EP188: Flourishing in Medicine: Exploring the PERMA Model with Dr. Maddie Lagina

Cultivating Joy in Medicine: Dr. Madeline Lagina on PERMA and Positive Psychology

In this episode of The Girl Doc Survival Guide, Dr. Madeline Lagina, Clinical Assistant Professor at the University of Michigan, delves into the importance of joy in education and medicine. Drawing from her paper on the PERMA model—a framework for well-being comprising Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment—Dr. Lagina shares personal anecdotes and insights on how joy and other positive emotions can significantly impact both educators and learners. The discussion explores how fostering joy can counteract burnout and enhance professional fulfillment, especially among physician educators.

00:00 Introduction and Guest Welcome

00:34 Personal Anecdote: The Impact of a High School Teacher

02:48 The Concept of Communicable Emotions

04:02 Exploring the PERMA Model

06:13 Applying PERMA to Physician Educators

12:57 Tips for Flourishing in Career and Life

15:34 Final Thoughts and Conclusion

Transcript

Christine Ko: ​[00:00:00] Welcome to The Girl Doc Survival Guide. Today I'm pleased to be with Dr. Madeline, or Maddie, Lagina, MD MPH. Dr. Lagina is a Clinical Assistant Professor of Pulmonary Diseases and Assistant Director of the Pulmonary and Critical Care Fellowship at the University of Michigan. She attended Emory University for college and medical school and trained at the University of Michigan. She has written on the PERMA model for physicians and that will be our main topic today.

Welcome to Maddie.

Maddie Lagina: Thank you so much, Christine. I'm so glad to be here.

Christine Ko: Yes, thank you. Before we hit the PERMA model, can you start by sharing a personal anecdote?

Maddie Lagina: Yes, absolutely. I had this AP bio teacher in high school, and he was this really gregarious, energetic, enthusiastic guy, and I loved going to his class because he just showed so much genuine excitement for the material he was teaching and genuine care for the students in his class. [00:01:00] He really valued connection and learning. He proved to me in a very tangible sense that joy is a communicable emotion. I would sit in his class and get more and more excited about biology and the sciences. I thought that was such a special thing, and it left such a lasting impression on me about education, the way I view it as a whole. It grew with me through my roles as an educator myself in college, in medical school, public health school, and through training, and now as an attending.

And I feel as long as you can commit to being excited in the moment and commit to being excited about having learners and teaching learners, you have a shot at generating something truly special that's so inspiring. So shout out to Mr. Zarney in Traverse City, Michigan for how excited and wonderful he was as an educator. 

Christine Ko: That's awesome. I love your story because it's true. I think teachers, especially high school, maybe don't get enough credit. They really can [00:02:00] change students' lives. I still remember some of my high school teachers, but I've never really gone back to my high school. But, Mrs. Lee, Ms. Widdekind. 

Maddie Lagina: It's incredible, isn't it? Incredible. You're exactly right. For people like us who have been through years, I'm not gonna say how many years, but years and years of training in education and had many people give us lectures and be our teachers. It's a testament to how important those formative moments are in education. And they can come, every now and then, maybe early on in the process or later on, but there's this moment of like connection with one or two of your teachers who you really resonate with. And I think that's really special. That's one of the most special things to me about education. I'm grateful for him. 

Christine Ko: Shout out to Mr. Zarney. I also am interested what you said. You said, joy is communicable? Can you expand a little on that? 

Maddie Lagina: Yes, absolutely. This was actually one of the motivators that I had behind writing the paper that we're gonna talk about today. There [00:03:00] are communicable or contagious emotions, and one of those is joy. Another is burnout. Burnout is also communicable. If your teachers are burned out, then the students that learn from them are more likely to inherit those challenging emotions or challenging perspectives. When I read about a little bit more about joy in the positive psychology literature, I just got so excited because I thought that's it, right? That's gotta be it. Soak in joy. That is really the underpinning for the paper that we wrote and the interest that I have in academics. 

Christine Ko: I spoke to a researcher in emotions named Dr. Batja Mesquita. Her concept is that emotions are actually between people. They're not like inside my head or my body. It's actually between you and me. That resonates with me, what you just said about joy, about burnout.

I read your paper about the PERMA model because I had spoken to a colleague of mine named Dr. William James, and he had mentioned Dr. Martin [00:04:00] Seligman's work on PERMA. Can you explain the PERMA model, what that acronym is and your interest in it? 

Maddie Lagina: Yeah, absolutely. The PERMA model is like many other models just a framework that we can use to better characterize the positive set of emotions that we experience that can help us lead to human flourishing. Seligman calls it overall wellbeing. The model has five different domains. It's an acronym for each of those domains. So P is for positive emotion. This is like savoring those little happy feelings that you have when you're doing your favorite hobby or reflecting on a moment that brought you a lot of sort of happiness in your day. E is for engagement. This is a really cool one.

This is really about flow. Flow is a subconscious kind of loss of attention when you're so deeply attentive to something; Seligman calls it getting lost in the music. This is defined by someone practicing something at the top of their character strengths. So If [00:05:00] an educator is creating a lecture or refining their lecture, they may enter a flow state where they're working for six hours and all of a sudden they look up and it's midnight and they have to go home. That's what engagement is. And then R is for relationships, which is pretty self-explanatory. This is what we were talking about earlier. The value that we have in these relationships and relational moments. And then M is for meaning, and meaning is defined in this model as participating in something that is more than self or greater than self; having a cause contributing to the common good. Those things are considered in alignment with meaning. And then the last category is A; A is accomplishment, and that's. Again, pretty self-explanatory, but it's working towards your internal goals. So you're setting a goal for yourself, and it's in alignment with what your kind of internal wishes and values are. That's accomplishment. The idea is that if you hit dingers in every category, you're [00:06:00] flourishing, right? If you're doing really well in positive emotion, engagement, relationships, meaning, and accomplishment, then you are flourishing. 

Christine Ko: Nice. Okay. And so you wrote a paper about PERMA as related to physicians?

Maddie Lagina: I wanted to use a positive psychology model to help us understand where really good educators in medicine were deriving their sources of joy. I was most interested in the professional aspect because we had talked all the time in my medical training and medical school and residency and fellowship about burnout and how challenging it is to treat, overcome; how challenging it can be to reduce the symptom burden, and I just thought why isn't anyone talking about the corollary here? Which to me was, why aren't we trying to amplify sources of joy for physicians at work? [00:07:00] And I had attended many pizza parties, wellness pizza parties, and thought, gosh, I wish that I myself had a better sense of what brings people joy at work. Specifically physician educators. I wanted to also pick that group of people because they have in their hands the most impressionable next generation of physicians, and if I understand that joy is communicable and so is burnout, then it was important to me to understand how these highly skilled educators, who had the future generations in their hands, derive joy from their work. That's what prompted the investigation and how we ended up writing the paper. 

Christine Ko: I love it. It's really applying, it seems to me, the positive psychology movement to medicine. Why not prevent burnout from the beginning and focus on the positives as you're saying. What did you find out with writing about PERMA as related to physicians? 

Maddie Lagina: PERMA model is [00:08:00] both a model used to characterize and understand positive emotions at work, but you can also make it work for you on an individual level. So if you look at those areas where people find a lot of fulfillment and joy, and one of them is lower than the others, then that might become a target for amplifying joy at work. And so the idea of our investigation was to just figure out what are the targets. We looked at highly rated physician educators, and we did a deductive coding of the responses to their interviews, and we found that a lot of the people who are in the highly rated educator group had very robust sources of joy within each category. So they were like, oh yeah, let me talk about all of the positive emotions that I get from the moment when something clicks with a student; or, oh, yes, absolutely, I derive [00:09:00] meaning from teaching the next generation of people, and they weren't given the PERMA model to concoct these things. They were just speaking freeform about where they derive joy. A lot of them were saying a bunch of stuff in each of these individual domains. And so we felt like, gosh, this seems to really well describe the breadth of professional joy for educators.

Christine Ko: Yes. To summarize what you said, what you found in your study is highly skilled educators, highly rated educators, have positive emotions, and they feel meaning, and they feel a sense of accomplishment when they're teaching. And the relationship with the learners is important and they're engaged in it. It's a state of flow. So like earlier when you said if you can hit something in all five of those areas, you're probably flourishing. So essentially, even though these highly skilled educators weren't given the PERMA model ahead of time, just extemporaneously, when they were asked what does bring [00:10:00] you joy? Their answers were just hitting all of these five areas.

Maddie Lagina: Exactly right. They responded with a lot of color in their responses, and they talked about various things that would fall really nicely into each of those categories, even though they hadn't been given any of those categories.

Christine Ko: It makes sense because I'm still a learner. As a learner, I have to say that more and more, I do believe that a really good teacher is so important. It can make something that seems really difficult much easier. And it makes sense about the highly skilled educators, what you found in them, because even going back to your teacher from the beginning and the two teachers I named that I remember from high school, just offhand, they were engaged with teaching and they cared about us as students. And I think they did find meaning. Like Ms. Widdekind was a math teacher. And I remember during the summers, [00:11:00] she would go take advanced math classes. She loved math.

Maddie Lagina: I love it. I love it. People actually have looked at this as well: does it matter if your teacher is good versus enthusiastic or open and energetic? The answer is no. Enthusiastic, joyful teachers are the people who inspire students to learn more and to connect with the material. If you put skilled people who derive a lot of joy from doing the job they're doing in front of learners, you just have the best combination for everybody. You have a lot of opportunity to spread joy and to spread enthusiasm and inspire people in those circumstances. 

Christine Ko: Nice. You said you were a resident when you did that work. Has it had a lasting influence on how you approach your job? 

Maddie Lagina: I would say definitely. It's really important to enter a space and be cognizant of the energy that you're putting [00:12:00] out to the people around you, particularly learners, cause they're particularly sensitive to contagious emotions. And I think if you really embrace the attitude of, I'm going to be joyful in this space; not necessarily, I'm going to feel happy all the time. I work in a medical intensive care unit. We have a lot of sick patients, but I try really hard not to create an environment that is without enthusiasm because I feel that's the key ingredient. If you can make somebody else's day the tiniest bit better, that includes your colleagues, patients, people around you; then you're gonna go home and feel better about the work that you did that day. That's probably the main takeaway from the paper and something that I'll keep with me as I continue my career as a medical educator.

Christine Ko: I like it. So that might then be your answer to this question. Do you have tips for [00:13:00] flourishing in your career or life for others? 

Maddie Lagina: Gosh, if my name was Martin Seligman, I feel like I could tell you so many more tips for human flourishing. What I would say is, nobody has it figured out. I wish I could say that doing this type of academic work has given me this armor against burnout. And like I said, I'm not like this perpetually radiating set source of joy at work. But I do think that being intentional about those positive emotions, taking a moment and reflecting on the things that went well, taking a moment to be grateful, identifying the times when you really connect with something, trying to prioritize connection with the people around you is like a super important part of the process. In my job as an intensivist, it's even more important because a lot of times the clinical work is challenging, [00:14:00] is fast-paced; it's emotionally charged, and if you let it take you away from this sort of center, your connection to the work you're doing and your connection to your team, then you can get lost in the day to day. Just reminding yourself that okay, we can take these moments, and be grateful, and try to focus on the positive. And even if you're not feeling it, try to put joy out into the world for the people around you. I think that's probably the best I could say. I'm talking about it in a professional context, but of course you could do that in your real life too. I do not always do those things, but I try my best. That's as much as we can do. 

Christine Ko: I think you're right. More and more, I believe, and I guess it's sad because it means in the past I didn't, but I believe my best has gotta be enough. It has to be because I'm not perfect by any means. There are days where I won't, as you said, I definitely will not radiate any sort of joy, much less even much positive energy. And maybe I'll be radiating negative energy. And [00:15:00] then hopefully someone else sees me and is, oh, you seem off today. And then they can give me positive energy and make up for my lack.

Maddie Lagina: That's right. I think that's a hugely important part of that, of this whole thing. That connection piece where we started talking about emotion as being relational. None of this happens in a vacuum, right? We're talking about interactions with people and connections with people. Drawing a lot of strength from that and trying to reciprocate some of those positive emotions can really generate something special.

Christine Ko: It comes exactly back to what you said in the beginning, that joy is communicable, and I really love that. Do you have any final thoughts? 

Maddie Lagina: I just wanna congratulate you on the work that you're doing. I'm so honored to be here. It's such a joy to talk to you.

Christine Ko: Thank you, Maddie. 

Maddie Lagina: My pleasure. Thank you so much.