Pre-TTE reflection

I’m excited to be joining you all for this experience in the next few days! It seems like it was ages ago when I submitted my application and COVID threw our lives into chaos but am glad that we are all now able to meet and learn from one another. There are many directions I can take this short blog post, but the reason why I applied and why I’m still going is not only the same but has been amplified during my internship year of medicine.

When I first applied, I was going into my MS4 year of medical school at UNC. I had just finished a longitudinal workshop on physician leadership. While we learned about many things, one was the idea of Just Culture and how it applied to NHRMC, the satellite campus of UNC in Wilmington NC. Just Culture is important for any organization or managerial structure, but for me, all the discussions led back to patient safety. During one of our sessions, the CEO described the end goal of Just Culture to us in a simple way. He said that he was continually striving to create an environment where the lowly med student, scrub tech, or custodian would feel comfortable approaching the attending surgeon if they noticed something that interfered with the patient’s safety. While this seems like a simple concept, one does not have to look far in the media to see what kind of dominating hierarchy exists in medicine and that underlings are often afraid to do something that may put them on the wrong side of their direct report.

How do we enact these changes in our own hospital systems? One way is to look at how we lead. We did an interesting activity involving….horses? (feel free to ask me more about it this week!). There are many ways to lead, from the front or back or from the middle of the pack. They each come with their own roles and responsibilities, and they may not always be the same. A great leader knows how to occupy each role, but importantly does not feel a sense of entitlement or express a sense of sorrow if the is not at “the front of the pack”. While it seems easy to just “try to recruit” those into medicine with these innate skills, these traits can take time to develop and need to be incorporated not only in undergraduate education but into CME as well.

During my medical internship this year, I tried to observe and be cognizant of how I and others interacted with other house staff.  For example, I noticed great examples of how leadership can be applied during dynamic team settings such as codes with multiple different players. Another scenario, although a less cortisol-filled one, that is of interest from a MedEd perspective was table rounds, where there is a strong hierarchy of medical students, intern residents, and attendings. I was very appreciative of how our attendings made the environment as punishment free as possible for the med student, and the entire team including our pharmacist, to speak up if they noticed something was wrong with their patient.

This is the essence of successfully implementing Just Culture, enforcing, and cultivating awareness that there should and will be no judgment or reprimand for speaking up when you believe patient safety or enhancing care is a factor. While I’m still learning a lot about my own biases and how I can be a better leader, I’m excited to see what this week has in store and to learn from all your experiences as well!