Authentic Connections in Medical Education

In this episode, Dr. Brad Sharpe dives into the power of authentic connections in medical education. Building on his Grand Rounds presentation, "What's in a Name? Authentic Connections in Medical Education," Dr. Sharpe shares practical tips for fostering a positive learning climate, emphasizes the link between connection and psychological safety, and explores how genuine relationships can drive motivation and improve educational outcomes. Tune in for insightful strategies to enhance teaching practices and create meaningful connections with learners. 

https://clime.washington.edu/

Grand Rounds: What's in a name? Authentic Connections in Medical Education

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[00:00:00] Amanda Garza: Welcome to CLIMEcast. I'm Amanda Garza, the CLIME Program Manager. In today's episode, we're excited to bring you a conversation between CLIME Associate Director Kate Mulligan and Dr. Bradley Sharpe on the topic of authentic connections and medical education. Before we dive in, here's a bit about our guest.

Dr. Bradley Sharpe is a professor of clinical medicine at UCSF and a highly respected clinician educator. He has held multiple leadership roles, including serving as a division chief for the Division of Hospital Medicine at UCSF Health and as an associate program director for inpatient affairs for the UCSF Internal Medicine Residency.

Passionate about teaching, Dr. Sharpe has dedicated his career to mentoring students, residents and faculty with a focus on clinical reasoning, problem solving and medical education innovation. He is also a national leader in academic hospital medicine, having served on the board of directors for the Society of Hospital Medicine and as a co-director of the Academic Hospitalist Academy.

Enjoy this episode!

[00:01:09] Kate Mulligan: Brad, thank you so much for joining us today. It was great to hear your presentation at Grand Rounds on the topic, What's in a Name? Authentic Connections in Medical Education. And just so our listeners know, we have a recording of that available from the CLIME website.

 I'm just delighted and excited that you can join me to continue that conversation. Maybe we'll go a bit deeper, maybe we'll go off on tangents. I think we're both people that do that very readily. But you've got so much experience and wisdom to share, so I thank you very much for taking the time to be with us today.

The first question I usually ask our guests is, can you share a little bit about, your career and how your interest was sparked in this topic or how your interest has evolved in the idea of the practice of making connections and how important that is in medical education learning environments?

[00:01:55] Brad Sharpe: Yeah, well first, let me thank you for hosting me for this and, for CLIME for hosting me for Grand Rounds an honor to be invited and to share on this topic that I'm doing. I'm passionate and interested in so, um, I really appreciate the opportunity. For my career, I've, maybe I'll go back to the beginning that I knew in high school that I wanted to be a teacher.

I loved teaching and was a teacher in, college, was a teaching assistant, chemistry major, taught in medical school, fell in love with teaching in residency, I've always been interested in this. It really was when I got the additional training as part of the Stanford Clinical Teaching Program that I realized then the power of a broader topic of learning climate, so the learning climate is that it's like the tone or atmosphere of a clinical teaching interaction. Are learners stimulated? Do they feel respected as individuals? And then is it a place people can say, I don't know? So that's a broader topic. Embedded in the middle of that is do the learners feel respected as individuals?

And that's part of this idea of connection and what got me really interested is realizing both from the evidence and my experience that 70 to 80 percent of my mind of effective teaching is the learning climate. Everything else that comes after is a byproduct of that, asking questions, giving feedback, acquisition of knowledge, skills, attitudes, that learning climate's the foundation.

So passionate because this is a component of building that positive learning climate that then sets the stage for all the learning that happens afterwards. And so this was, um, Fun to take some of that, look at the updated literature, and try to convert it into practical tips that anyone can put into practice in teaching in medical education.

[00:03:25] Kate Mulligan: Thanks Brad I think we'll direct learners to the Grand Rounds recording for definitions of connection, which you covered very well, and some other background material. But there were two initial takeaways for me that I wanted to offer you the chance to comment on, if you'd like.

And the first one was, I liked how you situated connection as a piece of psychological safety. Did you want to elaborate on that? 

[00:03:44] Brad Sharpe: Yeah, I framed it as a bit of background. So psychological safety in broad terms is a shared belief among team members that you can take risks, that it's okay to be wrong, admit mistakes, and that you won't be criticized for that.

This concept of feeling safe being vulnerable in the clinical teaching environment, or as a learner with teachers. If a teacher's trying to build psychological safety, one could imagine that feeling connected to teachers, feeling that the teacher respects me as an individual, cares about me, wants me to thrive and succeed, is a key piece. Then a learner, being able to say, I don't know, or being able to say, I need help. The connection sets the stage for a psychological safe space. So again, it sort of bundles up to creating that broader idea of a safe space for the learners. 

[00:04:30] Kate Mulligan: Thanks. I love, I love the fact that you, that you're talking about psychological safety and I will remind listeners that we do have another podcast on that too, that we've got other places to go for some more information.

Please check that out. Yeah. Thank you. Yep. So and then the other take home that I had initially that piqued my interest because we struggle at UW with that, uh, at least in the foundation space was that connection drives motivation. Ah, yeah. And I, I would love to hear any more thoughts that you have to offer on that.

[00:04:55] Brad Sharpe: Yeah, I think a couple I can add to that. So this is driven by something called self determination theory, which again, I'm not an expert in this whatsoever. I've read the reviews of this and looked at some of the literature, but what it defines is that humans are motivated especially around, like, professional roles is how it's often framed, by three things, by autonomy, mastery or competence, and then relationship or purpose.

So why I think it's important to relate the two To highlight the relatedness is if you just take the other two independently. Someone's autonomous, they're learning autonomy, they're developing skills, yet they don't feel connected to an individual, an institution, or a purpose. You can imagine there may be a lack of motivation surrounding that.

So, a key component of those three different aspects. Um, and that's sort of like part of the theory. And then take outside the theory is that for the listeners, if you imagine your previous role in training, um, I hope, I imagine you might have had an experience where someone you worked with, like, motivated you to be better.

That because, you said, that person pushed me to be better, and that we know is an attribute of effective teachers. So part of this is, what did they do so that you felt, you came to work and said, I'm going to work extra hard. I'm going to go home and read. I'm going to practice my suturing, whatever it might be, that the connection can motivate individuals for, for the benefit of that person and, uh, um, and setting high expectations for you and otherwise. So I think it is. Uh, a bit of human nature, if you will, and connects back to sort of some fundamental theories of motivation. 

[00:06:23] Kate Mulligan: Great, you just reminded me that in the talk you told the story about, I think it was a student who said to you, if I know that you care about me, you can give me the hardest feedback, and otherwise it's just dreadful.

[00:06:33] Brad Sharpe: Um, did I get that? Yeah, you got that. Oh yes, this is the anecdote I shared about a urology resident, The urology faculty we were talking about feedback But they listen if I think you care about me as a person and essentially he said you can give me the hardest feedback to Hear To get better and I will follow you.

This idea through a surgical lens, but it would be true about other specialties to say, if you feel like someone cares about you, they can push you to thrive and succeed. Sometimes, you can spin the lens- I didn't use this term today, I have in other settings to say, think of it in the lens of coaching.

So think of a coach of an athlete or a musician or a coach in any setting that coaches will push people to the limit and in a positive way. Like, that's my coach they're going to make me, better, but in our case, it's like make me more effective. So I think the power of the relationship to drive individual motivation, it's part of human's interactions with the coaching lens is the other way to view it.

[00:07:23] Kate Mulligan: Great thank you. That term coaching did cross my mind when you were talking today. Okay, then I think we might like to jump in on some nuances now, or at least I want to. I'm the one asking the questions. Okay. Uh, you had some really solid practical tips on how to connect in clinical settings.

I wonder if you wanted to give a quick list or summary of those before I ask you the hard questions. 

[00:07:44] Brad Sharpe: Yep. I can give a brief summary of what I highlighted as practical tips and the way I think of these are simple behaviors that anyone listening could put into practice this afternoon, tomorrow. So, one is Focusing on the initial welcome, when you initial meet a learner, how important that first seconds to minutes are.

Two is learning names and using names. Again, it's a way to say I care about you as an individual. Three is taking time to meet individually with that learner you're going to be working with. Beginning of a shift, beginning of a day in clinic, beginning of a longitudinal thing that you take time to meet, and that has some different components to it.

 Using icebreakers or more broadly getting to know people as individuals, having everyone share about themselves. Managing what the term I use psychological size. So psychological size is the way that a teacher, is perceived by the learners. Are you, you have a big psychological size, are you scary, frightening, or are you someone I respect and appreciate, or are you small psychological size, and you're someone who I don't want to follow, you're not a strong leader, or are you approachable?

 Managing that to the learners, again, you create that psychologically safe space. And then lastly is looking for opportunities for authentic thanks and appreciation, whether that's recognizing learners who have gone above and beyond, unsolicited, you recognize that and thank them. And simple things like bring food, go get coffee, if you have a moment in the day, to celebrate, just to say thank you, that I see you, I see how hard you're working. Those are some of the key tips. 

[00:09:09] Kate Mulligan: You introduced a new concept to me Brad, um, that of psychological size. Yeah. Could you perhaps give listeners an overview of what that is and why it's important?

[00:09:17] Brad Sharpe: Yeah, I really like this topic and if you're sitting in front of a browser and you type in psychological size, you won't find that much about it. So it's sort of bundling up other concepts in, um, sort of communication and psychology literature. But it's a term that we in our teaching program really like this concept.

As your psychological size is how you are perceived by the people around you. And this is true in life in terms of how you are perceived by the people you interact with we focus on your role as a teacher, how you're perceived by the learners. And as I mentioned earlier, you can be perceived as having a big psychological size.

I mean, you're big for the learner. That can be positive, or it can be not positive. Scary, frightening, or trustworthy, I believe in you. Same thing with having small psychological size. And that there are things that you cannot change in the moment to increase or decrease your psychological size. And then there are things that you can change in the moment to make yourself either bigger or smaller.

 I'm happy to flesh those out if it's helpful. Relevant to teaching, I remind people that everything from when you become the second year resident, if you're in a residency program, to when you become an attending, that learners in general, are terrified of you. There's a general thing, again, think about your experience as a learner, the attending, or the supervisor, until you got to know them, you were afraid of them because of their title and their role and otherwise.

And so, often I'm counseling faculty, um, In terms of making connections, that you think about making yourself more approachable and being intentional about that as part of this building connections, to make yourself approachable. So they'll be comfortable asking you questions and comfortable saying, I don't know, and being thoughtful about dialing up how you're perceived by the learners around you specifically.

[00:11:04] Kate Mulligan: That's a super rich topic. Yeah, very rich. I'm struck by how the balance in importance of this fact is that because I think I hear you saying that in residency the title carries a huge amount of psychological size, but then in other, in other arenas it might be how you dress or, gender yeah. Interesting. Great. Thank you.   

 In your grand rounds the focus of your talk right from the start was, Connection in clinical education settings. And you suggested that the rest of us could try and, make the translation, and we do.

But, I was wondering if you might have had some, um Tips, or have heard from other educators in other settings about how connection can be affected in those circumstances, or how it differs from the setting that you were suggesting. 

[00:11:48] Brad Sharpe: Yeah, and just to clarify, are there specific settings you're thinking about?

[00:11:51] Kate Mulligan: Oh, I was thinking about my class of 100 students lecture, or my class of 50 in a lab setting. But we could even venture into the Zoom land, if you want to. Okay. Talk about that. 

[00:12:01] Brad Sharpe: I should also say for the listener that I said in Grand Rounds, this is driven by evidence of adult learning theory, some evidence in literature and my experience.

So I would take that list of attributes let's start with a large group setting, a lecture to 150 people, a lecture to 1, 000 people. That if you think about, how do you connect with those people? So, some things apply, some things might differ. One, the authentic welcome, absolutely, is essential.

I mentioned this in the grand rounds, but let me flush it out a little more. There's some evidence that, learners within six seconds can judge the quality of a speaker in a lecture setting. So the method of this study went as follows. They took, these are college lecturers, they looked at their end of semester evaluations and said that person was, 4. 7 out of 5. Great. Then they said, well, what if we just showed one of their lectures to a bunch of, What do they rate them? They rate them 4. 7 out of 5. Like, oh, that's interesting. What if we cut it down to 30 minutes? The same, and they cut it down to 6 minutes, and basically the ratings in 6 minutes were equivalent to the whole semester evaluation.

Now, again, some of that tells you about charisma and other aspects, but in my mind, when you were In front of a large group for the first time, the first 10 seconds, the first minute matter a lot. The impressions are made and can I connect with you as an audience? And one, do you respect, do you think I'm competent?

It's hard to use names in a room of 150, so that won't work. You can't meet with them all individually. Icebreakers, also harder. You can't really do that. You can manage your psychological size. Meaning, coming into this, how were you introduced? Were you introduced as professor of medicine that has all these credentials?

And so in that case, are you actually with a bunch of students trying to make yourself more approachable? And then I would actually share a personal anecdote to start the talk. I would show a picture of a dog or a picture of something else. If I'm presenting at a national meeting where no one knows me, then I'm actually going to dial up how I'm perceived. I'm going to use some of those behaviors to make myself perceived as bigger and you should respect I've got these credentials and other things. The thanks and appreciation does not apply as much. So some apply. I'll add a few on the end and a large group speaking of something else I'm interested in, of like connecting with learners, eye contact actually becomes way more important.

It's important in all settings, but in large group teaching, one of the best practices for large group teaching to make connection is to be intentional about looking around the room. What does that mean? So the way I think about this is, you take a room, and I'll divide it into six quadrants. And I try to spend equal time making eye contact with people in those six quadrants.

So at least they feel like I am spreading out my attention. That's one. And then two, this was harder and often uncomfortable for us as humans. Best practices, let's say I'm looking at someone in the middle, third row from the back, that I would hold my eye contact with that person for three seconds. A best practice for connecting with that learner.

That can feel a little awkward in a room with hundreds of people. The psychology behind that is, they feel that connection, but so does everyone around them. One of my mentors uses the analogy, I don't know if this will resonate, that when a lion on the plains of Africa is hunting and makes eye contact with the zebra that they're going to chase down, all the other zebras feel that too.

All the other zebras feel like that lion is looking at that zebra, that everyone feels it. He says that's similar when you make eye contact with that person. That's it. I don't think that's the right story, so I'm out, but I see what you're saying. Yeah, making the analogy to a lion who's going to go kill a zebra may not actually apply to me giving a lecture, but I think the the eye contact thing is a way to make connection when you can't do it in the other ways. Then the last one, this is, again, I didn't talk about today, but is probably part of icebreakers and part of sharing about yourself, sharing your authentic self is there's some research on large group that in the first couple of minutes connecting yourself to some experience the audience has so that they get, that you understand what they're going through. 

If I'm visiting a different institution, I will share something about that institution like, I get what happens here at University of Washington. An intentional way to say, I'm connecting to you in at least some way that I've spent the time to think what's important to you. So, a couple things for large group teaching. 

[00:16:03] Kate Mulligan: Oh, that's great that's really helpful. And they're not things that I thought of. And I, I would add that I think when you're using digital devices and things, you can do word cloudy sorts of things, you know, for icebreakers, that you can do that sorts of things.

And I think we've explored those in other arenas, but I noticed that you didn't mention anything about Zoom. Is that intentional? I didn't. I didn't. 

[00:16:24] Brad Sharpe: So, connecting, is harder in the, digital environment, which we know, in the virtual environment, we know, partly because humans, some of the way we connect is actually and I didn't talk about this today, is relational in a way that goes beyond just my face, that humans connect as, like, physical mammals that go through the world.

And so you lose all of that. What does that mean? That means like if I'm working with a team, I'm intentional about where I sit and how I sit when I'm working with them. Intentionality, meaning I want to sit at their level. I want to be part of the team, but not, um, more prominent than I should be on the team.

The chair is going to be at the right level. I'm not going to be awkwardly standing in the corner. I'm going to be leaning in like I'm engaged, but not too intense. So there's an intentionality, and all that goes away on Zoom, because all you get is my face. So that's just the reality. So you miss that relation.

Again, I didn't talk about the Grand Rounds, but there is a physicality of teams rounding, or precepting in clinic, or the student who's presenting to the ER provider outside the room. There's a physical interaction that is, do I respect you? Am I listening? For Am I staring at the computer? Am I looking at my phone? Like Zoom sort of changes, but on Zoom, again, some of the same things that the welcome matters a lot, like the authenticity of the welcome. Names actually becomes way easier because often their names right there, you're like, well, Lisa, can I hear from you? I haven't heard from you in a while.

Actually, in some ways simplifies it. It's like having name cards or badges on people's foreheads, I guess. Um, and then I do think the power of using icebreakers or some equivalent I do think it actually becomes more important because it, it is an opportunity to break the, the barrier of speaking on Zoom.

If you say, hey, before we start this class, I want to get to know everyone a little bit because it's important that I understand where you're coming from and who you are as people. So everyone going to take 10 seconds and share, a holiday tradition, holiday defined broadly.

 Then you go around, so it achieves the same goal of flattening the hierarchy everyone gets to share, they share personal things. Then the barrier of speaking you've lowered that a little bit. So if later on in the session you're gonna ask for comments and questions, maybe people are a bit more likely to share.

[00:18:37] Kate Mulligan: Thanks for that, Brad. I did want to go back to one point that I think is worth emphasizing, really only for brand new educators, and that is, It's obvious to all of us that have been in a classroom for a little while, often from trial and error, how important it is that first interaction goes well, that first day, that first few minutes that you're mentioning .

I'm wondering if you have experience with repair strategies? If you make a misstep in that first interaction, or actually anywhere else along the connection process, got any suggestions on how to repair things? 

[00:19:09] Brad Sharpe: I will share, it's now been some time, Yet when I started out, I had missteps of what I thought would be the right way to approach, the right way to make connections.

 I can share that when I started, I swung too far in the casual, get to know you, I want to be your friend, and also too far in the I'm the new supervisor, I'm going to be too formal. Um, I think repair strategy, The main focus would be honesty and humility. This came up a bit in the Grand Rounds, of admitting that you may have misstepped or made a mistake and being comfortable doing that can be incredibly powerful.

It makes you more approachable, lowers the bar. Your psychological size, how you're perceived, but in and in a very powerful way, and then also flipping back to psychological safety, you modeling that then makes it okay for them to say, I don't know where I made a mistake. So what does that look like? Let's say the first day you, you thought you tried some way to get connected and you feel like it just didn't happen or didn't work or you were having a rough day and you didn't take time to learn people's names, and you called the student the student, and whatever you did that was not what you were hoping for. To just come in the next day and say, hey listen everyone, before we start, can I just say, yesterday was a rough day for me, and just admit, I had X thing going on busy morning in clinic. Okay so instead of thinking about this, I could be saying stuff like, I should I should have the flat tire on my car or my teenagers driving me crazy, whatever it is, just again, be honest and say, and I feel like we got off to the wrong foot. So I'm hoping we can start over. So can we try this today?

I think can go a long way we use this or often we're counseling to do this, and I certainly do that. Council this and patient care. or when there's tension. Go toward the tension, not away from it. So, this idea of, like, if you feel there's tension around the team's connection, try to, because the temptation is to, well, it's like, well, that's a weird place to go, but it's to actually go there and say, I feel like the, I feel like the team's not really gelling.

Can we talk about that? In that open ended way to, um, Because often the learners don't have brilliant thoughts about what may be more effective or done differently. So maybe it's, humility and it's just acknowledging where you're at with an openness. It can be hard to do, yet incredibly powerful, and a powerful role model.

[00:21:15] Kate Mulligan: I like that, I actually did the Teaching Scholars Program here back in 2000. And one of the things that I took from that was from a fellow participant and she was talking about how you externalize the internal. Oh, yeah. You just reminded me about that, like going towards the attention rather than away from it.

So, thank you. Cool. Okay. Well, I think we're going to change directions a little bit and talk about If you are someone who wants to get into being a connectedness practitioner, what kind of preparation or training might benefit a teacher wanting to become more connected with their trainings? We've got the practical tips, which are really helpful, but is there anything else that we need to think about?

[00:21:53] Brad Sharpe: Ooh, can I clarify, if someone's looking for additional training or they're hoping to enhance their skills, just to make sure I understand the question. 

[00:22:00] Kate Mulligan: Well, how do you prepare yourself to make connections successfully? 

[00:22:03] Brad Sharpe: So, a couple things that, and I will, phrase this and frame it as an ideal state.

The ideal state is you have time to do these additional things. These additional things include things like, one, if you're about to rotate and work with a learner or learners, you've actually, like, know their name, you've looked at it ahead of time. I didn't say this in the grand rounds, but priming yourself goes a long way. If I'm meeting a team of seven learners, and I'm trying to learn all the names, but on my way to meet them, I'm looking at their names because the brain really likes to be primed and then is ready.

When Jamal says, I'm Jamal, I'm like, I've seen that name. Also in an odd way, if you've seen the name before, not only is it familiar, but you generally have positive feelings toward it in this funny way. Humans have this, if you've seen a name, you're like, oh, I've seen that name before. So that's one.

Two is I talked about when you meet with learners as individuals, figuring out the context, where are they, meaning is this an end of third year medical student, is this a acting intern that's on week four or week one, , is this an anesthesia intern, Who's about to be done with anesthesia, whatever it might be.

Some of that, I'll ask them, but again, in the ideal world, I may spend time to figure out where they are. I might look at their schedule, because I can pull up their schedule and see where they are, and understand context for what they're coming into this. Also then signals, if I say, Oh, I know last month you were on this, how did that go?

So it then says, I care enough that I actually like thought about this ahead of time. So it is a little bit of research in preparation for connecting with learners. And then, a simple one, hard to do in practice, is try to give yourself the time. So, again, I don't do outpatient ambulatory medicine, but if I'm, if I know there's a new medical student that I'm going to be working with for the next three months, I'm going to see, can I block off that first 30 minutes, or maybe just make sure between 12. I don't have anything else on my schedule that I have that time blocked off. If it's not blocked off, then that, it's just hard to make that happen, or whatever practice listeners do, can you actually block out the time, beginning of the day, end of the day, it's sort of anticipating that this meeting is important and valuable and, um, we should take time and not have it be a sort of side show of the day. Acknowledging, of course, sometimes that's just not possible. You need to pick up your kids, whatever you need to do. It's challenging. 

[00:24:17] Kate Mulligan: I love that, I think there's huge value. My basic scientist interpretation of the doorknob moment where you just like take a moment and acknowledge a transition or a change into something and you, you're You have to calm yourself before you end up doing something important, you know, the next important thing, 

alright, the next question I had was, how we measure connectedness? So, I'm sure, we all have a sense of whether we're making connections or not, but is there evidence or a metric, um, that we use to measure connectedness? Connectedness, in the learning environment?

[00:24:46] Brad Sharpe: Oh, great question. I'll frame my response in two ways. One is the subjective sense that we have. I have an interest in sort of evolutionary biology, evolutionary psychology, of how humans end up how we are and as a hunter gatherer species, for most of our background, the ability to perceive I'm connecting with that person, I think generally humans are pretty good at.

I think the, the evidence in the social psychology literature would confirm that. I think the masks in COVID made that harder. I will share for myself. Um, if you're wearing masks and continue to wear masks in the clinical environment, I do think it makes it harder. In terms of in the literature, the metric in most studies is subjective perception. Likert scale. Ask the student, how connected do you feel with that teacher? Which as we know has imperfections, can be driven by things that maybe are not the things we want to measure. Yet, we're humans, and that subject, I feel connected, in some ways, that is what we want, is this subjective sense. And then I think some of the research did break that down of, you know, do you feel respected? Do you feel like they care about you as an individual? But as I understand it most of it is just this subjective sense. When you ask learners, and then for us, it's our perception of connection. Um, and if I can share an anecdote of humbled by that though, in that, um, this is some, in the last couple of years, I generally work hard at this in my practice.

I do hospital medicine, work with learners in the hospital, interns, residents, students, and I feel like generally making connections, and then I will get a written evaluation, this happened once in the last years, that, um, The learner clearly didn't feel connected and actually was frustrated by some of the things that I was doing.

And so I misjudged that, and so then that caused me to rethink, oh, is that a, persistent problem? Am I misjudging? So the next few times I was just much more thoughtful about, perceiving that and spending effort and energy saying, do I feel connected to them and do I feel like they're connected to me?

Again, in that non specific subjective way humans do this, because I was humbled when I thought I was brilliantly connecting, and by their comments I was not, actually. 

[00:26:47] Kate Mulligan: Is there evidence that connectedness exists? helps with learning, really. Even the subjective, you know, yes, I'm connected to my teacher. Do we have evidence that that's really improved learning, or that's still a bit shaky?

[00:26:59] Brad Sharpe: Yeah, , I will admit that for this presentation because I wanted it to be high yield and practical, I certainly didn't review every study that's tried to correlate those. There, at least what environment was it in? I believe it was in a college classroom environment where the fun part, um, for things like names, for example, easy to randomize people to using names versus not.

As an example, like that's easier to study if I remember, it was the feeling of connection, there was higher retention. So, the students who said I feel more connected to the teacher retain more material. Now when I say that, if you're a student of the research and education, you're like, wait a minute, I That's pretty confounded by all sorts of other stuff, right?

If, because how do you control for all the other confounders? So I would say may promote retention of knowledge, skills, and attitudes. While the other benefits, some of which I talked about, those are clearer, more interest, more engagement, feeling more connected, professional identity growth, I think, formation, those are a bit stronger.

But the actual retention, I would say maybe.   

[00:28:00] Kate Mulligan: Thank you for that, Brad. I think the next thing I'd like to delve into is what you see the challenges and pitfalls are of this practice of trying to make connections.

What thoughts do you have about the ways that connection making might differ with different identities? And um, I'm a couple years of the teacher and the trainees. Um, I know I sometimes feel it's easier to connect with some students than others, and it's been different at different times in my life.

[00:28:26] Brad Sharpe: Yeah, I can talk about a couple sort of, and I mentioned a little bit of this at Grand Rounds that, Because this is a personal connection, which we as humans do throughout our entire life, that there can be a bias, toward enhanced or higher value connections with people are more like, that are more like you, that you feel more connected to.

Because that's what would happen in real life. You meet someone at, you go to a party, haven't met someone, and someone's more like you, defined very broadly, background, interests, and interests. Language, tone of voice, you're more likely to spend 20 minutes talking to them than someone who's not. So we all bring that as humans, but you bring that in the clinical environment and that can then create bias where you will be more connected unintentionally with learners for whom you share interests, again, broadly.

It can be race, ethnicity, gender, background, almost doesn't matter. That's just a human byproduct. I shared an anecdote that pushed me to be I'm really intentional now about making sure that the time allocation, the perceived time allocation among the team I work with, that everyone feels like Brad's treating everyone the same.

For the reasons you could imagine, because if a learner perceives that you are favoring someone, that obviously has, can have all the downstream consequences, including disconnection. So that's one, and then my other thought, it was interesting when you talk about different phases of career, I think this does evolve over time.

In particular, let me highlight For listeners who are early on in your career. of years. So you finished training. Frequently, you stay at the same institution. So people know you and suddenly you went from that medical student intern resident to now you're the attending, you're the supervisor, and now you're working with the resident who you worked with two years ago.

That's a real challenge of like, where does connection look like? They're like, they might even have been your friend. You might've gone to dinner with them, gone to movies and now you're their supervisor. So that creates all sorts of tension. So, You Connection in that world, number one, recognize that as a thing, that that's a real thing.

Two is, for, again, new junior faculty, be careful of missing the mark, so to speak, of, one, is trying to be too friendly, too chummy and friendly and, I'm gonna connect with you, I use the example of, like, talking the language that residents talk, like, using their language may not be appropriate if you're the attending to be talking the way that they're talking, like, trying to fit in that's not your role to fit in. Your role is to connect with them as individuals. And you could also swing too far the other way, which is being too formal, trying to say, I'm the attending, I'm now in charge. Where then there's a disconnect between the previous relationship. So I would say in some ways it's maybe even more challenging to navigate for someone more junior to make appropriate sort of professional connections that enhance the age similarity and the similarities, yet also recognize your role. The last comment I make on that, one of my pieces of advice is just to call it out. If you're that new attending to say, listen, everyone, I just want to acknowledge I went through the training program. You all know me through this lens. I'm just going to acknowledge, we're going to work through how we can best work together.

That I am the attending, yet I'm only two years out of residency. So there's some things I'm going to know, some things I'm not. I want to work well, support all of you, just to call it out, again, this idea of go towards the tension instead of away from it, because at least then it's something that you can talk about if you need to.  

[00:31:41] Kate Mulligan: So Brad, how do you deal with a student that seems disconnected or, unwilling to embrace your attempts at connecting, and, and, and you perceive that, like, how do you go about handling that student or, or that trainee?

[00:31:56] Brad Sharpe: Yeah, thank you for asking. This does come up. Uh, intermittently and so I love clinical medicine, so often I think like what's my differential for that, like what are the potential causes that could lead a learner, despite my efforts to have them feel connected, that I feel like they're just not, and again, that subjective sense that I feel like this learner is not paying that much attention, they're answering one word answers to questions, other things.

So one, in environments where learners generally work quite hard and have excelled, um, I would think about wellness and burnout and mental health and, or other things going on. So that's a learner who I would, at some point meet alone and say, can I check in? Because here's what I've, I've noticed.

And then I'm careful, this is part of a feedback talk I give, of like, I feel like you're disengaged. Disengaged is my interpretation of their behavior. I would focus on the behavior itself. I've noticed that sometimes you don't join us on rounds, or when we're talking about patients, you're in the corner of the room on your computer.

Just want to talk through, like, what's your experience of that to get a sense, and then if there's an open dialogue, you can ask about mental health and well being, and other things going on in your life. One of the potential causes, sometimes it's just not interested in your specialty. So let's say one of the listeners does primary care and someone says, I'm going to do neurosurgery and they're like, you're going to force me to go to a half day clinic every week for three months if they show up and they're just checking the boxes. So, one, continue, the tips I went through before. Then my lens flips a little bit, like I want to meet this learner where they are and motivate them on something they're going to actually use.

So one, I'll ask, what goals do you have for this? Like, I don't have any goals for this. I was like, well, what do you hope to get out of this? And if that doesn't work, then I'm done. Desperately trying to figure out what might motivate them of like, well, do your parents have primary care providers? Like, you could help with that.

You're going to need a primary care provider someday. Here's things in the field of neurosurgery that if you understand them, you will be a better provider. So I'll share a fun example that I've used within my world. One anecdote was a student who is 100 percent committed to orthopedic surgery was doing the minimum to get by, not really engaged.

And I said, well, listen, let me flash forward to a Friday afternoon when you're the orthopedic So, let's say you're a surgery resident and your patient develops rapid atrial fibrillation, right, rapid irregular rhythm, typically you call the medicine consult resident. Well, on Friday, they might not get there until 8 or 9, so you're going to have to sit in the hospital for hours waiting for that med consult resident, but if you learn these three things, you can do that and then you can go home.

 Or I do teaching with the OBGYN department and they struggle with this a lot, about learners who come, who say, I'm not doing OB. I'm like, well, imagine you're on the subway, and the subway's stuck, and someone's about to give birth. Like, like, you'd like to be able to help them, right?

And like, these are the four things you need to know about labor that are going to help you get through that in flight emergency. So trying to find fun ways to say, oh, that would actually apply to what I do. Surgical technique, how you talk to patients, how you counsel end of life care, whatever it is.

Just trying to link up their perceived future role with the current learning, so it is, I guess, connecting with their future self, their future individual self, um, as a motivation, as like a, to motivate this is, yeah. Worth trying. Yeah, it almost sounds like motivation and connectedness can go in, in both directions, in each direction.

Yeah, yeah. So using motivation to get them to connect instead of connection. Yeah, yeah, I think that's right, yeah. Yeah. Bye. Well, thank you so much, Brad. That's been really lovely to have you come and talk to us. And, I'm glad that we were able to make this connection. And I hope it sticks because it would be lovely to maintain this across the institution.

So, thank you very much. Well, thank you for the opportunity. It was a lot of fun. Thank you so much. Bye 

[00:35:48] Amanda Garza: Thanks for listening. We hope you enjoyed this conversation with Dr. Sharpe on the power of authentic connections and medical education. A big thank you to Dr. Sharpe for joining us and to CLIME Associate Director Kate Mulligan for leading this discussion. If you found this episode valuable, be sure to subscribe to CLIMEcast and explore some of our past episodes for more conversations on medical education.

To learn more about CLIME and our upcoming events, visit our website at clime.washington.edu. It will also be linked in the show notes. Thanks for listening!