Coaching in Medical Education: Always observing, absorbing, and learning...

Coach Woodenism for the Week: "As you strive to reach your personal best, Alertness will make the task much easier".

In this series, we're applying Coach John Wooden's Pyramid of Success to medical education and leadership. We began by discussing the foundation of Attitude, Effort, Friendship, Loyalty, and Cooperation. The second row focuses on the mind, beginning with Self Control, followed by Alertness.

Alertness is the ability to be continuously "observing, absorbing, and learning from what is happening around you." For the leader, teacher, and clinician alertness is always essential. We must always be alert to our own strengths, weaknesses, opportunities and threats. Then we must be always aware of these same characteristics for our team, and most importantly, our patients and their families. 

Often times, the greatest threat to team alertness and ultimately patient safety is the the very culture of medicine itself. As students, clinicians, and support staff, we continue to apply "traditional", yet incredibly unrealistic models of human performance every day. We routinely work twelve hour shifts or longer, on consecutive days, often times with no breaks. Instead of debriefing after difficult situations, we quickly move to another clinical task, missing the critical opportunity to review our performance and learn to be better together.

Commonsense dictates that certain industries must as close to error free as humanly possible. Particularly, the military, aviation, nuclear power, healthcare, and others where peoples lives literally are at stake. Everyone working in healthcare knows that a decade after resident work hour restrictions, we still have a long, long way to go. As coaches in medicine, we need to be Alert to this continued weakness and threat. We must redesign our medical education and healthcare systems to require schedules, IT solutions, and rationale productivity measures that compensate for, instead of ignoring, our human nature.

This week, work on becoming an example of Alertness for your trainees. Ask questions and start discussion. Encourage self awareness. Find and test new solutions such as mandatory short breaks every two hours, micronaps on night shifts, and regular debriefing after challenging cases.

Make it a great week!

Where to Learn More:
Gaba. Fatigue Among Clinicians and Patient Safety. NEJM 2002.
John Wooden Quotes
Wooden on Leadership: How to Create a Winning Organization, by John Wooden and Steve Jamison
Coach Wooden: The 7 Principles That Shaped His Life and Will Change Yours, by Pat Williams and Jim Denney.