At what point did you decide that you do enjoy mentorship/teaching and wanted to pursue that as a career. And how have you come to realize that as part of your career in medicine?
“During my freshman year of college, I came to the conclusion that I wanted to be a high school math teacher and basketball coach, and so I went back to my high school to talk to some of my math teachers and basketball coach. They tried to convince me that it was a really bad idea. They pointed out that while some teachers get great satisfaction out of it, a lot of teachers at that level fall into it as a backup plan to something else. They had seen a lot of people burn out and some of them had actually burned out. My high school basketball coach was leaving teaching to go to physician’s assistant school. I did not have to decide right then so I went back to school and kept that in the back of my mind and took some education courses while switching my major from math and computer science to psychology. In my sophomore year of college, I had a roommate who was a junior, taking freshman premed classes. He decided to go to medical school two years later than most people. He was taking freshman chemistry and biology. I saw him do that and I looked around at the other people that were also doing premed and I had always thought I wasn’t smart enough or willing to work hard enough to be a doctor, but when I saw the people that were doing well as premeds, I thought “they’re not necessarily smarter than I am and I can work just as hard as they do.” So, I followed in my roommate’s footsteps and decided after thinking about it for a while that I was going to go premed also. It took me three tries to matriculate into medical school. But through it all, I knew I was always going to do some type of teaching down the road.
When I saw the people that were doing well as premeds, I thought “they're not necessarily smarter than I am and I can work just as hard as they do.”
In medical school, I saw the surgery residency director and I thought that could be an interesting job because surgery residents are so hardworking and so committed to what they do. It would be a great privilege to work with and help educate students who are so committed and hardworking. Later, I got into surgery residency, and about my third year of residency, I looked at the program director’s job again and I thought “man, that’s a job I never want to do,” mostly because nobody is ever happy with you when the annual residency schedule comes out. You’ve never gotten it just right; every faculty member, every service thinks that you didn’t give them enough residents, and every resident thinks that you didn’t time their rotation schedule right so they could go present their research or get married or take a vacation, etc. Nobody’s ever satisfied with the program director and that’s a really bad position to be in. So, I thought to myself, ”I do not ever want to be a program director,” but I did want to be a teacher, so I got here on faculty and started putting in some extra teaching time and running some teaching conferences for interested residents. A few years after I was here on the faculty, a few faculty members had left so we started taking in-house calls every third night. This dramatically increased the number of hours we had with the residents, and a few of us picked up some teaching awards along the way. It was a good experience, and I developed a good relationship with the residents. Eventually, the residency director at the time asked me to be the associate residency director. But two years later, she left to go to another institution, and so by default I became the program director in 2006. It’s been a tremendous journey and honor to have the privilege of directing the program.
However, I later realized that being a teacher is nice and a very good thing, but really what we all need to strive for is to be educators. Being an educator takes on a whole additional level of commitment because now it means you must have difficult conversations with residents; you have to tell them where they’re coming up short or where there are opportunities for improvement. You have to be the person that personally pulls them aside and says “I noticed there’s something you’re doing that you could do better because you’ve got peers that are better than you are.” The truth is we all need that, not just residents; I need that and so do the residents and so do the students to help them get better faster because there’s so much to learn in medicine; the medical knowledge is doubling some say now every 18 months. So, there’s so much to learn and relatively little time to try to do it and so the rate at which we need to attain expertise and knowledge is remarkable, and therefore the more constructive feedback we can get to people the better they’re going to be as learners.
All our learners are motivated and all of our learners want to learn but the question is can you help them learn faster and better. A lot of that comes with having a good relationship with the learner. If it’s someone whom you respect and you’ve observed them, and you’ve seen other learners at that same level who are doing something better, you can explain to them how to improve and it’s a magical relationship and that is something that will benefit you as much as it benefits them. Having that relationship reflects well on the mentor or the educator.”
What would you say is next for you as a medical doctor and a teacher?
“One of the things I’ve realized is that most residents at least and
most medical students will meet whatever standards we set but standards need to be clear and there need to be sufficient resources all in an environment that allows them and encourages them to meet those
standards. So as a result, again it’s less about teaching, more about
educating and giving feedback to help people meet standards, which is
more important than teaching. The residents and students will educate
themselves. And that’s part of what we are trying to teach; how to
self-educate. My involvement locally on campus and my involvement
nationally, I think is encouraging other people and encouraging even
some of the accreditation bodies to set high standards but clear and
well-defined high standards.
I am trying to also push and drive the raising of standards in terms of competency-based education. I am leading a competency-based educational effort here on campus (UT Health) right now that we started as a result of the pandemic, and we’ve got 10 residency or fellowship programs participating in this. In General Surgery, training for the entering class of 2023 and onwards will be based on a competency paradigm, but there is still a lot of work to do in determining competency. Pediatrics also has a pilot going on nationally. I am pushing for competency-based education locally and nationally. Our goal is to make our institution a national leader in that area so that we can be at the forefront of this evolution and keep producing better practicing physicians in all areas.”
Is there anything else you would like to add or maybe a statement to the rest of the interview?
“I think we have learned over the years that while we strive for perfection, we don’t achieve it. However, if we are open to the idea of spending time to look back at how we can do things better, committing to learning from mistakes and improving for next time, you’ll see that over time you’ll get significantly better at whatever it is you’re doing. And I’ve come to realize that it is not just true of our health system or our specialty, but it works on an individual level. Each of us is a quality improvement project in process and if you think of it that way, if you go through life that way, you’ll find that you’ll have much more success and much more career satisfaction. And as such, I would invite anybody to approach their medical training and their medical education with a sense of ‘I’m going to do the very best I can but I’m going to recognize that there’s always opportunities to do it better and if I keep working at it day in and day out, I will get better and better at what I do.’”
Each of us is a quality improvement project in process and if you think of it that way, if you go through life that way, you'll find that you'll have much more success and much more career satisfaction.
Story: Nasrullah Abdurrazaq, Photo Credit: Dr. Daniel Dent