In Response

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We read with great interest the comments of Watkins et al1 to our Open Mind article “Successful Personalities in Anesthesiology and Acute Care Medicine: Are We Selecting, Training, and Supporting the Best?”2 This was primarily diagnostic in nature, highlighting the ever-growing competition for positions in Graduate Medical Education, the under emphasis of emotional intelligence (EI) in selection of trainees and the increasing problem of burnout in practicing physicians. Watkins et al expand on these problems and are interested in our thoughts on specific solutions.
In the course of a relatively short time, medical practice has changed. Not that long ago, abusive physician behavior was tolerated. The Joint Commission and other regulatory bodies now work actively to prevent such behavior. Formerly, residents actually lived in hospitals, as house officers. Today, with Accreditation Council for Graduate Medical Education regulations, work hours are limited. Today, it is widely recognized that health care is delivered by a team of individuals—physicians, nurses, others—and that a poorly functioning team cannot deliver optimal care to patients.
The attributes needed to perform successfully in medicine evolve over time. Historically, a rigorous scientific education was the sine qua non for a career in medicine. Now, medical school graduates matriculate from a diversity of disciplines. A scientific background is necessary but not sufficient to guarantee success in medical school, training and practicing.
There are no simple solutions to assure that we select candidates who have good basic coping skills and EI, that we help them to foster adaptive coordination and resiliency to the stresses of training and practice and to enhance their communication and leadership skills. While Watkins et al recognize that only a small proportion of faculty are trained in this area, all faculty can support departmental efforts to promote self-awareness for all members of the department. It is strange that business, long accused of being focused exclusively on the bottom line, has been much more proactive in this area than has medicine. The solution for the equation no longer attains that we must sacrifice personal health and well-being for the sake of patient care.3 One does not preclude the other and demonstrably inhibits performance.
Scemama and Hull4 illustrated how leadership training can be evaluated and can mitigate some of the stress on both sides of the teaching/learning relationship. The lessons of emotional health, EI, and team building are prerequisites for both the success of future trainees and our ability to optimize care for our patients in the future.
Some simple techniques can immediately be implemented.5 All of us need to conduct 360-degree personal assessments to ensure that we are not engaged in self- deception concerning how others perceive us. Taking the view of being a team member and consideration for the feelings of others are also steps which can be introduced by department leadership. Finally, humility, a rather rare commodity in the clinical environment, is a goal which should be respected. As Ernest Hemingway said, “There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.
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