Hi, everyone. Thanks for joining us today. We're really excited to talk about leadership training for trainees by trainees. My name is Heather Burrell-Ward. We also have Rachel Rosales and Lily Bellisario with us. Rachel and I are residents at Brigham and Women's Hospital, and Lily is a fellow in the National Clinician Scholars Program at Yale. So we'll each go through our individual parts today, and we're excited to talk more about leadership. So today we'll share three trainee-led leadership initiatives from each of our programs. So first I'll talk about a six-session leadership development curriculum for resident physicians in psychiatry, and then Rachel will talk about leadership in writing, and Lily will talk about a growth mindset workshop. So first, a six-session leadership development curriculum for psychiatry residents. As I mentioned, my name is Heather Burrell-Ward. I'm an APA Leadership Fellow. I'm also the Chief Resident for Research at Brigham and Women's Hospital and at Harvard Medical School. So the principle guiding this curriculum is really that your leadership matters. In healthcare, care is becoming increasingly complex. We work in complex teams, interdisciplinary teams, and those teams require leadership. And yet, oftentimes there's a lack of leadership development training in medical schools and in residencies, and oftentimes physicians find themselves in leadership positions with very little leadership training ahead of that. And so we developed this curriculum to help ameliorate that deficit so that our residents would feel capable when they get into those leadership roles. And this curriculum is largely based off of a curriculum that I first participated in at the Duke University School of Medicine. So I do want to give them credit. In this curriculum, we've been adapted to the residency. So one of the ways this curriculum is structured is by looking into examples in our own lives. So the principle being the unexamined life is not worth living. We interact with leaders on a daily basis, good leaders, bad leaders. And so one of the key components of this curriculum is actually looking at the leaders with whom we interact and seeing what we can learn from them about leadership. We also will take this perspective by getting on the balcony of our own lives, reflecting on our own leadership. Where have we had successes and failures and where do we need to improve? So by looking externally at other leaders that we interact with, and then also by looking at ourselves and reflecting on our own leadership skills are two key components of the curriculum. So there's been a fair bit of research on essential components of leadership development curricula. And this has largely come out of the business school literature. So from this research, there are primarily four components for an effective leadership development curriculum. The first being space. You need a dedicated time and space to think about and to learn about leadership. You can't just go about your day-to-day life, even your day-to-day life as a leader and expect to just absorb leadership skills. It won't work. Next, you need a model. Leadership can often be described in really vague terms. It can be amorphous and ambiguous. And so we really need a model to anchor what are the key aspects of leadership? What are we talking about and how does it apply specifically to medicine? So we'll talk about that. So this model that we'll use was derived by Hargit et al in 2017. They're a group at Duke and they basically surveyed 92 physicians and residents and gave them a list of different leadership qualities, capabilities, and asked them to rank them. And so when they ranked them, these five categories came out on top. So these skills or aptitudes were specific to healthcare. So the idea is with the patient at the center of this model, the skills that we most value in our healthcare leaders are integrity, critical thinking, selfless service, teamwork, and emotional intelligence. And so these components of the model will be essential in our leadership curriculum as well. These are key skills that we'll focus on. So the third component of effective leadership development is action. So you can't just have an adequate space and time. You can't just have a model. You can't just be in a classroom and learn about these things and expect to become a leader. You need to actually put it into action. And so then once you put it into action, you need feedback on that. You need to know if you tried a different leadership skill or a different leadership style, was that effective? How did it work? Was it successful or did it fail? We really need to know how these things are working. So this curriculum was designed with a very specific structure. It was designed to be highly interactive. So it was designed as six one-hour sessions that's largely small group discussion and led by a peer facilitator. So when I first participated in this curriculum at the Duke School of Medicine, it was for medical students. And so the peer facilitators were also medical students. And now in the residency, as we deploy this curriculum among residents, I, as a fellow resident, serve as the peer facilitator. I think that's a really effective, really important component of the curriculum. So the way we've designed the curriculum is these six sessions are actually spread out longitudinally in the PGY1 and PGY2 year. So in the first year, we do the session on leadership versus management, which is also called what is leadership or what do leaders do? And then spread throughout the PGY2 year are five sessions on each of those sub-components of the leadership model. So integrity, critical thinking, selfless service, teamwork, and emotional intelligence. And there's a structure within each session. So before coming into each session, residents do a little bit of pre-reading. So about 10 to 20 minutes of articles on the topic designed to promote discussion. Then when the residents come to the session, we start off and do a very brief topic introduction. It's two minutes, very brief, really introducing the idea, defining the idea as it was defined in the articles in the pre-reading. And then there's a little media And then there's a little media clip. So five to 10 minutes, it could be a clip from a movie or a TED talk that's designed also to prompt discussion. And this also serves as food for the conversation if people haven't read the articles in depth or just had sort of a superficial understanding of them. And then finally, the vast majority of the session is discussion, really discussion among medical students or residents in this case. So for this first topic of what do leaders do, we have designed this to be a highly interactive session initially. And so in order to mimic that level of interaction, we're actually going to do sort of a mock session with Lily and Rachel and me so that you all at home can see what does this really look like when you do this curriculum. So the structure for this particular session is, as I mentioned, first you have the pre-reading. And so for this session, there are two articles. One is What Leaders Really Do by John Cotter. And then the Five Practices of Exemplary Leadership by James Kuz and Barry Posner. So there's the pre-reading, and then we'll watch a brief media clip from the movie Miracle. And then we'll talk about the discussion questions. And actually, when I send out the pre-reading to residents ahead of time, we include the discussion questions so that residents can think about them as they're doing the reading. So the discussion questions are, in what areas of your life do you lead? What areas do you manage? Share one example of an effective leader and an effective manager that you admire. And what do you think it means to lead in a patient-centered fashion? And is anyone you know leading like this? And then this final question we ask in a slightly different form every time. So this question is, what is one activity in your life in the next week that could benefit more from leadership than management? And can you begin to apply this now? So this question is designed to get at that action component of an effective leadership development curriculum. So although we have the space and we have a model, we're talking about these things, we really want to make sure that residents leave the session with an action item that they can work on with me over the next week. So obviously, we didn't send out any pre-reading. So what we'll do is sort of summarize the pre-reading and then have discussion about it. So in the first article, What Leaders Really Do, John Cotter really differentiates between management and leadership. So he says that management is coping with complexity while leadership is coping with change. And while management is planning and budgeting, leadership is better thought of as setting a direction, developing a vision for the future. And while management is organizing and staffing, leadership is aligning people. And where management is controlling and problem solving, leadership is motivating and inspiring. So you can see that management sort of, in my view, is often working within a set of given bounds or restrictions, and leadership is more thinking outside the box, thinking creatively and critically about a given problem. And then in the second article, The Five Practices of Exemplary Leadership by James Kuhs and Barry Posner, they outline five strategies that effective leaders use. One being model the way, inspire a shared vision, challenge the process, think critically, and don't be afraid to sort of think outside the box, enable others to act, so empower others, and then encourage the heart. So getting at that, the inspiration that leaders often take on. So now we'll go on to the media clip, which for this session is from the movie Miracle. So to set the scene a little bit, it's the 1980 Winter Olympics in Lake Placid, New York in the United States, and it is the quarter final for the men's ice hockey Olympic championship. It's the U.S. against the Soviet Union, and the Soviet Union is this ice hockey powerhouse made of professional players. They've won numerous back-to-back Olympic gold medals, and needless to say, the U.S. is not. They are made up of complete amateurs. It's this hodgepodge team of college players from across the country. They haven't played together. They really are the underdog in this scenario, and so there are three periods in hockey, and so this is a speech that the coach gives at the end of the second period, where the Soviet Union is leading three to two. So I will show you that clip, and then we'll come back and do some discussion. So So So So Great moments Are born from great opportunity And that's what you have here tonight boys That's what you've earned here tonight One game If we played them 10 times they might win nine But not this game Not tonight Tonight we skate with them Tonight we stay with them and we shut them down because we can Tonight we are the greatest hockey team in the world You were born to be hockey players Every one of you And you were meant to be here tonight This is your time Their time is done It's over It's over I'm sick and tired of hearing about what a great hockey team the soviets have Screw them This is your time Now go out there and take it So So So again, so we had that media clip, um, i'll give you a bit of the Update after is actually the us goes on to beat the soviet union four to three And then they go on to win the olympic gold medal So now we'll go into the discussion so this is where lily and rachel Have graciously agreed to to serve as discussants and so you'll see sort of how these sorts of Discussions play out when we do this curriculum with residents So rachel and lily, you know based off the pre-reading and the media clip and what we've Talked about, you know with leadership and management In what areas of your life do you lead and in what areas do you manage? You know, it's just so interesting to have these discussions in the middle of this COVID-19 pandemic when there is so much to manage And when I started this year, I thought I was going to be a leader and in some ways Like having these discussions reminds me of how much time I spend managing problems How we shift around our practice how we support residents and I've really been trying to figure out how can I step up as a leader and not just manage All the problems that have come up as we transform our way of living and way of working It's just so poignant And it sounds like this has really rung true for you in your chief role But that's sort of where you've seen a lot of Of management whereas often or as you sort of imagined it as a love leadership a little different Yeah, and also what I imagined myself doing and how I thought it was leadership And now i'm realizing it's more management and trying to carve out More leadership and push myself more to be a leader as an ambulatory chief in our residency Yeah Yeah, Heather, thanks so much for for allowing us to weigh in and and great work that you're doing I think from the side of being a resident and now fellow during the pandemic It really resonated with me when you shared that leaders set vision And I think oftentimes we have an opportunity to really be named and unnamed leaders And really every setting we go into in the way that we set vision for our teams Whether they're our research teams or medical students who are working with us today Just framing the discussion as so glad to have you here And today our vision for your time in the clinic is, you know We hope we can do this this and this And what would you like to see as your vision or mission today in the clinic? So I think there's always opportunities to really bring in a leadership mindset And I think also really taking the opportunity to listen to the people around you Hearing what those concerns are Having the opportunity to elevate other people's voices whenever you can I think there's so many subtle ways we can we can incorporate this into our day-to-day Mm-hmm, yeah I think definitely one theme that comes up, you know When we often do these discussions, we talk to the interns Intern residents often feel like they are managers They are checking off check boxes diligently But oftentimes they feel like they're more on the end of receiving orders than trying to lead And even then I sort of propose that even as an intern, you can be leading the team You can set the priorities and the vision for your clinical team, for your research team But it's a challenge to sort of make that shift from management into leadership So the next question is, think about an example of an effective leader And then an effective manager that you admire Because oftentimes these skill sets can be complementary But these are really, really important roles We need both leaders and managers So what do you think? Can you guys think of anyone that you know? Yeah, I mean, in our... This is Rachel And in our residency program, we just had a major transition in leadership in our residency program And our previous lovely program director left And the interim program director, Dr. Meyer, has really stepped up as a leader And inspiring people to understand that even though there's change going on Even though there's a pandemic, that she's there for residents And she wants to speak to them And she wants to hear about issues And that we're all going to get through this together And I've been really impressed how she has inspired people to feel okay Despite all the changes Whereas an effective manager in my role as outpatient chief The person who's managing... The people who manage all of our appointments And who are managing all the messages that are coming in And changing the way we practice The amount of tasks and organization that she has to have is astounding And we wouldn't be able to do our jobs without that Right, yeah And she doesn't necessarily set vision But she manages a lot and we need her Yeah, I think those are great, great points, Rachel I think one of the most... Or a few of the most effective leaders I've seen here at Yale New Haven Hospital Many of them were effective leaders in my mind Far before they got their leadership title or their associate dean title In that I think they really set the tone of the group that they were working with To really have a clear vision Make sure that all members of the team felt valued, heard, seen And then I would say an effective manager I think I agree similarly to Rachel That we have a phenomenal administrative assistant in our department Who is so organized, keeps us on track for every deadline, every submission And our office could not run without her Yeah, I think those are great examples I think, you know, in our own program I'm thinking about an effective manager that we have Is our education manager Who organizes all of these Zoom interviews for psychiatry residency applicants Which is this incredibly new task, challenging And she just does it flawlessly, really That she has to keep track of so many moving parts And I think of an effective leader Really, I have to give credit to our department chair Who, you know, during the pandemic has really outlined his vision For the way that we as the psychiatry department would serve the hospital And also serve our patients And he's really gone to bat for us For really to help us to serve the hospital In the role that is best suited to our specialty And so he has really led the department during this pandemic So next, what do you think it means to lead in a patient-centered fashion? And do you know anyone who's leading like this? I mean, I think that this is something that everyone thinks is so easy, and it's actually so hard in practice. Like I think a lot of people think they're being patient-centered when it can actually be really easy to lose sight of this because we have such complicated healthcare systems, and often the patient can get lost in all these systems. And for example, in outpatient, the head of our outpatient services is frequently trying to bring up a discussion of trauma-informed care and how do we prevent the systems from re-traumatizing patients and staff because it can be so easy to lose track of the human component of all these healthcare systems that are necessary to provide care. And I've really appreciated how she always centers discussions around that. Yeah. Yeah. And we think about sort of in this era with telepsychiatry, you know, that in many ways this is patient-centered for some patients if it makes it more convenient for them. In other ways, it may not be where it's a challenge. They don't have privacy. They don't have access to these electronic visits. Yeah. It's complicated. Yeah. Yeah. Lily, what were you going to say? Yeah. Yeah. I feel I'm so fortunate to have trained at an institution where we really try and practice patient-centered caring. So we would round actually my intern year with our patients at the center of their care. So we would enter their room and they would be in the middle of our huddle and they had the opportunity to listen to our patient presentation and then also correct us when we were wrong and also weigh in on the plan as far as what they really felt would be most beneficial for them. And so I think that was the kind of amazing gold standard experience I got to see is really holding our patients at the center and remembering that they're really why we're here and so much of why we do this work. Yeah. Yeah. Literally and figuratively putting the patient at the center of the discussion of the care. Yeah. And then finally, looking at this week, what are you all going to do differently? So what's one activity in your life where it would benefit more from leadership than for management? And how can you begin to apply this now? How can you make that shift? Yeah, I think the thing that strikes me any time we go over this, even though I think that I've heard this discussion before I've gone through Dr. Ward's curriculum, I always forget and it just drives home to me that often I default into management instead of leadership, which managers are important too. And when I get my long to do list and I'm looking at all of the boxes, I really want to challenge myself to step back and think about my vision and how I can communicate and empower others rather than just get tasks done and try and get other people to get tasks done. Yeah. That's a great goal. Yeah. Yeah. I think that sounds wonderful. One thing I've been trying to force myself to do is look at my calendar a week or sometimes two weeks in advance. And for example, next week we have a big meeting happening on Friday and it's really an opportunity for me now well in advance to decide what is the vision and mission going to be of this meeting aside from the agenda that we've already sent and who are all the key players that are going to be there and what's been going on in their life. And I think there's preparation to leadership that can pay dividends to making our members feel valued, but also really being intentional about setting that vision and doing it a week or two weeks or depending on the meeting well in advance so that we come prepared to be effective leaders. Yeah. That's a great goal. That's something we could all benefit from, planning further in advance. Yeah, absolutely. So thinking about the curriculum, as I mentioned, it's set up as six one-hour small group discussions. And so we just showed you the example of how this first session, the leadership versus management or what do leaders do session would be done in the PGY1 year. And then in the PGY2 year, there are five additional sessions on the topics below and they each follow the same structure of having a bit of pre-reading, the media clip, and then largely discussion. So I'm a researcher. And so my question is always, does this really work? Like what effect does this curriculum actually have? And so we wanted to answer this question. And so we surveyed residents. We asked them a number of structured questions. So Likert style questions about their leadership skills and competencies. And then we also asked them some free response questions. So we assessed four different groups of residents and it's a little complicated, so I'll walk you through it. And we assess them in June of 2020, so right at the end of the residency year. And so the first group we looked at were those residents who had attended the entire six session curriculum. And by June of 2020, this meant that the PGY2s and 3s in our residency had done all six sessions. And then we looked at those who had attended one session of the curriculum. So that would be the PGY1s. So at the end of their intern year, they'd done just that first session, like that you saw in this mock discussion. Then we also looked at those who had had no leadership training, the rising interns. So if you can imagine, June of 2020, these rising interns, so had just graduated from medical school or itching to get started in residency, but it had no formal leadership training in residency. So they actually served sort of as a baseline was our idea in conceptualizing why we would assess leadership in this group. And then finally, we assessed those who'd had no leadership training, but who had gone through residency. So these were the PGY4s. So they'd gone through all four years of psychiatry residency training, June of their PGY4 year. So they're about to graduate, about to go into the workforce. And for us, they served as a control group. So I'll walk you through some of the results of the survey and we'll go from there. So the first question we asked was, how likely are you to take on a leadership position in the future? So I'll orient you a little bit to the slide. So on the X-axis, we have each group. So those who had done the entire curriculum, partial, those that served as a baseline and those that served as a control. And then the color scheme is that the dark green is extremely likely to take on a leadership position. Medium green is somewhat likely, gray is neither, and then the blues were unlikely. So as you can see, when we looked at the group of residents who completed the entire curriculum, over 80% of them said they were likely to take on a leadership position in the future. And this was a little bit higher than the PGY4s, the control group who had had no leadership training, where close to 75% of them said they would take on a leadership position. But then if we look at the middle, so we look at the rising PGY1s that served as a baseline group on the right, and then the current PGY1s, so they just had one session. We see this interesting dynamic where the rising interns who are about to start residency, in that group, 100% of them, all of them said they were likely to take on a leadership position in the future. But only 50% of the interns who had just finished their intern year said that. This is actually an interesting pattern that holds throughout a lot of the survey questions where the rising PGY1s were very confident, felt very prepared, and were really excited about taking on a leadership position. So it actually suggests that maybe this is not a great baseline group, because it evolves so much during residency. So next we asked, how prepared do you feel for a future leadership position? So again, we have the four groups on the x-axis, and again, the same color scheme where the greens are prepared, light green is slightly prepared, gray is neither, and then the blues are slightly, moderately, or extremely unprepared. And so when we look at first comparing the PGY2s and 3s on the left, so those who had completed the entire curriculum, compared to our control PGY4s, you can see that they're about the same, actually, in terms of how prepared did residents feel. PGY2s and 3s, so those who had completed the entire curriculum, felt slightly more prepared, over 80%. And again, the PGY4s, the control group, 75% of them felt prepared for a future leadership position. But then when we look at this group again, we see the same pattern of comparing the PGY1s. So the rising PGY1s, so those about to start residency, 100% of them said they felt prepared for a future leadership position, compared to only 50% in the current PGY1s, who just finished their intern year, and they only felt slightly prepared. So again, we see the same pattern. So then we asked, how confident are you in your leadership skills? And again, we have the same, the four groups on the x-axis, the same color scheme, where the green is confidence, feeling confident, and then the blue, gray is neither, and then blue is feeling unconfident. So actually in this group, we see that the PGY2s and 3s, who'd completed the entire curriculum, were the most confident in their leadership skills, that 75% of them were confident, compared to the PGY4s, only about 50% of them were actually confident in their leadership skills. And then we look at the intern groups, so the rising PGY1s, the baseline group, so about to start residency, 70% of them said they were somewhat confident, and this compared to only 50% of those who had just finished their intern year. And finally, we asked them, how prepared do you feel to lead a team upon graduation? We asked this question because we really wanted to get at this imminence of leading a team immediately when you graduate residency. We wanted to make sure that this was a question that had some salience for the immediate future, that wasn't just thinking, you know, 10, 20 years down the line, could I hypothetically lead a team? And so in asking this question, and looking at the PGY2 and 3 response of those who completed the entire curriculum, they felt the most prepared to lead a team immediately upon graduation. So over 80% of them felt prepared to lead a team. This compares, is dramatically higher than the PGY4s, where only 50% of them said they felt prepared, and they were about to lead a team, potentially, in the next month after completing the survey. And then we look again at the rising PGY1s and the current PGY1s, and this you can actually see finally in this question, the rising PGY1s who are about to start residency, only 50% of them felt they could lead a team upon graduation from residency. And then again, we see this pattern where the current PGY1s who had just completed their intern years, they had the lowest reported preparedness to lead a team. So then we did a qualitative analysis, and asking residents free response questions about, what effect did the leadership curriculum have on your clinical practice and your clinical care and your professional life? And they reported a couple different themes. So people reported individual responses of improved teamwork. So they felt that it improved their communication with a multidisciplinary team, made them better at bringing out the best in their team members, they would delegate, they approached having students in a different way, they had more effective interactions with peers, and one resident even reported it affected their role as chief resident. They also reported increased or improved self-awareness, that they were able to step back in stressful situations, become more aware of their leadership style, and integrate their personal values into their clinical work. And then a big theme that we saw that came across from multiple residents in multiple different ways, was that it affected their leadership career goals, that they, as a result of the curriculum, had a greater understanding for what does it mean to be a leader and how can you be a leader in a number of different areas, in clinical work, in research, in education, that being a leader doesn't just mean that you're the CEO of the hospital. There's a lot of opportunities for leadership. And that they repeatedly reported this increased desire to have a leadership position. So in summary, this brief, six-session, discussion-based leadership curriculum can positively affect residents' leadership aspirations. And one other key part of the curriculum was that residents really enjoyed participating in it. It was something that was a small group discussion, led by a peer, something that residents enjoyed participating in, wasn't a chore, and reported that it actually affected their clinical practice. This was a really engaging way to get residents involved in leadership development. So in future work, we're expanding the curriculum into the PGY-4 year, using different tools of self-assessment, like the Myers-Briggs and the DISC, incorporating aspects of organizational leadership. So what does it mean to be a leader? As Rachel talked about, being in this chief role, this is a more formalized leadership position. How do you fit into the organization of the healthcare system? And then also, we have sessions that are problem-solving in these chief roles. So what are these leadership challenges that you're encountering? And how can we practically work to resolve them together? And this really gets at the action and feedback components of effective leadership development curricula. So in conclusion, I want to challenge you all at home. After attending this session, what's one thing that you will change this week, either for your own leadership development or for the leadership development of your trainees? I hope that you'll take away a number of different opportunities for leadership development for yourself and also for your trainees through this workshop. So thank you so much, and we'll move on to Rachel's presentation. Hi everybody. My name is Rachel Rosales. I'm an APA Diversity Fellow. I'm a fourth-year resident at Brigham along with Dr. Ward. And then this year, as I talked about in Heather's presentation, I'm one of the ambulatory psychiatry chiefs working with our outpatient leadership to optimize the resident experience there. And my part of the presentation is really going to be about ways to cultivate leaders who write. The ways that we can support each other as residents and the way that faculty can also support residents who write effectively. So what we're really going to focus on in this presentation is a writing group that we've tried to form and formed at the Brigham, in which we have regular meetings in which people present their works in progress. A lot of these meetings are mostly attended by residents who bring in their works, although we do occasionally have faculty who come in as well and can be very helpful in offering their perspectives. But you don't have to have faculty if you just have residents who are interested, although great to have all these perspectives. And any of the principles and strategies we talk about in this session could, of course, be implemented in one-on-one mentoring, research groups, lab meetings. We're really trying to make this as widely as applicable and helpful as possible. So let's create our own little mini-workshop right now and see what we can learn and see how we can make this an effective experience. So the very first project we're going to look at, we're going to do our own little writing group on, is an example in which a resident wants to write on using a quantitative approach to psychiatry. And this is an actual project that was presented in the Brigham Writing Group. The resident's specific goal was to use his background in biomedical engineering to improve psychiatric diagnostics and treatment. And his idea was to write a perspective paper that applied an engineering model to the brain and its activity. So I've recruited Lily and Heather to help me with this writing workshop because we're going to do a paragraph from his project. And Heather, could I nominate you to read this out loud? And even if it has errors, just keep reading it because this is a very early draft. Okay. Complex interactions between various brain regions play a role in how cognition, emotions, and various adaptive or maladaptive neurologic and psychiatric processes arise from the brain. It is therefore useful to conceptualize the brain as a complex system consisting nodes corresponding to gray matter assemblies and edges corresponding to white matter pathways that connects the gray matter assemblies. Communication and transfer of information between brain nodes can then be hypothesized to occur through synchronization in the activity of multiple brain regions. However, a highly synchronized ordered brain state is undesirable as this might represent a pathological disease state such as seizure activity. On the other hand, highly desynchronized chaotic state might correspond with schizophrenic brain activity. Therefore, extremes of either high ordered or low chaotic synchronization patterns can represent pathological activity in the human brain and are thus undesirable. What is desired for efficient and flexible communication is an intermediate state between order and chaos in which the brain can alter its degree of synchronization to adapt to various tasks. This leads to the concept of metastability, a property whereby members of an oscillating system tend to linger at the edge of synchronicity without permanently becoming synchronized. In the context of brain dynamics, metastability can be thought of as a measure of the flexibility and adaptability of the brain to various tasks. In this light, the brain has been previously compared to a tennis player hopping on their two feet in preparation to hit the tennis ball. Thanks for reading that out loud, Heather. It was long and I appreciate it. And those who are watching at home and Heather and Lily, I want you to think about reading this paragraph. What thoughts come up to you in terms of figuring out how to optimize this resident's goals? Yeah, for me, what comes across is there's just a lot of jargon, a lot of terms that I don't understand. I am not a biomedical engineer by any perspective. So as a clinician, I have a hard time relating this to the patients that I see in clinic and how this would apply to even to the basic neuroscience that I do understand. Yeah, and I think it's always so exciting, right? As leaders, we have opportunities to encourage and foster the growth of every training we work with. So how wonderful that they want to write something. And how can we empower them to make this even more palatable for other audiences? So I like to, in my own writing, use examples of, hey, sometimes when I write, I try and explain it to a colleague in a way that is succinct and easy to read aloud. So sometimes I'll even read my own work aloud. And if I find myself having to take breaths in between sentences or pause for air in between one sentence, sometimes that tells me my sentence is a little bit too long. So and then I might open it up to them and say, hey, you know, what do you think? Because I think oftentimes we're working with brilliant learners as well. And so we have the opportunity that they might have insights already into some areas we can support them. OK, so great comments about the clarity of the writing, the vocabulary in the writing, excitement around the content, but wondering about the communication of that content. And when we discuss this in our writing group, there were some key questions that came up for us. And in writing, it's always important to remember who's the reader, where would the reader find this piece, what are the target reader's goals and priorities, what's the best way to communicate with that reader, and does this piece do that? Because for example, the writer of this paragraph is a very passionate, talented biophysicist and has this great engineering background. But for example, depending on where he published a perspective piece, as me, Rachel, someone who's very interested in psychotherapy, who gets a little bit scared when people talk about engineering, part of me like doesn't even want to read this because it's like too much and I get overwhelmed by it. And so this is a really excellent piece to discuss. A lot of times when people think of writing groups, they think of the comparison between these two different paragraphs. They think that it's about wordsmithing, editing down, simplifying the sentences, which you must do. It has to be clear. It has to be short. It has to keep the reader's attention. However, people can get caught up in editing for years and making perfect, beautiful sentences, and they don't step back and think about their goals and objectives and think about what's the best way to accomplish what they want to accomplish. So actually, for this project, we spent very little time editing down his sentences because we realized that the resident really wanted to explore the applications of engineering and biophysics paradigms to psychiatric practice in much more depth than would be allowed by, say, a perspective piece. He wanted to talk to an audience that was already somewhat interested in or had some background in this topic, and he wanted more time and space in his writing to communicate his ideas. And so ultimately, as a group, we encouraged him to reevaluate and he decided to step back and write a book proposal, an outline, and he used that proposal to get more mentorship that would help him with his project and lobbied for protected time to work on this project, which he ultimately got. And if we had edited his piece extensively, it would have been a waste of his time and everyone else's time. So moving on to the next example, so this is Nurturing Diversity and Inclusion Among Psychiatrists, and the setting of this piece wasn't actually in the writing group, but we thought it exhibited a good teaching point. It was done more in the setting of a group of people with similar interests. And the resident's goal was to improve the experience of underrepresented minority in medicine trainees. And her idea was to write a paper about a unique program that supports trainees while also promoting community engagement. So, again, I'm going to nominate Heather to read out this entire first draft. Mentorship. Mentorship is a key component of residents' feeling of satisfaction within their training program and perception of career readiness. Furthermore, some residents are less likely to establish a mentoring relationship compared to their peers. The Minority House Staff Organization, MHO, has formal and informal structures that allow faculty to mentor residents and fellows. MHO also provides opportunities for House staff to mentor peers, medical students, undergraduates, and school-age students. For example, House staff can participate in a program that pairs them with a local high school student who is interested in STEM. Community service. Community service exposes residents to the local community and allows residents to continue the volunteerism that many participated in medical school. Each year, the organization focuses on a few initiatives, which have included volunteering at health fairs, providing basic medical aid at a local soup kitchen, and conducting charity drives. This relationship may also serve a dual role, showing to the community that the institution cares about their needs outside of hospital walls. Thanks for reading the second example. What thoughts do people have as they read this, both at home and amongst Lily and Heather? Yeah, I mean, it's surprising that this is the entire first draft, you know, that this is not a section. And certainly contains a lot of really exciting ideas, but I'd be interested to see as this progresses, you know, where it goes. Yeah, and I think it's an interesting example, because also, like, as we talked about in the setting of this, this was sent to a group of people who had similar interests. So this might not have been a draft that was ready for, say, a writing group that's ready for a general audience. But this really highlights how, if you have an idea that you're passionate about, you don't have to write a lot. You just need to get your ideas down on paper to start, and not to get so caught up in creating a longer project that you don't get started and start getting feedback. And so some other questions to consider is, you know, Heather, you already brought it up. Like, this is the entire first draft of the paper, and most people feel like first drafts have to be longer. And this is something that a lot of people wouldn't necessarily think about writing about, but people can write about unique and innovative programs. And often it's better to start out simple. I have this perhaps apocryphal quote by Albert Einstein, but if you start simple and have short drafts, it's easier to focus on the ideas rather than to get caught up in the writing. So I'm comparing this to the ultimate product that was published in Academic Psychiatry that was a more in-depth look at the program that evolved into something much more nuanced and lovely. And it started with two paragraphs. The final example we're going to look at is a paper that came out of one-on-one mentoring relationships. And the resident's goal was to promote and encourage resident leadership training, especially during a chaotic and clinically confusing time. And the resident's idea was to write a perspective piece about resident leadership during the COVID-19 pandemic. So if I could recruit you, Lily, to read out this early draft. Sure. So the current COVID-19 pandemic is a public health emergency that demands significant leadership throughout all aspects of the health care system. Resident physicians comprise a significant portion of the physician workforce on the front lines caring for COVID patients, yet are often overlooked as valuable leaders. It is anticipated that there will be a significant mental health burden on providers as a result of caring for high volumes of critically ill patients and facing decisions made in the setting of scarce resources that will place strain on the physical health and well-being of resident physicians. In this editorial, we draw upon our experience as resident physicians in psychiatry and current leadership fellows of the American Psychiatric Association to propose that resident physicians can be leaders in the current public health crisis by cultivating emotional intelligence. We do not mean to suggest that residents lack emotional intelligence, quite the contrary, nor to increase resident workload. Rather, we suggest that in times of all hands on deck that the leadership value of resident physicians should not be underestimated. Perfect. Thank you, Lily. And so as our last example, we are both looking at this in an example of writing and also trying to inspire meta questions in your mind and thinking about leadership in general. And as we're reading this, like what questions are coming up with people for people about this piece of writing and or leadership in general? I think they outline a lot of really thoughtful points and even kind of point out what some of their critics might say to ahead of time, which I think is a really great pro writing tip. I think that's something that's really great about this piece is in this early draft, there's so much passion behind it. And you can really tell where this person's motivation is coming from for writing this piece. And it's a little vague in terms of some of the specifics and some of the concepts are less clear. But you can clearly feel the passion and get excited about it. And so some questions, does this spark any ideas about how you residents might practice leadership at your institution or how attendings might challenge their residents to practice leadership? And then thus far, we really haven't examined the final product in a lot of depth. But I really wanted to compare and contrast the specific text of how this evolved. So Lily, can I recruit you again to read the paragraph on the left? Sure, sure. So the COVID-19 pandemic is a public health emergency that demands significant leadership throughout the healthcare system. Leadership is the ability to guide team or organization towards a stated goal or objective. This task requires creating a vision, critical thinking and empowering and inspiring team members. Leadership in medicine is often perceived as only occurring at the department or hospital wide level. However, policies created by hospital leaders must be translated by the medical teams who provide direct patient care. Thus, there is a need for leadership at the level of medical teams. Resident leadership is quintessential to ensure team function and patient care, especially in treating high volumes of critically ill patients with scarce resources. Resident physicians comprise a significant portion of many healthcare teams, yet are often overlooked as valuable leaders. In this perspective, I argue that resident physicians can demonstrate leadership during the current public health crisis by creating a culture of emotional intelligence in their medical teams. I provide practical recommendations that can be immediately implemented to improve emotional intelligence on medical teams in order to improve team function and patient care. Thanks, Lily. Yeah, so I thought this was a great example of how the passion really got translated into something that was still passionate, but more conceptually clear and set out things in a very stepwise manner. And, of course, this was turned into an actual perspective piece that was published recently. So, conclusory remarks. As people think about how to cultivate leaders who write at their institution, whether it's in a group setting or in more individual relationships, we really wanted to emphasize how just as leaders guide teams towards goals, a writer guides the reader toward a goal. And we as physician leaders really need to work on writing that gets across really creative ideas in an effective way. And part of that, of course, is the wordsmithing, but not to get caught up in the efforts of wordsmithing without really thinking about our ideas and objectives. We talked about various settings in which we can practice and cultivate writing. And, again, just talked about editing is important, but don't get caught up in editing before you've thought about the goals. And as I finish up this portion of the presentation, I encourage those at home to consider what thoughts or questions or ideas are popping up for them so that they can think about how to deploy some of these strategies and concepts at their home institution. Well, hello, everyone. Such a pleasure to be with you today, and I know I've learned so much from Dr. Ward and Dr. Rosales already. My name is Dr. Lily Balasuria, and today I'll be talking about growth mindset and leadership. I'm currently a first year national clinician scholar at Yale University and also a VA scholar at the West Haven VA. So I thought I would start with a quote. So often in life, things that you regard as an impediment turn out to be great and good fortune. And this is a wonderful quote from Ruth Bader Ginsburg on the idea of what does it mean when we're faced with challenges or impediments. And I don't know about you, but it can be really hard to see those as good fortune at the moment, even thinking about COVID-19 right now. And what does that mean as leaders when we're faced with challenges and how we want to respond? So today we'll be talking a little bit about taking a growth mindset, particularly as leaders and in challenging situations. So we'll start in general with what is a growth mindset? So in a growth mindset, people believe that their most basic abilities can be developed through dedication and hard work. Brains and talent are just the starting point. And this view creates a love of learning and a resilience that is essential for great accomplishments. And this theory was really developed by a psychologist, Carol Dweck. Now let's take growth mindset and put it in the context of leadership. So leaders with a growth mindset also focus on the process rather than just the outcome, which can be some of the most difficult things to do. But I know we can all think about a leader who we've worked with, who has really made it such an enjoyable process to do the work rather than just get to the outcome. And then on the converse side, we can maybe all think about a leader we've worked with where, gosh, were we just so glad that outcome was done and over because the process was perhaps not the most, not the easiest one to get through. So we'll be diving in a little bit today about the practical ways that taking a growth mindset and leadership can look like. So as leaders, we will encounter a diverse array of leadership styles. And there's a various array of aspects we can choose from and adopt from. And as trainees in particular, we're exposed to a lot of different leadership styles. And we have the opportunity to pick and choose different aspects we want to put into our toolbox. So taking a growth mindset perspective can help us keep an open mind to different types of leadership skills that exist that are maybe different than our own, or maybe ones that we just want to try out and see. Really helping us take a diverse and inclusive perspective to leadership. So we'll start by just thinking about what is a growth mindset and we'll contrast this to fixed mindset. So some examples of growth mindset is persevering in the face of failures. Finding inspiration in the success of others. Embracing challenges, which can be really hard to do in the moment. Accepting criticism well. Desiring to learn and building abilities. And we can contrast this to a fixed mindset, which might look like avoiding challenges, giving up easily, being threatened by other people's successes, desiring to look smart. Feeling like your efforts are fruitless, ignoring feedback, or feeling like your abilities are fixed and can't be grown. And for me, I know, particularly when I'm either on the wards with my trainees or in my research arena, I try and keep an ear out for what's going on in the milieu around me and how can I support all of those that I work with. And oftentimes that looks like just keeping an ear out for things I might be hearing in the environment that might be both growth mindset or kind of fixed mindset. So let's look at some of the language that we might keep an ear out for. So we're talking about growth mindset language, we might think about hearing something like failure is an opportunity to grow. I can learn to do anything. Challenges help me grow. My efforts and attitudes determine my abilities. Feedback is constructive. I'm inspired by the success of others. And I like to try new things. So those are some language examples of how we might see a growth mindset manifested. And then on the converse, fixed mindset. I think oftentimes I feel like I do hear these a little more often and are things for me to just keep an eye out for when I'm working on teams or supporting teams. So particularly how people talk about failures can clue me into maybe some challenges going on. So failure is the limit of my abilities. I'm either good at it or not. My abilities are unchanging. I can either do it or I can't. I don't like to be challenged. My potential is predetermined. When I'm frustrated, I give up or even just hearing the words I give up. Feedback and criticism are personal and this can be a big one and particularly as leaders as we learn to continue to improve in our ability to give feedback. How we see someone we're supporting receive that feedback can be a really big window into how they're doing. And I stick to what I know. So I hope those language examples can kind of solidify for us things we can be listening out for as leaders when we're supporting our teams. And this next slide that I share, I just wanted to highlight a few different examples maybe that we haven't hit upon. And of note, the left and the right have switched now. So fixed mindset on the left, growth mindset on the right. So some things to just keep an eye out for perhaps when you're leading a team or supporting a team. Maybe you notice that some of the members you're working with or supporting, they don't carry out any actions without first seeking approval. So how can you kind of help and grow that individual in their journey? Maybe focusing on proving themselves to you or maybe feeling like you're noticing they give up really easily. So those are just a few other examples I wanted to point out on this slide. And for me, I think I am a big sports fan. I don't know if anybody watched the last dance, right? But oftentimes we see these giants in our fields, whether it be medicine or in the NBA. And we sometimes maybe forget that they themselves have also gone through really difficult challenges who have made them the great leaders they are today. So this is a quote by Michael Jordan. I've missed more than 9000 shots in my career. I lost almost 300 games. 26 times I've been trusted to take the game winning shot and missed. I failed over and over and over again in my life. And that is why I succeed. And I'll say one thing we do here at Yale is we keep a CV or a resume of our failures. And we're not shy to share those with our trusted circle. So maybe you've submitted a manuscript now for the seventh time and it's been rejected. Maybe you've applied for three grants and haven't heard back from any of them or have not received favorable news. Knowing that this is all part of the process of you getting and growing into the next best version of the leader you are. And knowing that failure is part of that spectrum and that you're putting yourself out there and you're trying. And so we're not shy to talk about challenges we've had and also seeing them as opportunities to continue to grow and improve. And this is just one last quote. Success is not an accident. Success is actually a choice. And I think this speaks to also growth mindset. Being a choice, how we are going to face challenges and how we're going to respond from a place as the kind of aspirational leader we want to be that has vision and holds space for our teams to also become the best they can be. I wanted to include two quotes from my home institution. So I just won't know until I try over and over again. This is a quote from famous New York Times author Marjorie Rosenthal talking about what it is to sometimes try and not succeed and then try again and try again. And that it can be reminding ourselves that sometimes it's in this process of trying over and over again that we're finally able to succeed. And then my last quote, on this team, you will be heard, you will be counted, and you will be valued. This is a quote from Marcella Nunez-Smith, our Director of Health Equity here at Yale. I think as leaders, we also have the ability in the language we choose to use with individuals to take a growth mindset perspective of every person will be heard, they will be counted, and they will be valued. And I think similar to what Dr. Ward shared that we have an opportunity as leaders to set the vision and the mission of a team, and then really create the culture that we want our teammates to feel valued and heard. So, I want you to take a step back and think about what are one to two ways you've seen yourself hold a fixed mindset. I know it's really hard to turn the camera back on ourselves and ask ourselves, what's a way maybe I'm keeping my own self fixed in a mindset that's not helpful. Maybe it is a manuscript you've had trouble publishing and feeling like you know what this is just never going to get published. Or maybe it's a challenging situation right now in the environment of working in the pandemic and what it is to advance your career goals in a new kind of unforeseen territory that we're in and maybe some language that you use in your own mind about that, things are just never going to get better. So, I'll have you pause for a moment and maybe write down one way that you feel like you're holding a fixed mindset. And as you're writing that down, I'd encourage you to think about maybe one person that you trust to share that with that you want to hold yourself accountable with to growing in that area. And then this might look like first recognizing it, that's a huge step in recognizing the language that we are using to affirm or not affirm ourselves. And then also kind of going to that person and deciding ways that you want to improve upon that language of how you're going to turn that into maybe I'm learning to become a better writer, or I'm on my way to becoming a better writer. Part of not getting accepted to this journal is part of the journey of where my paper will ultimately get accepted or where my grant will ultimately get accepted. So, ways that we can reframe that narrative. And I'll bring us back to our growth mindset versus fixed mindset slide. So, are there ways that you could be persevering in the face of failures, which can be really hard to do in the challenging times we're in right now? Are there ways that we're embracing challenges as a form of getting to learn new skills? Are there ways that we could accept criticism in more helpful ways, both for ourselves and for our teams? Are there ways that we can grow in our desires to learn? And then going back to our language, how are we framing challenges in our own minds? And how are we helping our teams frame challenges? So, do we feel like we can try new things and see what happens? Do we feel like we can learn new things? Do we feel like failures are opportunities to grow and find a new way to persevere? And we know these can be so hard to do in the challenging times we're in. And we hope this information just provides even just a seed of opportunity to think about diverse and inclusive ways to think about the leadership styles we hope to carry with us when we're faced with challenges. We're so grateful to have had this time with you today. My email address is myfirstname.lastname at Yale.edu. We are always welcome the opportunity to hear from you in ways that we could be supporting you. And we hope this has been a helpful session about leadership today. Be well. Thank you so much, and we look forward to seeing you soon.

leadership training

trainees

Heather Burrell-Ward

Rachel Rosales

Lily Bellisario

leadership development curriculum

resident physicians

writing group

growth mindset

inclusive work environment