0:03

Hello, and welcome to Noon Conference,

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hosted by M R I Online Noon Conference connects the global radiology

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community through free live educational webinars that are accessible for all and

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is an opportunity to learn alongside top radiologists from around the world.

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We encourage you to ask questions and share ideas to help the community learn

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and grow. Today we're honored to welcome Dr.

0:25

Anez Mohammed for a lecture entitled Psychological Safety as an AC G M E

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Requirement Challenges and Solutions. Dr.

0:33

Mohammed completed her residency at the University of Toledo and was an

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abdominal imaging fellow at the University Hospitals of Cleveland.

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She's an assistant professor of radiology,

0:43

division of abdominal imaging at Case Western Reserve University,

0:46

university Hospitals of Cleveland.

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She's also the associate program director of the radiology residency.

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At the end of the lecture, please join Dr.

0:55

Mohammad in a live q and a session where she will address questions you may have

0:58

on today's topic.

1:00

Please remember to use the q and a feature to submit your questions so we can

1:03

get to as many as we can before our time is up. With that,

1:07

we're ready to begin today's lecture. Dr. Mohamed, please take it from here.

1:12

Hi everyone. Um, um, my name is Ines Mohamed. I am,

1:17

uh, assistant professor, uh, of radiology abdominal imaging, and the,

1:22

uh, associate program director of the residency.

1:25

Today we're going to talk about psychological safety as a new A C G M E

1:29

requirement. I have nothing to disclose. Uh,

1:34

our objectives today is to know what is psychological safety,

1:38

what are the barriers? Discuss the impact of, um,

1:43

creating a safety culture in healthcare, and also to, uh,

1:48

identify methods of fostering, uh, psychological safety in the, uh,

1:53

residency program. Uh,

1:57

so what is psychological safety?

2:00

Psychological safety is a personal belief that one can speak up,

2:04

take interpersonal risks, express concerns,

2:07

admit mistakes without the fear of being shamed, blamed, or ignored.

2:12

The aim is to create a culture where everyone feels comfortable

2:17

admitting their mistakes, so that we can learn from our mistakes,

2:22

return our failure into learning opportunities,

2:26

so be next time. When we are faced with the same challenge,

2:31

we are able to take better decisions.

2:36

Uh, as of, uh, July 1st, 2023, uh,

2:39

A C G M E has promoted psychological safety to be a requirement.

2:44

All residency programs have to comply per the A C G M E, uh,

2:49

common program Requirement definition,

2:51

psychological safety is an environment of trust and respect that

2:56

allows individuals to feel able to ask for help, admit mistakes,

3:00

raise concerns, suggest ideas and challenge ways of working,

3:05

and the ideas of others on the team,

3:07

including those in authority without fear of humiliation,

3:11

and the knowledge that mistakes will be handed justly. And Freddy,

3:16

now that we know what psychological safety is,

3:19

we have to stress what psychological safety is not.

3:24

It's not eliminating personal accountability.

3:26

It is not a permission to incompetence. It is not a guaranteed applause.

3:31

If I am saying that I'm gonna actively listen to you,

3:35

that doesn't mean that I have to certainly agree.

3:40

So,

3:40

psychological safety and accountability should go hand in hand

3:45

in our residency programs.

3:47

We don't want high psychological safety without accountability that will

3:52

place our students in comfort zone. Okay?

3:56

That means complacency. Complacency they don't know have,

4:00

they don't have to do anything. Um,

4:03

if of course we don't want high accountability and low psychological safety,

4:07

that's an anxiety zone. What we want is place our residents,

4:12

our medical students in the learning zone where there are high accountability

4:17

and, uh, high psychological safety.

4:22

Um,

4:23

it's particularly challenging to foster psychological safe safety in healthcare,

4:28

why there is built in hierarchy in medicine.

4:32

We have medical students, junior residents, senior residents,

4:36

junior attendings, senior attendings, uh, uh, section, uh,

4:41

chiefs and, and all and so on.

4:43

We also have different teams working together. We have nurses, we have admin,

4:48

we have technicians. And among these, there is hierarchy.

4:52

Hierarchy is not built in to be a bad thing. Actually,

4:56

the more senior person is most more knowledgeable,

5:00

and this is put in place as checks and balances to ensure patient safety,

5:05

to have better patient outcome. The problem, of course, is that, um,

5:10

it makes speaking up or, uh, building a a safe culture more difficult.

5:15

Uh, other thing, of course, is lack of awareness.

5:18

Why do we have to implement psychological safety? Um,

5:22

multi-generational workforce. Most of our residents are in the,

5:27

uh, new millennials last year, radiology actually, uh,

5:32

matched the first generation Z. Um,

5:35

each generation have their own aspiration,

5:39

their own way of communication, their own, uh,

5:42

ways that they wanna learn, uh, through. So, um, uh, other thing,

5:47

of course, is that, um, in medicine in general,

5:50

it's challenging and fast-paced environments.

5:52

Sometimes we have to take a cultural decision within seconds

5:57

to save patients' life. It's not really easier in radiology. Uh,

6:03

a big factor, um, uh,

6:05

a pillar for psychological safety is having interpersonal relationship between

6:10

the education and learner. Um,

6:13

radiology now is a hybrid learning environment where people are working

6:17

remotely. Also,

6:19

sometimes residents are working with attendings face-to-face in the reading room

6:24

in the morning,

6:24

and then they go on call and they're dealing with attendings they have never

6:28

seen before. Other thing is that we all, all under stress from the,

6:33

um,

6:34

the increasing clinical volume coupled with radiologist shortage.

6:41

So why does it matter?

6:42

Why do is it important to actually have psychological safety in, uh,

6:47

our programs show novel April 26th, 1986,

6:53

the worst nuclear disaster in history. Hundreds were killed,

6:58

thousands left with, uh, uh, consequences of high radiation exposure,

7:03

including cancer. The Committee for Safety in Nuclear Installation.

7:08

In their report on this end incident, for the first time,

7:11

they introduced the term safety culture.

7:14

It was said that that day in the control room,

7:18

there were workers who knew that something was wrong with the experiment that

7:23

they were doing, but they were so afraid.

7:25

They were so worried that they will be humiliated.

7:28

They were so afraid that if they spoke up, uh, to those in power,

7:33

they might get fired. Uh,

7:36

also it was said that there were two explosions that day.

7:40

The people who actually managed to escape the first explosion were

7:45

so occupied with, um,

7:48

who is going to be blamed for this disaster that they did not

7:53

tell the people who were living within the vicinity of, uh,

7:57

this nuclear implant, of this disaster that they have to run for,

8:01

for their lives.

8:02

People did not evacuate in this city for 36 hours.

8:08

Fast forward 2003,

8:10

Amy Edmondson was a PhD student.

8:13

She was going from one hospital ward to the other, uh, in a pediatric hospital.

8:18

She was studying the relationship between working in, um,

8:23

a healthy environment, high trust environment and mistakes.

8:28

That's when she found out something that did not make sense to her.

8:32

She found out something that was controversial.

8:36

She found out that nurses who work in effective teams,

8:40

who have good relationship, who have good leaders,

8:44

were actually doing more mistakes than nurses who are working in

8:49

a field culture. And when she investigated that further,

8:55

she found out that no, they did not do more mistakes.

8:58

They actually reported more mistakes,

9:01

and that's when she wrote her 2004 paper learning Form.

9:05

Failure in Healthcare. Dr.

9:07

Amy Edmondson is the first to introduce the term psychological safety.

9:12

She is the godmother of psychological safety.

9:14

If you google psychological safety right now, you'll see her pictures, her talk.

9:19

You will also see lots of information about the importance of

9:24

psychological safety in, in business, in economy. But in fact,

9:28

psychological safety was implemented for, um,

9:34

medicine.

9:35

Why study of the study has proven that there is a direct

9:39

correlation between patient outcome and healthcare team

9:44

working in a safety culture. I want you to,

9:48

to grab your attention to this particular paper,

9:51

which I think was very alarming.

9:53

This paper was published in Annals of Surgery in 2019.

9:59

Imagine a complex abdominal surgery going on,

10:03

and there was in the, or there was a resident,

10:07

the surgeon who I am quoting here,

10:10

was notorious for explosive triads and,

10:16

uh, flying objects.

10:18

And there was this invisible medical student who was watching the

10:22

surgery going from far away.

10:25

And when he noticed that the green towel

10:31

that's supposed to cover the handle where they, uh, move,

10:35

the light was missing, uh,

10:38

and he also saw the surgeon and the medical student repeatedly

10:43

reaching out and touching, uh, this, um, uh, handle,

10:48

uh, which means that the surgery was contaminated.

10:50

But he chose willingly not to speak up.

10:54

He was scared that he's gonna be humiliated from that surgeon, that he,

10:58

maybe he's not gonna get the residency, uh,

11:01

of the surgery residency that he wants.

11:03

By doing so by not speaking up, he puts a patient on patient under,

11:09

um, uh, um, a severe risk of infection and sepsis.

11:15

Another important thing that we have to be aware of is that

11:20

we work in an environment of shared knowledge.

11:25

Not one person person knows everything. Um,

11:31

everyone in the team have bits and pieces of information,

11:35

and sometimes the most important information is not with the chair.

11:39

It's not with the vice chair, it's not with the section head,

11:42

not even the attending.

11:44

The most important piece of information that's going to affect the patient is

11:49

going to be with our frontline workers, which is sometimes a medical student,

11:54

the technician, the nurse, the resident.

11:56

That's why if we want to protect the patient,

11:59

we have to protect the wellbeing of those entitled to care for

12:04

them. Um, of course there is,

12:10

um, a big, um, um, correlation between burnout,

12:14

which is emotional exhaustion,

12:16

depersonalization and low personal accomplishment, um,

12:20

among residents in, uh, in healthcare. Uh,

12:24

this particular paper, which was published in medical science, uh,

12:28

education in 2020,

12:31

had this survey of 110 residents in University of

12:35

California from various programs, some from pathology, some from pediatrics,

12:40

some from uh, radiology, some from surgery.

12:44

And they give them this questionnaire about mistreatment, mistreatment,

12:49

anywhere from gender and racial discrimination to belittlement and humiliation.

12:55

And we give them the, the mass slash burnout inventory, which, um,

13:00

is, uh, a standardized survey for prevalence of burnout.

13:04

What they found out was that 42% of the written of the

13:09

residents witnessed mistreatment of the co-residents.

13:12

25% reported personal mistreatment.

13:16

Those who report reported personal mistreatment were eight times more

13:21

likely to have burnouts and four times more likely to report an

13:26

anxiety and depression.

13:28

They found no significant relationship between depression, burnout,

13:33

and anxiety. And the, the specialty, the rest,

13:38

it doesn't matter if they were in surgery or in pathology.

13:41

It didn't matter if they had student debt.

13:43

It didn't matter the race and the gender.

13:47

The most important finding in my opinion,

13:49

was that mistreatment is rarely reported to institutions due to fear

13:54

of retaliation or belief that they will be ignored.

13:58

So if a resident or a medical student approach you

14:03

and tell you something is wrong,

14:05

most likely this is just the tip of the iceberg. There is more,

14:10

there is more going on, and that's why we have to actively dig for,

14:15

um, psychological safety breaches.

14:20

Um, we have residents,

14:22

we have medical students because we want to teach them, right?

14:27

So one of the very important implications of psychological

14:31

safety is on the learning ability. Um,

14:35

we have to understand the cohort of the people we are dealing with.

14:40

For a medical student, for a resident to get where they are today,

14:45

they have, um, continuously proven their success.

14:51

They might be perfectionist o over achievers.

14:55

These cohorts are particularly susceptible for what we call

15:00

imposter syndrome. What is imposter syndrome?

15:03

It's chronic feelings of self-doubt and fear of being discovered as an

15:06

intellectual flood imposter syndrome makes them more sensitive to

15:11

criticism and more, um, aspiring striving on,

15:16

uh, being acknowledged and being validated.

15:22

Um, in early, early 19 hundreds,

15:26

two pathologists called Yorks and Dawson had this exper

15:30

experiment. They, they had mice,

15:35

and they gave this group of mice a small amount of

15:40

electric shock. And what they found was that,

15:43

that this small amount of electric shock actually increased their

15:49

learning ability and improve the performance,

15:52

and they were better able to actually perform the tasks that they wanted,

15:56

wanted them to do.

15:58

When they actually increased the intensity of the electric shock beyond a

16:03

certain limits,

16:04

the mice focused on the focused on the pain

16:09

and their learning ability markedly de declined,

16:12

and they were not able to perform the task.

16:15

That's when the stot on curve came out,

16:19

which is actually the p the relationship between the performance efficiency and

16:23

an anxiety and optimal level of stress. Like,

16:27

let's say having an exam,

16:29

taking an exam can help you focus on the task,

16:33

but too much and anxiety can imper your ability to concentrate and your

16:38

performance begins to do, do you it?

16:40

We see that in our residency programs when we are part of CC meetings,

16:45

when we see a sudden dip in the performance of residents who were

16:49

before that doing well, I personally call that the cycle of fear.

16:54

They go on call, they make a mistake, they get shamed and blamed.

16:59

Now they have this self-doubt,

17:01

they go into an anxiety next time they're on call, on call,

17:05

the lose focus, more mistakes, mistakes and so on and so forth.

17:11

The most important question, what can we do better in our programs?

17:17

This is in a nutshell, what we can do better at an institutional level,

17:22

interpersonal level, and individual level. This is not,

17:26

these are not islands.

17:28

These are actually complimentary intercommunicated,

17:32

in my opinion, institutional is the easiest to implement.

17:36

Interpersonal is a little bit bit more difficult.

17:40

The most difficult by far is the ones that are individual

17:44

or, uh, personal level. Um, you know, the supporting mental health,

17:49

financial assistance, child childcare support, struggling residents,

17:54

whether academically or professionally.

17:56

I think each topic in these needs a one hour, uh, by itself.

18:01

So today I'm going to, within maybe the next 20 minutes or 30 minutes,

18:05

I'm going to focus on the institutional and the interpersonal

18:10

level. And I believe the most important is feedback.

18:16

Um,

18:16

first I'm gonna start with how can we train our residents to better

18:21

receive negative feedback?

18:23

When someone approaches me with a negative

18:28

feedback, when someone approaches me and tells me, you did,

18:32

you are not doing this right? You have to fix it.

18:36

The first thing that have to come to my mind is gratitude.

18:40

The person who actually takes the time, who caress enough,

18:44

who takes the interpersonal risk,

18:47

like they're risking the relationship with me to tell me,

18:52

um, I'm doing something wrong and how to fix it.

18:56

This person is a good guy. This is a person who caress about me. Second,

19:01

we must have a goth mindset.

19:05

A fixed mindset is that I made a mistake, I'm a failure, I give up.

19:11

The ghost mindset is, I made a mistake.

19:14

This is a learning opportunity. Next time I'm gonna work on myself,

19:18

and I'm not gonna repeat this mistake again. As Maya Angelou said,

19:23

do the best you can until you know better than when you know better. Do better.

19:30

In emotional intelligence,

19:32

it would tell you when you face a flare of emotions, weight,

19:38

and identify your emotion. Name your emotion. Um,

19:43

you can invest, navigate the, the feelings through this emotional wheel.

19:49

Are you actually mad or embarrassed?

19:53

Are you threatened or, um, uh, uh, guilty?

19:57

Are you overwhelmed or, uh, frustrated?

20:00

So name your feeling. What are you feeling right now?

20:06

And then forgive yourself. Uh, if somebody told you,

20:10

I've never made a mistake in my life, they're not saying the truth.

20:14

Everybody makes mistake. We fail fast to succeed sooner.

20:19

And then once we had, take all our time to actually absorb our feelings,

20:24

know what's, what's going on, and we must come make a plan.

20:29

Make a plan before it's too late.

20:30

If you somebody told you on your first call that this was, this was, um,

20:35

not the right thing to do, make a plan to fix it.

20:43

Then second thing is, how can we deliver a negative feedback?

20:49

Um, we can use the six WSS of investigation, or,

20:53

or we can say six Ws of, um, uh, negative feedback.

20:58

Before you give someone a negative feedback,

21:02

ask yourself this six questions.

21:05

Why am I giving this person the negative feedback to make them feel bad about

21:10

themselves?

21:11

Or to actually teach them something so that next time they would not repeat the

21:15

mistake? Where am I giving the feedback? Is it, um,

21:20

in a safe place for both of us? Is it in my office?

21:24

Is it where no one can hear? Or is it in a conference room?

21:28

Or is it where in public or everybody can hear what I'm saying?

21:34

Who am I giving the feedback to? What is my relationship with this person?

21:39

And more importantly, what do I want this relationship with this person to be?

21:44

At the end of this conversation, at the end of the day, we are all colleagues,

21:48

right? What are we saying? Are we saying, how dare you.

21:52

What year are you? Uh, how come an all three doesn't know that? Oh,

21:56

am I telling them, come, let's look at this case again. Tell me what you think,

22:01

um, uh, about it.

22:04

How are we giving the feedback is very important because if I'm looking to

22:09

somebody face to face, you know, I'm looking at their expression. Are they mad?

22:14

Are they smiling? But if I'm s sending,

22:17

like let's say a PACS chat or an email,

22:21

there is a very big chance of, um, misunderstanding.

22:26

And when, when am I giving the feedback?

22:29

Is it at 10:00 AM in the morning?

22:31

Is it at the lunch break or at 2:00 AM when the whole world is collapsing?

22:36

When they can't keep up, they can't,

22:38

they can't open their eyes and they can't keep up with the list.

22:44

Um,

22:44

the key elements of what we are gonna say in for an effective

22:49

feedback is that it has to be specific,

22:53

not vague or general one to two items per feedback. It has to be objective,

22:57

of course, not judgmental or personal.

23:00

It has to be constructive based on clear expectation.

23:04

It has to be fair and honest. And most importantly,

23:07

it has to be actionable, meaning that I told you,

23:11

you missed this finding in the aorta. Here is a paper, uh, or, uh,

23:16

an article or, uh, uh, a book about, uh, OTA read that.

23:22

Um,

23:22

and by far the most important thing when we as educators

23:27

give a negative feedback to a learner,

23:29

whether it's a medical student or uh, a resident, is empathy.

23:35

What is empathy? The ability to understand and share the feelings, thoughts,

23:39

and experience of another person from their perspective.

23:43

Put yourself in your learner's shoes. Demo demoralizing.

23:47

The learner is gonna have the opposite effect.

23:51

This is a paper in the anals of New Zealand in, uh, uh, uh, uh, uh,

23:56

surgery. And, um, they were talking about something very important.

24:01

They were saying that the residents who are

24:06

most in need of support, compassion,

24:09

and guidance and encouragement are actually the struggling residents.

24:15

And if we have resident who is on probation or, uh,

24:19

performance alert, or they're not doing well,

24:23

if we put them under more pressure,

24:25

it's gonna have a totally different outcome.

24:28

And another important thing that you talked about, and quite frankly,

24:33

some of us are actually guilty of it, or maybe all is an observer bias.

24:38

When I open a report from, um,

24:43

a resident on call, and I know that this person is the top of their class,

24:48

they are doing very well,

24:50

and I open the report and they're missing something in the back of my mind,

24:54

or most likely, they, they had a bad night,

24:56

most likely there was lots of interruptions.

24:59

This is not at all what's gonna be if the same mistake wa was done

25:05

by, um, a resident who I know they're not doing well. Uh,

25:09

so we have to avoid observer bias in judging, uh,

25:13

performance of struggling residents. Um,

25:18

we can't stress enough on the importance of positive feedback.

25:22

If you see something good, say something good. We, quite frankly,

25:27

we do, uh, very well with, um, focusing on negative feedback.

25:32

When somebody's doing something wrong, we'll go to them and tell them, oh,

25:35

fix this, but we're not doing a very good job when someone's doing, um, uh,

25:39

something, um, um, uh, good. We tell them that they're doing something good.

25:44

And as we said before,

25:46

the cohort of the residents and the medical students we're dealing with are, um,

25:51

are these overachievers and perfectionist,

25:55

positive feedback can boost the confidence and help com combat

26:00

imposter syndrome. Switching gears now to, um,

26:05

clear, clear goals and educational strategies.

26:09

These are four suggestions for strategies that we can give, uh,

26:14

our medical students. Um, uh,

26:17

clear expectations and goals. First,

26:21

preset expectations.

26:23

If we can tell the residents before every rotation,

26:26

these are the goals and objectives based on your level of training based on

26:31

A C G M E guidelines that you're supposed to, to, to have. Um,

26:36

these are the milestones.

26:38

These are the numbers of study that you are supposed to read based on

26:43

your level of training. Uh, this is your responsibility.

26:46

This is your working hour. You know, they, um,

26:49

let's say they're supposed to work from eight to five,

26:52

but if they have an an morning conference,

26:54

they are expected to be there at 9:00 AM. Um,

26:58

other thing which we can help our resident with is structured learning agenda.

27:03

We said that, um, most of our, uh,

27:07

residents are young millennials and Generation Z.

27:10

These generations are tech savvy.

27:12

They are used to getting information quickly through online.

27:17

And if you go online, there is,

27:19

there is multitude of information out there,

27:23

which can be confusing and overwhelming. If we can give our residents,

27:27

let's say, a four week structured curriculum with, uh,

27:32

exactly what they're supposed to read per week, that's, uh,

27:37

of course gonna be, uh, very helpful. Um, other thing, which,

27:42

um, some papers actually have found, uh, uh, helpful,

27:47

and we have, uh, did this survey in our program is mid rotation evaluation,

27:52

um, giving formal or informal, uh, uh, mid rotation, uh,

27:57

feedback to the residents can help them actually know where they are.

28:01

And if they are not doing well,

28:03

they will have enough time in the rotation to improve. Um, um,

28:08

uh, of course, formal competency evaluation is an A C G requirement or,

28:13

uh, is G M E accredit programs, uh, must be doing this.

28:17

They must have a C C C meeting, a C C C committee, clinical Competency, uh,

28:21

committee,

28:22

which is responsible for formal evaluation of the performance

28:27

of the residents, uh, based on A C G M E milestones.

28:32

These are very, very, like,

28:34

if we are planning to give our residents this structured

28:38

agenda, this is a very good guide for us.

28:41

The top 10 reading list from radiographics, it's beautiful. It's actually,

28:46

uh, divided based on specialty or rotation,

28:50

and give you basic and intermediate level what articles, uh,

28:54

radiographic articles, which is kind of, uh, addressing trainings, uh,

28:59

trainees, uh, or residents. Um, another thing, of course,

29:03

is the radiology resident lecture series. Um, again,

29:07

these are divided by body, body parts,

29:09

and there are lots of videos in there that you can actually

29:14

let this, the resident, um, look at these, uh, videos. Uh,

29:18

also the a u r, uh, so, uh, the a PDR R through their, uh,

29:22

the station of program director of radiologists, uh, through their, um, uh,

29:26

education committee, I think, uh, they are about to come out with, uh,

29:31

something similar to that with a structured, uh, learning agenda for, uh,

29:36

all residents, uh, based on, uh,

29:38

level of training and the rotation they're going into.

29:44

Um, another thing we wanna talk about is the Pygmalion effect. Uh,

29:47

we said that we want, um,

29:50

to give our residents clear expectations before the rotation.

29:54

What is the number of study I'm supposed to read? We don't want to give them,

29:58

uh, we don't want to give an OG one on the first CT rotation,

30:03

40 studies per day. We're setting them for failure.

30:06

They might not be able to do that. And also, we don't wanna tell them,

30:11

read four studies per day. You know, this big million effect of,

30:16

or self, uh, uh, uh, self-fulfilling prophecy is that,

30:21

uh, in education, it says that learners do better with more, uh,

30:26

is expected, uh, of them.

30:32

Okay? Uh, then we go to the read world, uh, go to the, uh,

30:37

our reading rooms, our conference, uh, uh, uh,

30:41

how can we foster psychological safety in the learning space?

30:46

First in the reading room, this was, um,

30:50

big chunk of what I'm saying now was very beautifully, um, uh,

30:55

outlined in, um, uh, a paper by Dr. Git and Dr. Petrol Lewis and Dr.

31:00

Gadi. Uh,

31:01

it's in the Journal of American College of Radiology that was published in

31:05

2023.

31:07

First thing we wanna do as educators is encourage inquiry.

31:13

The learners question reflects a knowledge gap that will affect patient care.

31:18

I want the resident to ask me now, when we are together,

31:22

staffing out the case, uh, tell me the question that they have,

31:26

admit that they ha the stuff that they don't know, you know, so that,

31:31

that will affect how the performance, when they'll by themself, um,

31:37

on call. So how can we do that? We want to, as we teach,

31:42

um, our residents in the reading room,

31:45

we want to give follow up non intimidating question to make sure that they

31:50

understand what we are saying and actually encourage them to ask questions.

31:54

It's okay to say, I don't know. Um, other than that,

31:59

is modeling intellectual, uh, humility. Uh, what is intellectual humility?

32:03

Is my awareness that there is limit to my own knowledge,

32:08

and that each encounter is a chance to gain knowledge.

32:11

How can I model intellectual humility By simply admitting that

32:15

there is stuff that I don't know. Like if I am as a junior attending,

32:20

there is a case that I don't really, um, I don't,

32:24

I'm not sure what the diagnosis is, it's okay to, uh, model, uh, um,

32:29

uh, uh, um, uh, humility and, uh,

32:32

go ask a senior attending,

32:34

or let's say I'm reading a CT of the abdomen, and there was something,

32:38

the spine that I don't, I don't know. It's okay to ask a new radiologist. Okay?

32:43

Admitting my own limitation can build trust and motivate

32:48

trainees to admit, uh, knowledge gaps. Uh, lastly,

32:52

we have to actively explore pers psychological safety breaches.

32:57

If there is a resident that appears emotionally distressed

33:02

or disengaged, we wanna actively go and ask them, how are you doing?

33:08

Um, second conference setting. Um, of course, uh,

33:12

a b the diagnostic, uh, oil exam are back. Um,

33:16

so a b r, um, this, this, uh,

33:20

res like all ones right now, they're gonna take the new, uh, a b r, uh,

33:25

oil exam. And that's why we will have to go back to the hot, uh,

33:30

seat sessions. Um, um,

33:33

so how can we call the hot seat session?

33:37

The first suggestion is to use the volunteer method,

33:39

meaning that I don't have to call, call one person out. Um,

33:44

I can say I want an R two, an R three, and someone volunteer.

33:49

If they're struggling, we can, um, allow them to call a friend.

33:54

Uh, if they're struggling, you can ask one of your colleagues, um,

33:59

emphasize on the thought processis.

34:01

It's okay if they didn't reach the diagnosis,

34:03

just tell them that the thought processis were, were right.

34:06

They described the lesion. Well, um,

34:09

don't give them 10 million M r I sequences.

34:14

Just tell them,

34:16

give them a couple of images or a couple of sequences and tell them maybe focus

34:20

on the liver. Um, another alternative would be, of course,

34:24

the anonymous audience response system, like, uh, poll everywhere.

34:29

Um,

34:30

other challenge that we have as educators when preparing for either

34:35

didactic or case conference is the generation gap.

34:39

We have millennials. I mean, we don't wanna brush everybody, uh, like,

34:43

like paint everybody with the same brush. But it,

34:47

it is the,

34:49

it is acknowledged that young millennials in particular have short attention

34:54

span. So you kind of have to actively grab their attentions,

34:58

especially in didactic lectures.

35:00

Generation Z are the first generation who are totally immersed in

35:05

technology. They have no, uh,

35:08

awareness of life before the internet, right?

35:12

They are digital natives. They have information at their fingertips.

35:17

Um, so maybe we can always, even if we're giving a didactic lecture,

35:23

we can make it more interesting by putting questions before and after.

35:26

And there is something called, um, uh,

35:28

gamification means it's an active type of learning,

35:32

like simulation or, um, uh, um, uh,

35:35

using games to actually, or group, uh, um, uh, case, um,

35:40

um, um, activities. Um, I think there is an, uh,

35:45

there is an, um, a site like that's called Kahoot,

35:48

that actually can help us with gamification of our cases.

35:52

Another thing is flipped classroom. The traditional classroom is actually,

35:57

uh, when we, um, uh, give a didactic lecture,

36:01

and then the student or the learner goes home and, um, studies,

36:06

um, the flipped classroom is other way around. I give them in advance, uh, like,

36:11

um, online articles or videos to watch.

36:15

And then the lecture can be dedicated to more, um,

36:19

case discussion or, um, asking them, uh,

36:23

for them to ask questions. Uh, and of course,

36:26

we have to incorporate online and table based, uh,

36:30

learning resources. Mentorship, um,

36:36

mentorship is a relation between a mentor and M N T.

36:42

And its effect is actually, uh, uh,

36:46

it affects the mentee, the mentor, and the program,

36:50

or the institute as a whole. For the mentee,

36:54

it contributes to the wellness career, goth and job satisfaction.

36:59

For the mentor,

37:00

it's a personal expression of thanks for the past and hope for the future.

37:05

It can keep this senior faculty up to date and help avoid their

37:09

burnout for the program. When they foster, um,

37:15

an effective mentor mentee program, they will have, um,

37:20

be rewarded with greater clinical and academic productivity.

37:24

They will have high rates of faculty retention and promotion.

37:29

A quality of a good mentee is that they embrace constructive feedback,

37:34

be cognizant of the mentor's time, follow through on assigned tax,

37:38

and maintain optimism. They should also, um,

37:42

it's expected that they show gratitude, appreciation, professionalism,

37:45

and ethical behavior. A good mentor, an effective mentor,

37:50

is the one that chose in enthusiasm, genuine concern,

37:54

and empathy about the mentee and availability.

37:58

How can our programs build an effective mentor group?

38:04

First, um, they have to encourage faculty to be mentors.

38:09

Reward them for the time, offer them protected time funding. C m e credit,

38:14

put mentorship, incorporate mentorship as a criteria for promotion.

38:19

Second, they have to do matchmaking. You have to match, um,

38:24

a mentor with a mentee that they share common interest.

38:28

Both of them have to commit to confidentiality. Whatever happens,

38:32

bet whatever is said between the mentor and mentee should stay confidential.

38:37

And, of course, representation for un, un, uh,

38:40

like unrepresented minorities. I mean, it's not, it's not,

38:45

um, crucial to match a female, uh,

38:49

mentee to a female mentor. Actually, as we know,

38:52

we have only 26% of the radiologists as females.

38:56

Maybe 13% of them are, uh, in leadership position.

39:01

If we're gonna limit our female residents to only female, um,

39:05

radiologists, we kind of limiting their, um, uh, chances. So,

39:11

um, it is good to match, um, like the same cohort,

39:16

if you would say, but it's not essential. And also,

39:19

you can have more than one mentor. Um, mentors as sponsors.

39:24

Sponsors actually take mentorship to the next level. Uh,

39:28

they put their mentee in the spotlight. Um,

39:33

they can support the application for, uh, a national committee.

39:38

They can write strong letter of recommendation.

39:41

They can personally use their power, uh,

39:44

in their radiological society to nominate their mentees for

39:49

talks at a, a regional or national level. Um,

39:53

mentoring OP is actually a concept that,

39:58

um, that actually, um, is taken from the economic,

40:04

um, concept of managing op,

40:06

meaning that the burden of the mentorship does not

40:11

fall only on the mentor.

40:14

The mentee has to share the responsibility.

40:17

Mentoring up is basically a mentee driven mentoring

40:22

relationship. The mentee has to take the initiative to

40:28

tell the mentor what are their goals and objectives from

40:33

this mentorship relationship. What are the gaps in their knowledge and,

40:38

and skills, and set objective and attainable, um,

40:41

attainable objectives and expectations. Lastly, online resources.

40:47

You, we don't have to limit our residents or our selves, actually,

40:52

to just having mentors within our institutes.

40:55

There are plethora of online resources. In this paper, actually,

41:00

there was by our, uh, prior residents, uh, ano and our, uh,

41:04

current, uh, uh, abdominal imaging attending Dr. Aya.

41:08

They actually lay there beautifully. All the resources that you can have,

41:13

if you need an online, uh, mentor, if you wanna be a mentor or a mentee,

41:18

you can, um, you can go to one of these, like there is the a u r,

41:22

the the r a, the, the sar,

41:25

if you want the subspecialty like society of abdominal radiology and so on.

41:32

Um, as we said, um,

41:36

big part of building a safe culture is having a good

41:40

interpersonal relationship.

41:42

How can we improve the interactions

41:47

of, um, our, um, like all the team,

41:50

it doesn't have to be just resident and radiologist, resident radiologist, um,

41:55

maybe, um, uh, technicians and nurses and admins.

42:00

We can, uh, plan social activities together. Uh, this, uh,

42:04

can be departmental or small groups. It can be an ice breaker,

42:08

a low stress eye breaker where technologist and radiologist and

42:13

residents, um, meet, uh, together. Um,

42:17

also we can do meet and greet for new attendings. And in these meet and greet,

42:22

um, uh, we can, uh, put like, um, um,

42:26

videos for like staff communication, uh, how to, um,

42:30

use nonverbal communications. And another important thing, which is kinda,

42:35

we, we as educators, we as radiologists,

42:39

as attendings, we want to know how well are we doing as far as communication.

42:44

If we can provide as a program, uh, anonymous, uh,

42:48

routine, anonymous feedback to the radiologist,

42:52

how well are they doing as far as communication with the residents?

42:56

And put it in a graph. Like, if you get,

42:58

if I get the feedback and I'm getting eight out of 10,

43:01

is eight out of 10 a good thing, like, uh, or is most of the, the,

43:05

the faculty is nine and nine out of 10,

43:08

or am I much better than everybody else?

43:11

So that will actually help me know where I stand as far as, uh,

43:15

psychological safety. Um,

43:18

we have to assess psychological safety.

43:21

We have to actively assess psychological safety.

43:24

And the first thing we have to know when we are assessing psychological safety,

43:29

when we are asking the residents, is something going wrong,

43:31

is that it has to be a bidirectional communication.

43:35

Silence is a communication. You know,

43:38

if somebody came and told me, this is going wrong to me, to somebody else,

43:43

this is a bad behavior. Something, uh, abusive, abusive is happening,

43:49

I must close the loop and go and tell that person,

43:53

this is what we are trying to do. This is what we did.

43:56

This is how we try to fix, uh, this problem. Um, uh, um,

44:01

uh, in the definition of psychological safety, is that that person,

44:05

when they speak up, they're not gonna be ignored. How can we, um,

44:10

um, uh, uh, uh, assess psychological safety? Uh,

44:15

we can, of course,

44:16

we have to provide our residents or medical students a

44:21

tool for anonymous feedback that they can send the feedback.

44:26

If they don't want to be known or identified,

44:30

they can have this tool to actually give an anonymous feedback

44:35

or a safety, uh, report, um, uh, without being identified.

44:40

Uh, other thing is that the fact that I never said that,

44:45

I don't want anybody not to approach me and tell me of something going on.

44:49

That's not really how, how it is.

44:54

It has to be perceived.

44:55

I have to actually actively tell them that I want,

45:01

I want to, I'm listening to you. I want to know if something is going wrong.

45:06

Um, leadership walkarounds is actually, uh,

45:11

an institutional initiatives where leaders, uh,

45:15

actively engage with frontline workers in various clinical settings to, uh,

45:20

identify safety risks. Uh, they have to focus on accomplishments, recognition,

45:25

and reinforcement to build trust. Um,

45:30

last psychological safety surveys. Um,

45:35

residency programs have to send regular standardized anonymous

45:39

surveys to assess safety, teamwork, work-life ban, balance,

45:45

uh, burnout and depression. And there are, uh, several, uh,

45:49

standardized surveys that can assess the, uh,

45:52

psychological safety score survey or the massage burnout inventory.

45:58

Um, this was, uh, actually an example of a psychological safety,

46:03

uh,

46:03

survey that was published in the Journal of Patient Safety

46:08

in 2022.

46:10

It has this question that through which we can use to assess, um,

46:15

um, psychological safety. Is it difficult to speak up if I have a problem?

46:21

Is it easy to ask question when there is something that we don't understand?

46:26

Are disagreement appropriately resolved?

46:30

Does the culture make it easy to learn from errors?

46:33

Is it difficult to discuss or speak up about errors, um,

46:37

or my suggestion, uh, taken seriously.

46:44

Um, last but not least, radiologists as educators,

46:49

we are human beings too. We are under stress, you know, um,

46:54

I believe, um,

46:56

the biggest transition in our career is not really the first day in medical

47:01

school. It's not really the first day in residency or fellowship.

47:05

It is that day you transition from being a fellow to being an attending

47:10

this first day that you are actually there. You are signing the report,

47:15

you are responsible for the list. And then on top of that,

47:19

I have a first year resident that I have to teach.

47:23

We are not teaching our residents to be educators.

47:27

We are teaching them to be radiologist, right? They know how to read,

47:31

but they don't know how to educate. So,

47:35

radiology programs, residency programs have to, uh,

47:40

adopt a culture where it is important to,

47:44

as part of their required scholarly activities, is that,

47:49

is education. We have to train, practice, give, uh,

47:54

provide feedback to our residents about being educator.

47:58

We have to give them protected time to go and educate the junior residents

48:03

and the, um, uh, and the medical students. Um,

48:07

other than that, we have to optimize educational interactions. It is, I think,

48:11

um, uh, it has been mentioned before,

48:15

I think at a u r meetings that some residency programs give a different

48:20

list, assign a different, uh,

48:22

reading list to attendings who are, uh,

48:26

working with, uh, residents. Uh, this can be a lower volume, uh,

48:31

uh, uh, uh, working list so that they have more time,

48:34

they have more time to actually teach the residents,

48:38

give them protected time to prepare for lectures, um, uh, um,

48:44

as much as possible, decrease intera, decrease interruptions,

48:49

um, uh, phone calls, um, or, um, uh, um,

48:53

anything that would, um, uh, affect efficiency. Um,

48:57

career advancement. I mean, there is, um, most, I mean,

49:02

every institute is different as far as their promotion, but I mean, I,

49:06

I believe most of the time it's difficult to be promoted as an educator.

49:11

In fact, uh, Dr. Petrol Lewis have in this known conference, she has a very,

49:15

very, very, um, um, uh, an excellent actually, um, um,

49:20

um, like lecture, uh, talk about how to be promoted as an educator.

49:25

I've personally watched that twice.

49:27

It is important to give us clear guide to how to be promoted

49:33

as educators. You know, um, um,

49:35

it's not just just about number of publications.

49:39

I wanna be my education activity to be taken into account.

49:44

This would encourage more faculty to spend more time and effort, uh,

49:48

educating, uh, residents. Uh, of course, we have to do faculty development.

49:53

Okay. Um,

49:53

we have to increase the awareness of importance of psychological safety.

49:58

As we said before, give them individual individualized, uh, feedback.

50:03

If we feel that they're not doing very well in their interpersonal

50:06

communication, we can give them, uh, provide them with training, uh, uh,

50:11

if needed be. And, um,

50:16

at the end, uh, I will leave you with, uh, this quote from Maya. Angel.

50:21

People will forget what you said. People will forget what you did,

50:24

but they will never forget what you made them feel. Uh,

50:28

this is actually the paper. If you wanna know more about psychological safety.

50:32

This was a paper we recently published in academic cardiology.

50:36

It has much more details than, uh, what we just said in this talk. And,

50:41

uh, thank you.

50:46

Thank you so much, Dr. Mohamed, for sharing your lecture today. At this time,

50:50

we'll open the floor up for some questions. If folks wanna ask a question,

50:55

you can put it into the q and a feature.

50:59

Sometimes it takes a couple seconds questions to come in. Dr.

51:08

Mohamed, I'm curious,

51:09

what kinds of things in your own program have you been implementing

51:14

in service of psychological safety and what's worked so far?

51:18

Uh, I think, um, building, uh, these anonymous surveys, um,

51:23

and giving them, uh,

51:25

we actually receive lots of these anonymous, uh,

51:29

surveys that actually initiated by, by the residents.

51:33

We also have these town halls,

51:35

like it's just the education team and the, uh, residents,

51:40

uh, together. Um, we have, uh, formal and informal, um,

51:46

mentorship, uh, groups like we have. We kind of match, make,

51:51

um, uh, our, uh, resident with an attending. Uh,

51:55

and the way we do it is that if attend,

51:58

if a resident tells me I'm interested in abdominal imaging,

52:01

they're gonna go with an abdominal imaging, um, uh, attending.

52:05

But it doesn't have to be just this attending.

52:08

They have can freely actually, uh, pick, uh, any, um,

52:14

any mentor, uh, that they want from the faculty.

52:18

Got it.

52:21

There's a lot of talk about burnout and across

52:26

radiologists in any part of their career. And wondering,

52:30

is there any advice on how medical students or residents can ask

52:35

for accommodations or,

52:36

or what this looks like in an environment where psychological safety is

52:41

paramount and and foremost? Yeah,

52:44

So burnout, actually, we have to give our,

52:49

first of all, they have,

52:51

we have to give them the space to actually talk about it. You know, um,

52:56

there is two ways.

52:57

Either we actually approach the resident who appear that they are disengaged or

53:02

appear that they are depressed and actively asking them if there is

53:07

something going on, or, um, 'cause burnout have so many,

53:13

burnout, have so many reasons. You know, it can,

53:16

it doesn't have to be just the workload, right? It doesn't have to be,

53:21

sometimes there's something going on in their personal life,

53:24

like a resident just had a new baby, or somebody just got married,

53:29

or, uh, they need some time off. You know, something is going on in their life,

53:34

you know? So the first thing is actually actively listening. Um, um,

53:38

if somebody appears to be, um, uh,

53:41

depressed or disengaged, we want to actually reach to them, um,

53:47

um, and ask them and try to, um,

53:51

try to listen to them and know what's, what's going on.

53:56

I think that's it for the questions. So I think we'll wrap there. Dr. Mohammed,

53:59

thank you again for this lecture, um,

54:01

and everyone else for being here and participating in this noon conference.

54:05

We really appreciate it.

54:07

You can access the recording of today's conference and all our previous no

54:10

conferences by creating a free M r I online account.

54:13

And be sure to join us again this week, Thursday,

54:16

October 19th at 12:00 PM Eastern, featuring Dr.

54:20

Steven Rowe for a lecture entitled Current Radiopharmaceutical Theranostic

54:24

Applications and Nuclear Medicine.

54:27

You can register for this free lecture@mrionline.com.

54:29

Follow us on social media for updates on future noon conferences. Thanks again,

54:33

Dr. Mohammed and everyone else. Have a great day.