457 - Welcoming New Learners, Being a Mentor, Plugging Into Your Outlet

From Teaching Physician and the Literature

1) Orienting a New Learner and Optimizing the Learning Environment

It is our hope that you are hosting students of some sort in your practice.  In doing so, first impressions are important -- the first day of a new learner’s rotation with you sets the foundation for their entire experience. When the learner arrives, meet with them to outline proper expectations and provide an introduction to the team and the clinical space.  Beyond getting to know one another, helpful agenda topics for this first meeting include orienting them to the office, outlining one another’s expectations, setting avenues for feedback, and reviewing goals.

Orienting them to the office:  

●     A few days before the learner arrives, send out an email to your colleagues and clinic staff announcing their arrival with some information about them. 

●     Make sure the learner know where to park and how to enter/exit the building, and where they can put their belongings.

●     Have someone give them a tour and introduce them to the team.  

●     Remember, you’re welcoming them into your practice culture and in many cases, providing them a “first impression” of Family Medicine/Primary Care. For someone new, even knowing about places to get lunch/food are important. 

Outlining expectations:

●     Together, review the evaluation forms you need to fill out at the end of the rotation for their school/program. This way, you both are aware of any specific educational needs or requirements, and it will be clear how they will be evaluated.   

●     Review any relevant office policies.

●     Define the level of involvement that is expected with patients, the anticipated patient load, and when they should involve you.  

●     Let them know the characteristics of the patient population your office sees.

●     Discuss guidelines and expectations for documentation and presentations.

Setting avenues for feedback:

●     How often will feedback be given? How should they give you feedback?

●     In what settings will it be offered? Real-time, one-on-one, mid-point meetings?

●     What is your feedback style? What is theirs?  This is a great time to talk about your supervisory style.

●     Are there any times where it is inappropriate for them to ask questions, such as in front of the patient?

Reviewing goals:

●     Talk through any goals they have for the rotation to ensure they know what they will and will not have the opportunity to do and to be certain their goals are reasonable for the rotation. 

●     Ask if they are comfortable sharing these goals with the other clinicians and staff they may be working with and share accordingly.

●     If you have goals as an educator, share those with them and ask for input. .

Optimizing the Learning Environment

In the clinical setting, time is the most cited barrier to teaching.  When a student begins the rotation, it is important to have a process for managing clinical workflow in order to create adequate time for education.  By enhancing efficiency, you will be able to teach and model the multi-faceted areas that are necessary for clinician success.  In trying to optimize that learning time, it is recommended to reflect on the learner’s impact on the office flow prior to their arrival.

Consider the following as you manage the clinic workflow:

●     Patient and staff perspectives of the learner/their abilities

●     How to identify patients who may not want a learner present and how to manage that interaction appropriately

●     The amount of time will you allot before going into the room to confirm the history

●     Structure of the day (it’s a good idea to meet with the learner and staff in the morning to review)

●     Specific aspects of patient care that would provide opportune learning experiences

Hannah’s Comments:

As you consider your workplace setting, it is important to keep in mind that the learner is consistently entering new learning environments.  For many, this can be overwhelming and exhausting.  A setting that is welcoming, well-organized, and has clear expectations relieves much of that anxiety and allows for more trust to be built between the learner and the preceptor.  The clinical learning environment is powerful - it provides a unique and valuable set of opportunities for instruction that a classroom cannot.  Keep that thought top of mind as you consider your role in the learner’s medical education.

References:

·         Modified from Teaching Physician. Orienting a Learner. Society of Teachers of Family Medicine. Retrieved from:  Link

·         Heidenreich C, Lye P, Simpson D, Lourich M. The search for effective and efficient ambulatory teaching methods through the literature. Pediatrics. 

2000;105(Supplement 2):231-7. Link

From the Literature and the Experience of Us All

2) Mentoring Learners

In its most basic sense, a mentor facilitates personal and professional growth through the sharing of learned knowledge and insight.  In the healthcare setting, this may look like supporting the learner in the areas of attainment of a practical skill, personal and professional development, research projects, and academic development through coaching, role-modeling, and goal setting. Mentors may also provide emotional support and appropriate counseling. 

Jacobi (1991) describes five key components to mentoring:

●     Mentors should help the mentee to achieve short-and long-term goals.

●     Mentoring should include role modeling and help with career development.

●     Both mentee and mentor should benefit from the relationship.

●     Relationships should involve direct interaction between mentor and mentee.

●     Mentors should be more experienced when compared with the mentee.

Mentorship can be formal or informal; short-term or long-term. In your clinical practice, you may work with a learner for a week or for years. Consider the ways big and small that you can walk alongside them as they grow as clinicians.

Mark’s (and Hannah’s) Comments:

It’s my (Mark) personal belief that we should all both have mentors and serve as mentors.  My many mentors continue to impact my life in profound ways, and I have found the opportunity to serve as a mentor to be some of the most rewarding experiences I’ve had in my professional work.  For those of you who mentor students, residents, and younger colleagues, THANK YOU for your willingness to do this and to “pay it forward.”   It is literally an investment in our future. 

When it comes to mentoring through transitions, whether it be going from the classroom to clinical rotations, one clinical rotation to another, medical school to residency, or residency to practice, learners in the healthcare field are regularly undergoing some type of transition early in their careers. It is incredibly helpful to have a mentor come alongside the learner as they navigate these.

This Pointer may catalyze an opportunity for you to thank some of your own mentors, whether past or present.  Whether they were “formal” mentors or not, they mattered as they took the time to speak into your life.  Sharing about that impact with them is one of the greatest gifts you can ever give someone who has served as a mentor for you. 

Reference:

Nimmons, D., Giny, S., & Rosenthal, J. (2019). Medical student mentoring programs:

current insights. Advances in medical education and practice, 10, 113–123. Link

From PeerRxMed (www.PeerRxMed.org )

3)  Now Might Be a Good Time to Plug Into Your Outlet

“Anybody can become angry - that is easy, but to be angry with the right person,  to the right degree, at the right time, for the right purpose, and in the right way - that is not within everybody's power and is not easy.”   Aristotle

 

My outburst caught me completely off guard.  After a seemingly trivial episode in which I realized I had forgotten something at home while traveling to work, I screamed a series of expletives to no one in particular.  Afterwards I felt both surprised and strangely a little better, but at the same time disturbed by the force of my reaction when I am usually pretty even keeled.  I wondered where that anger was coming from.

Later that day I took a few minutes to process this episode with one of my PeerRxMed buddies.  In doing so, I was able to see how a stressor from a work-related issue may have been the real source of my outburst, with my forgetfulness being a catalyst for the anger that was apparently lurking just under the surface.  We both observed that lately there seems to be a lot more pent-up anger (or anger-like emotions) being expressed in less than constructive ways among our colleagues and teammates, and noted the many reasons why this might be.  We also checked in with each other as to how we were processing our numerous present challenges and whether we were regularly accessing the outlets that we know are helpful for us.  Finally, we agreed that it would be wise for us to check in more frequently to specifically ask how each of us was doing, while not accepting “I’m fine” for an answer.

Most of us who work in healthcare have been led to believe the experience of anger is a very “unprofessional” emotion, and therefore we often deny that we’re even having such an emotion at all.   While certainly the manner in which one expresses their anger can be inappropriate and/or destructive, the experience of anger itself is quite natural and very understandable given our past 2+ years.

Wondering what the professionals recommend for “anger management” these days,  I visited the website of our colleagues at Mental Health America (MHA) and was relieved to find that perhaps my vocal outburst was not so inappropriate after all.  Some of their suggestions for outlets include consciously pausing and breathing, exercising, journaling, dancing, singing, going to a different room or outside, verbalizing the anger in an appropriate setting (aka “venting”), asking for help, and even screaming (in private).  And of course, they emphasized the importance of gaining a better understanding of the cause or causes of the anger for you, and managing both yourself and that circumstance. 

So, if you’ve experienced feelings of anger lately (or whatever you call your “anger-like emotions”), please know you’re not abnormal and you’re not alone.  It is important to utilize an effective outlet for the expression of this anger since suppressing it will not make it go away, but instead increase the odds that it will leak or burst out in untimely or inappropriate ways.  Please remember that your PeerRxMed partner is standing by to help support you, since I’m confident that you are no longer foolish enough to think you can or should manage your challenges and distress on your own.  Indeed, we all need to leave those days behind us.  After all, no one should care alone … ever. 

For more suggestions and details from Mental Health America, here are some links: 

·         Dealing with anger and frustration:  Link

·         Healthy ways to release rage:  Link

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Mark and John

Carilion Clinic Department of Family and Community Medicine

Feel free to forward Take 3 to your colleagues. Glad to add them to the distribution list.

Email: mhgreenawald@carilionclinic.org