By: Brian McBeth (@84Tigs) and Felix Ankel (@felixankel)
You are hired as an associate dean for medical education at a new medical school that is integrated into a dynamic health system. You are tasked with creating a “greenfield” (start from scratch) rather than a “brownfield” (transform existing structures) strategic vision for health professions education (HPE). You co-produce a strategic vision with stakeholders that includes the following pillars:
- Population centered workforce planning
- System wide competencies for practice readiness
- An infrastructure (finance, IT, communication, planning) to support 1 & 2
Consider the following (part 1)
As a residency director, you are considering two known student candidates for your program: one who has high scholastic aptitude and strong fund of knowledge, yet also is known at times for arrogance. The second is humble, with less developed cognitive and clinical skills, yet appreciates the significant need to learn. Within the simplicity of this construct, which is better for your program? Which has higher likelihood of being a successful resident? What about recruiting educational faculty – better to target teachers who are bright, dynamic, and successful, or should program strategy include development and retention of a core faculty that includes humility as a core value? Which are the better role models for residents, and ultimately does it also depend on the type of physicians and physician leaders a program looks to develop?
You decide to focus on humility as the foundational system wide competency for HPE. Why humility? Why is humility foundational? How do you start?
Humility as a system wide competency
Medical education traditionally has always prioritized knowledge and confidence as reflections of success, with students and clinical educators pushed to excel and demonstrate these qualities. However, the concept of intellectual humility, defined by Duke psychologist Mark Leary as a “recognition that the things you believe in might in fact be wrong – an awareness of one’s cognitive fallibility”, could certainly be seen as an asset for a learner. A humble intellectual approach acknowledges one’s blind spots, and a student who shows active interest in learning from the perspectives of others has potential to expand knowledge and grow skills. Additionally, the idea of relational humility, whereby an individual’s intuitive empathy and perspective – both intrapersonal (accurate view of self) and interpersonal (other-oriented rather than self-focused) – will shape communication and human relationships. A student or resident’s ability to learn is rooted in intellectual humility, while their ability to effectively interact with patients and other providers often depends on relational humility.
With a vision that includes population centered workforce planning, the investment by a medical school in thinking strategically about humility could pay dividends in terms of a physician workforce intelligence with the skills to incorporate new knowledge in a rapidly changing healthcare environment, as well as the competencies to support collaborative practice. Ultimately there is also potential for greater stability of the workforce by valuing relational humility and thus reducing interpersonal conflict – known as a significant contributor to burnout.
Humility can also be incorporated as a system wide competency, reflecting a new more-transparent perspective with bedside education; no longer is the clinician educator expected to manifest an unattainable image of mastery of clinical practice, but rather model a humble and inquisitive approach with learners, sharing tools and vulnerability when appropriate and demonstrating the longevity of a career built on continuing professional education and interpersonal investment. Likewise, medical schools building around a competency of humility will recruit faculty and learners with these perspectives and will also manifest leadership decisions and an academic direction that nurtures this value. For example, a research program and faculty development programs that recognizes diversity and inclusivity are natural outgrowths of an administrative emphasis on organizational humility.
Consider the following (part 2)
Three hard trends are influencing health care and health professions education.
- The value of a clinician is moving away from being a vessel of knowledge towards being a facilitator of collective wisdom. Intellectual humility allows a clinician to incorporate new knowledge, while relational humility facilitates communication, understanding and ultimately wisdom for better shared clinical decision making.
- A clinician’s professional identity is evolving from binary (you are either a physician or not a physician) to quantum (you are both a physician and informaticist or even a new identity yet to be created). Intellectual and relational humility both provide foundations from which to engage other disciplines, expanding scope of perspective and create new professional identities.
- The center of gravity for innovation in health care and health professional education is moving from the core of historical hierarchical institutions to the periphery of non-hierarchical trust, communication, and personal learning networks. Organizational humility will give medical schools and health systems the flexibility to foster trust among learners and educators, facilitate communication between providers and patients, and ultimately sustain a healthier and safer work environment for care delivery, while promoting wellness and longevity of professional staff.
Individuals and HPE learning organizations with an explicit focus on humility as a core value will have an easier time adapting to this future.
Questions to consider
- How is humility valued in your operational unit?
- Can you identify examples of intellectual, relational humility, and organizational humility?
- How is humility embedded in your culture? Can you find clues in “language, artifacts, and celebrations”? How are revered trainees and educators described (language)? What hangs on the walls (artifacts)? What happens at orientation and graduations (celebrations)?
References
1. Schein E, P Schein. 2018. Humble Leadership: The power of relationships, openness, and trust. Oakland: Berrett-Koehler Publishers, Inc.
2. Holiday R. 2016. Ego is the enemy. New York: Penguin Random House.
3. Leary MR, KJ Diebels, EK Davisson, KP Jongman-Sereno, JC Isherwood, KT Raimi, SA Deffler, and RH Hoyle. Cognitive and Interpersonal Features of Intellectual Humility. Pers Soc Psychol Bull. 2017; 43(6):793-813.
4. Davis DE, JN Hook, EL Jr. Worthington, DR Van Tongeren, AL Gartner, DJ II Jennings, and RA Emmons. Relational Humility: Conceptualizing and Measuring Humility as a Personality Judgment. Journal of Personality Assessment. 2011;93(3):225-34.
5. Krumrei-Mancuso EJ, MC Haggard, JP LaBouff, and WC Rowatt. Links between Intellectual Humility and Acquiring Knowledge. Journal of Positive Psychology. 2020;15(2):155-170.
6. Warm EJ, B Kinnear, S Lance, DP Schauer, J Brenner. What Behaviors Define a Good Physician? Assessing and Communicating About Noncognitive Skills. Acad Med. 2022;97(2):193-199.
Photo Credit: Piqsels
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