Leadership II
Physicians Leading | Leading Physicians

Meaning and Purpose: Refocusing on the Why in Medical Education

Article · August 7, 2017

Most doctors find meaning and purpose as they serve the needs of their patients. How could you not, as you deliver a baby, explain life-changing therapies, or discuss preferences for end-of-life care? However, most doctors also feel immense frustration as they attempt to deliver great care amid the demands, limitations, and inconsistencies of today’s health care system. Burnout becomes epidemic when this frustration kills physicians’ sense of meaning and purpose.

These sources of frustration aren’t going away on their own, and we must find a way to alleviate and even prevent physician burnout if we are to sustain our health care system. We believe that one answer lies in transforming medical education to include teaching future physicians to cultivate meaning and purpose. Not only will this type of education help them combat their own burnout in the existing health care system, but it will also help them lead that system in more meaningful, less frustrating directions.

Traditional medical training focuses on “how” — cultivating knowledge and skills through memorization, imitation, and practice. It has largely ignored “why,” perhaps assuming that medical students must answer that question for themselves, or that they have already answered it adequately before applying to medical school. But throughout medical training and later in practice, they encounter conditions and situations that may challenge their initial reasons for becoming physicians, and their training doesn’t give them the tools to find new meaning and purpose in their work.

Cultivating a sense of meaning and purpose during medical training can also create a personalized lattice onto which knowledge and facts can attach and grow. It is easier to remember the mechanism of each contraceptive method when you feel a sense of purpose to reduce reproductive injustices faced by low-income women, or the anatomy of a joint if you find meaning in preserving mobility and independence among the injured or elderly.

Moreover, meaning and purpose help medical students see the bigger picture. Students with well-defined meaning and purpose will learn facts and hone clinical skills as a means of manifesting their vision, rather than simply to pass an exam. The growing number of medical students seeking dual degrees and international experiences suggests that the students themselves want to go beyond traditional medical training and find ways to put it in a larger context. However, they should not have to rely on extracurricular experiences to tap into their professional meaning and purpose.

Medical Education Leadership Training on Meaning and Purpose: 2015 RWJ Clinical Scholars Rate Their Leadership Program Experience

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How to Teach Meaning and Purpose

We believe that the necessary training in meaning and purpose should go hand in hand with training in leadership. Although today’s physicians, as part of team-based care, must understand basic principles of management, those principles will not in themselves help to develop and sustain meaning and purpose. Where managers concern themselves with “how,” leaders must concern themselves with “why.”

Training in leadership skills will help our future physicians understand where their efforts and their organizations fit into the big picture. Though we refer below to a “leadership” training program, we believe that this process of developing meaning and purpose is essential for all health care professionals, whether or not they are in, or aspire to, formal leadership roles. Not only would this type of training give them the flexibility to be comfortable taking on ad hoc leadership roles throughout their careers, as many will be called to do, but many health care professionals are, or should be, de facto leaders in their relationships with their patients.

We tested this type of training over 3 years through the Robert Wood Johnson Foundation Clinical Scholars Program (RWJFCSP) at the University of Michigan (UM). (While funding for the original program ended in 2015, it has been replaced by the National Clinical Scholars Program, a similar effort with different funding sources.)

This program provided young physicians with post-doctoral training in health services and health policy research. The mission of the program was to develop clinician “change agents” to lead the transformation of heath and health care. In addition to statistics, research design, and health policy, the program included our course on leadership, designed to help the scholars explore their values, their leadership style, and the impact they want to have.

We designed this leadership program to balance the development of leadership knowledge and skills with deeper personal meaning and purpose. The curriculum combined reflective process, coaching, and facilitating instruments to help learners develop meaning and purpose, as well as the leadership skills to achieve their goals. Specifically, we had them contemplate the following key questions:

  • Leadership identity: Who am I going to be?
  • Ideals: What really matters in my life?
  • Influence: What is my unique way to build trust with others?
  • Impact: What is my mission and vision?

Approximately 20 scholars met weekly in a yearlong seminar format. Each session focused on a key leadership question (e.g., “What are my strengths?”). The session presented relevant leadership theory, followed by exercises to promote reflection and discussion. In the case of the strengths session, the goal was not to learn about strengths, but to gain insight on one’s own strengths and how they apply to one’s practice. Over the course of the seminar, learners had a chance to reflect on and develop their own unique answers to key questions. The answers to these questions served as the foundation of their future leadership.

Leadership Training in Meaning and Purpose: RWJ Clinical Scholars Program Leadership Course Framework

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We conducted three annual cycles of this curriculum. In reviewing the program evaluations, we noted significant learner progress in multiple areas such as understanding one’s values and strengths, forming professional relationships, and setting career goals. For example, participants in the 2015 course felt they had made significant progress in areas such as articulating their values, building their professional networks, and speaking compellingly about their work. Learners themselves also noted key areas of personal growth:

  • It really clarified the trajectory that I’m on with respect to my research and, particularly, I liked the emphasis on defining my values and WHY I’m doing this research. . . . [T]aking this class really helped re-connect with those values and clearly link them to my career path.
  • The class created a time and mental space in which I could strategically consider and hone my vision for my own career. It was truly the first time in my formal (and long) education that someone had encouraged me to do this and provided me with the tools to do this.
  • In stark departure from most of our formal medical education, this class wasn’t about following a prescribed path. In fact, it was explicitly about developing one’s OWN vision, one’s OWN unique set of benchmarks.

Each year, we revisited the set of questions we posed to learners, but the general framework of “Ideals,” “Influence,” and “Impact” remained consistent.

Adapting the Meaning and Purpose Model for Medical Education RWJ Clinical Scholars Program

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The curriculum described here was designed for junior physicians but could be readily adapted to complement existing curricula for learners at other levels, including premedical students, medical students, residents, fellows, and even attending clinicians. Although there is not yet a clear consensus on the framework, we have found it useful to think of a circle divided in half: one is knowledge/skills, and the other is meaning/purpose. Bridging the two halves are three domains: intrapersonal (self-development), interpersonal (team development), and “extrapersonal” (interaction with the broader system).

Returning Meaning to Medicine, and Purpose to Practice

We believe the type of leadership training we describe can help future physicians provide better patient care with less burnout, and perhaps prolong their careers. As scientific rigor and clinical expertise are matched with meaning and purpose, we believe the balance will enable physicians to take the lead in transforming health care for the benefit of patients and society.

 

This article originally appeared in NEJM Catalyst on February 1, 2017.

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