See, Hear, Feel

EP53: Dr. Michael Dewsnap on reflection, the lived experience, and emotional intelligence

March 15, 2023 Professor Christine J Ko, MD / Dr. Michael Dewsnap Season 1 Episode 53
See, Hear, Feel
EP53: Dr. Michael Dewsnap on reflection, the lived experience, and emotional intelligence
Show Notes Transcript

Dr. Michael Dewsnap lends his insights as a medical educator in leadership on the role of reflection in integrating the lived experience and emotional intelligence. He addressed the hidden curriculum, and given that physician time is valuable and limited, channeling the lived experience is likely key in developing the skill of emotional intelligence. Dr. Michael Dewsnap, PhD, MSEd is the Executive Director of the Learning Environment Engagement Program in the central Office for Diversity at Texas A&M University. He is as an Instructional Assistant Professor in Humanities in Medicine in the School of Medicine. Dr. Dewsnap earned his M.S.Ed. in Educational Administration from Baylor University and his Ph.D. in Education and Human Resource Studies with a specialization in Higher Education from Colorado State University. He teaches and is engaged in scholarly activity around leadership in medicine, especially as related to the lived experience of physicians. Dr. Dewsnap has a recent article on the lived experience of medical training and emotional intelligence. 

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I have the honor of speaking with Dr. Michael Dewsnap. Dr. Michael Dewsnap, PhD and MS Ed is the Executive Director of the Learning Environment Engagement Program in the central Office for Diversity at Texas A & M University. He is an Instructional Assistant Professor in Humanities and Medicine in that School of Medicine there. Dr. Dewsnap earned his Master's of Science and Education in Educational Administration from Baylor University and his PhD in Education and Human Resource Studies with a specialization in Higher Education from Colorado State University. He teaches and is engaged in scholarly activity around leadership and medicine, especially as related to the lived experience of physicians. Dr. Dewsnap has a recent article on the lived experience of medical training and emotional intelligence, and I'll put a link to that into the show notes. Welcome to Dr. Dewsnap. 

[00:00:58] Michael Dewsnap: Thank you very much. Very pleased to be here. Appreciate it. I'm really excited to talk about this topic. It excites me. So let's get going.

[00:01:05] Christine Ko: Can you define the lived experience for listeners? 

[00:01:09] Michael Dewsnap: Absolutely. That's a very important question, and again, thank you for having me here. The lived experience is really our everyday interactions, our social exchanges, and what that might look like for, say me, is when I'm working with medical students, and either I'm giving a lecture or I'm facilitating a small group. It's my interactions with those medical students on the topics. It's when I interact with them in the hallways, maybe when I'm sitting even on committees like a curriculum committee or a student performance committee. It's how I understand what it means to be a faculty member, an administrator in medical education. What it might be for physicians is history taking, interacting with other medical students, patients, those specific interactions that really provide meaning to the people from those experiences. The everyday life experiences that you and I encounter. 

[00:02:00] Christine Ko: Yeah. I always wanted to be a doctor. My medical school was traditional, the first two years. Just educational, and you didn't really have patient interaction. And then the second two years, you're on the wards, you're doing different clinical rotations. And the lived experience of training to be a doctor was so different than the educational one for me. It was very hard for me, I think, partially because I wasn't good at these relationships of interacting with residents and attendings. I didn't have a good basis for how to do that successfully.

[00:02:34] Michael Dewsnap: A lot of times in medical education, we use a different term that really relates to the lived experience of, say, medical students and what medical students learn from being in medical school. It's a term called the "hidden curriculum". What we learn about the norms of behaviors, what's accepted, what's not. If an attending says it's okay to be open and talk and ask questions, and then you go into rounding, and you are open and you ask a question, but then it's not accepted, then you know that the norm is, don't ask it here. The hidden curriculum and lived experience are very similar and very important to the life of a physician. 

[00:03:07] Christine Ko: Yes. The hidden curriculum. I think our ideals and what I teach and what I'm taught are quite different from the hidden curriculum, which is confusing. 

[00:03:17] Michael Dewsnap: Yeah. It can be confusing. Sometimes the awareness of those aspects is a good place to start. 

[00:03:22] Christine Ko: Coming back, then, to emotional intelligence, which we mentioned just briefly, to pick up on the hidden curriculum and any kind of incongruence with the ideal lived experience and what the actual lived experience is for someone.... Can you define what emotional intelligence means to you, and why it's important? 

[00:03:43] Michael Dewsnap: Yes. Very important term. I've heard it defined in various ways. It's a capacity, like it's almost like buckets that you either have filled or you don't, and different people have different size buckets, but that's a very static view. I've also heard it as an ability, something you can develop, but also an ability can atrophy, if you don't use it, just like a skill. Based on those different definitions in the literature is, it's a deliberate awareness of one's own emotions that moves you towards the ability to self-regulate those emotions, for yourself, and also the deliberate awareness of the emotions of others and to be able to manage those relationships. You can have a skill, but whether you deliberately use those is another thing.

[00:04:29] Christine Ko: I appreciate that definition because I don't think I fully realized how much emotion plays a role in all of these everyday interactions. I was more focused on, what are we supposed to do? And what are we supposed to learn here? It took me time to develop that awareness that emotion actually does come first. it is there. I've thought recently much more about shame in medicine and shame in medical learners. I read this book called Between Us by Dr. Batja Mesquita, where in her research, emotions are not the same between individuals. Emotions are situated between you and me, between a medical learner and the attending, which I think goes along with that lived experience and the hidden curriculum. If I have an interaction with someone who welcomes my questions, even if I feel shame about not knowing, it's very different than if I feel shame, and I have questions, and I can tell that they just think I'm an idiot. 

[00:05:31] Michael Dewsnap: Yeah. Shame is a very interesting topic. There is a performative aspect of medical education that sometimes is so embedded within learners. There's an implicit understanding of if you don't know that there is a sense of shame that you have to have, and that can be detrimental in many ways. There is a reason for emotional intelligence and being aware of, okay, I don't know, I feel this performative culture. I'm not measuring up, I just don't know... that leads towards that self-regulation because it can be very detrimental to the learner, and maybe even also lead towards aspects of, say, burnout.

[00:06:05] Christine Ko: Yes. Shame in the US is much more something that you just absolutely turn away from, and you do not want to examine it. It's not a motivating thing. It's actually a very destructive and detrimental emotion in the US, and especially for medical learners, because then as you said, for someone who feels, oh, I'm trying so hard and have learned a ton, but I still don't know X, Y, Z, I'm never gonna learn X, Y, Z...., and you continue to feel shame about that, yet you turn away, then yeah, I think it's a complete recipe for burnout. 

[00:06:36] Michael Dewsnap: Absolutely. I used to be a learning specialist working directly with medical students, and often they would come to me and say, oh, I'm just not getting it. Or, I feel embarrassed when I don't know something. And a lot of times their response is, I'll just try harder. That becomes very difficult cycle of just trying harder when you feel that shame; there's not always enough time to try harder. So it can lead to other aspects that are not helpful for that learner. 

[00:07:00] Christine Ko: Yeah. I appreciate that you just brought up the aspect of time. I think everyone knows that doctors just don't have enough time. Can you talk about how that sort of intentionality of combining emotional intelligence and lived experience can really help medical learners and physicians?

[00:07:17] Michael Dewsnap: A really key, critical component to intentionally bring that together, learning and lived experience, is reflection. I'm a very strong proponent of reflection. Oftentimes reflection can be perceived as a very soft, fluffy thing in a hard science-based field, but it's really self-assessment, and stepping back ,and saying not only what went well and what could have gone better with the patient. Reflecting inward about how did I handle this situation when I talked to the patient; or when I talked to the tech, when I interacted with that family member, what could I have done better? How could I have framed it? So reflection bridges the gap between learning and the lived experience. Reflect on what you experienced so that you can learn from that experience as well, the medical context, how you not only deliver medicine, but how you understand how to become a physician.

[00:08:11] Christine Ko: Yes. How to become a physician. Can you address what you mean by that? Becoming a physician?

[00:08:18] Michael Dewsnap: Becoming a physician: it's not just about the facts and knowledge cause you're not gonna go into a clinic and have maybe a, b, c, d over a patient's head and select it. Part of becoming a physician is understanding the art of medicine. For example, I spoke with a student yesterday during a small group. And I was fortunate to have my wife in the room who had that clinical perspective. One of the students brought forward the example of a patient coming in when she was shadowing a physician. This patient communicated that they would drink maybe a 12 pack of Coke a day. Then the physician very tersely turned to the patient and said, you just need to stop that. The student said that patient began to start crying because that's what they had. They didn't like water. It was easy. It was this and that, this, that and the other. So part of the patient communicating is that they want their own experience to be validated, that they have emotions and feelings. So part of becoming a physician, from my perspective as a non-clinical educator, is understanding that there is a humanity component to it, too. That yes, there is knowledge, yes, there are facts that are extremely important, but you all are in the business of the human experience. Understanding that you may not have those emotions as much when you see patient after patient after patient, but each patient is coming to you with these emotions, and these realities, and their lived experiences that are very important. So part of becoming a physician is being able to interact with their own human experience.

[00:09:39] Christine Ko: Yeah. For me, I realized I need to be a human being in the room, as a doctor. Not to blame the hidden curriculum, but I do think that I got it from the hidden curriculum that I was exposed to, that being a doctor is about facts and knowledge, and that emotion did not need to be addressed. Maybe I misunderstood. Like for example, Dr. Osler's comments on emotion... Physician, leave emotion outside of the room. It's hard because I think he wasn't exactly wrong. Of course I shouldn't come into a room and be bawling or angry. I do need to be calm myself because the patient's lived experience is more important than my own in that moment. But I can't ignore the fact that I'm a human being, and just say tersely, oh, you just need to stop that, because that's never gonna be well received. We know that it doesn't work with family, it doesn't work with friends. It's not gonna work with a patient. 

[00:10:30] Michael Dewsnap: You're right. We see maladaptive responses from physicians, and even other fields, to where they feel like emotions are not supposed to be there. This is going full circle back to emotional intelligence. Emotional intelligence: there's a couple of components. The first is understanding your own emotions and then moving towards regulating that. That's a piece that has been missing in a lot of literature and especially in the leadership literature, which is my area. Emotional intelligence is that skill that leads into being able to effectively lead others. If you could understand perspectives, challenges, stressors of those on your interprofessional healthcare team, you can begin to understand how to work with them more effectively, which leads to a lot of other positive benefits. Being able to effectively lead is being able to effectively understand who you are as a person, who you are as a human. When I talk to students, I say, in the end, I hope that you become keen observers of the human experience. Your own and of others. Why? Because you're dealing with the human experience, sometimes from birth to death. [Yeah.] Physicians have the responsibility to understand that. To me that, that's exciting. 

[00:11:39] Christine Ko: Yeah. One thing that has helped me combat burnout is really recognizing that lived experience of patients and what a privilege it really is to see that. I did mean to go back to something you said about your work in leadership and how there hasn't been so much reflection of these concepts in literature on medical leadership. Because medicine is still very hierarchical, it is hard when leadership doesn't set an example. 

[00:12:10] Michael Dewsnap: Yes, hierarchies are very deeply embedded within medicine. That becomes problematic when the messaging is contrary to what, say, student learners or other physicians see. That's hard to change when the hierarchy is so embedded. How do you do that? It starts with each person and starts with that awareness. 

[00:12:31] Christine Ko: Yes. I so appreciate all of your thoughts and time. Do you have any final thoughts? 

[00:12:36] Michael Dewsnap: I really appreciate being here. I had the blessing to walk alongside my wife, who is a physician, throughout her medical education, residency, now professional practice. It's been a fun journey. I really enjoy medicine and medical education and working with physicians cuz you all have the responsibility of the human experience. And so that's quite an honor for me to be a part of a little bit of the journey, for many physicians.

[00:12:59] Christine Ko: Thank you. Thank you for your time. 

[00:13:02] Michael Dewsnap: Thank you very much.