Beyond Surviving Residency

Today, Ben chats with professor of sociology Dr. Jonathan Imber about his book "Trusting Doctors, the Decline of Moral Authority in American Medicine" which examines how American physicians in the early 20th century acquired an unprecedented level of trust that was subsequently lost.  They touch on some of the themes from the book, the importance of reflection and character for medical trainees, and Ben asks Dr. Imber if the medical profession can regain some of the trust it previously held.  Listen to find out where some of that trust remains!

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Show Notes:
18:44 - "The Finest Traditions of My Calling: One Physician's Search for the Renewal of Medicine" by Abraham Nussbaum
18:53 - "What Matters in Medicine: lessons from a life in primary care" And, "A Measure of My Days: the Journal of a Country Doctor," by David Loxterkamp
19:57 - "Treatment Kind and Fair: Letters to a Young Doctor" by Perri Klass

20:40 - "Taking Care of the Hateful Patient" NEJM article by James Groves

33:10 - "Forgive and Remember: Managing Medical Failure" Charles Bosk

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Show Notes: (Books mentioned during this episode)

2:48 The Disappearance of Moral Knowledge by Dallas Willard
17:25 Knowing Christ Today by Dallas Willard
18:27 The Making of the Modern University by Dr. Julie Reuben
22:19 The Closing of the American Mind by Allen Bloom
44:38 The Ruthless Elimination of Hurry by John Mark Comer

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Part 1/5 of Sir William Osler's "A Way of Life".

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Ben sits down with Dr. Kain Weaver a 3rd year psychiatry resident in Charlotte North Carolina and friend from medical school.  Kain shares his own medical journey through residency.  Plus, they touch on margins, habits, as well as the one trait that Kain says makes a good physician. 

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This week Ben approached physician spiritual wellness from a Christocentric perspective.

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This week Ben chats with Dr. Warren Kinghorn to talk about medical education as moral formation from an Aristotelian perspective. We touch on the question, "what is health?" And how we - knowingly or not - bring our own commitments & experiences to answer that question. Dr. Kinghorn explains how medical education is viewed and treated as a technical project and what step we can take to become a person of practical wisdom who brings their whole self to the patient encounter.

Show Notes:
18:44 - Back to the Rough Ground by Joseph Dunne 

Duke University's Theology, Medicine, and Culture Initiative 

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This week, Ben introduces a conceptual framework for the components of a "good physician" and touches on how this may be useful as we are framing "bad apples" in medicine.

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The Weekly Reflection: What are the essential components of becoming a good physician?   Ask someone this week - a fellow resident, attending, a patient, a nurse, your friend, or your mom.  You may be surprised with their response.

Mentioned in this episode:

1. Krupat, E; Dienstag, J; Padrino, S et al.  Do Professionalism Lapses in Medical School Predict Problems in Residency and Clinical Practice?, Academic Medicine: June 2020 - Volume 95 - Issue 6 - p 888-895  doi: 10.1097/ACM.0000000000003145
2. Aequinimitas by Sir William Osler
3. Duke TMC Episode with Dr. Walter Lee

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Ben introduces his framework for reclaiming your margins by asking one simple question.

Here's a simple app for tracking your margins:  Toggl Track  

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Ben sits down with Christine - a Pediatrics Resident in San Antonio TX - to reflect on the residency experience.  They discuss the journey in residency of figuring out who we are, what makes us happy, and being open to unforeseen pivots in our career trajectories.   Ben brings up the assumption that medical education is viewed as a deficit of knowledge instead of as a formative process of virtue and character.  Plus, Christine shares the one place in her life she gave up on after intern year that might surprise you!

Mentioned in this Episode:
- "The Gift of Imperfection" by Brene Brown

- Read the interview transcript here!

The Weekly Reflection:

1. Do bad physicians exist?
2. For those who feel uncomfortable with the language of a "bad physician" and would rather discuss someone who is "not a good physician" or who does "not practice good medicine", reflect on what may be at the root of your discomfort.

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Dr. Kristin Collier joins Ben on the podcast to discuss the role of spirituality & religion in physician & trainee wellness. We talk about spiritual distress and suffering, Dr. Collier's theology of medicine, the gift of the Imago Dei for medicine, and the need for meaning-making in medicine.

Show Notes:

Dr. Kristin Collier's Articles:
- The Role of Spirituality and Religion in Physician and Trainee Wellness
- Is it Time to More Fully Address Teaching Religion and Spirituality in Medicine?

35:00 "It's Not Just Time Off": A Framework for understanding Factors Promoting Recovery from Burnout Among Internal Medicine Residents 

38:15 The Finest Traditions of My Calling by Abraham Nussbaum

45:47 What it means to be Human: The Case for the Body in Public Bioethics by Prof. O. Carter Snead

Who are we becoming in residency? Residents struggling with big questions of meaning and purpose amidst their daily life need a conceptual framework to discuss this with others in the profession. Unfortunately, medical education typically is not equipped to inform or direct residents in this area of the residency experience. In this episode, Ben introduces his description of "physician spiritual wellness" and brings up some arguments to encourage skeptics to continue exploring it.

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References:
- Spiritual Wellness varies by culture & tradition article.
- Residency is our “journey of faith, personal growth, and moral challenges," is a quote from Solving Resident Burnout by Daniel Orlovich
- Residency is when we "come of professional age - acquiring the knowledge and skills of [our] specialties or subspecialties, forming professional identities, and developing habits, behaviors, attitudes, and values that last a professional lifetime," is a quote from Let Me Heal by Kenneth Ludmerer
- The national wellness institute definition of spiritual wellness.

The Weekly Reflection: Write out the description of physician spiritual wellness and reflect on your journey & response.
- Physician Spiritual Wellness is the journey for meaning and purpose amidst our day-to-day life as persons within medicine. It is the interaction of the inner life with the “rough and rugged stretches” of our path, and its destination is the good physician.

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The first step in finding more rest in residency is to reclaim the margins of our days and our weeks.  This week's episode introduces this concept and challenges listeners to start analyzing how they use their time.

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The introduction to Sir William Osler's "A Way of Life".

Become a Wayfarer to get exclusive access  to a bonus segment! Ben helps you dive deeper to clarify everything that may have gotten lost in translation over the 108 years since Osler originally gave this address.  

A brief glimpse into the problem this series is trying to address.

The Weekly Reflection: Reflect on one of the questions below.

1. Busy -  How will I spend my time in residency? 
2. Hollow - Who am I becoming in residency? 
3. Demoralized - What does it mean to be a good physician?

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Kickoff your journey to beyond surviving residency with an  introduction to your host, the aims of this podcast, and what to expect from this series.