Time Stamps

• 01:12 Learning Journey
• 05:58 Lifelong Learning
• 11:14 Time Management
• 16:38 Role Modeling
• 19:59 Re-Calibrating Failure

Show Notes

Overcoming a Fixed Mindset and Imposter Syndrome:

• A fixed mindset
  • Describes the belief that intelligence, talents, and personalities are fixed traits that cannot grow.
  • Promotes proving one’s intelligence and hinders one’s acceptance of challenges or failures
  • The pressure of a fixed mindset fosters imposter syndrome, which is when an individual doubts their skills due to the internalized fear of being exposed as a fraud.
• In contrast, a growth mindset views intelligence, talents, and personalities as learnable and able to be improved with effort.
• But for some learners, failure may not just be seen as a learning opportunity but feel as if they have major consequences.
  • But this, at times, causes  compulsive studying and a fixed mindset, which can lead to emotional exhaustion and burnout.

Keys to Effective Learning and Teaching:

• As an auditory learner, Dr. Graham creates narratives and utilizes podcasts to help her learn about her patients.
• She recommends finding 3 areas that you want to have clinical expertise and find ways to teach or consult about it.
• Block out specific time to cultivate areas of expertise.

Time Management:

• One framework for time management is to separate deep work from shallow work.
  • Deep work: Focused learning such as reading literature, listening to a podcast, preparing a talk or writing a manuscript.
  • Shallow work: Mostly related to communication; reading emails, checking labs, responding to messages.
  • Schedule and chunk time for deep work and for shallow work that fits within your work cycle.
• Discover what methods allow you to have a (1) good task management system and (2) peripheral brain that serves as an organization system for references and other materials
  • Example from Dr. Graham:
    • Task management:
      • Kanban board (Ex. via app/website Trello) to organize tasks for projects
    • Peripheral brain
      • Dropbox or another repository for information that may work for you (ex. notecards)

Role Modeling:

• As a leader, it is important to role model intentionality around time spent at work and off of work.
• The culture of busy-ness is the identity that we must always be working a
  • But some of the most productive people do not ascribe to the culture of busy-ness.
  • Having time to play and experience boredom improves creativity and efficiency.

Re-Calibrating Failure:

• When repeatedly failing, look at structures and systems that may be hampering progress.
• Self-evaluation and course correction are important whenever we find ourselves falling back on bad habits.

Transcript

Dr. Shreya Trivedi: Hi everyone! This is Dr. Shreya Trivedi, and I’m joined by…

Dr. Margaret Lie: Dr. Margaret Lie, a PGY-2 at Beth Israel Deaconess Medical Center.

Dr. Shreya Trivedi: And I’m so excited for this special episode, especially as the next academic year kind of sets in. One of the things I love doing is talking to clinicians who are so respected and so loved and kind of looking under the hood and asking, “hey, how’d you here?”

Dr. Margaret Lie: And so today , we interviewed Dr. Kelly Graham, the primary care program director, director of Ambulatory Training, and co-director of a faculty scholarship program at Beth Israel Deaconess Medical Center.

Dr. Shreya Trivedi: So first, we will go through Dr. Graham’s learning journey and how that’s changed over time. 

Dr. Margaret Lie:  And then we will move into how she sets up for lifelong learning, both on a daily basis but also annually for herself.

Dr. Shreya Trivedi: And then because Dr. Graham wears so many hats, we will get into the structures she has in place for time management.

Dr. Margaret Lie: And lastly, we will end with how she role models boundaries and how she uses her position of power to help others. 

Dr. Shreya Trivedi: Yep! So let’s get into this dive, a bit more of a personal dive — and we hope you leave as inspired as we were. Let’s start with Dr. Grahams learning journey.

Dr. Kelly Graham: So my learning journey I think, if I were to try to give you the big picture of what actually happened that got me here today, which I think I’m incredibly privileged to be a medical educator, to get to teach residents and mentor them and design training programs, was really, I had to overcome a fixed mindset and imposter syndrome. We tell learners become an open mindset learner. It’s the better way to be. It’s more efficient, but, it’s really from a position of privilege that I think we tell people to become that type of learner when often times your learning journey starts very young. And so I’m a first generation college student. I was raised in a financially disadvantaged family and for me, the only real ticket out of that life to have a better life was through higher education. It was not going to be through access to private schools or programming outside of school. It was just going to be me grinding it out and getting scholarships and essentially being a perfect student. And so how does that translate to everyday learning behaviors? What it meant was that failure just wasn’t an option for me. And so when I hear people talk about “embrace failure”, you know, “failure is a great learning opportunity.” They’re right, absolutely right. But for me, that was just never true, and I want to give voice to that because I think there’s a lot of us in medicine, not an opportunity. It could put me back to where I started. I can’t disappoint my family and myself, and it’s my responsibility to make that change so my children can have a better life. So, I don’t know how others experienced this, but for me it was compulsive studying to the point of exhaustion. I would take and retake and retake notes, until I couldn’t sit up anymore. 

Dr. Margaret Lie: Wo!. You know I have never heard anyone call out how we put growth mindset on this pedestal. 

Dr. Shreya Trivedi: And just to be on the same page, we are talking about the aspect of growth mindset here that sees failure as a natural part of the learning process and identifies failure as an opportunity for growth.

Dr. Margaret Lie: Which in theory  sounds great but in reality, we don’t have the luxury to learn from failures, especially in a system that values getting things right, such as exams, on the very first try.

Dr. Shreya Trivedi: Yeah, this even comes up in real life with like first impressions, right? It’s really hard to embrace growth mindset when it can seem like we have very little lee-way room sometimes to be anything but excellent.

Dr. Kelly Graham: I was just going to get in on grades. That was my ticket. So I did it. That was my identity and what came with that identity was secrecy. I don’t think that that identity is embraced by the majority of students who end up in medical training. So I had to learn how to be a secret gunner, which meant I had to also have the burden of having these learning behaviors in secret and really making sure that nobody saw them. I had to learn how to look like everything was cool, everything was fine, but really that’s not, that wasn’t what was happening. It ends in emotional exhaustion and burnout. I’d gotten to the end of residency and I was pretty burnt out. Nobody knew. I still had this look on the outside. I was even asked to be a chief resident. I think I was still really good at that secrecy and that imposter syndrome.

Dr. Margaret Lie: And here, we are defining imposter syndrome as doubting your skills due to internalized fear of being exposed.

Dr. Shreya Trivedi: Oh, I can relate to that internalized fear of being exposed so much. And you know the crazy thing, Margaret? I thought I was using all the things that come with imposter syndrome to my advantage, I thought if it kept telling myself I am the dumbest one here, which, I work harder than everyone else and have that reassurance of not being exposed.

Dr. Kelly Graham: It was when I had my children that I had my first opportunity to embrace failure and to really learn from it. So I had my children in rapid succession. This is a funny story, but they were born basically a year and a half apart. My methods were super inefficient and no longer sustainable to be a mother and a full-time physician. 

Dr. Shreya Trivedi: So, I think a lot of us come to this realization when we become parents. For me, I didn’t have that extra 6 hours in my day to let me be my inefficient self and really take my sweet time with things so that it would guarantee I wouldn’t fail at something.

Dr. Margaret Lie: So I’m curious, Shreya, how did Dr. Graham change her mindset?

Dr. Shreya Trivedi: So I think a big part of her changing her mindset was wanting to not role model that imposter syndrome for her own children. She wanted to break that cycle of burnout and exhaustion and prevent her children from carrying on the same habits that ultimately would NOT serve them well in the long run.

Dr. Kelly Graham: It was a reflection moment for me because I was realizing that this stuff begins around how you praise children, how you model your own learning, how do you model failure? And I was not doing that the way I wanted to for my children. So I had to sort of relearn and reparent my own learning style, which I’m still doing today. I’m still a recovering imposter/fixed mindset learner.

Dr. Margaret Lie: So at this point in the interview, I was so curious. How did she relearn habits that really served her as a lifelong learner and as a mother who really wanted to be present for her children?

Dr. Kelly Graham: I had to come to terms with my learning style, it turns out a lot of people have a little bit of everything. I am a like asymmetrically strong auditory learner. 

Dr. Shreya Trivedi: OK, don’t come at her for identifying a learning style. Yes, I know med-ed literature had debunked learning style, but audio was just what worked for her life.

Dr. Kelly Graham: Why was I retaking all those notes? It’s because I was creating a narrative and story. I was writing stories about the clotting cascade. I can save so much time by using podcasts. It has been incredibly instrumental to me popping in a podcast for my commute to work and doing so intentionally around clinical questions that I’m getting at the bedside that are not really cementing for me as I’m treating patients. So, every Wednesday morning, it’s my medical podcast day, and I’ve been doing that now for years. That’s how I studied for the boards.

Dr. Margaret Lie: And it’s not just that she would maximize her commute, but it was what she would do with that learning that mattered.

Dr. Kelly Graham: As an auditory learning learner, I need to actually didactic teach, so I teach on the topics I treat the most.

Dr. Margaret Lie: She would then tell stories she learned from the podcast or elsewhere to her colleagues, to her residents, and to her teams to really build her knowledge base and reputation up that way.

Dr. Shreya Trivedi: And not only did she have a consistent practice to capture the breath of lifelong learning through podcasts and turn those into everyday teaching topics, she also had consistent practice for depth in her lifelong learning. She actually put this advice that she now gives to her residents and early faculty. 

Dr. Kelly Graham: When you finish your training, you should come up with like three areas that you want to have clinical expertise. You spend the time that it takes to read everything that you need to read to get yourself up to speed, and maybe you do it over a few years and try to become somebody who teaches about this and consults on committees about it. You pick that one thing and you build yourself up to the point where you could run a CME talk on it. And if you’re lucky and you work somewhere where you actually can do that kind of stuff or can teach residents annually about that topic. So I did that with hypertension, diabetes, and hyperlipidemia, and cardiovascular risk.

Dr. Margaret Lie: You know, all this is great but the thing that I often struggle with (and many listeners probably do) is the consistency aspect. How was she able to do this consistently?

Dr. Kelly Graham: My sister and I have this inside joke that we set. Our life is all about setting up stations and systems. And just remember when they would tell you when you learn a procedure, 50% of it is just setting it up and then the procedure actually goes very well. It’s not the procedure itself that’s hard. It’s making sure the setup and the consent and everything is done. And then after that, it actually always felt like it was like a rock rolling down a hill. Life is like that too. When you set up a system or a structure that works really well for you, it’s easier to fill it, fit with your life, right? Because your life is going to be chaotic and uncertain and disorganized.

Dr. Shreya Trivedi: Oh man, yes! Life is chaotic and messy and disorganized. And I totally agree with the setting up systems and stations, especially the stations aspect with children, right – there’s a coloring station over here, another activity station over here – that keeps everyone from constantly going to the TV.

Dr. Margaret Lie: You know, Shreya, I personally don’t have a lot of stations living in a studio…

Dr. Shreya Trivedi: Oh yes, aw the resident life, yes!

Dr. Margaret Lie: But yeah let’s get into the systems, I’m curious about the systems she developed to gain expertise in certain topics.

Dr. Kelly Graham: I have a couple of subscriptions that summarize key clinical studies in your field. I don’t read the emails. I open them, I scan through the titles, and if there’s a title in there that’s like, yep, I’ve gotta know that. I slide it to a folder called “stuff I need to read in May,” and I’ll get to what that means in a second because I can spend two minutes on that email and no more. That’s my rule for managing communication for non-urgent communication. I set a date. I do something called meeting free days, and these are really important.  I clear a day in May, and I do it in May because it’s right before the next academic year starts. It’s completely blocked, which means my admin cannot schedule any meetings. There’s no clinic. That is the day I open that stuff I need to read in May day. And I update all my talks and I update any visual learning materials that I create, infographics, whatever it is that I use to teach on that topic or to practice medicine for that topic.

Dr. Margaret Lie: You know, I feel so relieved in how she offloads keeping up with literature to a folder and then has a week in the year where she knows she will have the headspace and protected time for it! Instead of just trying to keep all these articles and tasks in her brain and trying to get it done when she can.

Dr. Shreya Trivedi: Yeah, I often think we like walk around with a cloud of “shoulds” over our heads. And I should read that latest c.diff guideline or I should read that latest RCT on that important topic, but I think we end up actually doing is just walking around with this sense of overwhelm instead of offloading it. Right? Offloading that sense of guilt. Offloading that sense of shame. 

Dr. Margaret Lie: That’s so true, Shreya. It all goes back to what she and her sister joke about – life is all about systems and stations! We just went her system for keeping up with literature based on areas one might really want to dive into, but she has another calendar system for time management.

Dr. Kelly Graham: If I were to share one or two pearls about time management, the first thing that I would say is that you should manage your time better than your money because it’s the most important and precious resource that you have. And no one teaches you how to do this as a trainee at any level.

Dr. Margaret Lie: That’s such a profound statement. I feel like it’s so easy to squander my time.

Dr. Shreya Trivedi: Yeah, and now that i think about it, i’m actually glad we’re bringing all this up because I think you really can’t talk about lifelong learning without talking about how you actually manage time to allow for that learning. 

Dr. Kelly Graham: It’s really because there’s a framework to use for time management. The basic idea here is that you have to separate what’s called deep work. Basically, the brain doesn’t work well unless you separate your deep work and your shallow work and you bucket them together and block them. And so if you take those principles to your calendar and actually implement them, which means that you block out deep work time. So examples of that would be, doing a lit review for your research project, reading your diabetes updates, listening to a podcast about a clinical question that came up that week. Shallow work also needs its own time bucket that you set aside and you really do need to give it its own. Shallow work is like a gas that will fill up the space of the container. It will intrude into your every moment. What is shallow work? It’s reading tweets, responding to them, reading emails, responding to them. A lot of communication is shallow work, checking labs and sending normal labs letters. So if it’s non-urgent and it takes longer than two minutes, you take that shallow work and you give it its own time in your work cycle as well.

Dr. Margaret Lie: So, how does she operationalize her shallow work time? As a PCP, Dr Graham blocks off an hour for shallow work in the morning, her ramp up time, and an hour of shallow work in the afternoon, her ramp down, and then the rest of that admin time is used for whatever deep work she needs. 

Dr. Shreya Trivedi: Yeah, and once I saw her schedule and hopefully we will put something that resembles that in the infographic or show notes, I realized that my calendar system, after seeing that, was just a set up for failure. I schedule something every single hour, as if competing tasks aren’t going to pop up and  I just kept doing that everyday, and not reevaluating my system and adding that buffer time I really needed.

Dr. Kelly Graham: The only time shallow work’s allowed to intrude on the day is if it’s urgent. Or it takes less than two minutes. I always slip and move back into sort of like a bad system and I need to right my course, but the idea is that I have a way to right my course. It takes a lot of practice.

Dr. Shreya Trivedi: I so wish I could go back and tell my younger self what I’ve learned from Dr. Graham and others. I think now I just know myself so much better. My energy better and I can chunk out my day to meet my energy more. But gosh, it is a journey to appreciate what works for your learning and constantly course correct along the way.

Dr. Kelly Graham: Aside from a really good calendar system and time management system, and you kind of need a task management system too. It can be a notebook with a pen and an Excel spreadsheet. I use a Kanban board, which is a, is a Japanese method for task management. When I started to have to manage a team as a program director and manage research projects, I found that I really did need a peripheral brain. 

Dr. Shreya Trivedi: And here, we are defining peripheral brain as some sort of knowledge management system where you store your teaching points or even tasks for a project. And yes, I have  seen her Kanban board, by the way, on Trello and, I just want to say, I am not one to do hyperboles, but she integrates so seamlessly that she even connects her emails so that if anything requires more than 2 minutes, it gets it own card on the Trello board, all her team members are on it and so they can keep track of tasks easily. She’s really got this figured out!

Dr. Margaret Lie: Not only does she have a peripheral brain to keep track of these tasks, she has a space for important documents such as articles and presentations, which she refers to as reference files.

Dr. Kelly Graham : But right alongside of that you need reference files. Where you actually take the information and store it because you can’t really put information on those. And so mine’s pretty simple. I use like documents, word documents, and Dropbox. So each project has a board and a Dropbox folder. And in that folder will be where that, all of that information, like let’s say I read all the new studies on hypertension, that’s where the summary is going to live, right, so that I can then put it into the slides and into the committee and into all the places in my actual life. But separating your peripheral brain into a task manager and an information storage is really important. And there’s a lot of different ways to do it. And you have to find, the key is you have to find the way that works that you’re actually going to use. And so, I have friends that walk around with index cards in their pocket because that works for them. And so knowing that about yourself is really important and trying different things.

Dr. Margaret Lie: Wow, I can’t help but be inspired by how intentional she is from her consistent task management system with her trello to a peripheral brain like dropbox to organize her new articles. What’s important is finding a system that you’re actually going to use, even if it’s a physical filing cabinet or multiple desktop folders on your computer. Whatever really works for you!

Dr. Shreya Trivedi: And this may be a good point to pivot to the fact that she’s not just intentional in what she role models at work, but she is also intentional about what she role models when she’s off work. And it’s something that really came with doing the hard work and having a strong sense of her own identity and who she wants to be.

Dr. Kelly Graham: Honestly for me, as somebody who has a big life outside of my job, that’s a really important identity. I decided pretty early on that I wanted to be a co-parent for my children. I didn’t wanna be a secondary parent or a primary parent.  That requires intentionality around how you’re spending your time and how much time you’re spending at work and how you’re making space and time for your life outside of work. My work is really a vessel to just so that I can have a big life outside of work. I love my work and it’s part of my identity and not “or” –  it’s an “and” statement.  I am a mother and a friend and a wife and a woman. I have a lot of identities outside of my work that are extremely important to me. 

Dr. Shreya Trivedi:  I’m really glad we are getting into this because just as important as understanding someone’s habits, are understanding how they actually  set boundaries to embrace all their other identities.

Dr. Kelly Graham: You have to model it. I hate speaking for other people, but what I will say is that, everybody has this culture of busyness and everybody is hyperbole, but most people in academic medicine are experiencing this toxic culture and participating in it, and they don’t like it. Nobody likes it. If you are privileged enough to have a position where you can begin to role model an alternative, it is incumbent upon you to do that. It was a part of my goal for my my job, was to say we are a team of humans and we have lives outside of this job. We don’t email each other after 5:00 PM or on weekends unless it’s an emergency. And then we call, we give each other our phone numbers and we call each other. If I’m playing a board game with my kid and one of my teammates needs to call me because something’s going on,  it really does not bother me. But if I open up my email and I see eight messages from the night prior. I cannot work 24/7. So we have to respect that communication also can’t happen 24/7. This is how our team functions, and I want you to have a life outside of this work so that when you are here, you’re present. We’re not looking at our phones. We don’t have our laptops open. We’re with each other. We’re present. Role modeling some of these practices is really, really important as a leader. I had to correct a lot of my own behavior, like my urge to go and send an email if I was choosing to work late. As soon as I do that, I don’t care what I say to my team. They’re watching what I’m doing, and I’m normalizing that behavior and they all start doing it. It’s like really predictable. So, I think it’s really important for us in leadership to start to rethink how we provide equity on our teams and model that. And that busyness doesn’t mean more productivity. It just means burnout for a lot of people.  So you’re not just doing it for yourself, you’re doing it so that you can take better care of your team. 

Dr. Margaret Lie: I love how respecting people’s time is a way that she flexes her leadership power and privilege to improve other people’s lives. 

Dr. Shreya Trivedi: Yeah, what a flex, right ! And such a role flip on how we often have seen power flexed. 

Dr. Margaret Lie: You know, Shreya, I’m just in awe – I feel like Dr. Graham is this brilliant clinician for her patients, for her residents, and an expert leader for the team.

Dr. Shreya Trivedi: Not to mention a just master manager of herself and her time.

Dr. Margaret Lie: Yeah, on top of that, she’s figured out a way to actually be present for her loved ones.

Dr. Shreya Trivedi: Yeah, but you know as humble as she is, she will also remind you just how many tries it took to get there.  

Dr. Kelly Graham: The only thing you can expect is that you’re gonna fail a lot as you get there. And that, those cycles of failure are how you hone it, I don’t think there’s ever a moment where you have to say, I’m just not good at this. When you’re repeatedly failing, it’s really that moment where you look outside and say ‘What’s happening?’ ‘What’s not working?’ It’s more just evaluating yourself first. How do I adjust this swing so that I can get it right? I’m watching my kids right now learn sports and it’s amazing how they actually have to spend a lot of hours with intentional practice and learn how to move their body five degrees this way to get the swing right. I think when you’re failing repeatedly like that, really what you need to do is stop trying to work on your swing and start thinking, is there a structure or system around me that’s setting me up for failure?

Dr. Shreya Trivedi: Yes, it all goes back to setting up systems and stations! Margaret, I feel like we probably should have called this episode systems and stations.

Dr. Margaret Lie: I agree! I know everyone defines failures differently, but I appreciate hearing that Dr. Graham was up for bat, took a swing, and even though she may have missed the first time, she gave herself feedback and adjusted for the next time. 

Dr. Shreya Trivedi: Absolutely! I am so curious, Margaret, going working on this episode and reflecting on your own habits and systems. I’m curious have you done anything differently? I know you’re in a studio apartment, so maybe the stations weren’t really changed much, but yeah, I’m curious if you can be a little bit vulnerable with us?

Dr. Margaret Lie: So, one of the things that I implemented from her talk is the importance of course correcting. I’ve been a lot more conscientious of my learning habits. So, I found out what really works for me is not to stay in my bed to study, but actually go out into the city and find a good place to focus. When I find myself slipping back into bad habits, getting back on the bed, I realize it’s not too late to get up, to get out, it’s never too late to try again.

Dr. Shreya Trivedi: For me, what stood out to me was hearing her call out growth mindset and really giving space to the idea that sometimes being open to failure may not be an option based on your upbringing and other situations or circumstances. And then I really loved hearing how Dr. Graham had unlearn certain habits that were not serving her. And I think for me there was so much unlearning and it took pain actually, reflecting back on residency to fellowship and then all the other things I had to unlearn when I became a faculty member. And I’m there’s still more unlearning to do.

Dr. Margaret Lie: I think thats kind of how medicine is. It’s just a process of learning, unlearning, and re-learning.

Dr. Shreya Trivedi: Which, Margaret, it’s funny, we are doing an episode on learning, and we end with un-learning!

Dr. Margaret Lie: Yeah!

Dr. Shreya Trivedi: And with that, I guess we’ll go to our outro!

Dr. Margaret Lie: And with that we are at the end of our episode!  

Dr. Shreya Trivedi: And if you want to hear more stories in medicine or lifelong learning, let us know! 

Dr. Margaret Lie: If you found this episode inspiring, please share with your colleagues and give it a rating on Apple podcasts or whatever podcast app you use! 

Dr. Shreya Trivedi: It really does help people find us! Tweet us, leave us a comment on our website, or on instagram or facebook page.  

Dr. Margaret Lie: This episode was made as part of the Digital Education Track at BIDMC. Thank you to all our great educators and mentors!

Dr. Shreya Trivedi: As always, we love hearing feedback. Email us at hello@coreimpodcast.com. Opinions expressed are our own and do not represent the opinions of any affiliated institutions.

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