Focus medical education on training the whole person [PODCAST]

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“Had I understood the nature of my struggles and felt permitted and supported in actively addressing them, I would have been more effective, a better learner, and more fulfilled. After trying out a few clinical settings, a lot of reading, and some much-needed coaching, I found my identity as a healthy, inspired physician. Eventually, by setting boundaries and understanding my patterns, I discovered what I needed to thrive.

So, maybe we need to reimagine medical education. From medical school onward, physician education and training should be conceptualized as a career-long process supporting the holistic development of life-long learners, leaders, and healers. Certainly, there has got to be a better way than my circuitous, self-designed, and at times, painful and exhausting pathway.”

Tracy Asamoah is a child and adolescent psychiatrist and can be reached at Tracy Asamoah Coaching.

She shares her story and discusses her KevinMD article, “It’s time to focus medical education on training the whole person.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show. We share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today in the show, we have Tracy Asamoah. She is a child and adolescent psychiatrist, and she wrote the KevinMD article “It’s time to focus medical education on training the whole person.” Tracy, welcome to the show.

Tracy Asamoah: Thank you for having me, Kevin.

Kevin Pho: We’ll get into the article a little bit, but first off, can you share your story and your journey to where you are today?

Tracy Asamoah: Absolutely. Well, you know, I actually think the story is interesting in two parts. It’s interesting from the very practical, technical aspect. I wanted to be a doctor, I think, as early as I can remember. I actually started out wanting to be a veterinarian and decided that I didn’t want to deal with anything that crawled or was slimy or gross. So I ended up deciding that maybe I wanted to focus on humans, and I became really interested in working with kids and pediatrics. So I went through middle school and high school and entered college with the idea that I wanted to go into medicine, really thinking about doing pediatrics.

I got to medical school and realized that I was really interested in stories. I wanted to hear about how people got to where they got to, but from the standpoint of their thoughts, what they felt about it, and their experiences, and I wasn’t so interested in labs and physical exams and all of that stuff. So I decided to go into psychiatry, but I wanted to stick with working with kids and adolescents. So I went and did a fellowship in child and adolescent psychiatry after I finished my psychiatry residency.

From there, I really thought that I was going to stick with the traditional path: going into academics, working with residents and medical students, doing teaching, and maybe doing some research. I just had this very rigid idea of what I thought being a physician was. I was that kid who went straight through high school, college, and medical school, and didn’t take a break. I ended up doing academic medicine and did that for a few years early in my career.

My husband and I eventually settled in Austin, Texas, and at that point, I was able to step back and take a look at what I was doing. I realized that I wasn’t really interested in academic medicine as much, but I wanted to do some teaching and do more work in the community. So I ended up in a community-based practice that was great. It had an integrated approach to health care. Our mental health clinic was located adjacent to a pediatrics clinic, so it was a really nice opportunity to serve patients in a more holistic way. Unfortunately, it was a pretty toxic work environment, and it was toxic across the board for all of the providers and staff. Eventually, it became something that led to a lot of dysfunction in that particular setting, and so I found myself at a crossroads.

I think this is where my journey is actually more interesting, from a change in my mindset, than it is from the steps that I took. When I came to that crossroads, I had to make a decision. Was I going to stay in that work environment, which was leading to symptoms of burnout? I was resentful, I was detached, and I was tired. Or was I going to try to do something different? I really didn’t know what that different would be. I knew that I’d never considered myself someone who was going to do private practice, but I knew that was an option, and I knew that there were potentially other things that looked different clinically that I could explore.

The thing that was interesting during that time period, the place where my mindset started to shift, is that for most of my training and career, I had a very rigid idea of what being a physician was. It was seeing lots of patients, teaching, maybe doing some academic writing, and that’s what being a successful physician looked like. I think I had this idea in my head from early experiences. You know, I was raised by parents who fought in civil rights, and they wanted their kids to have a chance of being successful, and that meant having their kids go to college, get an education, and become professionals. I really held on to that. That was something that I thought I needed to do for them, but I also thought that the meaning behind that was that that was what success looked like. So becoming a physician who practiced in a certain way was where that took me.

I also was a perfectionist. I’ve always been a perfectionist, and so I had to do things a certain way, and it had to be done on time, and I didn’t want to get left behind, and it had to look a certain way. So that really led to me going straight through and feeling like medicine and my pursuit of my practice had to look a certain way. And then I got to this crossroads and realized that it wasn’t going to look exactly the way I thought it would, and I decided that I could do things differently. It made me confront a lot of things.

I think that’s how I found coaching, because I realized I was going to have to confront these rigid ideas I had about what it took and what it looked like to be a physician. I realized that I struggled with things like imposter syndrome, that I kind of always felt like I wasn’t quite fitting into the settings that I was in, and I had to take another look at that. But it really started to open up what I decided being a physician could be.

So I took a turn. I ended up taking about four months off and stepping back and deciding what made sense, and I explored coaching, and that’s when I started getting more interested in coaching. I actually decided I wanted to continue seeing patients, but I wanted to do it my own way. So I opened a small private practice, and I started doing some writing, and I do some contract medical writing now. I really decided that shifting my idea of what medicine looked like, and what being a physician looked like, was the shift in mindset that just took me in a completely new direction.

Kevin Pho: I talk to so many physicians today who do exactly what you say. They shift their mindset, and yeah, they want to deviate from what a traditional physician used to be. How difficult was that transition for you?

Tracy Asamoah: It was incredibly difficult, because it was a mind shift that I had to make without a lot of knowledge, at that point in time, about all of the things that really went into me building up those previous beliefs about what a physician was. I had a lot of limiting beliefs that held me back from wanting to pursue things that didn’t quite fit what I thought other people might think being a physician was. So I had to really be able to step back and say, “OK, if I’m going to do something that’s sustainable, that I’m able to really dig into and have a passion for and build a career out of, it has to be something based on what I think a physician is in a very holistic, ideal way.”

And so I had to shift to seeing my training as not the end point. Becoming a physician wasn’t my end point. It really was a starting point, based on me having experienced a whole bunch of experiences and training in my early career: gathering a foundation of knowledge in mental health, and having the background of practicing both in medical and community-based settings and in academic settings, and seeing that these are skills, and this is a fund of knowledge that I can use to create and build something different. Becoming a physician actually wasn’t my destination. It was something that I could use to build what I could offer with the set of training and skills that I had been able to gather over the years.

So it took some work to get there. It wasn’t something that I just automatically jumped into. You know, it took years. And I think that’s what private practice allowed me to do, to be honest. It was that bridge that let me do something that I had created and built, but that still allowed me to serve in a more traditional role as a physician seeing patients, as I discovered a little bit more about what that could really look like.

Kevin Pho: All right, so let’s transition now into your most recent KevinMD article that you wrote. It’s titled “It’s time to focus medical education on training the whole person.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Tracy Asamoah: Yeah, absolutely. So as I’ve been coaching more and more women physicians, I have heard very similar stories: that we identify the role of being a woman and being a physician in certain ways. A lot of those things that we find ourselves stuck in are based on ideas that maybe came from other resources or other folks’ expectations, but not so much based on what we ideally wanted for ourselves.

Some of this, I think, comes in how we’re trained. We’re trained to become really good diagnosticians, really good at understanding illness and disease, and really good at figuring out solutions to really complex problems. But we’re not trained so well in understanding how we show up as doctors and healers. We’re not trained to understand the emotions that we might experience, or the things that we might think about that limit how we show up as we practice. We’re not trained to be leaders, and all physicians, in some capacity, at some point in time, are going to be leaders.

So when I thought about this article, I thought, “Gosh, it would be really great if the things I talk to women about were taught as soon as we decide we want to become physicians.” Like, why are we waiting until we’ve worked and we’re experiencing burnout and really struggling with perfectionism and all of these things that come up later in our careers to figure it out? What if we could do this as part of our training? So you’re taking anatomy, but you’re also taking something about leadership, and you’re taking courses in imposter syndrome and perfectionism. So I wrote the article, you know, kind of tongue-in-cheek, about what if we could redesign the curriculum, but really with this idea that the things that we end up struggling with later in our careers should be things that are brought out into the open and discussed as soon as we make the decision that this is the field that we want to work in.

Kevin Pho: Now, you talked about some subjects that a lot of physicians don’t have any training in. You mentioned things like leadership, imposter syndrome, managing burnout, and work-life balance. So what are some of the specific things? Well, I would say, what are some of the top things that you feel physicians need training on after they leave medical school?

Tracy Asamoah: Yeah, you know, one of the main things that I really wanted to point out in this article is that a lot of physicians get really good training on the kind of practical, day-to-day aspects of seeing patients, but not on how we show up. So how do you show up as a leader? You know, how do you engage with the team? How do you get a team to be cohesive and allow everyone to have a role? How do you inspire everyone behind the mission of whatever your practice or clinic is? How do you communicate? How do you manage your own emotional experiences, as well as those of the people who work with you?

So there are some very practical things about social intelligence and emotional intelligence, and about being able to build a vision and hold, share, and communicate that vision. Basic communication skills are some things that I think we should be trained in, no matter what setting. You know, some of us will go into formal leadership and get formal executive leadership training, which is great, but leadership is a part, I think, of every physician’s life at some point. So having basic training around that is really important.

And then there are the things that are difficult. We live in a very difficult environment to practice medicine, and things like burnout, anxiety, and depression continue to increase. So having basic information about what those sorts of things look like when they show up is really crucial. It’s good for the individual. It’s good for the individuals who work with the people who are experiencing those symptoms. It’s also good for institutions, because we know the data shows that when we have wellness programs that address burnout and address stress, patient errors go down, physician engagement goes up, physician satisfaction goes up, patient satisfaction goes up, and revenue improves. It’s good for every part of the system.

Kevin Pho: We’re talking to Tracy Asamoah. She is a child and adolescent psychiatrist and a physician coach. She wrote the KevinMD article “It’s time to focus medical education on training the whole person.” Tracy, you mentioned leadership being one of the skills that physicians need to develop. Now, if there was one actual tip that you could share with physicians that can help their leadership qualities, what would that one tip be?

Tracy Asamoah: I think the number one thing is being able to be reflective about your internal experience. You have to be able to understand, reflect on, and get curious about whatever you’re experiencing emotionally, internally. Because how you engage with other people, your patients, your co-workers, and your staff, and how you approach your work, is all based on how you’re experiencing your internal self and your internal emotions, and how those thoughts and feelings are interacting. So understanding that, being open about it, being curious about it, and then being able to make decisions based on it would be a starting point.

Kevin Pho: And if a physician wants to learn more about leadership, you talked about physician coaching. Are there any online resources or any books that you recommend that they follow up on?

Tracy Asamoah: Yeah, I think, you know, the first place that I would start, honestly, is if you’re with an institution that has programs that help with getting skills around physician leadership, I would start there. Books, that’s a good one. I don’t have specific books that talk about physician leadership. From the standpoint of just day-to-day leadership, I would actually start with something like Kristin Neff’s book, Self-Compassion. Because again, it’s starting with how you experience your internal self. That’s as opposed to looking specifically at books that talk about how to be a leader, because, honestly, those are going to look at things like how you understand medical economics and how institutions work. But where I would really encourage people to start, in general, no matter what your position is, is looking at how you experience your internal self. So books that reflect on that would be a good place to start.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Tracy Asamoah: Yeah, you know, my take-home message is to be open and curious about whatever you’re experiencing right now, but to see your training and your position as a physician not as your end destination, but as a starting point. And then to be able to see and get curious about what it could be the start of. What could you be doing that would allow you to show up completely as who you are, to use your unique set of skills and knowledge, and to be the physician that you really, truly, ideally would like to be?

Kevin Pho: And how can people reach you?

Tracy Asamoah: So my website is the best place to reach me. It’s tracyasamoahcoaching.com. I’m also on Instagram and LinkedIn, so any of those would be great places to reach me.

Kevin Pho: Tracy, thank you so much for sharing your time and insight, and thanks again for being on the show.

Tracy Asamoah: Thank you for having me. It was fun.

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