Leadership and Professional Development

“Lead me, follow me, or get the hell out of my way.”

—George Patton

The concept of leadership is often viewed through the lens of the individual. Terms such as “born leader” are canon in our lexicon, and motivational images are common, frequently paired with a singular majestic animal on a mountain peak, meant to inspire awe in the value of the individual leader. This mindset can be problematically reductive, suggesting that leadership is binary and mutually exclusive: we are either leaders or followers. The terminology can also be pejorative, as few are likely to populate a curriculum vitae with examples of being a great follower.

Leadership can instead be regarded as a role rather than a personality trait or superpower. Many of us inhabit multiple leadership roles in our professional lives. Whether participating on a committee, designing an educational curriculum, overseeing a clinical service line, or supervising learners as ward teaching attending, we function as leaders in the context of our relationships with other members of the numerous cohorts within which we work. As leaders, we must consider our relationships to others in a group as opposed to our intrinsic personalities.¹

The following pearls can help operationalize relational leadership concepts^2,3:

We are not alone. In any given leadership role, we must understand with whom we work (and often depend upon) and what we need to do to allow others to help us succeed. When entering a leadership role with a new group, it is important to assess the interests and skill sets of the rest of the team by either formal or informal means. Many are used to doing so on the first day of attending on a new ward service, but this concept also applies to other roles, such as chairing a new committee.

Work with individuals and groups whose knowledge, experience, skills, and/or attitudes are complementary to our own. This is not as easy as it sounds; when hiring individuals or assembling groups, we tend to gravitate to those like ourselves. Seeking different opinions and styles can be valuable, and promoting diversity, inclusion, and equity is paramount. To do so, we must make efforts to understand our own personal strengths and limitations, ideally supplemented with observation and feedback from a trusted mentor or coach. Taking an honest look at our preconceptions and assumptions is crucial. Consider how we view other silos with which we interact and the presuppositions we make, such as the “typical” surgeon or emergency department practitioner.

Recognize and publicly share shortcomings. Transparency about our limitations allows us to build relationships that are more effective and impactful. A leader who meaningfully reveals a weakness for which they need other group members to contribute specific expertise can allow team members to feel more connected or engaged with that leader or group by shifting from interpreting an ask as “Do this task” to the more empowering “I need your help.”

Leadership can be effectively conceptualized as a relational skill, fulfilled by various roles in our professional lives. Collaboration, introspection, and transparency are essential to becoming a successful leader.

The author gratefully acknowledges Dr David Berg for his invaluable mentorship as well as the core faculty of the SHM-SGIM Academic Hospitalist Academy 2.0 for their support and encouragement.

“Lead me, follow me, or get the hell out of my way.”

—George Patton

The concept of leadership is often viewed through the lens of the individual. Terms such as “born leader” are canon in our lexicon, and motivational images are common, frequently paired with a singular majestic animal on a mountain peak, meant to inspire awe in the value of the individual leader. This mindset can be problematically reductive, suggesting that leadership is binary and mutually exclusive: we are either leaders or followers. The terminology can also be pejorative, as few are likely to populate a curriculum vitae with examples of being a great follower.

Leadership can instead be regarded as a role rather than a personality trait or superpower. Many of us inhabit multiple leadership roles in our professional lives. Whether participating on a committee, designing an educational curriculum, overseeing a clinical service line, or supervising learners as ward teaching attending, we function as leaders in the context of our relationships with other members of the numerous cohorts within which we work. As leaders, we must consider our relationships to others in a group as opposed to our intrinsic personalities.¹

The following pearls can help operationalize relational leadership concepts^2,3:

We are not alone. In any given leadership role, we must understand with whom we work (and often depend upon) and what we need to do to allow others to help us succeed. When entering a leadership role with a new group, it is important to assess the interests and skill sets of the rest of the team by either formal or informal means. Many are used to doing so on the first day of attending on a new ward service, but this concept also applies to other roles, such as chairing a new committee.

Work with individuals and groups whose knowledge, experience, skills, and/or attitudes are complementary to our own. This is not as easy as it sounds; when hiring individuals or assembling groups, we tend to gravitate to those like ourselves. Seeking different opinions and styles can be valuable, and promoting diversity, inclusion, and equity is paramount. To do so, we must make efforts to understand our own personal strengths and limitations, ideally supplemented with observation and feedback from a trusted mentor or coach. Taking an honest look at our preconceptions and assumptions is crucial. Consider how we view other silos with which we interact and the presuppositions we make, such as the “typical” surgeon or emergency department practitioner.

Recognize and publicly share shortcomings. Transparency about our limitations allows us to build relationships that are more effective and impactful. A leader who meaningfully reveals a weakness for which they need other group members to contribute specific expertise can allow team members to feel more connected or engaged with that leader or group by shifting from interpreting an ask as “Do this task” to the more empowering “I need your help.”

Leadership can be effectively conceptualized as a relational skill, fulfilled by various roles in our professional lives. Collaboration, introspection, and transparency are essential to becoming a successful leader.

The author gratefully acknowledges Dr David Berg for his invaluable mentorship as well as the core faculty of the SHM-SGIM Academic Hospitalist Academy 2.0 for their support and encouragement.

“Lead me, follow me, or get the hell out of my way.”

—George Patton

The concept of leadership is often viewed through the lens of the individual. Terms such as “born leader” are canon in our lexicon, and motivational images are common, frequently paired with a singular majestic animal on a mountain peak, meant to inspire awe in the value of the individual leader. This mindset can be problematically reductive, suggesting that leadership is binary and mutually exclusive: we are either leaders or followers. The terminology can also be pejorative, as few are likely to populate a curriculum vitae with examples of being a great follower.

Leadership can instead be regarded as a role rather than a personality trait or superpower. Many of us inhabit multiple leadership roles in our professional lives. Whether participating on a committee, designing an educational curriculum, overseeing a clinical service line, or supervising learners as ward teaching attending, we function as leaders in the context of our relationships with other members of the numerous cohorts within which we work. As leaders, we must consider our relationships to others in a group as opposed to our intrinsic personalities.¹

The following pearls can help operationalize relational leadership concepts^2,3:

We are not alone. In any given leadership role, we must understand with whom we work (and often depend upon) and what we need to do to allow others to help us succeed. When entering a leadership role with a new group, it is important to assess the interests and skill sets of the rest of the team by either formal or informal means. Many are used to doing so on the first day of attending on a new ward service, but this concept also applies to other roles, such as chairing a new committee.

Work with individuals and groups whose knowledge, experience, skills, and/or attitudes are complementary to our own. This is not as easy as it sounds; when hiring individuals or assembling groups, we tend to gravitate to those like ourselves. Seeking different opinions and styles can be valuable, and promoting diversity, inclusion, and equity is paramount. To do so, we must make efforts to understand our own personal strengths and limitations, ideally supplemented with observation and feedback from a trusted mentor or coach. Taking an honest look at our preconceptions and assumptions is crucial. Consider how we view other silos with which we interact and the presuppositions we make, such as the “typical” surgeon or emergency department practitioner.

Recognize and publicly share shortcomings. Transparency about our limitations allows us to build relationships that are more effective and impactful. A leader who meaningfully reveals a weakness for which they need other group members to contribute specific expertise can allow team members to feel more connected or engaged with that leader or group by shifting from interpreting an ask as “Do this task” to the more empowering “I need your help.”

Leadership can be effectively conceptualized as a relational skill, fulfilled by various roles in our professional lives. Collaboration, introspection, and transparency are essential to becoming a successful leader.

The author gratefully acknowledges Dr David Berg for his invaluable mentorship as well as the core faculty of the SHM-SGIM Academic Hospitalist Academy 2.0 for their support and encouragement.

Nothing changes without personal transformation.

—W Edwards Deming, 1986

Failure is common among quality improvement projects, but also predictable. Health professionals have multiple competing priorities. Improvement projects rarely reduce an individual’s workload. In our experience coaching health professionals, we have found that improvement teams often overlook two important facts: improvement requires behavior change, and everyone resists change.

Quality improvement education focuses on the development of technical skills (eg, process mapping, measure development, data analysis). Technical skills are necessary, but insufficient, to lead change. Process maps and run charts guide improvement work but alone do not motivate frontline staff to change workflows. Rather, soft skills (eg, communication, negotiation, change management, influencing others) convince frontline staff and hospital leaders that change is worth their time and effort.^1,2 Successful improvement teams combine technical skills and soft skills to inspire behavior change.

We propose three practical skills that all improvement teams can adopt to inspire change:

Understand your stakeholders’ needs. Early identification and engagement of stakeholders (individuals or groups who may affect or be affected by the project) is critical. Improvement teams must consider stakeholders at multiple levels in the organization, from frontline staff to executives. The easiest way to understand stakeholders is by talking to them. Often, stakeholders lack time for scheduled meetings, so teams must rely on informal conversations in hallways and elevators. The key is to understand what will motivate the stakeholder to change. Put yourself in the stakeholders’ shoes: What are their needs and priorities? How might their needs and priorities motivate them to change? What potential barriers exist that prevent the stakeholder from making a change?

Tailor your message to establish a rationale for change. Build upon what was learned from stakeholders and decide how the rationale for change will be communicated. What can you say that will influence others to see the problem as important? Recognize that the rationale is different for different stakeholders; a financial rationale may inspire hospital leaders but alienate staff who are driven by patient and staff satisfaction. Even carefully crafted messages may not resonate with stakeholders as intended. Improvement teams must monitor the impact of their message with different stakeholders. Developing a clear, concise, and compelling rationale for change is often challenging and iterative. Multiple communication channels (ie, email, newsletters, formal and informal conversations) must be employed to spread your message.

Share small and large wins. Talking with stakeholders is not a one-time event. Stakeholder interest may decrease over time. Frontline staff can become complacent, falling back into old behaviors. Priorities of hospital leadership can shift. Successful teams maintain lines of communication throughout the project to share successes and sustain stakeholder buy-in. Small and large wins matter. Project outcomes (large wins) may take months to achieve. Teams can maintain stakeholder interest by demonstrating that project processes are feasible and acceptable (small wins). Maintaining regular communication also affords teams the opportunity for early identification of organizational barriers and facilitators that may impact their project. Ongoing communication of project wins sets the stage for sustainment by embedding the change within the local culture.

The goal of any improvement project is to create sustainable change. To do this, improvement teams often need hundreds of people to change the way they work. Change is hard, but improvement teams can overcome resistance to it by strategically engaging stakeholders and thoughtfully communicating the rationale for change.

Nothing changes without personal transformation.

—W Edwards Deming, 1986

Failure is common among quality improvement projects, but also predictable. Health professionals have multiple competing priorities. Improvement projects rarely reduce an individual’s workload. In our experience coaching health professionals, we have found that improvement teams often overlook two important facts: improvement requires behavior change, and everyone resists change.

Quality improvement education focuses on the development of technical skills (eg, process mapping, measure development, data analysis). Technical skills are necessary, but insufficient, to lead change. Process maps and run charts guide improvement work but alone do not motivate frontline staff to change workflows. Rather, soft skills (eg, communication, negotiation, change management, influencing others) convince frontline staff and hospital leaders that change is worth their time and effort.^1,2 Successful improvement teams combine technical skills and soft skills to inspire behavior change.

We propose three practical skills that all improvement teams can adopt to inspire change:

Understand your stakeholders’ needs. Early identification and engagement of stakeholders (individuals or groups who may affect or be affected by the project) is critical. Improvement teams must consider stakeholders at multiple levels in the organization, from frontline staff to executives. The easiest way to understand stakeholders is by talking to them. Often, stakeholders lack time for scheduled meetings, so teams must rely on informal conversations in hallways and elevators. The key is to understand what will motivate the stakeholder to change. Put yourself in the stakeholders’ shoes: What are their needs and priorities? How might their needs and priorities motivate them to change? What potential barriers exist that prevent the stakeholder from making a change?

Tailor your message to establish a rationale for change. Build upon what was learned from stakeholders and decide how the rationale for change will be communicated. What can you say that will influence others to see the problem as important? Recognize that the rationale is different for different stakeholders; a financial rationale may inspire hospital leaders but alienate staff who are driven by patient and staff satisfaction. Even carefully crafted messages may not resonate with stakeholders as intended. Improvement teams must monitor the impact of their message with different stakeholders. Developing a clear, concise, and compelling rationale for change is often challenging and iterative. Multiple communication channels (ie, email, newsletters, formal and informal conversations) must be employed to spread your message.

Share small and large wins. Talking with stakeholders is not a one-time event. Stakeholder interest may decrease over time. Frontline staff can become complacent, falling back into old behaviors. Priorities of hospital leadership can shift. Successful teams maintain lines of communication throughout the project to share successes and sustain stakeholder buy-in. Small and large wins matter. Project outcomes (large wins) may take months to achieve. Teams can maintain stakeholder interest by demonstrating that project processes are feasible and acceptable (small wins). Maintaining regular communication also affords teams the opportunity for early identification of organizational barriers and facilitators that may impact their project. Ongoing communication of project wins sets the stage for sustainment by embedding the change within the local culture.

The goal of any improvement project is to create sustainable change. To do this, improvement teams often need hundreds of people to change the way they work. Change is hard, but improvement teams can overcome resistance to it by strategically engaging stakeholders and thoughtfully communicating the rationale for change.

Nothing changes without personal transformation.

—W Edwards Deming, 1986

Failure is common among quality improvement projects, but also predictable. Health professionals have multiple competing priorities. Improvement projects rarely reduce an individual’s workload. In our experience coaching health professionals, we have found that improvement teams often overlook two important facts: improvement requires behavior change, and everyone resists change.

Quality improvement education focuses on the development of technical skills (eg, process mapping, measure development, data analysis). Technical skills are necessary, but insufficient, to lead change. Process maps and run charts guide improvement work but alone do not motivate frontline staff to change workflows. Rather, soft skills (eg, communication, negotiation, change management, influencing others) convince frontline staff and hospital leaders that change is worth their time and effort.^1,2 Successful improvement teams combine technical skills and soft skills to inspire behavior change.

We propose three practical skills that all improvement teams can adopt to inspire change:

Understand your stakeholders’ needs. Early identification and engagement of stakeholders (individuals or groups who may affect or be affected by the project) is critical. Improvement teams must consider stakeholders at multiple levels in the organization, from frontline staff to executives. The easiest way to understand stakeholders is by talking to them. Often, stakeholders lack time for scheduled meetings, so teams must rely on informal conversations in hallways and elevators. The key is to understand what will motivate the stakeholder to change. Put yourself in the stakeholders’ shoes: What are their needs and priorities? How might their needs and priorities motivate them to change? What potential barriers exist that prevent the stakeholder from making a change?

Tailor your message to establish a rationale for change. Build upon what was learned from stakeholders and decide how the rationale for change will be communicated. What can you say that will influence others to see the problem as important? Recognize that the rationale is different for different stakeholders; a financial rationale may inspire hospital leaders but alienate staff who are driven by patient and staff satisfaction. Even carefully crafted messages may not resonate with stakeholders as intended. Improvement teams must monitor the impact of their message with different stakeholders. Developing a clear, concise, and compelling rationale for change is often challenging and iterative. Multiple communication channels (ie, email, newsletters, formal and informal conversations) must be employed to spread your message.

Share small and large wins. Talking with stakeholders is not a one-time event. Stakeholder interest may decrease over time. Frontline staff can become complacent, falling back into old behaviors. Priorities of hospital leadership can shift. Successful teams maintain lines of communication throughout the project to share successes and sustain stakeholder buy-in. Small and large wins matter. Project outcomes (large wins) may take months to achieve. Teams can maintain stakeholder interest by demonstrating that project processes are feasible and acceptable (small wins). Maintaining regular communication also affords teams the opportunity for early identification of organizational barriers and facilitators that may impact their project. Ongoing communication of project wins sets the stage for sustainment by embedding the change within the local culture.

The goal of any improvement project is to create sustainable change. To do this, improvement teams often need hundreds of people to change the way they work. Change is hard, but improvement teams can overcome resistance to it by strategically engaging stakeholders and thoughtfully communicating the rationale for change.

“Well begun is half done.” — Aristotle

In the clinical environment, team composition changes frequently and time is limited. As a result, teams often jump directly into patient care, addressing issues related to interpersonal dynamics only after they arise. Team leaders can accelerate the process of forming highly effective teams by deliberately leveraging principles of teaming, or the process of “how to turn a group of strangers into a team.”¹

On the first day with a new team, a common misconception is that teaming will take away time, when in fact it will save time. Investing a few minutes before rounds to clarify roles and expectations can streamline subsequent shared work. For example, an attending might request to accompany residents and medical students for new admissions in the last 2 hours of the workday, rather than following the usual pattern of discussing the case after the team completes a full evaluation on their own. Importantly, attendings should clarify their intent—to preserve learning opportunities while helping teams wrap up on time—and their role, which is to provide real-time feedback, facilitate decision-making, or assist with documentation. This 2-minute upfront investment results in improved team camaraderie, better task coordination, and fewer late days in the hospital.

By integrating a few positively framed, thoughtful questions into introductions, teams may also discover surprising expertise or valuable perspectives that positively impact team performance.² For example, in lieu of questions about level of training or hometown, you might ask, “What is an experience outside the hospital that helps you inside the hospital?” or “What skills allow you to contribute best on teams?” These questions might lead, for example, a medical student to leverage her background in computer science to help her team design new electronic health record shortcuts. Or, they might enable a resident with a personal history of leukemia to help the team communicate with a young patient facing a prolonged hospitalization for a newly diagnosed serious illness. With typical introductions, these opportunities and unexpected solutions can easily be missed.

As part of teaming, members should also explicitly share individual work-style preferences to avoid misunderstandings that may adversely affect subsequent work. On new teams, members—especially trainees—expend considerable energy scrutinizing subtle behaviors, such as a clarifying question or a blank stare, to assess whether their performance is perceived favorably. That energy can be reallocated to more important tasks by encouraging each person to state nuances of their work style that may be misinterpreted. For example, an attending might share, “I ask questions to identify what to teach, not to judge knowledge, so don’t worry about saying you don’t know,” whereas a resident might warn, “I have trouble concentrating when I’m hungry, so I often get impatient if we don’t take a break for lunch.” Without this information, a student might feel unnecessarily embarrassed by an attending on rounds, and an attending might incorrectly interpret a resident’s impatience around lunchtime as a reflection of low commitment. Individual work styles vary, and recognizing these differences upfront allows teams to maintain a sharper focus on more important issues, such as clinical care.

In the hospital, we find ourselves in perpetual motion, with frequent transitions of care and new team members. Teaming offers a concrete method to proactively avoid predictable challenges and to enable teams to become more efficient, effective, and connected. Furthermore, teaming empowers us to substitute the uncertainty of ever-changing teams with the excitement of discovering what each new team can achieve through intentional leadership at the outset.

“Well begun is half done.” — Aristotle

In the clinical environment, team composition changes frequently and time is limited. As a result, teams often jump directly into patient care, addressing issues related to interpersonal dynamics only after they arise. Team leaders can accelerate the process of forming highly effective teams by deliberately leveraging principles of teaming, or the process of “how to turn a group of strangers into a team.”¹

On the first day with a new team, a common misconception is that teaming will take away time, when in fact it will save time. Investing a few minutes before rounds to clarify roles and expectations can streamline subsequent shared work. For example, an attending might request to accompany residents and medical students for new admissions in the last 2 hours of the workday, rather than following the usual pattern of discussing the case after the team completes a full evaluation on their own. Importantly, attendings should clarify their intent—to preserve learning opportunities while helping teams wrap up on time—and their role, which is to provide real-time feedback, facilitate decision-making, or assist with documentation. This 2-minute upfront investment results in improved team camaraderie, better task coordination, and fewer late days in the hospital.

By integrating a few positively framed, thoughtful questions into introductions, teams may also discover surprising expertise or valuable perspectives that positively impact team performance.² For example, in lieu of questions about level of training or hometown, you might ask, “What is an experience outside the hospital that helps you inside the hospital?” or “What skills allow you to contribute best on teams?” These questions might lead, for example, a medical student to leverage her background in computer science to help her team design new electronic health record shortcuts. Or, they might enable a resident with a personal history of leukemia to help the team communicate with a young patient facing a prolonged hospitalization for a newly diagnosed serious illness. With typical introductions, these opportunities and unexpected solutions can easily be missed.

As part of teaming, members should also explicitly share individual work-style preferences to avoid misunderstandings that may adversely affect subsequent work. On new teams, members—especially trainees—expend considerable energy scrutinizing subtle behaviors, such as a clarifying question or a blank stare, to assess whether their performance is perceived favorably. That energy can be reallocated to more important tasks by encouraging each person to state nuances of their work style that may be misinterpreted. For example, an attending might share, “I ask questions to identify what to teach, not to judge knowledge, so don’t worry about saying you don’t know,” whereas a resident might warn, “I have trouble concentrating when I’m hungry, so I often get impatient if we don’t take a break for lunch.” Without this information, a student might feel unnecessarily embarrassed by an attending on rounds, and an attending might incorrectly interpret a resident’s impatience around lunchtime as a reflection of low commitment. Individual work styles vary, and recognizing these differences upfront allows teams to maintain a sharper focus on more important issues, such as clinical care.

In the hospital, we find ourselves in perpetual motion, with frequent transitions of care and new team members. Teaming offers a concrete method to proactively avoid predictable challenges and to enable teams to become more efficient, effective, and connected. Furthermore, teaming empowers us to substitute the uncertainty of ever-changing teams with the excitement of discovering what each new team can achieve through intentional leadership at the outset.

“Well begun is half done.” — Aristotle

In the clinical environment, team composition changes frequently and time is limited. As a result, teams often jump directly into patient care, addressing issues related to interpersonal dynamics only after they arise. Team leaders can accelerate the process of forming highly effective teams by deliberately leveraging principles of teaming, or the process of “how to turn a group of strangers into a team.”¹

On the first day with a new team, a common misconception is that teaming will take away time, when in fact it will save time. Investing a few minutes before rounds to clarify roles and expectations can streamline subsequent shared work. For example, an attending might request to accompany residents and medical students for new admissions in the last 2 hours of the workday, rather than following the usual pattern of discussing the case after the team completes a full evaluation on their own. Importantly, attendings should clarify their intent—to preserve learning opportunities while helping teams wrap up on time—and their role, which is to provide real-time feedback, facilitate decision-making, or assist with documentation. This 2-minute upfront investment results in improved team camaraderie, better task coordination, and fewer late days in the hospital.

By integrating a few positively framed, thoughtful questions into introductions, teams may also discover surprising expertise or valuable perspectives that positively impact team performance.² For example, in lieu of questions about level of training or hometown, you might ask, “What is an experience outside the hospital that helps you inside the hospital?” or “What skills allow you to contribute best on teams?” These questions might lead, for example, a medical student to leverage her background in computer science to help her team design new electronic health record shortcuts. Or, they might enable a resident with a personal history of leukemia to help the team communicate with a young patient facing a prolonged hospitalization for a newly diagnosed serious illness. With typical introductions, these opportunities and unexpected solutions can easily be missed.

As part of teaming, members should also explicitly share individual work-style preferences to avoid misunderstandings that may adversely affect subsequent work. On new teams, members—especially trainees—expend considerable energy scrutinizing subtle behaviors, such as a clarifying question or a blank stare, to assess whether their performance is perceived favorably. That energy can be reallocated to more important tasks by encouraging each person to state nuances of their work style that may be misinterpreted. For example, an attending might share, “I ask questions to identify what to teach, not to judge knowledge, so don’t worry about saying you don’t know,” whereas a resident might warn, “I have trouble concentrating when I’m hungry, so I often get impatient if we don’t take a break for lunch.” Without this information, a student might feel unnecessarily embarrassed by an attending on rounds, and an attending might incorrectly interpret a resident’s impatience around lunchtime as a reflection of low commitment. Individual work styles vary, and recognizing these differences upfront allows teams to maintain a sharper focus on more important issues, such as clinical care.

In the hospital, we find ourselves in perpetual motion, with frequent transitions of care and new team members. Teaming offers a concrete method to proactively avoid predictable challenges and to enable teams to become more efficient, effective, and connected. Furthermore, teaming empowers us to substitute the uncertainty of ever-changing teams with the excitement of discovering what each new team can achieve through intentional leadership at the outset.

“By learning you will teach, by teaching you will learn.”

–Latin proverb

The COVID-19 pandemic thrust hospitalists into uncertain clinical situations where scientific evidence was rapidly changing and expert consensus was not always available. Amidst this, our learners were eager to better understand this new disease and how to properly care for patients. This forced hospitalists, as educators, to face the question: “How do you teach when you don’t have the answers?”

Teaching outside a hospitalist’s expertise existed before the COVID-19 pandemic and will continue to exist. It is a challenge encountered frequently by both junior and senior faculty across all disciplines, yet is rarely discussed.¹ However, great learning can still occur when we teach at the edge of our comfort zones.

You don’t need to be an expert to be a great teacher. Although most educators know this, we often fear that disclosing our knowledge limitations exposes our weaknesses. But a successful start to the learning journey begins with establishing trust and confidence with your learners. Remaining authentic in your knowledge base will inspire more credibility than false pretenses of content mastery. Phrases like, “This topic is new for me as well. Here’s what I do know and what I don’t know” or “What a great question. I wish I had a great answer. Let me get back to you” set a standard for honesty and reduce teaching pressures. In turn, learners will be more comfortable acknowledging their own uncertainties and will be more likely to voice their hesitations or ask questions on rounds.

The field of medicine is steeped in hierarchical structure, where the attending is assumed to have the most knowledge. But this may not always be true, as learners are often more up to date on a subject than the attending. By reexamining traditional hierarchies and instead considering ourselves as part of a learning team, we can promote a more positive educational climate.

When a learner asks a question that you don’t have an answer for, the response “Great question. I can tell you what I think, but I’m interested in first hearing your thoughts” reflects that you respect your learners and their skills and experiences. You can also ask them to do a literature review and report back to you and the team the next morning. By inverting the hierarchy, you are teaching humility, adaptability, and shared responsibility, as well as demonstrating the skills of being a lifelong learner.²

As educators, we often hold ourselves to unrealistic expectations of being omniscient knowledge vessels. In times of crisis or uncertainty, teaching about how to learn and where to learn become just as important as what to learn. Invite learners to observe how you navigate ambiguity. For example, I recently interacted with a colleague on an unfamiliar case. She said, “Dr Wang, I don’t know much about malaria. Can you share with me what made you consider this diagnosis?” Additionally, admitting to learners when you have made an error not only clarifies their learning, but also role models continuous personal improvement.

By modeling humility by acknowledging our own limits, respecting our learners’ knowledge and experiences, and demonstrating how we manage uncertainty, we can enhance the learning environment and inspire our learners.

“By learning you will teach, by teaching you will learn.”

–Latin proverb

The COVID-19 pandemic thrust hospitalists into uncertain clinical situations where scientific evidence was rapidly changing and expert consensus was not always available. Amidst this, our learners were eager to better understand this new disease and how to properly care for patients. This forced hospitalists, as educators, to face the question: “How do you teach when you don’t have the answers?”

Teaching outside a hospitalist’s expertise existed before the COVID-19 pandemic and will continue to exist. It is a challenge encountered frequently by both junior and senior faculty across all disciplines, yet is rarely discussed.¹ However, great learning can still occur when we teach at the edge of our comfort zones.

You don’t need to be an expert to be a great teacher. Although most educators know this, we often fear that disclosing our knowledge limitations exposes our weaknesses. But a successful start to the learning journey begins with establishing trust and confidence with your learners. Remaining authentic in your knowledge base will inspire more credibility than false pretenses of content mastery. Phrases like, “This topic is new for me as well. Here’s what I do know and what I don’t know” or “What a great question. I wish I had a great answer. Let me get back to you” set a standard for honesty and reduce teaching pressures. In turn, learners will be more comfortable acknowledging their own uncertainties and will be more likely to voice their hesitations or ask questions on rounds.

The field of medicine is steeped in hierarchical structure, where the attending is assumed to have the most knowledge. But this may not always be true, as learners are often more up to date on a subject than the attending. By reexamining traditional hierarchies and instead considering ourselves as part of a learning team, we can promote a more positive educational climate.

When a learner asks a question that you don’t have an answer for, the response “Great question. I can tell you what I think, but I’m interested in first hearing your thoughts” reflects that you respect your learners and their skills and experiences. You can also ask them to do a literature review and report back to you and the team the next morning. By inverting the hierarchy, you are teaching humility, adaptability, and shared responsibility, as well as demonstrating the skills of being a lifelong learner.²

As educators, we often hold ourselves to unrealistic expectations of being omniscient knowledge vessels. In times of crisis or uncertainty, teaching about how to learn and where to learn become just as important as what to learn. Invite learners to observe how you navigate ambiguity. For example, I recently interacted with a colleague on an unfamiliar case. She said, “Dr Wang, I don’t know much about malaria. Can you share with me what made you consider this diagnosis?” Additionally, admitting to learners when you have made an error not only clarifies their learning, but also role models continuous personal improvement.

By modeling humility by acknowledging our own limits, respecting our learners’ knowledge and experiences, and demonstrating how we manage uncertainty, we can enhance the learning environment and inspire our learners.

“By learning you will teach, by teaching you will learn.”

–Latin proverb

The COVID-19 pandemic thrust hospitalists into uncertain clinical situations where scientific evidence was rapidly changing and expert consensus was not always available. Amidst this, our learners were eager to better understand this new disease and how to properly care for patients. This forced hospitalists, as educators, to face the question: “How do you teach when you don’t have the answers?”

Teaching outside a hospitalist’s expertise existed before the COVID-19 pandemic and will continue to exist. It is a challenge encountered frequently by both junior and senior faculty across all disciplines, yet is rarely discussed.¹ However, great learning can still occur when we teach at the edge of our comfort zones.

You don’t need to be an expert to be a great teacher. Although most educators know this, we often fear that disclosing our knowledge limitations exposes our weaknesses. But a successful start to the learning journey begins with establishing trust and confidence with your learners. Remaining authentic in your knowledge base will inspire more credibility than false pretenses of content mastery. Phrases like, “This topic is new for me as well. Here’s what I do know and what I don’t know” or “What a great question. I wish I had a great answer. Let me get back to you” set a standard for honesty and reduce teaching pressures. In turn, learners will be more comfortable acknowledging their own uncertainties and will be more likely to voice their hesitations or ask questions on rounds.

The field of medicine is steeped in hierarchical structure, where the attending is assumed to have the most knowledge. But this may not always be true, as learners are often more up to date on a subject than the attending. By reexamining traditional hierarchies and instead considering ourselves as part of a learning team, we can promote a more positive educational climate.

When a learner asks a question that you don’t have an answer for, the response “Great question. I can tell you what I think, but I’m interested in first hearing your thoughts” reflects that you respect your learners and their skills and experiences. You can also ask them to do a literature review and report back to you and the team the next morning. By inverting the hierarchy, you are teaching humility, adaptability, and shared responsibility, as well as demonstrating the skills of being a lifelong learner.²

As educators, we often hold ourselves to unrealistic expectations of being omniscient knowledge vessels. In times of crisis or uncertainty, teaching about how to learn and where to learn become just as important as what to learn. Invite learners to observe how you navigate ambiguity. For example, I recently interacted with a colleague on an unfamiliar case. She said, “Dr Wang, I don’t know much about malaria. Can you share with me what made you consider this diagnosis?” Additionally, admitting to learners when you have made an error not only clarifies their learning, but also role models continuous personal improvement.

By modeling humility by acknowledging our own limits, respecting our learners’ knowledge and experiences, and demonstrating how we manage uncertainty, we can enhance the learning environment and inspire our learners.

“Being a role model is the most powerful form of educating.”

—John Wooden

The typical approach to faculty development in education often emphasizes specific teaching skills, such as rounding and teaching styles, providing expectations, and giving feedback. Before these strategies can be applied, however, we must first take note that memorable and influential physicians share common practices of compassionate, person-centered care. Role models are important in professional, character, and career development.¹ Role modeling compassionate patient care gains learners’ respect and engagement, and, ideally, inspires them to grow as people and physicians. An often-overlooked foundation of improving as a medical educator is working to improve our bedside interactions and role modeling compassionate care.

As new roles and promotions draw us away from clinical commitments and toward administrative work, it is easy to become disconnected from the value of clinical medicine. We risk unintentionally perpetuating a hidden curriculum that undervalues humanistic care when we do not explicitly endorse empathic values and behaviors. Exemplary teaching physicians respect patients, care for their well-being, and consider the big picture.² Next time you are rounding, remember the importance of bedside patient interactions.

With that in mind, here are three key strategies to consider for effective physician-patient interactions.

1. Start strong: It is crucial to get off to a good start by leading with respect and kindness. Knocking and pausing before entering the patient’s hospital room shows you remember that they are in vulnerable positions, with little privacy. Smiling warmly when greeting patients shows you are happy to see them. Greet them using their preferred honorific and introduce yourself and your team each day. Ask whether it’s okay to mute the television, but remember to turn the volume back up when leaving. Convey warmth with appropriate touch, consider small acts to make the patient more comfortable, and, when possible, sit at a patient’s eye level.

2. Show empathy: Be patient and remind yourself that hospitalized patients and their families are often in the most difficult times of their lives. In addition to being in vulnerable positions, patients are often lonely and anxious. Humanistic physicians get to know patients as people and beyond their medical illness by talking about nonmedical topics.³ Ask about their family, their pets, memorable moments in their lives, sports teams, favorite shows, and how they pass the time while hospitalized. Are there any photos they would like to share with you? Ask, too, before you leave the room whether they need you to reach something for them. Use humor thoughtfully, and always with kindness. Demonstrate humility about your own abilities, and what you know and do not know about the patient’s diagnoses, and their lived experience.

3. Strive for trustworthiness: Advocate for the patient and show them and your learners that you care. Make shared decisions when straying from guideline-directed care. Aim for trustworthiness; patients’ distrust is an adaptive response to how they have experienced healthcare, so while you do not have to take distrust personally, you should take addressing it as a personal obligation. Be aware of your own privilege, and that how patients perceive you is a reflection of how they have experienced the world, including other clinicians. Model vulnerability, including showing appropriate sadness when there is bad news to report and acknowledging grief.

Being a better clinical teacher starts with being a better doctor. Role modeling compassionate and person-centered care is a cornerstone of being an exceptional clinical teacher.

We gratefully acknowledge SHM’s Physician-in-Training Committee, whose support made this collaboration possible.

“Being a role model is the most powerful form of educating.”

—John Wooden

The typical approach to faculty development in education often emphasizes specific teaching skills, such as rounding and teaching styles, providing expectations, and giving feedback. Before these strategies can be applied, however, we must first take note that memorable and influential physicians share common practices of compassionate, person-centered care. Role models are important in professional, character, and career development.¹ Role modeling compassionate patient care gains learners’ respect and engagement, and, ideally, inspires them to grow as people and physicians. An often-overlooked foundation of improving as a medical educator is working to improve our bedside interactions and role modeling compassionate care.

As new roles and promotions draw us away from clinical commitments and toward administrative work, it is easy to become disconnected from the value of clinical medicine. We risk unintentionally perpetuating a hidden curriculum that undervalues humanistic care when we do not explicitly endorse empathic values and behaviors. Exemplary teaching physicians respect patients, care for their well-being, and consider the big picture.² Next time you are rounding, remember the importance of bedside patient interactions.

With that in mind, here are three key strategies to consider for effective physician-patient interactions.

1. Start strong: It is crucial to get off to a good start by leading with respect and kindness. Knocking and pausing before entering the patient’s hospital room shows you remember that they are in vulnerable positions, with little privacy. Smiling warmly when greeting patients shows you are happy to see them. Greet them using their preferred honorific and introduce yourself and your team each day. Ask whether it’s okay to mute the television, but remember to turn the volume back up when leaving. Convey warmth with appropriate touch, consider small acts to make the patient more comfortable, and, when possible, sit at a patient’s eye level.

2. Show empathy: Be patient and remind yourself that hospitalized patients and their families are often in the most difficult times of their lives. In addition to being in vulnerable positions, patients are often lonely and anxious. Humanistic physicians get to know patients as people and beyond their medical illness by talking about nonmedical topics.³ Ask about their family, their pets, memorable moments in their lives, sports teams, favorite shows, and how they pass the time while hospitalized. Are there any photos they would like to share with you? Ask, too, before you leave the room whether they need you to reach something for them. Use humor thoughtfully, and always with kindness. Demonstrate humility about your own abilities, and what you know and do not know about the patient’s diagnoses, and their lived experience.

3. Strive for trustworthiness: Advocate for the patient and show them and your learners that you care. Make shared decisions when straying from guideline-directed care. Aim for trustworthiness; patients’ distrust is an adaptive response to how they have experienced healthcare, so while you do not have to take distrust personally, you should take addressing it as a personal obligation. Be aware of your own privilege, and that how patients perceive you is a reflection of how they have experienced the world, including other clinicians. Model vulnerability, including showing appropriate sadness when there is bad news to report and acknowledging grief.

Being a better clinical teacher starts with being a better doctor. Role modeling compassionate and person-centered care is a cornerstone of being an exceptional clinical teacher.

We gratefully acknowledge SHM’s Physician-in-Training Committee, whose support made this collaboration possible.

“Being a role model is the most powerful form of educating.”

—John Wooden

The typical approach to faculty development in education often emphasizes specific teaching skills, such as rounding and teaching styles, providing expectations, and giving feedback. Before these strategies can be applied, however, we must first take note that memorable and influential physicians share common practices of compassionate, person-centered care. Role models are important in professional, character, and career development.¹ Role modeling compassionate patient care gains learners’ respect and engagement, and, ideally, inspires them to grow as people and physicians. An often-overlooked foundation of improving as a medical educator is working to improve our bedside interactions and role modeling compassionate care.

As new roles and promotions draw us away from clinical commitments and toward administrative work, it is easy to become disconnected from the value of clinical medicine. We risk unintentionally perpetuating a hidden curriculum that undervalues humanistic care when we do not explicitly endorse empathic values and behaviors. Exemplary teaching physicians respect patients, care for their well-being, and consider the big picture.² Next time you are rounding, remember the importance of bedside patient interactions.

With that in mind, here are three key strategies to consider for effective physician-patient interactions.

1. Start strong: It is crucial to get off to a good start by leading with respect and kindness. Knocking and pausing before entering the patient’s hospital room shows you remember that they are in vulnerable positions, with little privacy. Smiling warmly when greeting patients shows you are happy to see them. Greet them using their preferred honorific and introduce yourself and your team each day. Ask whether it’s okay to mute the television, but remember to turn the volume back up when leaving. Convey warmth with appropriate touch, consider small acts to make the patient more comfortable, and, when possible, sit at a patient’s eye level.

2. Show empathy: Be patient and remind yourself that hospitalized patients and their families are often in the most difficult times of their lives. In addition to being in vulnerable positions, patients are often lonely and anxious. Humanistic physicians get to know patients as people and beyond their medical illness by talking about nonmedical topics.³ Ask about their family, their pets, memorable moments in their lives, sports teams, favorite shows, and how they pass the time while hospitalized. Are there any photos they would like to share with you? Ask, too, before you leave the room whether they need you to reach something for them. Use humor thoughtfully, and always with kindness. Demonstrate humility about your own abilities, and what you know and do not know about the patient’s diagnoses, and their lived experience.

3. Strive for trustworthiness: Advocate for the patient and show them and your learners that you care. Make shared decisions when straying from guideline-directed care. Aim for trustworthiness; patients’ distrust is an adaptive response to how they have experienced healthcare, so while you do not have to take distrust personally, you should take addressing it as a personal obligation. Be aware of your own privilege, and that how patients perceive you is a reflection of how they have experienced the world, including other clinicians. Model vulnerability, including showing appropriate sadness when there is bad news to report and acknowledging grief.

Being a better clinical teacher starts with being a better doctor. Role modeling compassionate and person-centered care is a cornerstone of being an exceptional clinical teacher.

We gratefully acknowledge SHM’s Physician-in-Training Committee, whose support made this collaboration possible.

“As we work to create light for others, we naturally light our own way.”

– Mary Anne Radmacher

Perhaps unknowingly, hospitalists establish microcultures in their everyday work. Hospitalists’ interactions with colleagues often occur in the context of shared workspaces. The nature of these seemingly minor exchanges shapes the microculture, often described as the culture shared by a small group based on location within an organization. Hospitalists have an opportunity to cultivate well-being within these microcultures through gracious and thoughtful acknowledgments of their peers. Collegial support at the micro level influences wellness at the organizational level. A larger shared culture of wellness is necessary to nurture physicians’ personal fulfillment and professional development.¹

We propose the CARE framework for cultivating well-being within the microcultures of hospital medicine shared workspaces. CARE consists of Capitalization, Active listening, Recognition, and Empathy. This framework is based on positive psychology research and inspired by lessons from The Happiness Advantage by Shawn Achor.²

Capitalization. Capitalization is defined as sharing upbeat news and receiving a positive reaction. Emotional support during good times, more so than during bad times, strengthens relationships. When a peer shares good news, show enthusiasm and counter with an active, constructive response to maximize the validation she perceives.²

For example, Alex sits at her desk and says to Kristen: “

My workshop proposal was accepted for medical education day!” “

Congratulations, Alex! Tell me more about the workshop.”

Active listening. Active listening requires concentration and observation of body language. Show engagement by maintaining an open posture, using positive facial expressions, and providing occasional cues that you’re paying attention. Paraphrasing and asking targeted questions to dive deeper demonstrates genuine interest. 

“Katie, I could use your advice. Do you have a minute?”

Katie turns to face John and smiles. “Of course. How can I help?”

“My team seems drained after a code this morning. I planned a lecture for later, but I’m not sure this is the right time.”

Katie nods. “I think you’re right, John. How have you thought about handling the situation?”

Recognition. Acts of recognition and encouragement are catalysts for boosting morale. Even brief expressions of gratitude can have a significant emotional impact. Recognition is most meaningful when delivered deliberately and with warmth.

Kevin walks into the hospitalist workroom. “Diane, congratulations on your publication! I plan to make a medication interaction review part of my discharge workflow.”

Leah turns to Diane. “Diane, that’s great news! Can you send me the link to your article?”

Empathy. Burnout is prevalent in medicine, and our fellow hospitalists deserve empathy. Showing empathy reduces stress and promotes connectedness. Sense when your colleagues are in distress and take time to share in their feelings and emotions. Draw on your own clinical experience to find common ground and convey understanding.

“I transferred another patient with COVID-19 to the ICU. I spent the last hour talking to family.”

“Ashwin, you’ve had a tough week. I know how you must feel—I had to transfer a patient yesterday. Want to take a quick walk outside?”

Hospitalists are inherently busy while on service, but these four interventions are brief, requiring only several minutes. Each small investment of your time will pay significant emotional dividends. These practices will not only enhance your colleagues’ sense of well-being, but will also bolster your happiness and productivity. A positive mindset fosters creative thinking and enhances complex problem solving. Recharging the microcultures of hospitalist workspaces with positivity will spark a larger transformation at the organizational level. That’s because positive actions are contagious.² One hospitalist’s commitment to CARE will encourage other hospitalists to adopt these behaviors, establishing a virtuous cycle that sustains an organization’s culture of wellness.

“As we work to create light for others, we naturally light our own way.”

– Mary Anne Radmacher

Perhaps unknowingly, hospitalists establish microcultures in their everyday work. Hospitalists’ interactions with colleagues often occur in the context of shared workspaces. The nature of these seemingly minor exchanges shapes the microculture, often described as the culture shared by a small group based on location within an organization. Hospitalists have an opportunity to cultivate well-being within these microcultures through gracious and thoughtful acknowledgments of their peers. Collegial support at the micro level influences wellness at the organizational level. A larger shared culture of wellness is necessary to nurture physicians’ personal fulfillment and professional development.¹

We propose the CARE framework for cultivating well-being within the microcultures of hospital medicine shared workspaces. CARE consists of Capitalization, Active listening, Recognition, and Empathy. This framework is based on positive psychology research and inspired by lessons from The Happiness Advantage by Shawn Achor.²

Capitalization. Capitalization is defined as sharing upbeat news and receiving a positive reaction. Emotional support during good times, more so than during bad times, strengthens relationships. When a peer shares good news, show enthusiasm and counter with an active, constructive response to maximize the validation she perceives.²

For example, Alex sits at her desk and says to Kristen: “

My workshop proposal was accepted for medical education day!” “

Congratulations, Alex! Tell me more about the workshop.”

Active listening. Active listening requires concentration and observation of body language. Show engagement by maintaining an open posture, using positive facial expressions, and providing occasional cues that you’re paying attention. Paraphrasing and asking targeted questions to dive deeper demonstrates genuine interest. 

“Katie, I could use your advice. Do you have a minute?”

Katie turns to face John and smiles. “Of course. How can I help?”

“My team seems drained after a code this morning. I planned a lecture for later, but I’m not sure this is the right time.”

Katie nods. “I think you’re right, John. How have you thought about handling the situation?”

Recognition. Acts of recognition and encouragement are catalysts for boosting morale. Even brief expressions of gratitude can have a significant emotional impact. Recognition is most meaningful when delivered deliberately and with warmth.

Kevin walks into the hospitalist workroom. “Diane, congratulations on your publication! I plan to make a medication interaction review part of my discharge workflow.”

Leah turns to Diane. “Diane, that’s great news! Can you send me the link to your article?”

Empathy. Burnout is prevalent in medicine, and our fellow hospitalists deserve empathy. Showing empathy reduces stress and promotes connectedness. Sense when your colleagues are in distress and take time to share in their feelings and emotions. Draw on your own clinical experience to find common ground and convey understanding.

“I transferred another patient with COVID-19 to the ICU. I spent the last hour talking to family.”

“Ashwin, you’ve had a tough week. I know how you must feel—I had to transfer a patient yesterday. Want to take a quick walk outside?”

Hospitalists are inherently busy while on service, but these four interventions are brief, requiring only several minutes. Each small investment of your time will pay significant emotional dividends. These practices will not only enhance your colleagues’ sense of well-being, but will also bolster your happiness and productivity. A positive mindset fosters creative thinking and enhances complex problem solving. Recharging the microcultures of hospitalist workspaces with positivity will spark a larger transformation at the organizational level. That’s because positive actions are contagious.² One hospitalist’s commitment to CARE will encourage other hospitalists to adopt these behaviors, establishing a virtuous cycle that sustains an organization’s culture of wellness.

“As we work to create light for others, we naturally light our own way.”

– Mary Anne Radmacher

Perhaps unknowingly, hospitalists establish microcultures in their everyday work. Hospitalists’ interactions with colleagues often occur in the context of shared workspaces. The nature of these seemingly minor exchanges shapes the microculture, often described as the culture shared by a small group based on location within an organization. Hospitalists have an opportunity to cultivate well-being within these microcultures through gracious and thoughtful acknowledgments of their peers. Collegial support at the micro level influences wellness at the organizational level. A larger shared culture of wellness is necessary to nurture physicians’ personal fulfillment and professional development.¹

We propose the CARE framework for cultivating well-being within the microcultures of hospital medicine shared workspaces. CARE consists of Capitalization, Active listening, Recognition, and Empathy. This framework is based on positive psychology research and inspired by lessons from The Happiness Advantage by Shawn Achor.²

Capitalization. Capitalization is defined as sharing upbeat news and receiving a positive reaction. Emotional support during good times, more so than during bad times, strengthens relationships. When a peer shares good news, show enthusiasm and counter with an active, constructive response to maximize the validation she perceives.²

For example, Alex sits at her desk and says to Kristen: “

My workshop proposal was accepted for medical education day!” “

Congratulations, Alex! Tell me more about the workshop.”

Active listening. Active listening requires concentration and observation of body language. Show engagement by maintaining an open posture, using positive facial expressions, and providing occasional cues that you’re paying attention. Paraphrasing and asking targeted questions to dive deeper demonstrates genuine interest. 

“Katie, I could use your advice. Do you have a minute?”

Katie turns to face John and smiles. “Of course. How can I help?”

“My team seems drained after a code this morning. I planned a lecture for later, but I’m not sure this is the right time.”

Katie nods. “I think you’re right, John. How have you thought about handling the situation?”

Recognition. Acts of recognition and encouragement are catalysts for boosting morale. Even brief expressions of gratitude can have a significant emotional impact. Recognition is most meaningful when delivered deliberately and with warmth.

Kevin walks into the hospitalist workroom. “Diane, congratulations on your publication! I plan to make a medication interaction review part of my discharge workflow.”

Leah turns to Diane. “Diane, that’s great news! Can you send me the link to your article?”

Empathy. Burnout is prevalent in medicine, and our fellow hospitalists deserve empathy. Showing empathy reduces stress and promotes connectedness. Sense when your colleagues are in distress and take time to share in their feelings and emotions. Draw on your own clinical experience to find common ground and convey understanding.

“I transferred another patient with COVID-19 to the ICU. I spent the last hour talking to family.”

“Ashwin, you’ve had a tough week. I know how you must feel—I had to transfer a patient yesterday. Want to take a quick walk outside?”

Hospitalists are inherently busy while on service, but these four interventions are brief, requiring only several minutes. Each small investment of your time will pay significant emotional dividends. These practices will not only enhance your colleagues’ sense of well-being, but will also bolster your happiness and productivity. A positive mindset fosters creative thinking and enhances complex problem solving. Recharging the microcultures of hospitalist workspaces with positivity will spark a larger transformation at the organizational level. That’s because positive actions are contagious.² One hospitalist’s commitment to CARE will encourage other hospitalists to adopt these behaviors, establishing a virtuous cycle that sustains an organization’s culture of wellness.

Siloed, adj.:

Kept in isolation in a way that hinders communication and cooperation . . .

—Merriam-Webster’s Dictionary

Humans naturally separate into groups, and the medical field is no exception. Being a member of a likeminded group, such as one’s specialty, can improve self-esteem and provide social organization: it feels good to identify with people we admire. Through culture, these specialty-based groups implicitly and explicitly guide and encourage positive attributes or behaviors like a hospitalist’s thoroughness or an emergency medicine physician’s steady management of unstable patients. Our specialties also provide support and understanding in challenging times. 

Despite these positive aspects, such divisions can negatively affect interprofessional relationships when our specialties become siloed. A potential side-effect of building up ourselves and our own groups is that we can implicitly put others down. For example, a hospitalist who spends extra time on the phone regularly updating each patient’s family will appropriately take pride in their practice, but over time this can also lead to an unreasonable assumption that physicians in other departments with different routines are not as committed to outstanding communication.

These rigid separations facilitate the fundamental attribution error, the tendency to ascribe a problem or disagreement to a colleague’s substandard character or ability. Imagine that the aforementioned hospitalist’s phone call delays a response to an admission page from the emergency room. The emergency medicine physician, who is waiting to sign out the admission while simultaneously managing many sick and complex patients, could assume the hospitalist is being disrespectful, rather than also working hard to provide the best care. Our siloed specialty identities can lead us to imagine the worst in each other and exacerbate intergroup conflict.¹

Silos in medicine also adversely affect patients. Poor communication and lack of information-sharing across disciplines can lead to medical error² and stifle dissemination of safer practices.³ Further, the unintentional disparaging of other medical specialties undermines the confidence our patients have in all of us; a patient within earshot of the hospitalist expressing annoyance at the “impatient” emergency medicine physician who “won’t stop paging,” or the emergency medicine physician complaining about the hospitalist who “refuses to call back,” will lose trust in each of their providers. 

We suggest three steps to reduce the negative impact of specialty silos in medicine: 

1. Get to know each other personally. Friendly conversation during work hours and social interaction outside the hospital can inoculate against interspecialty conflict by putting a human face on our colleagues. The resultant relationships make it easier to work together and see things from another’s perspective. 
2. Emphasize our shared affiliations.⁴ The greater the salience of a mutual identity as “healthcare providers,” the more likely we are to recognize each other’s unique contributions and question the stereotypes we imagine about one another. 
3. Consider projects across specialties. Interdepartmental data-sharing and joint meetings, including educational conferences, can facilitate situational awareness, synergy, and efficient problem-solving. 

Our medical specialties will continue to group together. While these groups can be a source of strength and meaning, silos can interfere with professional alliances and effective patient care. Mitigating the harmful effects of silos can benefit all of us and our patients.

Authors’ note: This article was previously published using the term “tribalism,” which we have since learned is derogatory to Indigenous Americans and others. We apologize for any harm. We have retracted and republished the article without this language. We appreciate readers teaching us how to choose better words so all people feel respected and valued.

Siloed, adj.:

Kept in isolation in a way that hinders communication and cooperation . . .

—Merriam-Webster’s Dictionary

Humans naturally separate into groups, and the medical field is no exception. Being a member of a likeminded group, such as one’s specialty, can improve self-esteem and provide social organization: it feels good to identify with people we admire. Through culture, these specialty-based groups implicitly and explicitly guide and encourage positive attributes or behaviors like a hospitalist’s thoroughness or an emergency medicine physician’s steady management of unstable patients. Our specialties also provide support and understanding in challenging times. 

Despite these positive aspects, such divisions can negatively affect interprofessional relationships when our specialties become siloed. A potential side-effect of building up ourselves and our own groups is that we can implicitly put others down. For example, a hospitalist who spends extra time on the phone regularly updating each patient’s family will appropriately take pride in their practice, but over time this can also lead to an unreasonable assumption that physicians in other departments with different routines are not as committed to outstanding communication.

These rigid separations facilitate the fundamental attribution error, the tendency to ascribe a problem or disagreement to a colleague’s substandard character or ability. Imagine that the aforementioned hospitalist’s phone call delays a response to an admission page from the emergency room. The emergency medicine physician, who is waiting to sign out the admission while simultaneously managing many sick and complex patients, could assume the hospitalist is being disrespectful, rather than also working hard to provide the best care. Our siloed specialty identities can lead us to imagine the worst in each other and exacerbate intergroup conflict.¹

Silos in medicine also adversely affect patients. Poor communication and lack of information-sharing across disciplines can lead to medical error² and stifle dissemination of safer practices.³ Further, the unintentional disparaging of other medical specialties undermines the confidence our patients have in all of us; a patient within earshot of the hospitalist expressing annoyance at the “impatient” emergency medicine physician who “won’t stop paging,” or the emergency medicine physician complaining about the hospitalist who “refuses to call back,” will lose trust in each of their providers. 

We suggest three steps to reduce the negative impact of specialty silos in medicine: 

1. Get to know each other personally. Friendly conversation during work hours and social interaction outside the hospital can inoculate against interspecialty conflict by putting a human face on our colleagues. The resultant relationships make it easier to work together and see things from another’s perspective. 
2. Emphasize our shared affiliations.⁴ The greater the salience of a mutual identity as “healthcare providers,” the more likely we are to recognize each other’s unique contributions and question the stereotypes we imagine about one another. 
3. Consider projects across specialties. Interdepartmental data-sharing and joint meetings, including educational conferences, can facilitate situational awareness, synergy, and efficient problem-solving. 

Our medical specialties will continue to group together. While these groups can be a source of strength and meaning, silos can interfere with professional alliances and effective patient care. Mitigating the harmful effects of silos can benefit all of us and our patients.

Authors’ note: This article was previously published using the term “tribalism,” which we have since learned is derogatory to Indigenous Americans and others. We apologize for any harm. We have retracted and republished the article without this language. We appreciate readers teaching us how to choose better words so all people feel respected and valued.

Siloed, adj.:

Kept in isolation in a way that hinders communication and cooperation . . .

—Merriam-Webster’s Dictionary

Humans naturally separate into groups, and the medical field is no exception. Being a member of a likeminded group, such as one’s specialty, can improve self-esteem and provide social organization: it feels good to identify with people we admire. Through culture, these specialty-based groups implicitly and explicitly guide and encourage positive attributes or behaviors like a hospitalist’s thoroughness or an emergency medicine physician’s steady management of unstable patients. Our specialties also provide support and understanding in challenging times. 

Despite these positive aspects, such divisions can negatively affect interprofessional relationships when our specialties become siloed. A potential side-effect of building up ourselves and our own groups is that we can implicitly put others down. For example, a hospitalist who spends extra time on the phone regularly updating each patient’s family will appropriately take pride in their practice, but over time this can also lead to an unreasonable assumption that physicians in other departments with different routines are not as committed to outstanding communication.

These rigid separations facilitate the fundamental attribution error, the tendency to ascribe a problem or disagreement to a colleague’s substandard character or ability. Imagine that the aforementioned hospitalist’s phone call delays a response to an admission page from the emergency room. The emergency medicine physician, who is waiting to sign out the admission while simultaneously managing many sick and complex patients, could assume the hospitalist is being disrespectful, rather than also working hard to provide the best care. Our siloed specialty identities can lead us to imagine the worst in each other and exacerbate intergroup conflict.¹

Silos in medicine also adversely affect patients. Poor communication and lack of information-sharing across disciplines can lead to medical error² and stifle dissemination of safer practices.³ Further, the unintentional disparaging of other medical specialties undermines the confidence our patients have in all of us; a patient within earshot of the hospitalist expressing annoyance at the “impatient” emergency medicine physician who “won’t stop paging,” or the emergency medicine physician complaining about the hospitalist who “refuses to call back,” will lose trust in each of their providers. 

We suggest three steps to reduce the negative impact of specialty silos in medicine: 

1. Get to know each other personally. Friendly conversation during work hours and social interaction outside the hospital can inoculate against interspecialty conflict by putting a human face on our colleagues. The resultant relationships make it easier to work together and see things from another’s perspective. 
2. Emphasize our shared affiliations.⁴ The greater the salience of a mutual identity as “healthcare providers,” the more likely we are to recognize each other’s unique contributions and question the stereotypes we imagine about one another. 
3. Consider projects across specialties. Interdepartmental data-sharing and joint meetings, including educational conferences, can facilitate situational awareness, synergy, and efficient problem-solving. 

Our medical specialties will continue to group together. While these groups can be a source of strength and meaning, silos can interfere with professional alliances and effective patient care. Mitigating the harmful effects of silos can benefit all of us and our patients.

Authors’ note: This article was previously published using the term “tribalism,” which we have since learned is derogatory to Indigenous Americans and others. We apologize for any harm. We have retracted and republished the article without this language. We appreciate readers teaching us how to choose better words so all people feel respected and valued.