Professional Identity Formation for the Health Professions Educator

Thank you so much for that lovely um introduction. It is great to be with you here on this beautiful morning. We also got the cold front that you did. Um heard you had a little snow. Very exciting for November. Uh wonderful to be with you. I do want to acknowledge that um we are in challenging times and I'll set the stage there in a moment. Uh having said that I am the most empowered and optimistic I have been in a long time because of gatherings like this gathering people in community to refocus on the very important missionbased work. Um so much is happening in the world right now and in our country and having said that I think it gets amplified for us in in medicine because we have some really significant um things to consider. We're caring for patients. We're caring for our learners. We're caring for vulner vulnerable populations and we are defending science right now. So a lot for us to consider as was mentioned. I'm going to talk a little bit about the challenges and trends that are affecting our work world um as well as our our personal world, but um I will focus mostly on the work environment. And I think this is really important to consider because some of the strategies we're going to talk about are are things to countermeasure the distractions of of dealing with constant and new problems. And uh we will also talk a little bit about how it's so important right now to focus in on certain parts of the faculty life cycle for for our individual faculty members who are supporting patients and learners across our systems. And uh a core anchor there is strategic career planning. And it is a gift to be able to spend time to even think about um that that topic because we're so busy. Uh my disclosures include federal grant funding as well as um I hold equity interest in a startup that's not a startup anymore, the IP pass patient safety institute and receive honorary and awards. Uh but my bigger disclosures are two. One is that I am on a lifelong leadership learning journey. I learn every day from people I work with and really excited to share ideas with all of you and learn from you today. And also uh my second disclosure is that I have a bias that to provide the best patient care and to do the best science in the in the United States, we need a workforce that mirrors our patient population and we need a leadership workforce that mirrors our workforce population and our patient population. And so the most of the work I do now aligns with supporting people on the pathway to the highest levels of leadership to ensure that our science and our medicine is the best it can possibly be. To support that I like to share my personal professional mission, vision and values. Um and this is an exercise I do with all my faculty and learners actually. And uh it's really important because we want to remember that we need to anchor in our mission-based work. We have to remember what that work was. Sometimes we're so caught up in the busyiness of a day, it's hard to remember why we went into medicine in the first place and why are we doing all the work, what brings us to work every day to do this important um stuff. Um, so my personal mission is to transform the landscape of academic medicine to develop and sustain an equitable and inclusive leadership environment that will optimize scientific exploration and patient care for all in the United States. My personal vision is to lead academic medicine in the development, implementation, and sustainment of a national culture of inclusion and excellence. And my values include inclusion, belonging, patient- centered care, collaboration, innovation, and opportunity. And now I I want to highlight the fact that uh collaboration, innovation, and opportunity are a lot of what we're going to focus on today. Um and we have really significant opportunities um to make change right now in healthcare. I'm going to talk just a moment about my leadership program. The program I lead um it's called executive leadership in academic medicine as was mentioned and I created a second uh program called executive leadership in healthcare about four years ago. Elam just celebrated its 30th anniversary and I'll share a little bit about our outcomes in a moment. But the goal of our programs is to really support and develop people on the pathway to the highest levels of leadership to give them the skills to be vassel in managing major change management um and innovation in healthcare and science and along the way to help raise their visibility to optimize their influence and ensure they have great impact. We were created to preserve the legacy of female medical college. So my school now Draxel University College of Medicine is actually a legacy school of female medical college. That school was created in 1850. It was the first medical school in the world to support women in their pursuit of medicine and science. And we um have the really wonderful fortune of supporting the archives of um the legacy center at Drexel. My office oversees it. I share that with you because it's the largest collection of artifacts for women in medicine and science in the entire world. People travel from all over the world to study there. You are welcome if you come to Philadelphia. you're welcome to visit us and our archavists will curate a individual experience for you. So if you're interested in the history of women in orthopedic surgery for instance, you you will ask our archavists to share artifacts and they will collect them and share stories about the people who came before us. These are pictures I often share because as we're challenged and and sometimes thinking we have it so hard right now, it's such a difficult day. I think about the shoulders of the giants we're building upon and up at the top are examples of three women who um overcame a lot of adversity in their quest to be doctors. The first woman on the right and the left hand side I apologize far left is Dr. Kokami. Um she graduated um from medical school in 1889. She actually traveled here from Japan. Um and she returned to Japan. She was the first woman to head a a gynecologic um department in Tokyo. And she did not stay in her role very long because the um the emperor who was uh serving at the time refused to come visit her or acknowledge her her leadership. So she uh protested that and and resigned from her position. The second woman um is Dr. Anandi Jooshi. She uh traveled here from India. um that what was then Bombay. Um at 9 years old she was married and at 10 lost a baby and it was at that experience that she wanted to offer better health care for women in her country. So she came she was sponsored by her husband who was significantly older than her to come to the United States to go to our medical school which she did and she completed and then returned to India to practice. Unfortunately, she contracted TB and and died at a very young age. Then Dr. Eliza Greer um was one of the first uh African-American women to go to medical school. She graduated in the 1880s as well. She um is a wonderful history. She was the first woman to practice medicine in Georgia. Black woman to practice medicine in Georgia. And to support herself to get through what was then sort of the equivalent of undergraduate, so college and then medical school, she um alternated years in school with years of picking cotton in the fields. So she had come from a family enslaved and and so that's how she supported herself. And then finally, the other pictures you see come from our collection. And I note the uh picture of our amphitheater. So these are the pictures that hang on our walls of our medical school. And uh if you compare our amphitheater picture to the classic ones, Mass General and John's Hopkins, you can see how inspiring these are to our students. And again, we are building on the legacy of this college. Um we've had many women deans. Interesting though, you know, the first woman dean on the far left is Anne Preston. Um, and there's a very famous case we use in our program named after her and she became a dean at 38, the first woman dean of a medical school in the world. And then Marian Spencer Fay um was um dean in the 1960s and we haven't actually at our own school had a woman dean since then. I do point out Martha Tracy who's in the middle. I have this amazing picture in my office of Martha Tracy and Marie Curie standing on the on the streets of Philadelphia. A very um empowering um photographs. So our program Elam why I'm spending so much time here is I'm really passionate about thinking about how the history has helped informed the development of our program as well as the um really the strategic lifting of all people up as we travel through time. Um we were founded in the 1990s again to preserve the legacy of female medical school. Um we first had fellows from medical schools and now we are interprofessional. So we have uh fellows from dental schools, pharmacy schools, public health schools. We've had international students who have come from Europe, from South America, from the Middle East. In 2012, we developed a sister program called Elates um executive leadership in academic technology and engineering and science to support women who wanted to um be leaders in those fields. and the the sort of opportunity there was far more difficult than it was even for us in medicine. In 2022, as I mentioned, I created this ELH program because traditional ELAM supports women on a traditional academic pathway to department chair and dean, provost and beyond. Um, ELH supports w women in the history um to to go to positions of CEO, CMO and and roles in our hospitals and health care systems. Last year I started an allyship program which um was very wellreceived and we are building um we are working to develop programs that support changes in our infrastructure in our systems to really make profound change in our environments. Um we created that program in 2025 and it's under evolution and the concept here was we have to get away from fixing individuals um for advancement to fixing systems that really support inclusion and opportunity for all. And this year we opened our program to all to men and to women. So we have men in our programs at this point and that evolution actually has been very very positive and again our mission remains the same to support all that work to get everybody opportunity to go to the top of leadership in our country in medicine and science. Our accomplishments to date, we have 1,600 graduates who serve in leadership roles in over 300 institutions across the country, everywhere from UCSF to Harvard to everywhere in between and north and south. Um, I point out like since 2021, how many of our graduates have been appointed as deans in public health and medicine? 22 in medicine, 10 in public health. I I say that's important because people have really utilized our network to achieve really amazing things and including um Dr. Rebecca Cunningham is the first woman president at the University of Minnesota and we have two elums who are finalists in very important president positions right now. Um I will note that circle that demonstrates NIH and CDC directors that number was significantly higher in January and as we know um we've had vulnerability in leadership at NIH, CDC, FDA and our work collectively as a community has been to support people in those roles um to transition to continue to contribute the amazing science and leadership that they've had. Um, so that's another important piece. Threearters of the women deans of our medical schools are graduates of our program. We're very proud of that. I'm going to take a moment to talk about the landscape of where we've been in the last five almost six years now. And I I want to share some of the elements of the forces that we've been managing. And this will be very familiar to you because you've lived through it. And the reason I believe it's so important is because we have to think about vulnerabilities in our workforce and and the pathways through careers so that we can um be strategic with how we support people um and not just assume everybody's going to be fine as as we're managing such challenging times. So this is a word cloud of the words that I've collected over the last um several years about how we describe what's been happening to us. And uh I often point us back to 2019 if people remember 2019. And at that point of time in healthcare we definitely had some vulnerabilities in our systems and our programs. We used to say we're leading in uncertain times in in 2017, 18,1 19 and mostly the challenges we were facing were transitions in leadership or uh some of the financial uh forces related to reimbursement and and other threats to our um everchanging landscape with mergers and acquisitions and things like that. But over the last six years, five and a half years, things have really amplified. And these are all the words we were hearing. Um, over the last six years, we're leading in challenging times and crisis and dual crisis and poly crisis, unprecedented times, and now we're we're really moving into a time of chaos. And I'll define what that means in a moment. And there are people who study this that are far more understanding of all the nuance and for forces that make us um define a time of crisis versus chaos. But I will share what I have learned. Um and uh this is an arc I use to represent what's happened in the last 5 to six years and some of the forces that have amplified um the problems in certain parts of the last 5 years. I am looking for a better representation because we're not truly in an arc in that this implies we're in ending ending into a more calm period of time and what uh the experts in the country have shared is that we're not ending this anytime soon and so I need another representation because the uncertainty of this time will continue. So I'll start again reflecting back on 2019. We were in times of uncertainty, in challenging times. Um, and all of a sudden we had the pandemic hit us and that was truly a crisis in the world as well as to us in healthcare as we were really managing at the front lines uh to maintain science, to care for our patients, to learn about this new virus, to combat it, um, as well as continue to do all the other work we needed to do. Um and then in the summer of 2020, we um experienced what is termed a dual crisis and that was after George Floyd's death. So there were forces that um impacted our systems in many ways. And so we were combating um you know the virus and then you know managing um this new uh crisis and dual crises uh tend to lead to poly crisis. So poly crisis is when you have um multiple effects. So if you think about the effects of the crisis we were dealing with including um financial strain in our system, burnout in our workforce and uh people leaving our workforce. So, uh, workforce deficits, nursing in particular, um, and then soon following after that in some of our our specialty fields, when you have multiple crises that are complex and interacting in a very, um, uh, integrated way, you end up in a poly crisis, which is very challenging to manage because you can't just tackle all of it with one strategy. So how to be strategic in that time was really important and people were really starting to choose different aspects of the poly crisis to tackle and the medical students who were students throughout this whole time um heard the words unprecedented time uh for very very often. In fact, our graduation speaker um uh in 2023 um had a jar on the podium and he put he said, "If I had a nickel for every time I heard unprecedented times as a medical student," and he would throw a nickel in every time he said the word. It was a really great way to represent what what those students had gone through. All of that led to a time of outrage and uh this is wellstudied by many. Um there's a a author I really appreciate. His name is Romana. He's from Oxford. He's a sociologist at Oxford. And he writes about uh the the confluence of things that make us vulnerable to times of outrage. There have been periods in the world where we have experienced outrage and we we experienced this in in 23 24. The two forces that happen are one when people feel hopeless and despair. So all the culmination of all the previous years people feel hopeless we're not going to get out of this and the second factor is when people feel systems are rigged against them those two confluences come together and there is an othering factor so people really um start um splitting and othering each other and we saw that play out in so many ways in in the world in in the US but we did in our organizations too and this was the time where I really noted that people were so reactionary and coming to complain in a very very um angry way in in ways I hadn't seen them as individuals do before and a lot of people would come to me to say they are doing this to us to which I would often ask who is they I don't know if it was me my you know co-leaders uh but it was really a challenging time to problem solve because people were split in angered and othering each other. And finally, here we are um in the year 2025 um with a new administration. We had 142 executive orders in 100 days. And many of them affected our systems of healthcare and science. And we are now in a time what people call call chaos. And some of the definitions of chaos um or elements of chaos include a confused and unorganized state um where there is unpredictability and in a very complex system which healthcare by definition is right small changes can lead to vastly different outcomes. So we are in complexity and it's challenging how do we manage it? But the biggest piece of that is that there's rapid change and those 142 executive orders and the new rules that have come at us have made it profoundly challenging to manage in healthcare. So colleagues and I so that's a lot to handle and think about but we've all lived through it and and um we have resilience as a community. I will add that this is a um strategy and we're putting together a representation that we're evolving, my colleagues and I at Elam to think about what it is we need right now to really be able to go forward from where we've been. And a lot of these strategies you've seen people use over time, a lot of people right now are writing about in medicine, in healthcare, in business, and in other professions. The importance of courage right now. Um being brave. Um which means we are living in brave spaces, not necessarily safe spaces. But we need to have courage and move forward with courage. Having said that, being really strategic and smart about it because as we know um there can be untowards uh issues if people are um overly um brave in what they do. So that balance of being brave but also being strategic and smart about it. The pieces that I have been thinking about that are so important and they're linked to how to demonstrate this courage is being really clear in what work we need to do. Um, so as leaders being clear and and articulating with in all the noise around us what it is that we're going to focus on as well as being um very transparent in our communication, demonstrating to people around us we know what we know and and also noting what we don't know. Um and then how are we going to move forward in that um uh unknown the uncertainty part approaching things with curiosity and this gets away from the time of othering. We need to be curious and and active listeners. Luckily as in medicine healthcare we're trained to be active listeners and to uh be open without judgment to people's opinions. And then another clear component here is how do we build community and anchor in community and fortunately as things have improved with the pandemic and we're now in this h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h world of how we use zoom and in person, we can be really creative with community and how we anchor there is important and and I will link that later to how strategic career planning for individuals needs to be supported by community now more than ever. I've been partnering with members of John Cart's um uh uh firm, I'm sorry, consulting firm. Um to think about how can we go back to our missionbased work, do our missionbased work while we have this continual background of uncertainty and a little bit of chaos or a lot of chaos. How do we do that? And there's a concept they remind us of that I think is really important to consider right now. When people are under threat, this is, you know, there's a lot of literature in sociology and psychology that I won't go into now, but we tend to move into survive mode. We protect ourselves. We need to move into survive mode at times to seek the threats and mitigate them. Having said that, when we're in survive mode, we aren't doing the other work we need to do to move things forward in our medicine and science. So, how do we get people from survive to thrive? And on any given day, by the way, we some of us may feel like we're in survive mode. certainly have my days where wow the difficult conversations, the threats, the anger that are real, finances or funding flow that really put us into a survive experience. But we have to move into thrive. Um seek opportunity to make improvements and do the good work that we do. Um so how do we modulate that survive and move into thrive? And another um concept that they bring to the conversation is how do we adapt to this change? So as we mentioned, you know, this isn't going away and change is going to continue to happen as systems that are so complex are reacting to what has been happening. So external changes are continuing and they're moving at a faster pace than our internal changes can. Um, and so fortunately that leaves an opportunity gap. Um, and as I've been thinking about my own career and how I've journeyed through it, I have noted particularly to my mentees that I have noted I am a opportunity gap filler. So I see those open spaces and move into them to create infrastructure to solve sticky and wicked problems to help us move forward. So even though we could look at it very negatively or we could look at it very positively and we can do innovation that we never could have done before because the experience is different and the environment is different and to do that I think it's critically important to anchor in our mission and defining it is important and I mentioned mine in the beginning and so a lot of the work I do as a mentor and a sponsor is to help people really think about what their true mission is why did they come into this field into this work and to support it going forward. Um just going back to that for a moment. Um uh Tate Shannifelt who was the first um what chief wellness officer in the country uh talks a lot about how leaders in the country if we can spend 20% of our time in our mission-based work, how much more satisfied, resilient we are and that really mitigates burnout. So defining your mission and finding opportunities to spend time in that space is really important. It doesn't mean we're going to be able to do 20% every day, but over the course of weeks, if we're able to spend time, it's really um healthy for us as as physicians, as scientists, as leaders. Um the other thing we have to consider right now is um the concepts around modern leadership. This is a paper I wrote a couple years ago about, you know, in in medicine in particular, we're very hierarchical and traditional. And having said that, there are modern leadership skills that we actually are trained in that make us great leaders. Now, I'll I'll make a quick note, which is if you'll remember back to when the three of the four presidents presented to Congress and then had real challenges after that, three of them were replaced by physicians. So, the people who took their interim roles um and it was really fascinating because people were commenting on the fact that they had these modern leadership skills. So, we as physicians, we collaborate, we're relational, we build relationships, we're great listeners, we work with lots of different people. Um, and we understand the importance of um supporting others. So, we know how to value others and that makes us by definition really fantastic potential leaders. I mentioned this courageousness in uncertain times and uh I think I mentioned earlier I I have been more empowered than I have been in a long time because of being able to anchor in community be a being able to see those opportunities to move forward and pivot and innovate and being able to support community is is super important. So I I feel more calm than I have in a long time. So what are we going to do in this pathway? So we have all these patients and learners and faculty and all these people who are dependent on us and I do believe there's a clear path forward. This links back to what I was originally asked to speak about which is um the importance of professional identity formation. And for me, this links to the ideas of focusing on mission-based work. And professional identity formation is um just briefly as a as a definition is um adapt an adaptive developmental process that happens as a result of two things happening. One is your individual growth over time. how you develop psychologically as a person and that's influenced number two by what's happening in the collective out there in the world. So how socialization occurs, how you are influenced by the forces that are happening. And for us, I I extrapolate that to how forces happen at different phases of our faculty life cycle and how we respond to those individually and as a community are really very important in in professional identity formation. So knowing who we are, but that takes work and um we are so busy it's hard to find time to take pauses in our everyday to do this work. So one of the things I share with my faculty, my learners is you have to build this work into your very busy day, week, month, year um and then interact with other others to share that um uh this concept of um professional identity formation. It's not linear. It's dynamic. It's always evolving and it evolves throughout our whole career even to the time of retirement. And there are things that threaten our professional identity. Um, things that are dissonant with our our values sometimes in our environments and our work. And we have to figure out ways as as a community to support people through that. Um, in some of the articles I read, they they talked about the imposttor syndrome and how that can be detrimental for us in our positive professional identity formation. And uh there's a lot of controversy right now about imposttor syndrome. Um and I can speak more to it later, but uh imposttor syndrome was originally uh described as you as an individual felt like an imposttor and that was something on you. Um why were you not confident? And now we realize that it's really our environment our the context of of our learning environments in particular that uh create this this confidence issue. So we have to think about how environments are more safe, psychologically safe and support inclusion and that will help mitigate burnout and other things. I mentioned the faculty career cycle. So I'm a student of the faculty career cycle and I mention this because in our field of medicine we have been so focused over the last 20 years on recruitment in and that's how we've gotten you know diversity in numbers increased but we're focused on recruitment in recruitment in who are we recruiting into medical school into residency into our faculty. Um and then we don't spend enough time thinking about the other components of the life cycle of our faculty which include um professional engagement. How we help people explore different parts and subp parts of their career. How do we support potential exit pauses and re-entry into our field? We are not good at that. and and also finally how do we position people to be successful in transition to retirement with succession planning. So all these pieces are are happening in the background as we are you know deciding ourselves how we want to be as professionals in our careers. So supporting transitions are super important and and we've been bringing this into the conversation of the fellowships I lead but also into my day-to-day with my faculty that transitions are as important as um being successful when you get there. So how do we structure support for that? So strategies to support the evolution of professional identity formation in a healthy way include strategic career development. So professional development planning. So what I do in my structures of working with my students, working with my residents, working with my faculty is to bring structured professional development planning into our everyday, every month, every year experience. So a formal experience that's different than the faculty annual review um which are tend to be very much accomplished uh focused on accomplishments rather than strategy to move yourself successfully in through those transitions to accomplish next steps. So professional development planning takes time but really helps us focus clarity on goals and helps us organize ourselves and helps prioritize ourselves and a experience I had as a a sort of early to midlevel career member. I was a residency program director at the time an associate program director. One of the leaders of the hospital came and said to me, you know, you know what the problem with our jobs is to which I had many answers. And he said, "The problem is is we come in with 10 things to do only to find that we're number one on 10 people's to-do lists." Which completely resonated with me because that is how every day could go for me. Um, and if you don't prioritize the work of your own professional development planning and engage others in that process, it's a really missed opportunity. And as we know, time flies um in our careers. So the active um and I've published this um I actually have planners that I've published on professional development planning, but for me it starts with that articulating mission, vision, values, what we talked about in the beginning of my presentation. but also the hard work of ident identifying your own strengths and challenges and addressing whether you're overusing strengths and and under addressing challenges which is often easy to do because of blind spots. setting clear goals, objectives, strategies, and timelines, but also then using the professional development plan as a vehicle to have conversations with mentors to help enhance that plan and get advice and feedback. Again, this takes time for reflection and self assessment, which takes time. Um, and so again, that um amplifying the idea that you have to build this into your your very busy day in life. And I actively build this into the programs that I lead. And again reminding what the mission, vision, values are. I mentioned mine in the beginning. Mission is your purpose. And that is a great anchor for us right now. Vision is a description of the future self you want to be. And it is aspirational, but it is a great, you know, so many people now have vision boards. Um, it's a great way to think of why you're doing this work and to keep you moving on that forward trajectory. And then finally, the values are really the core unchanging principles that guide you and sometimes are really helpful to reflect on when you're challenged in in very, you know, adverse ways um and deciding what next steps you want to take to move through those problems. I'm a big proponent of leadership skills development. Uh I think it's really important um for us as individuals getting good skills really empowers us and helps us learn how to influence and make impact. And right now the leadership skills I focus on um in my programs include things like financial acumen and negotiation and conflict resolution. Super important. But I've really been focusing on the skills of excellent change management because we need to do mission based work with chaos and that requires very high level skill and requires that you use your influence to move things forward. Um and uh we have to be in a continual learning mode here. And I the best leaders I know are continually moving and leading and not just resting on the skills that maybe were making them successful in 2018. Um because we have to have those fast modern leadership skills um that include collaboration and really bringing people along on a change management spectrum and setting leadership growth goals is is very important as part of your professional development plan. So I have uh colleagues who wrote about the um the the extreme importance of this particularly in mid and senior levels um and then really mapping out deliverables of of how you um want to apply those leadership skills. I'm now going to talk a little bit about mentorship and sponsorship. And mentors are critically important as people, you know, journey through the strategic career planning processes because it's a a vehicle again to engage in conversation that's really strategic in helping people move forward and also using mentors to do that assessment of are you overusing your strengths or under addressing challenges that you may be facing. and uh a very helpful experience. So in my programs um I use mentors actively, periodically and intentionally um to meet with people to evolve professional development plans and making sure their goals align with their mission, vision, values and that they're really strategic with that growth phase. Sponsorship is never been more important. I'm trying to in my own world where I can build a culture of sponsorship. When I speak to leaders across the country, I remind people that they have the power to sponsor others. And the difference between mentorship and sponsorship is that sponsorship uh is used to give somebody an opportunity that they couldn't have gotten on their own. And sponsors by definition are powerful and influential and use their own social capital to help a person advance in a quicker way than they could do on their own. And this this skill set of sponsorship can really catapult people very quickly to rising star status. Um it's important and this is from the literature that women are it's important to recognize women are overmentored and under sponsored. Um it's there's an interesting article by Linda Children and colleagues that was published in Journal of Women's Health recently that looked at data from the doubleAMC standpoint survey. So that they collect data across the country from all the faculty and it is academic faculty and uh it looked at career satisfaction. Interestingly, women are less satisfied with their career in medicine across the whole faculty life cycle and it's amplified in mid-career and there are several reasons for that um that I could discuss later but uh one of the things they noted is that women use their mentors uh to solve sticky and wicked problems. they use mentors and conversation how to get through adverse issues whereas men tend to use um mentors uh to do strategic career planning. So that's a very interesting phenomenon in and a lot to unpack there and men tend to get sponsored more quickly because of that. And also there's a lot there's a whole body of literature about um where people are when they get sponsored and often they're not at the in the right spaces. Um but we could talk more about that later. Uh but sponsorship's really very powerful and we need to use that um opportunity more to help people all people. Um professional coaching is something I mentioned that's out there now. It is a booming field. Um and very proudly professional coaching was brought into academic medicine by my colleagues at Elam. And it you know when I was a a resident coaching was very punitive. If you got a coach there was a remedial issue. Now people use um professional coaching to really help with that strategic career planning to help with transitions um if they're going into a leadership position helping them being successful when they arrive in their leadership roles. and is a great um thing to think about in certain phases of a career. And I have access to hundreds of coaches now. So when people are interested, you can reach out to me and I'll help connect you with one if that serves you at that time. And thinking about um when to say yes to opportunities, I think of this myself, but also for my mentees, we have generational differences. We have five generations in the workforce. We have different generational values. And so I've been a student of that work as well. I'm writing a paper right now with some other colleagues across the country. Uh how can we really capitalize on the amazingness of the the values and the skill sets of the different generations rather than othering other generations which is sometimes very tempting. Um don't want to do that. But as we're talking to each other about opportunity, thinking about the values of the generation and how to engage people in conversation that is is productive to be open to thinking about opportunity. This goes back to sponsorship. Sometimes we are actively sponsoring somebody to join into something that as a sponsor we see wow this is a great opportunity for someone to be exposed to a new community to network to get skills to see data in a different way if it's the finance committee for for instance um and the person we're trying to encourage to take on that idea the spons C immediately says no because they look at it as too much time or too much work or they can't see the benefit. So this is a birectional thing. We have to as sponsors make our case of why this is important. Um but on the sponty's end I I often say you need to use a strate a process of strategic yes and strategic no. So don't say yes and don't say no without really understanding what it is you're saying yes to no to and as well as the opportunities and the unintended consequences of that. So really being intentional with that. And then finally I'm just going to end with this concept of time which I've mentioned multiple times. There is infinite amount of work to do. Um, so I'm encouraging people in my world to to focus, to pick and choose what they're really going to dive into. And while time is fixed, energy is renewable. So bringing us back to missionbased work is so important. and helping us as a community um manage our time and opening up time and space to think about strategic career planning and mentoring and active sponsorship is really important. So with that I thank you for your time at a very early time of the day and uh I I will open up to questions and I will take my this is my hope slide. We're moving forward together. So, thank you so much. I'll I'll take the slides down. So, if people have questions, I'm happy to answer. Thank you so much, Dr. Spectre. Um, I haven't seen any questions in the chat yet, but feel free to unmute, raise your hand, and um engage in any questions or conversation with Dr. Spectre. It is early, so I'm awake now. So, I just wanted to say how many excellent takeaways I got from that presentation. Um, I'm on staff here in the office with Mariah and Sarah and Sherry and JT, and I haven't had an opportunity to view a lot of these presentations, but this one particularly really spoke to me about the challenges that we have as women and as minorities in the workforce and how we can grab onto opportunities to to advance and to better our skill set. Thank you. I think that's the nice thing. This applies to everybody, every part of our organization. So, thank you. Dr. Atkins has a question. He's got his hand up. Yeah, Dr. Spectre, thanks so much. Um I was wondering if you could speak a little bit about how we facilitate some of this uh space for um personal you know missiondriven growth at an institutional level or in a broader sense for maybe not even at an institutional level but against broader groups. How do we create that space for people? Thank you for the question. This is like my everyday job is actually to to do this work. Um I'd make a couple of reflections. One is people are exposed to this kind of thinking when they're in residency. You know, they had to do ILPS, individualized learning plans, and they had to do it in fellowship. So they are exposed uh for more senior generations they're they didn't have that opportunity. Um so what I do is I try to build on that. Um there are two two phases of career I'm particularly focused on that I pay my attention to the most right now and that is people who are late early career about to be mid-career and then those who are early career and I'll and I'll just share briefly why the people late early career to mid-career historically have been our most vulnerable faculty and Um, I share often that when people come to me, they're like, I I need somebody to talk through my career. I am really, you know, not doing great. I'm thinking about leaving. Um, I asked them where where they are and they're almost always 70 years 7 to nine years out of training. It's just this really interesting time. And um, I wrote a paper with colleagues about the vulnerability of the mid-career woman faculty in medicine. uh but I think this applies to lots of mid-career faculty now and particularly anybody with underrepresented status and the factors that affect them are when you're a superstar student fellow resident early faculty member everybody wants to work with you and elevates you gives you opportunity lots of praise all these things happen and then as you enter into the mid-career range all of a sudden you're you're competing with people you're competing for resources for opportunity And because the joy of our work, right, is we have new people coming in every single year into our systems, the senior people move to the more junior people again. And the mid people sort of get left behind and are often forgotten and they feel like they're in a sticky situation. I call it the sticky floor situation. They just can't move and they're not they don't know what to do. So paying attention to that group, which they really appreciate. So I build programs that support that group in particular. Um during this last year I have noted that the most distressed people in our system are the early faculty because they haven't been here long enough to really establish themselves and they haven't gotten enough you know bumps under their belt to know that things are going to be okay and they're often afraid to reach out. And as I've gone across the country, and this is true with my own faculty, when you get them privately, they'll say, "Yeah, they're really worried. They're terrified." And particularly if their um funding is linked to any of the threats that are out there. So, I do this work with them. Um and then I guess the last piece I'll add is when I build programs, I start small. And my dean likes to say that we go after the coalition of the willing and the enthusiastic. So, that's who I bring into my spaces. um and really focus on them. So, I don't know if that helps. Happy to talk offline, too. Any other questions or comments for Dr. Spectre? That was super helpful, Dr. Spectre. That you actually answered um Dr. Atkins u question, but I was going to have a similar but different question and and and that answer um covered it as well. So Oh, great. I have a lot of um successes and then maybe some failures of setting programs up. So happy happy to share lessons learned. Yeah, I think a lot of um folks in our organization are also concerned with um just starting to mentor others and feeling um feeling ill equipped to do so because they don't feel super confident in their own skills. And so, um presentations like this, questions like this can really be helpful. and any additional tips that you can offer for folks who are starting down the mentoring path um for students, residence fellows and even junior mid-career faculty. Yeah, I think uh one of the strategies I use with building skills for mentors in particular are bringing them into their own peer groups to have those discussions. Um and there are some people who never had a great mentor, so they don't know how to mentor. Um I also I I caution against the people with the great VA who think they're amazing mentors who when you interview their mentees there there's some dissonance there. So you know um that um that also happens. So how do we bring peer groups together to have those deep discussions and how to help people problem solve? In my own program, by the way, all the fellows experience peer mentor groups and those are supported by senior mentors. And to support those senior mentors, we have their own group where we meet every other well every month actually and and talk through the issues that are needed to support those people. So having a layered approach is is really effective. Yeah, I really like that approach. You don't have to do it alone. No. Um, uh, Dr. Wesley asks, "How do you mentor people considering a career pause or career pivot? Um, what does that thought process look like?" Oh, Dr. Wesley, great, great, great, great question. Um, I would say I I'm reached out to right now this year at least three to four times a week with people in distress, um, who need help. uh thinking about a pause and then another three times for people who have a great opportunity they want to move forward to. And so for part partly my system has come from just experience over and over again. Uh the first thing I usually do is is try to really just actively listen and understand what all the nuances are. And many of the people in the pause piece or maybe wanting to exit are people in that mid-career space who are um struggling with the stickiness, not feeling that they they have a spot to advance, kind of tired of the work they're doing. Um, and one factor I did not add into the mid-career space is often they are in the sandwich generation and they're supporting maybe particularly elderly or ill parents, supporting their own families and their partners in challenges or other friends. So, um, trying to get all that together and and helping them do an assessment of do they really need to leave and pause and take a real leave or is it that they need to uh relinquish some of their responsibilities or go part-time. What I get nervous about for clinicians in particular, which I know you're aware of, when you pause, all the issues related to medical lensure and certification and things like that have to be really clear to people because it's, as you know, so hard to get back into our field on a national level. I'm trying to work on that because I don't I don't think that's a healthy way as a field to be. Um and then on the people who are transitioning up I or thinking of new role the first thing I do is again congratulate them hear their excitement caution them though that it's really competitive to get new leadership roles or new roles right now and then what I try to do is arm them as much as possible to be ready for any interview processes including what their paperwork looks like how are they preparing for interviews um and getting a uh opportunity for them to talk to others who have the role they're trying to get. Um, and so using the network to support people in that. So there are a couple of different strategies depending on what they want to do.