Phronesis: Practical Wisdom for Leaders with Scott Allen

James Stoller, MD & MinhTri Nguyen, MD - Developing Leaders in Healthcare

• Scott J. Allen • Season 1 • Episode 234

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Dr. Stoller is Chairman of the Education Institute at Cleveland Clinic. He holds the Jean Wall Bennett Professorship of Medicine at Cleveland Clinic Lerner College of Medicine and the Samson Global Leadership Academy Endowed Chair. He is a pulmonary/critical care physician in the Cleveland Clinic Integrated Hospital Institute. He serves as the Senior Associate Dean for Academic Affairs (Cleveland Clinic) in the Case Western Reserve University School of Medicine.

In 1979, Dr. Stoller earned a medical degree from Yale University School of Medicine and later completed an internship and residency at Peter Bent Brigham Hospital in Boston. He then completed fellowships in pulmonary/critical medicine (Brigham and Women’s Hospital and Yale), clinical epidemiology (Robert Wood Johnson Clinical Scholars Program at Yale), and respiratory intensive care (Respiratory Intensive Care Unit of the Massachusetts General Hospital) before joining the Respiratory Institute Staff at Cleveland Clinic in 1986.

Dr. MinhTri Nguyen recently graduated from Cleveland Clinic’s Hematology and Oncology Fellowship program.  He has had leadership experiences as the Associate Director of Outpatient Services at Metrohealth’s Internal Medicine Department, Chief Resident, and President of the House Officer’s Association at MetroHealth. 

MinhTri has a longstanding interest in emotional intelligence and leadership, with ongoing research in both subject matters related to physician training. He is a certified coach, currently coaching resident physicians and clinical leaders. In the fall, he will be joining Stanford Health Care, where he will practice Hematology/Oncology with University Medical Partners while continuing his academic interests in leadership development for physicians.


A Quote From This Episode

  • "The practice of leadership like medicine (both fields in their own right) is continuous. To be a good practitioner of medicine you need to be in tune with the practice and practice medicine. So the same thing applies to leadership you need to be in tune with the field of leadership and practice leadership."


Resources Mentioned in This Episode


About The International Leadership Association (ILA)

  • The ILA was created in 1999 to bring together professionals interested in studying, practicing, and teaching leadership. Register for ILA's 26th Global Conference in Chicago, IL - November 7-10, 2024.


About  Scott J. Allen


My Approach to Hosting

  • The views of my guests do not constitute "truth." Nor do they reflect my personal views in some instances. However, they are views to consider, and I hope they help you clarify your perspective. Nothing can replace your ref

Note: Voice-to-text transcriptions are about 90% accurate, and conversations-to-text do not always translate perfectly. I include it to provide you with the spirit of the conversation.

Scott Allen  0:00 

Okay, everybody, welcome to the Phronesis podcast. Thank you for checking in wherever you are in the world today. I have two physicians with me today. First, I have Dr. Jamie Stoller, who is the chairman of the Education Institute at the Cleveland Clinic. He holds the Jean Wall Bennett Professorship of Medicine at Cleveland Clinic Lerner College of Medicine, and the Samson Global Leadership Academy Endowed Chair. He is a pulmonary critical care physician at the Cleveland Clinic Integrated Hospital Institute. He serves as a Senior Associate Dean for Academic Affairs at the Cleveland Clinic in The Case Western Reserve… Okay. I’m gonna say that again. He serves as the Senior Associate Dean for Academic Affairs at The Case Western Reserve University School of Medicine. In 1979, Dr. Stoller earned a medical degree from Yale University School of Medicine and later completed an internship and residency at Peter Bent Brigham Hospital in Boston. He then completed fellowships in pulmonary critical medicine, at Brigham and Women's Hospital in Yale; clinical epidemiology, at Robert Wood Johnson Clinical Scholars Program at Yale; and respiratory intensive care, the respiratory Intensive Care Unit of the Massachusetts General Hospital, otherwise known as Mass General, before joining the respiratory Institute staff at the Cleveland Clinic in 1986. I also have Dr. MinhTri Nguyen, who is a graduate of Cleveland Clinic's hematology and oncology fellowship program. He has had leadership experiences serving as the Associate Director of outpatient services at Metro Health's Internal Medicine Department, Chief Resident, and president of the House Officers Association at Metro Health. This year, he was named one of Northeast Ohio's top 25 under 35 movers and shakers award. MinhTri has a long-standing interest in emotional intelligence and leadership, with ongoing research in both subject matters as it relates to physician training. He is a certified coach, currently coaching residents, physicians, and clinical leaders. In the fall, he will be joining Stanford Healthcare where he will be practicing hematology oncology with University Medical partners while continuing his academic interests in leadership development for physicians. MinhTri, I think you were one of the first podcast guests I ever interviewed. This is back in like 2012, I think you were president of the Student Union at Case Western Reserve. Am I correct? 

 

MinhTri Nguyen  2:31 

Yeah. No, absolutely. My first podcast was with you, so it's the same experience. Yeah, that was back when I was student body president. 

 

Scott Allen  2:39 

Oh, wow. And Dr. Stoller, it is so good to see you, sir. You are a long-standing champion of leadership within the Cleveland Clinic, and I'm excited, excited, excited for our conversation today. Before we begin, I think what I'd love to do is go with both of you. I would like to just talk about this source. What's the source of your passion for leadership? It's so cool you have these incredible track records within the context of medicine, but both of you have oriented, at least, and there's some energy around this topic of leadership. And Dr. Stoller, maybe we start with you, and then we'll go to MinhTri.

 

James Stoller  3:15 

Sure. Well, again, I am delighted to be here, Scott, and to join you and MinhTri on this important topic. I've had a long-standing interest in healthcare leadership development, and it really stems from the perception of need in the end. My own journey, to answer your question, is a little bit serpentine in the sense that I didn't begin my career with a passion for physician leadership, or physician leadership development, it evolved. And it evolved out of a series of somewhat serendipitous events, which I think probably describes much of the readership or listenership of this podcast. In my own career, I've observed what others have called the arrival fallacy. What is that? You finish training, MinhTri is right on the cusp of beginning his career as an attending. I'm sure he, like I did earlier in my career, has a whole bucket list of boxes to check on, things that he wants to accomplish as a budding, talented hematologist, oncologist, academician, etc. And the details of the bucket list don't matter, but I found myself about 15 years into my career here at the Cleveland Clinic, having checked those boxes. And on doing so, I experienced a sort of deflation of energy around even my own career. Your listeners don't know me, but I'm the least likely person imaginable to experience a deflation of energy. That said, it sent me on a bit of a journey to talk to colleagues, and I realized that all of my colleagues in a similar place in their careers had experienced this phenomenon, but no one had a language for it. And so, I was referred to a colleague, now friend, then a professor of organizational development at the Weatherhead School of Management in Cleveland. Eric Nielsen is his name. And I went to Eric's office and described this phenomenon to him, and became aware in that conversation that this was not idiosyncratic, it was quite expected that for knowledge workers like doctors, lawyers, engineers, professors, we experience sort of a cyclicity of our career with mastery, and that mastery occurs in 7 to 10-year cycles. And that as mastery, and I don't want to sound immodest here, there is plenty of pulmonary critical care I've yet to learn, but the learning curve does shallow a bi. And, as it shallows, there's a certain restlessness and desire to learn more. So, I became aware that there was a discipline called organizational development that understood this, about which I knew nothing, actually couldn't have told you what it was at the time. And so, Eric was running the master's program, and I said, “You know what? I'm now curious, you have my attention. And the only way I'm going to learn this is to commit to an educationally accountable environment, like doing a degree.” Because if you put me in school, I know how to do that. So, I signed up and earned a master's degree. The curriculum, as you well know since you teach this, Scott, is informed by all of the elements of leadership. I finished that with a curriculum in my head and then with an invitation from the Cleveland Clinic to start to develop a leadership curriculum. That prompted me a little later in my career to actually be in a leadership position and find out whether I could actually do it or not. That was the source of my interest in serving in the role that I currently occupy, and I'm delighted to occupy as chair of the Education Institute, leading our efforts in education at the Cleveland Clinic. So, that's my story, if you will, and I'm sticking to it.

 

(Laughter)

 

Scott Allen  7:09 

That's wonderful. And MinhTri, how about you? What is your pathway?

 

MinhTri Nguyen  7:14 

Yeah, Scott, thank you for having me, and it's always really nice to talk to Dr. Stoller as well. So, my sort of motivation in going to this, I think, academically, I've always been really passionate about human behavior and studying human behavior. I find it just extremely fascinating. So, what happens in a certain situation is that one person would choose one outcome and another would choose a different outcome. So, this sort of, I guess, interest in sort of studying human behavior and observing what one would do in certain situations if you sort of scale that in leadership, I find it extremely interesting what we look at with how one person can affect the overall behavior of many, and then the opposite, how many can over time affect the role of the leader. And so the study between leader and follower, and sort of the individual follower as well, I think that that's what really kind of drove the academic interest in all of this. So, at the heart of it, it's human behavior. I think that's what drove me to major not only in pre-med in biology, but also psychology. So, I think the psychology of leadership is really interesting. Practically, I've always had a curiosity about leadership, particularly how change agents sort of affect our everyday lives, and how one becomes a change agent. I came to the United States at a very young age and was thrust upon a lot of changes in my life. And I think, because of that, I became really comfortable with change. When I started looking around me to see how other people reacted to change, leadership was just a very obvious field to look at. And in undergrad… It's funny. I was talking to somebody about this the other day about how my trajectory in leadership started. It started way back in eighth grade, in junior high. I ran for leadership positions, not really knowing exactly what leadership was all about. And then, since then, ever since high school, undergrad, medical school, residency, etc, I've always sort of gravitated towards leadership roles, and I think part of that is just because I've been so comfortable with change. But it wasn't until undergrad that I kind of saw leadership as more of a study in a field that I could really get into academically. So, I had great mentors. I met a lot of great leadership consultants. I met you also as an undergrad, and I think that really spearheaded a lot of my academic interests in how we can take this into medicine.

 

Scott Allen  9:46 

That's wonderful. Well, I know that the two of you, you're embedded. You're embedded 24/7, 365 because that's when hospitals are open. You are embedded in this. And so, I think for both of you, what are some opportunities you see for leadership education among physicians? What are the needs? I think you, better than anyone, have a really keen interest. What I love about this conversation is that, Dr. Stoller, you've been in the context for a number of years, and you have your wisdom and insights into how things have shifted and what still needs to shift. As you said, Dr. Stoller, MinhTri is kind of beginning that process and looking up at a career. So, I'm interested in hearing about what you both see. So what opportunities do you see for leadership education among physicians? MinhTri, maybe we start with you?

 

MinhTri Nguyen  10:41  

Yeah. I think there are maybe three things that I would say. One is that there is an opportunity, I think, in medicine to start early. There's an opportunity, I think, to embed oneself in the learning of leadership, in medical school, in residency, and continuously onward from that point. I know that this is sort of something that's been talked about, and in some ways, it has been incorporated into medical training, but that is an area of interest for me because I feel like that's sort of a lost opportunity that we haven't really capitalized on quite a bit yet. The next question is, do we call ourselves leaders just because we had medical school training in leadership? I don't think so. I think the practice of leadership, like medicine, both fields in their own right, are continuous, and so I think to be a good practitioner of medicine, you need to not only be in tune with the practice, but you also need to also practice medicine. So, the same thing applies to leadership; I think you need to be in tune with the field of leadership as well as practice leadership. So, my second point to this is that one opportunity is that we need to have something that's continuous for leaders within the medical field, physician leaders. And that's something that I think comes in the form of leadership coaching, or consulting, or having someone who is really in tune with the field of leadership. You can do this yourself, obviously; you can be in tune, but I find physicians are strapped for time sometimes, and so we may not always have the time to look to other fields and make sure that we're up to date with that. The last thing I would say about this piece is it's great to incorporate leadership learning early, and it's also great to make sure that it's a continual practice. But how do we start, and what sort of foundation do we use to start because there are so many out there looking at the literature itself? I am particularly interested in the emotional intelligence leadership model. I find that it sort of brings itself to the medical field really easily. It's something that honors the sensitivity that's needed for medicine. I think it manages the stress and intensity of medical situations very well. There are a lot of studies that look at emotional intelligence and emotional intelligence leadership that have shown benefits, not only for physicians in terms of burnout and satisfaction but also for patients. It results in great patient-centered care and patient outcomes. And I think that this is something that we can teach early and is helpful in a multitude of ways, not only in medicine, but I think for the person in general. So, I think those are my three.

 

Scott Allen  13:28 

Awesome. Love it. Love it. Dr. Stoller, how about you? How do you think about that question?

 

James Stoller  13:33 

Well, first of all, I want to underscore MinhTri's comments. I would respond, I guess, in the following way, Scott, I think the opportunities are legion. And if I think about my own journey through this, it's in my career, medicine has evolved, and you alluded to this at the outset, from a sort of heroic lone healer model to a collaborative model. The concept of a heroic lone healer was actually framed by my co-intern, Tom Lee. Dr. Tom Lee is now the Chief Medical Officer at Press Ganey. Tom and I were interns together and he wrote a paper in the Harvard Business Review in which he described doctors’ curriculum as heroic lone healers. And as I reflect on my own training, I hope it was much better now. We were trained to be the patient advocate and the bastion of knowledge on our patients' behalf. It was not taught as a team sport, nor were we selected for medical training or medical school as team players. I often reflect on the difference today versus then, and, at least, in our own medical school, the Lerner College of Medicine, it's entirely a team sport, and we are selecting medical students for their ability to be team players and to teach one another in a collaborative environment. So, that journey frames the obvious need, which is that doctors, at least in the hidden curriculum, again, it's better now, the hidden curriculum is not one of leadership competencies around change management, team building, and situational leadership, and conflict resolution, and all of the curricular attributes of leadership development. The hidden curriculum is often one of command and control. And so, there is,, therefore,, a need, in my view, to actually unfreeze, using sort of aluminum terms, unfreeze those early behaviors and refreeze a new set of behaviors that are very different than the competencies that make us great doctors or scientists. And so, the way I think about the need is in three buckets. One, and this is framing work from the Center for Creative Leadership, is teaching leadership as a curriculum, so people need to have a foundational understanding of many of the concepts that Dr. Nguyen alluded to; change management, which is core to leadership, emotional intelligence, situational leadership, building teams, resolving conflict, all of which are deeply embedded in self-awareness and self-reflection. The emotional intelligence piece. The second is coaching and mentoring, so having coaches that are available to you, supportive and nurturing, not acrimonious, because lots of feedback in medicine is actually acrimonious, rather than developmental if you will. And then, third is experiential learning. The idea of being in leadership roles, learning from that, being accountable for that, and leveraging success as a leader to garner opportunities for greater and greater scopes of leadership. And I think careers in medicine and leadership are often punctuated by that sort of trajectory. You're asked to chair a committee, you do a good job. You're then invited to chair a larger organizational activity. You're then invited to be a department chair or division chair. And then perhaps a dean or then a CEO, etc, etc. These are progressive leadership roles predicated on success in the prior role. So, to answer your question succinctly, you know they say lung doctors are long-winded about the short-winded, and I'll try to believe that reputation, but I think the short answer is that there is an incredible need. I'm pleased to think that I'm part of the front-running organizations in healthcare, and I'm part of one, The Cleveland Clinic. Front-running organizations are deploying such curricula in service of developing leaders in their healthcare providers. Not just doctors, but interprofessional curriculum. I'll stop there. 

 

Scott Allen  18:00 

I love it. Well, and if you think about it, your three elements right there; curriculum, coaching, and experiential learning. If we were trying to develop a physician, it would seem that those would be three core ingredients. A strong curriculum, some experience… You don't start with a heart, you start with a gallbladder, correct? So, we've got experiential learning, we've got the curriculum, and we've got coaching along the way, and then kind of escalating levels of authority or scope that the individual is then prepared for. MinhTri, I know you wanted to jump in there.

 

MinhTri Nguyen  18:39 

Yeah. So, I touched upon this a little bit about the continual need for either you yourself or someone who's in tune with the field to make sure that you are, I guess, up to date in your leadership sort of knowledge or whatever. And I think this is true of what medicine is as well. Medicine as a field has sort of evolved through time. So, we don't treat patients the way that we used to treat them because, at that time, we knew differently. Now, we know that we treat this in a different way. I think leadership also started off in the same sense. We used to think leadership was something that you were born with, that it was intricate to a male figure, and all this stuff, but we now know, I think, through a lot of studies and through a lot of just trial and error that these sort of previous thoughts about what leadership is, these previous thoughts about what medicine and treatment used to be, no longer is true. And so, to me, what's most important out of all of this is that, if you are a leader, you have to have a continual, I guess, passion for renewing your knowledge base that can then transpire to practice. And so, that coaching component, I think, is particularly important if you yourself are not already embedded in the field. 

 

Scott Allen  19:59 

Yeah. Because of that learning, to your point, how we treated the course of care in 1980 was very, very different than it is in 2024. The course of care probably was not as effective as it is in 2024, and so was continuous learning. Dr. Stoller, I know you want to jump in there. What do you think?

 

James Stoller  20:22 

Well, I was going to underscore, I guess, again, what Dr. Nguyen said. The way I think about this is through the lens of a spiral curriculum. As one teaches leadership to medical students, their needs and their lens are very different than the lens of a resident, a fellow, an early attending, or a more senior attending. And so, while the curriculum is the same, if you think about it through the lens of emotional intelligence, self-awareness, self-management, relational awareness, and relationship management, medical students are much more, as they should be, self-absorbed. They're trying to figure out how to learn a complex body of material, and they're less focused on their interface with the organization than they should be. On the other hand, as one becomes, for example, a chief resident, that's a pivot point in which you're pivoting from a focus on self-growth to an early leadership responsibility for a group of colleagues and trainees in a training program. This is why, for example, we at the Cleveland Clinic have run for now 16 years a chief residence leadership workshop. Which we take the Chiefs offline, and they recognize that this is not Kansas anymore, that their roles and responsibilities are a little bit different than being the individualistic, capable doctor that they are at that point in their careers. And, as one then emerges from early training into early attending-hood, if that's a word, then one interface with the organization. You're on committees. You're now a change agent of scopes of greater and greater responsibility. There, the spiral curriculum is much more focused on relationship awareness and relationship management, and some of the competencies that appear in the lower right quadrant of the emotional intelligence map, if you will, are situational awareness and service orientation to the organization, and altruism. And so, the competencies evolve as the needs of the learner evolve. And to Dr. Nguyen's point, this should begin, and does begin in our institution, in medical school, but the content of the learning changes over time because the stickiness of the learning and the needs of the learner change over time. If that makes sense. 

 

MinhTri Nguyen  22:59 

It's like precision medicine. We're so used to making sure that it's patient specific. Well, I think this is leader specific.

 

Scott Allen  23:08 

Well, I think the two of you are hitting on something that I've been reflecting on recently. I have conversations with people from all over the world every week, and I put those out into the world and get feedback on the episodes and such. It's so interesting to me because, well, you could look at some domains like, let's just go with the military, or you could look at a domain like healthcare, and let's just look at developing a physician for now. And Dr. Stoller, I think you said this beautifully, but in leader development, we don't always scaffold it well. So, even karate has figured that out. “Hey, we're going to start off with a white belt.” And my equivalent from a leader development standpoint could be something of the effect of, have we started with active listening? Are you skilled at active listening? We need to stack some of these behaviors and make them age and stage-appropriate so that, as the individual develops and moves through the organization, we've actually truly built some knowledge but also built some skill. And again, in medicine, I think we're very, very, very seasoned at how to do that from a care standpoint. That education in the College of Medicine at Lerner, I imagine, is very well mapped out. I don't think we do that well in leader development. We have faculty members and colleagues entering the conversation on systems thinking and chaos theory. That's black belt content. That's when you're a little further along. But it's this huge hodgepodge of mashup of concepts and content that is not… It's kind of a messed up Dojo where you never really know where you're going to get, and we never really know what you're going to get. These are all important topics, but often not age- and stage-appropriate. I know both of you have some reactions. MinhTri, you want to jump in?

 

MinhTri Nguyen  25:05 

Yeah, real quickly. But this is the basis for one of my academic research projects, as Dr. Stoller knows. So, I study emotional intelligence and emotional intelligence leadership in medical trainees because I believe that it is a scaffolding for leadership. It is a foundation that I think we can use. Part of my research, looking at the literature, is surrounding what sort of interventions or academic research has already been done in this field. And through my quick overview of everything, it seems like we're very quick to take interventional types of needs. So, a lot of the studies that have been done on trying to increase emotional intelligence have been just that. There's really no previous study knowing what happens with emotional intelligence, even within medical training. No one has written about this trend. We don't know if medical trainees actually lose emotional intelligence throughout their medical training. We don't know if it actually increases, or at what point it actually gets higher or lower. So, part of the study that I'm trying to look at is, well, maybe we should kind of work a little bit backward here and kind of see what are the needs before we start intervening because, as you said, it's just a hodgepodge of a lot of interventions that we don't actually have a really good basis for yet.

 

Scott Allen  26:27 

Yes. Yeah. And as Dr. Stoller so beautifully said… And you might be defining spiral a little bit differently than I am. I'm saying scaffold, but it's appropriate, and it builds upon. And it's not just the knowledge, but there's knowledge, there's a skill, there are experiential elements of all of this so that we're in this consistent space of learning, growth, and development, that, again, builds upon where that learner is and is appropriate. Again, at times, I'm in the classroom, and we're teaching the students concepts that won't be applicable until they're 28 or 30 years old. And what are we doing? Dr. Stoller, what do you think?

 

James Stoller  27:12 

I was going to sort of add to the conversation about scaffolding or spiral curriculum in the following way. And I think there's a funny nuance in medicine. First of all, I agree with both you and Dr. Nguyen that emotional intelligence is foundational. One of the components of emotional intelligence, as you pointed out, Scott, is active listening. And here's the nuance in terms of teaching leadership to doctors; every physician in medical school learning to take history is trained in active listening. We paraphrase, the patient comes. I'm a lung doctor, and patients who are short of breath come and see me. And Mrs. Jones might say to me, “Dr. Stoller, I'm becoming more short of breath over the last three months, particularly in climbing stairs.” And, at some point in the interview, I, like every doctor, would paraphrase that, at some point would say to Mrs. Jones. “So, Mrs. Jones, I understood you to say that you've been getting more shorter breaths over the last three months in climbing stairs, is that correct?” And, of course, that is the quintessence of active listening. I paraphrased in service of two things: making sure I heard her and making sure that I got it right. Now, the paradox here is that, while every doctor learns active listening, they practice active listening in a clinical context. But when we take doctors out of the clinical context and put them in a committee meeting, it's the antithesis of active listening. They're not actively listening to each other. And, in fact, I've often likened meetings among doctors, I can say this as I am one, not to be disparaging, but it's often like a Viking dinner in which there's warring dialogs, to use David Brooks term. People are censoring sentences, cutting each other off. There's no decorum on active listening. And so, the point I'm trying to make is that, as these competencies are scaffolded or spirally developed in medical students, what we have to do is connect the dots so that the competencies that we use in clinical medicine actually apply to non-clinical leadership contexts. And the other point to make is that doctors are all evidence-based animals. And my experience of the evidence that provides sort of an inflection point or a call to action for their own behavior, seeing their own behavior, not hearing evidence articulated at a high level, but seeing their own behaviors and then using feedback on their own behaviors as a predicate for changing the behavior. That's where coaching, that's where experiential activities come in as part of the pedagogy of leadership development. I'll stop there.

 

Scott Allen  29:59 

That's great. Well, Dr. Stoller, you've been at this for a while, and I think what I would love to hear from you is “What do you know?” And I'm putting that in quotes, about developing leaders in your context. “What do you know?” Quote-unquote about developing leaders. You've been doing the work for decades, and it's incredible.

 

James Stoller  30:26 

Well, what I know is this, as with all things, we have more to learn. But what I know today is that number one, this is important work. Number two, organizational success and healthcare organizations are organizations by their very nature. Organizational success requires great leadership. Great leadership is a team sport. I know that. I know that front-runner organizations in healthcare have committed to developing curricula and offering leadership development to healthcare providers within the organization. I know that this is best done interprofessionally, not just with doctors, but with doctors, nurses, and allied health professionals, all working together and learning together because, again, the practice of medicine is an interprofessional and multidisciplinary activity. I also know that as individuals join organizations-- because most doctors are, in fact, joining organizations as they finish their training, very few are going off by themselves into private practice as an individuals -- that organizations, in order to recruit and retain talent, must provide developmental pathways for people in the organization, whether it's developing as a scientist, developing as an educator, developing as a leader. Offering leadership curricula and programs intramurally within organizations is a very important recruitment and retention strategy for talent, so I'll stop there.

 

Scott Allen  32:13 

And Dr. Nguyen, as you look at your career, and again, we know that you're focused a little bit on emotional intelligence and that that's a passion for you, what else are you kind of observing as needs in the healthcare context? What else stands out for you as an opportunity that we're missing right now?

 

MinhTri Nguyen  32:42 

I think I'll speak about what leadership can do for physicians in general. The approach can be EI, emotional intelligence, or other leadership styles. But my thought on this is it comes from, I guess, my hope of what healthcare can be. I really, truly feel, as a new early career physician, that physicians enter the field of medicine for all really good reasons, altruistic reasons, and humanistic reasons. I think many of us, and particularly since the pandemic has really brought this out, a lot of us are starting to feel sort of dissatisfied and less fulfilled in these roles because we find that when we do enter sort of the working years of our physician roles, there's a bit of dissatisfaction and disempowerment within the role of being a physician. And I think that with the hope that I have for sort of embedding leadership within physicians is that we sort of, in some ways, take back the field of healthcare in certain ways, be it within an organization, be it within ourselves individually, because I think we get so inundated with learning the medical parts of our work that we lose sight of these other sort of skill sets that ultimately end up being very important for us to run healthcare, which has grown to be such a beast. It's not just about the clinical work anymore; it is about what Dr. Stoller had said: managing teams and working with multidisciplinary people and non-clinical people. And so, my hope is that if we do sort of pump more of this leadership learning into a physician's life, that in the grand scheme of things, the big picture of why I love doing this work is that it will hopefully empower physicians to not relegate ourselves as like a cog in the wheel, but eventually, empower us to a point where we can push healthcare and push it to a point where we remember it to be what we entered healthcare as; a bit more humanistic.

 

Scott Allen  34:55 

Dr. Stoller, anything stands out for you?

 

James Stoller  34:58 

I agree with that. I think staying close to one's roots and the initial impetus to be a doctor and to be reminded about that over the course of a complex career that gets invaded by many other complex agendas, all of which are important, but which can cloud one's initial appetite to be a physician, I think is very important. We know, for example, and this has been studied and published, the Jefferson Empathy Scale, that empathy, characteristically, among third-year medical students, starts to decline. And that’s precisely the time in their career when they get immersed in hospitals, and on call, and they're tired, and they're stressed, and the reality of being a doctor starts to impose upon them beyond biochemistry and pathology and pharmacology, etc. And so, that's a perfect example of what Dr. Nguyen is talking about. And I think that going to the balcony, if you will, and taking a look at oneself periodically, often with a coach, for example, can be very helpful to remind oneself about the reason we're doing this, to begin with, and what we're here for. But that requires leadership, teams, and awareness of the competencies, as we've been saying and discussing in this conversation, that are overlaid on top of being a really, really, really good doctor. It starts with being a really, really good doctor. And leadership, at least in my institution, and I suspect in most, being a candidate to be a leader is predicated on your commanding clinical respect of your colleagues. Leaders aren't selected because the candidates are deemed not to be capable as doctors, and therefore, why don't we give Jamie a leadership opportunity? I think it’s quite the opposite. I think that leadership is predicated on commanding the respect of your colleagues in your primary role, i.e., being a doctor, but recognizing that the attributes of being a great doctor are insufficient to make you a great leader, and that's the fundamental thing that we've been talking about here. And so, on top of having developed oneself as a really solid clinician, one then needs to take on this extra agenda of learning leadership competencies. If that makes sense.

 

Scott Allen  37:28  

It does. And I was having a conversation with a person this morning, and we were talking about how complexity is just exponential... Today, leadership is exponentially more complex than it was 40 years ago. And that's for any number of different reasons, whether it's globalization, digitization, multi-generations in the workforce, or multiple generations in the workforce. And I oftentimes will say, and Dr. Stoller, I think I've said this to you, I can't think of a more difficult context to lead in than healthcare. Maybe in wartime, that's more challenging, but in a day-to-day, I'm just going to work. I can't think of a more challenging context to lead in than healthcare. Which, to MinhTri, your point is that, you know what? We need to ensure that we're doing this work well and preparing these people to serve in these roles. And Dr. Stoller, what you just said, Jamie, really stood out for me was, look, we need to make sure that they're experts in their craft first. Yes. And then, it's almost like you have to take a step back, check the ego, and you have a whole new mountain to climb when it comes to this work of, ‘Now, how do I get work done through others and with others in a very, very complex setting?” Where many of the approaches and the knowledge that I have in this setting, kind of that lone wolf, doing it myself, studying hard, a lot of that, it's not going to serve me well in this new role, in this new context, and I'm going to have to, in many ways, be ambidextrous. Does that make sense?

 

James Stoller  39:20 

Perfect sense.

 

Scott Allen  39:23 

MinhTri? 

 

MinhTri Nguyen  39:25 

Yeah. I want to highlight, I think, what Dr. Stoller mentioned about how physicians are, I think, promoted to their leadership roles based on clinical acumen, oftentimes. And then he writes about this wonderfully in his call to action. And I think it's sort of a double-edged sword too because what happens is, if we forget about leadership training earlier on, then we run into that situation that you're talking about, Scott, where you do now when you're in that leadership role, you almost have to sort of forget all of your leadership lone wolf training, sort of situation, and then learn a new subset of clinical or leadership skills that you never heard of before. So, the double-edged sword there for an organization is, one, you just lost a really good clinician, one of your best clinicians, actually, that's the reason why they were promoted, because now they have all this work that's not clinical. They're not doing their clinical work anymore, or maybe they're doing less of it. And so, not only have you lost a really good physician, you've earned a really bad leader. So, it's a double-edged sword. You're losing on both sides. So, my argument to all of this would be that we start leadership training early because then, yes, you get to that point, you do lose a little bit of your clinical work, but you actually still had some of that leadership work prior to being in that new leadership role. You don't have to start from scratch.

 

Scott Allen  40:48 

Yeah. And we don't lose on both ends like you just said. It's a beautiful puzzle you all. It's a beautiful puzzle. And I have great respect for the fact that you are working the puzzle. I just love this conversation because my passion is how we better prepare people to serve in these really challenging roles. It's not easy, it's not easy. It's very, very difficult. And, at times, I don't think we do a good job of that in all kinds of contexts in organizations. But healthcare is a fascinating context. And, in many ways, I think, prepared to do the work better than many organizations because there's a lot of structure, and there's a lot of hierarchy and a lot of learning and continuous learning that exists. So, I just have great respect. Well, as we begin to wind down our time together, I would love to know what's caught your attention recently. And so, I always end these conversations by saying, “What have you been reading, streaming, or listening to? It could have something to do with what we've just discussed. It could be nothing. It could have nothing to do with what we've just discussed.” But maybe, Dr. Nguyen, what has stood out for you recently? What's been catching your attention?

 

MinhTri Nguyen  42:05 

This is really funny. This will at first seem like it's very not connected, but I think it is. So, I started taking a course on Coursera. It's a free course. It's on AI. It's through Andrew Ng, N-G, from Stanford, who does a free course on AI. The reason why I did this, and this is kind of funny, is because I was talking to a friend the other day, and we kind of joked about it. It seems like everywhere I go, be it at a conference a lecture, or anything where there's a speaker talking, it just seems like when it gets to the question and answer session, someone always inevitably raises their hand and asks about AI and how it will affect that presentation, topic, whatever it be. So, it's always a joke that I'm like, “If you don't know what to ask,  just ask about AI.” So, that's sort of my running joke. But I'll be honest here, I think there is a connection here to what we're talking about, and that is that I see technological advances in our society. We can see it as one thing as physicians. We can see it as a threat that these technological advances can take over our duties and our roles as physicians. Or we can see that these technological advances really -- I think Adam Grant said this at one point -- really places a premium on interactions and relationships that we have with each other. And so, the soft skills that we learn, the skills that we learn in leadership training, and emotional intelligence, things like that, the things that really make us human, I think that's what's going to be becoming really increasingly important for us to master as physicians because of the technological advances.

 

Scott Allen  43:46 

Love it. Love it. Exploring AI. Dr. Stoller?

 

James Stoller  43:51 

Well, that's a wonderful question. I guess my passion is really anchored in high performance and organizational effectiveness. And so, much of what I have read and think about is that. A particular lens around this is based on work that I and several co-authors have published on virtue-based leadership. When one creates environments that are anchored in the seven classic Aristotelian virtues of trust, compassion, hope, justice, wisdom, temperance, etc., that unleashes discretionary effort in the organization. That's where high performance comes from. So, in that regard, I avidly read David Brooks, one of my favorite pieces it is called the ‘Moral Bucket List,’ in which he talks about resume and eulogy virtues. We've written on this several recent books that I don't want to sound self-promoting, but the work on ‘Better Humans, Better Performance,’ which is a book that Dr. Peter Rea and Dr. Alan Kolp and I have co-authored, I think, is our attempt to try to make sense of this across multiple sectors. MinhTri and I have also mentioned Adam Grant. I love his work ‘Give and Take.’ I've recently finished his book, ‘Hidden Potential,’ which is really about selecting talent on the basis of its trajectory, rather than on… It aligns very well with our holistic view of interviewing medical students, trainees, and residents. And then lastly, I guess, there are two talks that are on YouTube, one older by Don Berwick, his commencement address to the Yale Medical School maybe 5, 10, years ago in which he… It's just amazing, I won't even attempt to summarize it. And then, more recently, Ken Burns addressed… He was a commencement speaker at Brandeis University this year, and I think he delivered what I would regard to be an incredibly articulate, brilliant presentation to the graduating class of Brandeis just several weeks ago. So, those are the things that have recently caught my attention. 

 

Scott Allen  46:14 

Love it. I will also put links to all of those resources in the show notes. And I will put a Coursera AI, just a general link so people can figure out where to go. 

 

MinhTri Nguyen  46:25 

Yeah. The name is ‘Generative AI,’ by Andrew Ng.

 

Scott Allen  46:31 

Awesome. And so, a book for the two of you that has caught my attention in recent times; Steven Kotler, ‘The Art of Impossible.’ K-O-T-L-E-R, ‘The Art of Impossible.’ Absolutely incredible. And so, he is extending the work on flow and how people enter flow states. And he has studied world-class athletes. And just fascinating, fascinating listen, I listen to it, or read if that's what you choose to do. Well, Dr. Nguyen and Dr. Stoller, thank you so much for joining me today. I really, really appreciate your time. And thank you for the incredible work that you're doing. You are exploring and making the world a better place on a few different fronts, and we appreciate that.

 

MinhTri Nguyen  47:19 

Thank you for having me, Scott.

 

James Stoller  47:20 

Thank you. Thank you.

 

Scott Allen  47:21 

Okay. Be well. 

 

 

[End Of Recording]