The Lure of Lore: How Medical Students Learn to Navigate Interprofessional Interactions

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On this episode of the Academic Medicine Podcast, discussing a new study that explores medical student learning during interprofessional interactions in clinical clerkships are author Kelsey Miller, MD, EdM, Research in Medical Education (RIME) Committee member Bonny Dickinson, PhD, MS-HPEd, and AAMC MedEdSCHOLAR Kelvin Pollard, MD. They explore the “lore” about working with other health professionals that medical students learn from their peers during clerkships and how interprofessional interactions shape students’ professional identity, autonomy and collaboration skills, and sense of their role on the health care team.

This episode is now available through Apple Podcasts, Spotify, and anywhere else podcasts are available.

This episode is the first in this year’s 3-part series of discussions with RIME authors about their medical education research and its implications for the field. Check back next month for the next episode in the series.

A transcript is below.

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Transcript

Toni Gallo (00:03):

Welcome to the Academic Medicine Podcast. I’m Toni Gallo. Every year Academic Medicine publishes the proceedings of the annual Research in Medical Education or RIME sessions that take place at the AAMC’s Learn Serve Lead Meeting. This year, the RIME papers, including the one we’ll be talking about today, will be presented throughout the Learn Serve Lead meeting, which is taking place in San Antonio, Texas in November. The RIME papers are available now to read for free on academicmedicine.org. As in previous years, I’ll be talking to some of the RIME authors on this podcast about their medical education research and its implications for the field. Today for the first of this year’s RIME conversations, I’m joined by Dr. Kelsey Miller, one of the authors of “Exploring Medical Students Learning Through Interprofessional Interactions in Clinical Clerkships: A Qualitative Analysis.” Also with us are RIME Committee member Dr. Bonny Dickinson and MedEdScholar Dr. Kelvin Pollard. We’ll be talking about the findings from Kelsey’s study, including how medical students learn to engage in clinical work through interprofessional interactions and how these experiences shape their professional identity and their understanding of the different roles on a health care team. So to start our conversation, I’m going to ask everybody to introduce themselves for our listeners.

Kelsey Miller (01:32):

Thank you Toni, and thank you for having me. Hi everyone. I’m Kelsey Miller. I am a physician. Clinically, I work as a pediatric emergency medicine physician at Boston Children’s Hospital. I’m also a medical educator and a medical education researcher, and so I work at Harvard Medical School. I have a few roles there, but probably most relevant to this paper is that I co-direct our interprofessional education curriculum and then I am currently pursuing my PhD in medical education through Maastricht University. Thanks again for having me.

Bonny Dickinson (02:09):

Hi, my name is Bonny Dickinson and I’m really glad to be here. I’m excited to talk about this interesting paper. I’m the senior associate dean for faculty affairs and director of medical education research at Mercer University School of Medicine, and I’m also a faculty member in the biomedical sciences department. My interests are in medical education in general and more specifically how basic science faculty find their way into medical education and how they adapt their repertoire of knowledge to fit the needs of medical students. I’m a second year member on the RIME committee and so really excited to be here and looking forward to the discussion.

Kelvin Pollard (02:48):

Hello everyone. My name is Kelvin Pollard. I am an internal medicine physician at St. Louis University School of Medicine. There I’m an assistant professor and associate program director for the internal medicine residency program. I spend a lot of time in the primary care outpatient clinics but also do some hospital medicine and specifically in medical education I’m interested in health disparities and also interprofessional communication and working on teams. Really excited to be here and looking forward to the discussion.

Toni Gallo (03:17):

Well, thank you all for joining us today. I’m looking forward to our discussion too. Kelsey, could you get us started and tell us about your paper, maybe what prompted you to do this study and a little bit about the methods that you used?

Kelsey Miller (03:31):

Of course. So this study is part of my PhD program of research and that focuses specifically on better understanding interprofessional workplace learning. So why did I choose to focus on that? I think I had lived experiences where I was shaped in significant ways by interactions I had in clinical spaces with people who weren’t physicians… nurses, pharmacists… that really impacted who I became as a physician. And so when it came time to figure out an area of research, I was really intrigued by how are others shaped by these similar interactions, which I know are sort of inevitable and happening all over the place. And was my experience sort of a unique one or something that was shared more broadly? I think we know a lot about physicians and how they sort of support trainees in workplace learning, but a lot less about how the other people that we’re interacting with do that.

Kelsey Miller (04:37):

And so that’s what led to my interest in the PhD and that particular topic. This study is really the first empirical study in that work. We started with a critical review trying to understand a little bit about what was known on the topic both within health professions education, but also looking to some of the disciplines outside of health professions education. But this was really fun. We got to dive in and actually talk to people about their lived experience. I’m going to say we throughout because this is a team effort and I want to acknowledge that from the start, we decided to do this as a constructivist grounded theory study because we felt like this was a socially complex phenomenon where it would be helpful for us to build an understanding along with the people we were interviewing. And we chose to focus specifically on medical students because they’re at a time where they’re really dependent on others to help them navigate workplace learning.

Kelsey Miller (05:38):

We sort of know that they need support in order to find ways to participate and sort of understand what’s happening. And so this seemed like a ripe area for study in terms of looking at how health professionals might be providing that type of support. And so the study involved talking to them, I think we’ll probably get to this because a thing that has been sort of fun for me to learn, but we used a technique called rich pictures to sort of elicit stories from the students about their interactions with health professionals and then with a team that included physicians but also members of other health professions. We looked at the data and tried to understand how are students learning through these interactions and what are they learning? And with that also came some findings about ways that that learning might not be fully realized.

Toni Gallo (06:31):

So the first finding I’m hoping we can all get into is this idea of the lore that the students talked about and that was the term you used for the stories and the advice that the medical students heard from their peers and from physicians and others. And that really shaped how they went into these interactions with other health professionals. And that seemed very in line with the idea of a hidden curriculum where it’s not necessarily a formal part of what students are learning, but there’s all of this other observation and what they pick up and what they hear maybe more informally from their peers and colleagues. So I’m hoping we can dig into that and what are the implications of that and what did you find in your study and what has everybody else seen in this area? Kelvin?

Kelvin Pollard (07:25):

So I wanted to make a comment about the lore. So I can think about when I first entered into training all of the things that I heard about how important it was to communicate with nursing staff and other staff, and also in the importance of building that rapport. And I also trained during the time when we were in the middle of a pandemic, which we had never seen before. So a lot of communication was happening through telecommunication and not necessarily in person just trying to reduce that risk of exposure, but I would learn soon that it was very, very important to actually go and communicate with people sometimes and not always write something in the chart or send a message. So kind of like that face-to-face communication, interacting with those staff. So whether it’s a nurse, a case manager, a pharmacist, there is so much that can be gained by actually taking the time to communicate with them. And so early on I learned that and then now as a faculty member, I try to impart that wisdom or that information onto my trainees. And I find that a lot of times when I go and have a conversation, we end up with a better outcome sometimes than just trying to write something in a chart or place an order without context.

Kelsey Miller (08:34):

Kelvin, thank you for sharing that because I think your lived experience really echoes a lot of what we saw, which is that I don’t think it’s unique to interactions with other health professionals, but we certainly saw students being confused about how to approach these professionals in clinical spaces and that they were turning to, like you described, sort of the things they’d been told and that’s where that word lore came from. One of the students actually used it, but then when we sort of dove more deeply into it, we really liked the fact that it captured that this was verbally passed down and that it was storytelling and maybe a potentially sort of more negative spin is stereotyping as well. But that then what needed to happen is exactly what you described Kelvin, which is they had this lore and then they went and had actual experiences and all of a sudden they were forced to think about how does this lore hold up to the experience I had.

Kelsey Miller (09:34):

I think what’s interesting is that that lore shaped the experience a little bit. So it wasn’t just like a comparison, it was sort of a framing, but then you had to loop back and sort of reconcile that. And I think one other thing I want to sort of highlight from Kelvin’s comment, which is sort of now as a faculty member, you’re intentionally talking about this. I think we saw that this was predominantly coming from peers, although there were times when people were looking to faculty, it tended to be if they sort of felt like what they had gotten from their peers was insufficient. And so we’ll probably circle back to that with it having implications. I know Toni, you asked originally about the hidden curriculum, but I want to give Bonny a chance to weigh in here before we tackle that specifically.

Bonny Dickinson (10:17):

No, I think it’s really interesting that the lore concept, and it intrigued me because you hear a lot about gossip and how gossip can permeate the learning environment. And it’s interesting that gossip has more of a social need to it, whereas lore is more kind of mythical and almost used to inform and you didn’t come across gossip. Is that true or was that just something that you didn’t find or didn’t report?

Kelsey Miller (10:45):

We didn’t hear students talking about it in a way that really evoked gossip and it wasn’t a word that they used. They used the word lore, like I said. They used rules. So unwritten rules, I think it will resonate with all of us. Some of the examples… don’t interrupt a nurse during sign out… sort of things like that that I remember hearing. And laws, they even sort of talked about laws, so it seemed more than gossip. It seemed sort of a way to be that had been verbally passed down. So I think related, but we wanted to capture that it was more than just talk that it was sort of a code to live by when you didn’t know how else to approach these interprofessional interactions. And Toni, I don’t know if you want me to circle back. I know you started with this question of hidden curriculum.

Kelsey Miller (11:35):

It wasn’t something that immediately came to our mind when we first started talking about lore, and I think that’s because this, at least for me, extended the concept of hidden curriculum a little bit. I think often hidden curriculum is talked about as the implicit messages that we send and most commonly in the setting of people that are slightly ahead of us or faculty, what are we implicitly signaling to the people coming up behind us? This was explicit, this was not hidden at all and it was mainly among peers, but I do think it’s really related and maybe an extension of how we need to think about the hidden curriculum with a bit more of a broader lens. So that was an evolution in how we were thinking about this and not something that was there from the start.

Toni Gallo (12:26):

I’m curious how you all think about this sort of informal learning that the students are talking about and if… is this model working? Peers are passing on what they’ve picked up or should this be formalized in some way? Maybe from your own experience or what you heard from the learners here, how do you think about this kind of learning? It’s obviously very important to how the students are able to interact in the clinical space, lessons they will probably pass on to the next class of students. So what do you think about the informal way this is happening now versus should this be formalized in some way?

Kelvin Pollard (13:06):

So I think there’s probably pros and cons to both sides of this. I think definitely we always need to hear first experiences from a person and I think that’s beneficial, but I think there is also utility in maybe formalizing it. And I think slowly if we look at medical curricula across the US, we’re starting to see more and more medical schools incorporate experiences that will drive this kind of interprofessional communication. So for example, St. Louis University, our medical students, they get to go and hang out with social workers, community workers, they get to talk to nurses. In my medical school residency, we allow our residents to actually rotate with our rapid nurses when they’re transitioning from intern year to second year. So again, this gives them first eye account of what those individuals are doing and then I feel like it provides them more context to be able to better do their job once they’re in the role as the physician.

Kelvin Pollard (14:03):

So I think yes, definitely we could do a better job at formalizing a curricula and focusing on some of these interprofessional skills and we should continue to build that, but I don’t think we should discourage hearing experiences and kind of passing out that information. I think that goes along with the idea of just saying we hear things, but we have to, and I always use this word all the time with my trainees trust but verify and so receive the information but then go out and make your own account and utilize those things that are useful.

Kelsey Miller (14:35):

I want to pick up what Kelvin said there and just say one, it’s really exciting to hear people thinking about this in similar ways to sort of how I envisioned this prompting conversation. So I agree. I don’t think it’s either/or. I think it is both/and. Workplace learning is inevitably somewhat informal. There are going to be interactions, experiences that are sort of not scaffolded and we know that’s going to happen, but there are ways to help structure or shape what experiences, what aspects of experiences, people focus on. I think there are ways to formalize things to help them make sense of those experiences. Entering clinical spaces there is so much happening and I think if we don’t formalize it a little bit, then we have a hard time helping students understand what they’re supposed to be paying attention to and what they’re supposed to be taking away and how they’re supposed to be interpreting things. So I agree with what Kelvin said, which is I don’t think we ever want the informal part to go away. It’s just that I think we want to make sure that we help people by formalizing some aspects of it to take away the things that we think are most beneficial to them.

Bonny Dickinson (15:56):

I think that’s really important. I like the both/and approach and what really struck me as needing to be addressed was the concept of the gatekeeper function and a debrief as you suggest in the paper, a debrief would be important to dispel some of the misconceptions on both sides. It was interesting that the students felt that they were being denied in some instances an opportunity to participate. And what is interesting is that there was a bit of a lack of introspection there that maybe the other health care professional was trying to save time or trying to prevent a harm to the patient or trying to keep things safe and unpacking that together and understanding the reasoning behind allowing someone to participate or not for maybe very legit reasons would seem to reduce that tension that seems to be with that gatekeeping function. I thought that was really interesting,

Kelsey Miller (16:56):

Bonny, I’m so glad you picked up on that because the fact that students or trainees think about other health professionals as gatekeepers isn’t necessarily new. We’ve seen that before in the literature. I hope what we can add is a sense of how the students are interpreting that to sort of guide what they’re taking away from these things. So it’s not just that they’re sort of feeling like they were denied something, but that some of them are thinking about, well, did I do something wrong? Was there a reason that I was denied this? And you can see as you highlighted, their lens is a narrow one as it sort of developmentally should be and there’s not thoughts to what other things might be contributing to this or maybe this isn’t about me. And so I think this is an opportunity to get back to our conversation to formalize some of this and to sort of say let’s give them a chance to ask those questions. As you’ll see, if you read the paper, they didn’t. They’re doing this on their own, they’re not clarifying, they’re not asking even if they’re confused, they’re just sort of leaving with that confusion of, I don’t know why I did or did not get that opportunity. They’re not probing. And so I think that’s a way that we could maybe change the system a little bit to help support that.

Toni Gallo (18:17):

Let’s dig in a little more to this idea of a debrief with the medical students and the other health professionals. Kelsey, you and your co-authors say the students didn’t seek clarification. Nobody mentioned when they were confused about an interaction or didn’t know how to take something that happened. They did not go back to the other health professionals for more information or clarification. So how are you thinking about what a debrief might look like with the team or how to help medical students take that next step and sort of not be on their own processing what just happened?

Kelsey Miller (18:55):

I first want to acknowledge the privilege I have in wearing the researcher hat of sort of suggesting that we do that and how complicated that actually is to do in actuality. These are busy health professionals, these are students who have lots of competing demands. And so I think first to highlight that it will require investment to make these interactions happen. I think what we see is that they’re not happening spontaneously. So to me what this looks like is creating structures within our student training in the clinical spaces where we set up opportunities for them to ask either individually, as a group, why did this interaction go this way. Help me understand. I think it’s important to highlight that that has implications too for how we ask our interprofessional colleagues to engage in those and sort of how do we create time and space for them to be willing to do that in thoughtful and meaningful ways.

Kelsey Miller (19:55):

I think it also highlights the fact that as physician supervisors who sort already have at least structured roles and variable amount of time to spend with students debriefing their clinical interactions, it may be something we want to incorporate. It may be something… I think we want to be careful. We don’t want to say we know why that happened, but as a step could sort of ask what other explanations might there be or encourage them to go ask that health professional or at least get them thinking beyond the sort of self attribution that they’re doing now.

Bonny Dickinson (20:32):

I’d like that and I think in the landscapes of practice literature, that would be a way to facilitate boundary crossings and meaningful interactions that are safe for the medical students so that they don’t feel so siloed in their roles and thinking about the landscapes of practice. They’re really not part of a community of practice yet. They’re peripheral or boundary objects they might be called, but they’re peripheral participants in the physician community of practice and they’re not really part of other communities of practice yet. And so bringing people together facilitates that important discussion between communities of practice and people can feel a little bit more close together if they were able to do that in a safe way.

Kelvin Pollard (21:20):

I just wanted to kind of piggyback and give a comment about ways that I’ve found ways to activate my medical students to make them feel as an active participant or part of the team. So one of the first things I do when I’m inpatient as an attending, I always tell them, number one, this is a safe space. Number two, this is a opportunity for you to actually get practical experience to be a physician. And then three, I actually want to hear your thoughts, your concerns, your comments. So by doing that kind of early saying like, Hey, I actually do want to hear from you, and a lot of times it’s the third year student with great differentials that can really help us and ground us and find that thing that we’ve all been overlooking. So a lot of times I’ve had students who have astutely found DVTs that maybe a trainee might’ve missed, and so I truly activate and I tell them that all the time that you are an active participant on this team and your information and the time you get to spend with the patient is valuable. And so just by reiterating that and activating them, I also repeatedly asked them what things went well with that interaction, what things could have I done better? And so just showing that me as an attending, I also can grow, I can learn, and so just by I actively model that so that way my trainees and my medical students will feel comfortable receiving that same feedback.

Toni Gallo (22:42):

One of the things I think that maybe is mentioned in the limitations is that you didn’t talk to the other health professionals about these interactions too. And so I want to talk a little bit about that and bringing them into this research and what we might be able to learn from talking to the people on the other side of these interactions and what are some of the questions that you all would like to ask them to help us think more about this?

Kelsey Miller (23:08):

I want to hear what Bonny and Kelvin have to say about the questions they want to ask. And part of the reason I want to hear that is we are in the process of doing that study now, so we are in the process of talking to other health professionals about their interactions with medical students. And so I would love to hear things you’re wondering about Bonny and Kelvin.

Bonny Dickinson (23:32):

I guess what I was wondering about are whether nursing students and PA students have their own experiences of training in an environment where they’ve maybe developed lore for other health care professionals or even physicians and how that might differ.

Kelvin Pollard (23:47):

I think the biggest question that I would have is I’d be interested to know, number one, I would want to know what is it that they think that our medical students could do better to maybe feel like an integrated part of the team? And then how do we do that from their standpoint? What is it that we could do better to have them well prepared to be able to interact with them?

Toni Gallo (24:07):

Kelsey, what can you tell us about the study that you’re doing right now?

Kelsey Miller (24:11):

Yeah, first I just want to say those are really great questions. I think this idea of what other intraprofessional lore is sort of out there is a really interesting one as well as sort of how we can best prepare our students for these interactions. What we’re talking about these health professionals right now is sort of really trying to understand both routine and memorable experiences. What was really interesting is we had to spend a lot of time thinking about who do we talk to? Because in the stories that students told me for this study, they mention a lot of health professionals. And so from a medical research standpoint, that’s a very diverse population. And so doing qualitative research with a very diverse population has its advantages and its limitations. And so one of the things that was really interesting was the conversation about how broad of a net can we cast in a way that we can authentically understand these health professions experiences without lumping or generalizing. And so that has been a tension. We’ve been playing with a lot to sort of want to know what might be shared but not presume that a nurse’s experience is the same as a social worker’s experience. So it’s been a really interesting study to think about. I’m in sort of the early interview phase. And so I don’t have too much to offer you in terms of insights yet, but only sort of the foreshadowing that we agree this is a really interesting question and are trying to understand it a little bit better.

Toni Gallo (26:00):

I think we’ll all look forward to reading that study when it’s ready. I want to switch topics a little bit. One of the other things that the students described through the interactions that they had with the other members of the health care team was this idea of their role and the role of others and sort of boundaries. And that felt a lot like helping them figure out what does a physician do as part of a team? What are the roles of all of the other clinicians that they’re interacting with? And so I’m hoping we can talk about that piece of the study and your findings and what did that look like and what might we learn from those responses.

Kelsey Miller (26:42):

Again, it’s really exciting for me to hear your questions because what happened for our team as we were doing this study is that we started to realize pretty early that there was a lot that the students were talking about related to identity. I think landscapes of practice as a sensitizing concept certainly has a fair amount of focus on identification and knowledgeability being something that sits at the intersection of competence and identity. But we heard so much about identity not only in terms of who students were relative to other health professionals, but in terms of who students were sort of relative to the physician profession and to their trajectory towards that profession that we actually modified the interview a little bit for sort of the later interviews for this study, conducted additional interviews, and then sort of went back informed by theories of professional identity formation to look more specifically at how these interactions are influencing the student’s professional identity formation. So it is just really exciting to hear sort of the things that struck us also striking other people. And so that study is submitted for publication, so hopefully coming out soon, but really looks at both how these interactions are shaping my sense of myself as a future physician and how these are shaping students’ sense of themselves relative to the other people that are populating the landscape.

Toni Gallo (28:16):

Anyone else want to jump in?

Bonny Dickinson (28:18):

I think that’s a very interesting concept, and the students get some mixed messages, which is you’re training to be autonomous, right? You’re going to be the leader, you’re going to be independent, and then you have to balance that with being able to work effectively as part of a health care team that certainly must have some impact on professional identity formation as they matriculate through a curriculum.

Kelvin Pollard (28:41):

I just wanted to make a comment. I’m starting to see more hesitancy and sometimes in fourth year students in my ambulatory rotation when they’re acting as an acting intern and they’re required to kind of let the MA or nurse know what they need and how they’re for follow-up plans. And so I see them grow over that four weeks of time, but there also is some hesitancy and nervousness surrounding being autonomous and making those decisions. So just as much as we have to encourage them to definitely play nice work well with others, we also have to, in the same token, encourage them to actually be the leader and step up and make those decisions to provide good care. So I see both sides of it in that sense.

Kelsey Miller (29:26):

You both picked up on this tension around autonomy, independence, and how much of that is meant to be part of the physician profession. And that’s certainly something we saw students struggling with and I think in this paper and in these subsequent analyses, these interactions are shaped by everything that has happened before them and sort of the ways we’ve structured our training systems. And so for example, for this paper, we see a lot of when I am taught predominantly or exclusively by physicians, the people that I see as capable of shaping my learning are physicians. And it’s harder for me to see people that I haven’t been introduced to as teachers before in that role. I think similarly when we talk about tensions around independence or autonomy, we have a competency-based medical education system that we’ve really bought into, and a lot of that is about when can you do this on your own?

Kelsey Miller (30:36):

That’s the language that we use and I think there’s some great work Stefanie Sebok-Syer is doing out of Stanford pushing back at this and sort of saying a lot of this, what we’re assessing is really interdependent. And so sort of this language we have of independence has implications for, I think from her perspective how we assess students. I think from my perspective of how we develop students and future physicians and that these interprofessional interactions are sort of one place where we’re seeing that tension play out in ways that may shape how much they internalize that, but I think it’s happening at the individual level, but very much shaped by what comes before and what is surrounding them.

Toni Gallo (31:19):

I want to go back for a second to your methodology, the idea of rich pictures and asking the students to draw those to reflect the interactions that they had. And I wonder if you could talk a little bit about identity and what does it mean to be a physician? And it seems like different things might come out when you ask a student to draw a picture then maybe that they would realize if you would just ask them a verbal question. So could you talk a little bit about your method and maybe what you were able to draw out of the students by having them draw those pictures?

Kelsey Miller (31:54):

Of course. I’ll say doing the rich pictures as an elicitation tool was a really fun part of this study. As you alluded to, the goal with rich pictures is for people that are participating in studies that they might be able to see things that were previously not at the surface for them. As well as that you can articulate things through drawing that maybe you can’t articulate as well with words. As the person who was fortunate enough to do the interviews, it really gave me interesting things to probe. So for example, you could see that they had drawn smiles on the faces of the other health professional and had left their face blank or had not drawn a smile on their face. And that’s a question that you can then ask as an interviewer and sort of say, why aren’t you smiling? That gets to a range of emotions that I don’t know that I would’ve been able to tap into without those pictures. Or tell me about where you’ve positioned yourself in this picture. What does that have to say about how you feel in terms of your belonging on this team in terms of your relationship with this person? And so getting to see sort of what they drew allowed me to probe into really specific parts of that and I think create some content of the interview that would not have been there without that activity.

Toni Gallo (33:24):

Kelvin, Bonny, any questions that you want to ask?

Bonny Dickinson (33:28):

Yeah, I have a question for both Kelvin and Kelsey. As practicing physicians, how have other health care professionals in your environment continued to shape your professional identity?

Kelvin Pollard (33:40):

I’ll say definitely I’ve had wonderful nurses, pharmacists, social workers, case managers, all who have made a significant impact on my career. I think about as an intern in the ICU, the ICU nurses were really who helped to whip me into shape and they really put me in a position to look good on rounds. They provided me with all this useful information. And so early on I found value in those relationships and tried to build those relationships. And so definitely I attribute a lot of my success throughout residency to many of those great people. And then now in practice, I collaborate with great nurse practitioner, pharmacists, and social workers. And I realized early on that without my medical student, without my nurses triaging, I really cannot effectively do my job. And so I always repeatedly thank them and try to let them know how much I appreciate them. And then I also always try to approach them in a professional manner and they do the same for me. So definitely they’ve definitely shaped, shaped my career.

Kelsey Miller (34:47):

Kelvin touched really nicely, very sizable impact that other health professionals had on me during training. In terms of my professional identity now, I think there’s a few specific ways. One, they are really important sources for me in terms of understanding how I’m doing as a collaborator, which is for me a very important part of my professional identity. And I think something that comes, I have intraprofessional collaborations, and so I think those contribute to it. But a big part of that sort of how effectively am I able to bring people in, how effectively am I able to work with them is something that I really only get information or that I get important information from by interacting with those other health professionals. I also do think that they continue to shape how I feel about my core competencies as a physician, not that collaboration isn’t, but if you think about medical knowledge, procedural skills, things like that, I still remember a clinical assistant…

Kelsey Miller (35:52):

So in our environment, in the ER, those are often recent college graduates. People that are hoping to go to medical school, sort of may have had little medical experience prior to this, but they help us by keeping patients still when we do laceration repairs. And one of them, after we had done a couple together, gave me a compliment on sort of the quality of the repair. And it is something that stands out to this day because it was someone who’s seen many physicians do this. It was sort of someone who gets to be there but gets to see the entire experience, not just sort of the cosmetic outcome or things like that. And just the fact that this person offered it was really validating experience for me. And so even now, I think they sort of are important to shaping when I feel like I’m doing a good job, when I feel like I have opportunities to grow, as Kelvin alluded to earlier. I very much am looking for those. So I hope that answers your question, but Bonny, I think in many ways they remain core to my professional identity journey.

Toni Gallo (36:55):

I want to finish up our conversation today. If each of you have anything else you want to share with learners or with educators, things to think about, recommendations around clinical interactions with other health professionals, anything we didn’t touch on yet, just kind of final thoughts that you want to share with listeners. Anyone want to go first?

Kelvin Pollard (37:18):

Alright, so for medical students, I just want to say be open to learn from every single person that you interact with from the nurse… I also think there’s even things that I’ve learned from our janitors, in fact, in the hospital because many of them have been around the hospital for many, many years. So they even talk about interactions and you can learn from them. And then for faculty, I would just encourage you to model good behavior. So all of the good interactions and things that you can do in front of our trainees and our medical students because we realize they’re going to just model after what we do. So having good behavior in the learning environment, the clinical environment, in my opinion, lead to solid resident physicians and future attendings.

Bonny Dickinson (38:02):

I was just going to say I am not a practitioner, but I thought that the stories that you shared about how other health care professionals impact your every day is something the students need to hear. In fact, I put it in the chat. We were chatting with each other because if they hear it from you, then it becomes something that’s part of their mindset that this is… these are individuals who are going to contribute not just now in their early careers but as they continue to evolve their careers and to pay attention to that and be tuned into it.

Kelsey Miller (38:32):

Thank you, Bonny. I think I’ll probably come back to this concept of lore. I don’t think lore is bad, nor do I think it’s ever going to go away. I think it can be really helpful in your trying to navigate something that feels unfamiliar, but I think I would encourage students to be aware of it and to sort of guard against it having an outsized impact. I think one of the things that struck me the most in this study was the fact that people would have many positive interactions with a health professional, and then if they had one that was different but confirmed something that they’d heard that the lore continued. And so I would hope that people would be able to say, actually, most of what I’ve had has been disconfirming to this, but you need to know that it’s there. You need to know that you’re sort of primed to be looking for it in order to have that type of thoughtful reflection.

Kelsey Miller (39:25):

And so I think that would be the biggest thing I would offer, which is, listen, it’s helpful, but know that you’re listening and know that it’s shaping you. And coming back to what Kelvin said, trust but verify and verify based on your own experiences would be my sort of thing I would want to leave the students with.

Kelsey Miller (39:43):

In the spirit of someone who studies interprofessional education and collaboration, I feel like the most fitting thing for me to end with is just a thank you to my team who I was privileged to get to talk to you today. But this in no way reflects my work. It reflects the interdependence of the group of people that collaborated on this as well as the students who very generously gave their time. So I just wanted to end by acknowledging those very important contributions.

Toni Gallo (40:10):

Would you like to name your colleagues and co-authors?

Kelsey Miller (40:10):

A special thank you to Andrea Barker, Anique de Bruin, Jonathan Ilgin, and Renee Stalmeijer, who all contributed in ways that shaped this paper for the better.

Toni Gallo (40:26):

Well, I want to thank you all for a great conversation today. I want to encourage our listeners to read Kelsey’s paper and to read the other RIME papers. They’re all available on academicmedicine.org right now. And if you are attending the AAMC’s Learn Serve Lead meeting, come check out the RIME sessions. You’ll be able to hear more about Kelsey’s paper and more about all of the other papers this year in the collection. So thank you all so much.

Toni Gallo (40:52):

Make sure you check back next month for the next episode in this year’s RIME series. We’ll be talking about parenting in medical school and the dual identities of medical student parents.

Toni Gallo (41:04):

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