Physician Success and the Science of Behavior

Changing Expectations

The ACGME has implemented requirements focused on professionalism, interpersonal communication, and system-based care.  This is a reflection of changing expectations.  Having a mastery of clinical and technical knowledge is still paramount, but only the foundation for success.  Similarly, in July, 2019, the ACGME Common Program Requirements will mandate wellness programs for residents and faculty.  The broader healthcare ecosystem needs to pro-actively address physician wellness in a more comprehensive, holistic, preventative manner.

Engaging patients in their care, leading multi-disciplinary teams, and designing and implementing new, more efficient and effective care delivery models, require skills that have not, traditionally, been the focus of the medical school or residency experience – or of on-going physician training and development.

The successful physician has outstanding communication skills, is collaborative, adaptable and resilient.  Every health system is looking for solutions – solutions that will help physicians to succeed, to enhance physician health/wellness and to ensure physician career success.  Physicians, themselves, are looking for solutions and tools, too.  They need to understand their behavioral strengths and challenges, as well as understand the environment that he/she is working in– to be effective.

Why So Slow to Adopt New Strategies?

We’ve known for decades that great clinical outcomes rely on teamwork and effective collaboration.  We also know that skilled leaders impact quality of care and organizational success.  Yet, medicine is only recently adopting the individual and organizational development strategies and tools long used by other industries and professions. 

For example, medicine might be the only profession that would give someone the keys to a large department of people, resources and revenue based strictly on the fact that he or she is an outstanding clinician, researcher and teacher – and then wonder why that leader struggles.

Why has the profession and the education system, been so slow to recognize, and address, this need?

  1. Tradition.  Experienced physicians will tell you that twenty years ago, their training, and their faculty and mentors, frowned upon spending time on the business of medicine or, talking about behavioral skills.  Granted, there is limited time – time they wanted to spend on clinical knowledge and skills, but some of this was just traditional obstinance.  Paying any attention to understanding the broader delivery system, or interdisciplinary communication skills, was somehow an affront to the sacred nature of the profession.  (When, in reality, it only allows physicians to be more effective in caring for patients!)
  • Physicians are Unique.  Their training is unique, and uniquely stressful. They must master a constantly expanding body of knowledge, maintain a sacred, intimate, relationship with patients, and often work under extreme pressure.  Some assume they are so unique that strategies from other realms won’t translate. But when we think about what makes them successful, or why they struggle, they have a lot in common with other professions.  They struggle because of a lack of emotional intelligence, communication skills, self-awareness, or because they are asked to lead before they’ve developed leadership skills – The same personality traits and behavioral challenges that come into play in any professional role.
  • A Lack of Scientific Research.  Physicians are trained as scientists.  They want to see the data.  They may appreciate the need for solutions.  They may understand the theory of how these tools apply to them.  But – without physician-specific, physician-led research, they are, rightfully, skeptical.

The Science is Catching Up

All of this is changing.  The pressures on health systems and on physicians, is overcoming traditional resistance. Physicians, themselves, and physician leaders and professional organizations are recognizing that the job requirements have changed –- and we need a different approach.  Most importantly, behavioral scientists have turned their attention to the problem and, no surprise, the research is showing that the same strategies that work with other professionals can work here- as long as they are applied to the specific and unique context of physician training and practice.

J3Personica has collaborated with medical schools, residency programs, and physician leaders to build the research foundation for the work that needs to be done.  We’ve explored how the concepts of enhanced self-awareness, personality and behavioral traits, and organizational development approaches, can be adapted to help medical students, residents, physicians and physician leaders, succeed. 

A quick summary of some of the more interesting findings and the implications (much of these findings are from research published or presented at the Society for Industrial Organizational Psychology annual conference, Military Medicine, Academic Medicine Emergency Medicine Education and Training, the Journal of Neurosurgery, and the Journal of Surgical Education):

  • Joint Commission has established that failures of leadership are the second leading cause of sentinel events.  Leadership training is critical for medical students and residents.  Yet, only 1 in 5 neurosurgery residents report that they get specific leadership guidance from their mentors.
  • There are, indeed, unique medical specialty personality profiles.  For instance, certain traits are common to successful emergency medicine residents -– especially vigilance, team-orientation, adaptability and a hands-on, practical approach to learning. This has implications for how students choose their area of specialization, for how we choose, and train residents, and how they will respond to stressors.
  • USMLE scores, the number of journal publications and class rank, the data traditionally used to choose residents, are NOT predictive of performance. 
  • Residency selection interviewers are often biased toward candidates with similar personality trait profiles – rather than criteria that are more likely to predict success.
  • There is a pervasive lack of physician leadership training and mentoring
  • Medical/surgical residents report that tools which provide insight into their personality and behavioral traits, help them to better understand and improve their performance and to understand their own leadership potential and gaps.
  • There is a correlation between certain personality traits and effectiveness of patient interaction and communication.  An understanding of these traits can improve the quality of communication training. 

What Should Happen Next?

This work is just the foundation.  There is much more to do.  When asked “Is there some data/research/validation of these concepts and tools – with physicians?” Now, we can respond with a resounding “Yes.”  What should happen next?

  • Integrate training on enhanced self-awareness, behavioral skills and wellness into every medical school curriculum.
  • Change the way we select medical/surgical residents – leveraging research on the attributes and criteria that predict success – and continue focused training during residency on behavioral skills, leadership, communication and other non- clinical, but critically important, skills.
  • Rather than ineffective, traditional didactic training on these topics, take advantage of personalized behavioral data, mentoring, coaching and technology – based developmental tools.
  • Continue this same process during the physician’s career life cycle – ensuring physicians choose the right practice setting, have a plan for career success, and preparation for leadership roles, for those who have the inclination and ability.

Sounds easy enough.  Actually, it’s not complicated.  We do this for other professions. It’s time we recognize the vast investment in educating, and training physicians and what’s required to make them successful.  Given the needs of our health system, and how important it is that we produce physicians prepared to meet these challenges, a new approach is imperative.  There is a lot of work underway.  We need to continue to build that work on physician-led science.