose, and then start talking.
When a patient-care task was missed on wards, I decided it was time to practice. First, I assumed the best—why would a considerate, competent resident fail to do this task? Maybe I was unclear about the importance, maybe the resident was busy with an acutely ill patient, or maybe the resident lacked an organized system for tasks. Then, I identified our mutual purpose—to provide high-quality patient care and avoid attending over-reach (for the benefit of us both!). Now, it was time to talk. Almost immediately, the small misunderstanding became clear and was an easy fix. My resident appreciated the chance to discuss the lapse, and I trusted my resident more at the end of the conversation than before.
Crucial Accountability provided me the skills to address unmet expectations, trading my internal one-sided narrative for a two-person conversation of mutual understanding and growth.
Dr. Hall’s pick:
Grit4 by Angela Duckworth
Dr. Hall
TAKE HOME: No matter how challenging our work can be and how many times we get knocked down, grit can help us get back up.
Grit is a combination of perseverance and passion. It can seem like an innate skill for a hospitalist, but it is helpful to give it deliberate thought. In Grit, Angela Duckworth uses countless examples to explain the importance of grit. As she says, “At various points, in big ways and small, we get knocked down. If we stay down, grit loses. If we get up, grit prevails.”
In hospital medicine, we use grit when we get knocked down by an upset patient and quickly get up to apologize sincerely because we can commiserate with the delayed procedure. We use grit when we get knocked down by a family member not believing in the very disease afflicting our patient, but we quickly get up to care for that patient as well as we care for anyone.
We get knocked down when a patient’s goals of care do not seem aligned with their terrible disease, but we use grit to keep following up to hear and understand, and to ensure that we are addressing them as a human and not just as a disease. We use grit when we keep submitting a manuscript to other journals after getting knocked down by rejections. We may get off-balance when we encounter a struggling learner, but we use grit to approach them with patience to help them make gradual steps to improve.
My lesson from Grit is that grit is how we succeed in helping our patients, our learners, and ourselves.
We hope these books will help you prioritize the right career opportunities, pursue durable lifelong learning, manage unmet expectations, and persevere through clinical challenges.
Dr. Nelson is an instructor of medicine at Harvard Medical School/Beth Israel Deaconess Medical Center, Boston. Dr. Saunders is an instructor of medicine at Harvard Medical School/Beth Israel Deaconess Medical Center, Boston. Dr. Scott is a hospitalist physician at Baptist Health Hospital, Lexington, Ky. Dr. Hall is an associate professor of medicine and pediatrics at the University of Kentucky College of Medicine, Lexington, Ky.
This article is presented by the SHM Physicians in Training (PIT) Committee, which submits content to The Hospitalist on topics relevant to trainees and early-career hospitalists.
References
- McKeown G. Essentialism: The Disciplined Pursuit of Less. London: Virgin Books, 2014.
- Brown P, Roediger H, McDaniel M. Make It Stick: The Science of Successful Learning. Cambridge, Mass: Belknap Press, 2014.
- Patterson K, Grenny J, McMillan R, Switzler A, Maxfield D. Crucial Accountability: Tools for Resolving Violated Expectations, Broken Commitments, and Bad Behavior. 2nd ed. New York: McGraw-Hill Education, 2013.
- Duckworth A. Grit: The Power of Passion and Perseverance. New York: Scribner, 2018.
Recommend In Shock by Dr. Rana Awdish. Think this came up on EM Crit. But applicable to any clinician. Great perspective from an intensivist who became a patient herself on her final day of her fellowship while pregnant, coded, had a long 8-year journey back to full practice. Some great pearls for being present for both your patients and yourself, something I see sorely lacking in health care today but so necessary.