Transcript The Carrot and the Stick Program Directors as Coaches Mark L. Friedell, MD Chairman of Surgery University of Missouri Kansas City APDS Presidential Address San Diego, CA March.

The Carrot and the Stick
Program Directors as Coaches
Mark L. Friedell, MD
Chairman of Surgery
University of Missouri
Kansas City
APDS Presidential Address
San Diego, CA
March 21, 2012
“My reward has been
watching you develop
into fine young surgeons.
I wish you all the best and
will always be glad to
help in any way I can.”
H. Brownell Wheeler, MD
June 1984
“To Brownie Wheeler, my friend
and mentor. Thank you for giving
me the opportunity to have a
successful and rewarding career
in surgery and surgical
education and for all your
support along the way.”
Mark Friedell, MD
President, APDS
2011-2012
January 14, 2011
“ Each resident has a story to tell. And
nothing is more rewarding than
observing their developing cognitive and
technical skills. Although they learn
much more after they leave us, I hope we
have made a little imprint on their souls.”
--Bruce Brener
Am J Surg 1996;172:97-9
The Definite Dozen
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Respect yourself and others
Take full responsibility
- How can you improve if you are never
wrong
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Develop and Demonstrate loyalty
- Surround yourself with people better than
you and appreciate them
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Learn to be a great communicator
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Listening is crucial
Discipline yourself
- Discipline separates excellent from
average
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Make hard work your passion
Don’t just work hard, work smart
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Success is having the right person in the
right place at the right time
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Know yourself and those around you
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Put the team before yourself
Make winning an attitude
- Confidence is what happens when
you’ve done the hard work that entitles you
to succeed
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Be a competitor
- You can’t always be the most talented
person, but you can be the most
competitive
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Change is a must
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It’s what you learn after you know it all
that counts
Change equals self-improvement
Handle success like you handle
failure
- You can’t always control what happens
but you can control how you handle it
- Sometimes you learn more from losing
that winning.
Similarities between Coaches
and PDs
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Recruitment
Creation of a culture/providing
opportunity
Coaching the players (residents)
Being a role model
Life-long learning (PBLI)
Job gratification
Core Competencies
Basketball
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Professionalism
Communication
Teamwork
Life-long learning
Fundamentals
Fundamentals
Surgery
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Professionalism
Communication
SBP
PBLI
Patient Care
Medical knowledge
Building a Team
(Recruitment)
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Character move important than
talent
Expectations shared with
candidates
Coaches who were your former
players will know the culture
Surround yourself with people
strong enough to say no
PHYSICIAN ATTRIBUTES
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CONSCIENCE
SENSE OF HUMOR
LOVE OF LIFE
BOUNDLESS ENERGY
STRENGTH AND
STAMINA
OUTSIDE INTERESTS
HOBBIES
TOLERANCE
UNDERSTANDING
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CONFIDENCE
HUMILITY
INTELLIGENCE
LOVE OF TEACHING
BREADTH OF VISION
SEARCH FOR TRUTH
HUMANITY
WISDOM
RECEPTIVE TO
CHANGE
- Arthur Aufses, MD
1996
Creating a Culture
Team Analogy
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Wooden: “It takes 10 hands to
make a basket”
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K: Individual fingers vs. a fist
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Summitt: Individual pencils vs.
pencils bound together
Creating a Culture
Positive learning environment
Little Red Book 2012
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Is the house staff happy?
Is morale good?
Is there turnover?
Who really does the cases?
Is the attending/resident staff supportive or
abusive?
Creating a Culture
An extended family
Traditional social functions
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Graduation banquet
Welcome party
ACS reception/dinner
Christmas party
Attending important events in the
lives of the residents
Honoring members of the team
Seniors teaching juniors
Central Surgical Association
Presidential Address:
Surgical leadership – lessons learned
Layton F. Rikkers, MD, Madison, Wis
“My wife has been a fully engaged
partner in my leadership activities. She
is a first rate recruiter, an insightful
counselor on difficult issues, and a major
contributor to the family-like atmosphere
we have been able to establish in the
department.”
Surgery, 2004:136:717-724
Creating a
Culture
Providing
Opportunities
Providing Opportunities
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Board passage rate
Fellowships obtained
Case numbers
Comfortable doing general
surgery after 5 years
Reputation of program
Coaching the Players
Wooden’s four P’s
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Planning
Preparation
Practice
Performance
In basketball and in life
Coaching the Players
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Use every minute of practice
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Conferences
Rounds
Skills lab
OR
Disciplined intensity
Direct, honest, timely feedback to
allow them to reach full potential
Coaching the Players
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The carrot and the stick
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The importance of balance
in life
“Most important, there is probably
no better carrot than approval from
someone you truly respect, whose
recognition you seek.
Acknowledgement, a pat on the
back, a wink, a nod of recognition,
or praise from someone you hold in
high esteem is most powerful.”
- John Wooden
Use of the Stick
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Lack of professionalism
Absent work ethic
Not being a patient advocate
Poor communication skills
Poor ABSITE scores
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Dishonesty or lack of integrity
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Balance in Life
Cats in the Cradle
My son turned 10 just the other day.
He said, “Thanks for the ball, Dad,
come on let’s play.
Can you teach me to throw?”
I said not today, I got a lot to do, he said,
“that’s okay. “
And he walked away but his smile never
dimmed,
And said, “I’m gonna be like him, yeah, You
know I’m gonna be like him.”
Presidential Address
Surgical mentorship
Irving L. Kron, MD
“Cardiac surgery is a life-time obsession.
There is more to life than this. We must
convey this to our residents and
students. Balance is everything. We
must be able to look after our families,
our friends, and ourselves. Teaching this
aspect of humanity will make us better
physicians and surgeons.”
The Journal of Thoracic and Cardiovascular Surgery, 2011:142:489-492
The Role Model
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Lead by example
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The student should exceed the
teacher
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Be able to enjoy the success of your
students
Presidential Address
Lessons Learned as a Surgical Chairman
Edward M. Copeland, III, M.D.
From the Department of Surgery, University of Florida, Gainesville, Florida
It is a privilege to have the life of
another person placed in your
hands. It is a unique privilege to
serve as a role model for those
who will assume the
responsibility of the lives of
others.
The American Surgeon, 2002:68:505-507
“I believe giving and receiving the benefits
of mentoring is a lifelong process.”
“ ‘The student should exceed the teacher.’
I believe this mantra reflects the attitude
and posture of a real mentor.”
The American Surgeon 2007; 73(6):529-37
Central Surgical Association
Presidential Address:
Surgical leadership – lessons learned
Layton F. Rikkers, MD, Madison, Wis
“One of the results, and indeed a
foremost objective of mentoring, is that
some of those you mentor might surpass
you. When that happens, a key
characteristic of the good mentor is the
capacity to step into the shadows and
shine in the reflected light when the
television cameras arrive.”
Surgery, 2004:136:717-724
Life-Long Learning
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“It’s what you learn after you know
it all that counts.”
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“I have a love-hate relationship with
losing. I hate how it makes me feel
but I love what it brings out. It
forces our players and coaches to
improve and make better decisions.
PD PBLI
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Resident failure to perform
Board exam failures
A poor recruiting year
An unpopular rotation
An unpopular faculty member
A poor ACGME survey
A poor RRC review
The Rewards of Coaching
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Watching the development of the
players under your guidance.
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Becoming a life-long friend and
mentor to the former players.
Presidential Address
The Top 10 Reasons Why General Surgery Is a Great Career
Richard C. Thirlby, MD
Every surgeon in this room is somebody’s hero.
Of all the letters I have received from graduates of
our program thanking me for being part of their
training, perhaps the one that affected me most
profoundly ended like this. “How does a student
thank a mentor?...How do we thank you for
those gifts? We emulate you.”
Arch Surg, 2007:142:423-429
“In my office, I have a picture of both
you and Dr. Quijada in the waiting
room. About one in five patients ask
me about it and I always enjoy giving
them the background with great
pride. Both of you made my training
a personal matter and I’ll never
forget it.”
Joseph Muller
2003
“I am having a blast in fellowship. I am
doing 15-20 endocrine cases per week.
On call I have had some variety as well. I
did a femoral embolectomy, sigmoid
colectomy, duodenal perforation and
appendectomy so far. I am living on cloud
nine. I am functioning as a junior
attending with the bosses preferring to
leave me alone but very willing to help if
needed. I am grateful every day for my
training from ORMC.”
Mark Versnick, MD
2011
HBW: Resident Advocate
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Enjoyed working with residents
Cared about residents’ welfare
– Service vs. education
– Stress
– Encouraged their input
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Took pride in their
accomplishments
Provided positive reinforcement
during residency and career
“ Would you like to
speak to the man in
charge or the
women who know
everything?”
“Actually, having a really topflight program is the product of
virtually everybody related to it,
particularly the residents
themselves. In this regard, I
think the prospects are bright.”
H. Brownell Wheeler, MD
July 1984