[00:00:00] Christine J. Ko: Welcome back to SEE HEAR FEEL. Today, I have the pleasure of speaking with Dr. Marie Angele Theard, who is an anesthesiologist with over 20 years of experience in the field of neuroanesthesiology. She was educated at the University of Illinois, where she also completed her residency. And then she went on to complete a fellowship at Washington University in St. Louis. Dr. Theard is certified by the American Board of Anesthesiology and is a member of the Society of Education in Anesthesia, American Society of Anesthesiologists, and she is on the Board of Directors of the Society for Neuroscience in Anesthesiology and Critical Care. She is currently a neuroanesthesiologist in the Department of Anesthesiology at the University of Washington, and an Associate Director of the Education Training Corps at Harborview Injury Prevention Center in Seattle, Washington. She has a very well written article on the growth mindset, and the link will be in the show notes. We are going to focus on that growth mindset today. Thank you to Angele for being here with me.
[00:01:03] Marie Angele Theard: Thank you, Christine,
[00:01:04] Christine J. Ko: Could you start with a personal story about yourself, that will help listeners know who you are?
[00:01:09] Marie Angele Theard: I'd be glad to. Thank you again for inviting me to do this podcast. As a faculty neuroanesthesiologist, oftentimes we're supervising maybe two residents in two different operating rooms. What typically happens, I'm just going set the scene, is that, the night before, your resident calls you, tells you about the patient, and makes a plan. Then the next morning, we go see the patient together. We make sure there's nothing different. We go over the plan with the patient, and they have an opportunity to ask questions before proceeding to the operating room. On one occasion, we had a patient, it was a young Latina woman coming for surgery. We went through all the questions and answers, and she asked if she could speak to a chaplain before going to the operating room. That's not unusual. Surgery is pretty anxiety provoking and everyone has a different way of coping. It wasn't an unusual request. I went to go check on my other room, and I told the team, I said, let's just wait until she gets to talk to the chaplain, and then we'll proceed. So after I finished taking care of my one operating room, then I went back to the other operating room and everyone had arrived, and I said, oh great! The patient's on the operating room table, and I bent down, and I asked, did you get a chance to speak to the chaplain? And she said, No. And I paused, I stopped. I remembered when I had surgery years ago, and how nervous I was, and how afraid I was, and what that feeling was like. I kept thinking about her request, and I stopped. I said, everyone, I just want silence. I held her hand, and I announced, everyone, the neurosurgical team, the anesthesia team, the nursing circulator, I'm going to pray with this patient. And so we prayed. Things went great, she did really well. I saw her in the recovery room and the first thing she said was, “Thank you for praying with me.” The business that we're in, medicine, it's a job that's about healing, and the focus is really on understanding. Understandably we focus on understanding the physiology and the pharmacology and being able to apply that to taking care of patients, but healing is also about understanding a very vulnerable group of people and finding a way to help them with whatever small thing that they're asking. Sometimes we have to go outside of our wheelhouse to really be in the shoes of this person, to be able to understand what they're requesting and how important it is.
[00:03:30] And that is what I do. I do all of the pharmacology and all the physiology, and I love it. And I really love engaging with patients because it affected me, too, that day. I was happy that I was able to do this small thing for someone; that it meant so much. That's what I do in medical education, understanding learners, and being able to engage with them to help them thrive and to do well because ultimately they're going to become the next group of physicians out there to care for patients.
[00:03:57] Christine J. Ko: Thank you. That's such a beautiful story. I love it on so many levels because you've touched on, with that one story, the essence of what I'm trying to do with this podcast. I feel that there's not enough time to talk about things like empathy and really connecting and the small things that actually aren't so small. There were so many other things you did during the surgery as the neuroanesthesiologist that were critical, but really the biggest thing to her was that you took that time.
You mentioned how you're dedicated to learning yourself but also teaching the next generation and those around you. A growth mindset is so important to that. [00:04:44] And that's what your article that's in the show notes speaks to. In your words, can you explain what a growth mindset is versus a fixed mindset?
[00:04:53] Marie Angele Theard: Sure. I'd be glad to. Christine, thanks for your thoughts. I really appreciate that. I want to say, thank you to one of my mentors, Dr. Rebecca Harrison, one of the authors of the paper; she really led me through understanding the growth mindset and fixed mindset. These are really ways that we view our abilities. The growth mindset says that the abilities that we have, we get from trying, from working hard. So you try, and in the field of medicine, we have guidance through our preceptors and educators to help us do well. So we learn. The growth mindset learner, the growth mindset educator, the administrator, the faculty member: they can learn anything that they put effort in and try. You welcome challenges. You're excited about that. When you fail, you learn, and in medicine, that is so critical because that's oftentimes the space where most of the learning occurs in medicine. Being able to try and learn from your mistakes makes you a phenomenal learner and very proficient in medicine.
[00:05:54] The fixed mindset really characterizes a lot of our society. It's actually much more predominant. People who have this type of mindset, they stay away from challenges. They don't want to be wrong. They are their ability. And so anytime they fail, they take it as a strike as to who they are. They don't look forward to challenges. They avoid them. They're a little bothered when someone else is succeeding. They're a little threatened. They tend to downplay their mistakes, which I think is one of the biggest problems in medicine: hiding from your mistakes. So you don't take the time to understand them and get better.
[00:06:28] Christine J. Ko: Thank you for those definitions. I first read Carol Dweck's book called Mindset, where she talks about this concept that she developed: of the growth mindset and the fixed mindset. As you mentioned, the fixed mindset is prevalent though, in society. In your article, you talk about how the fixed mindset really characterizes healthcare and medical education. Can you talk about that?
[00:06:50] Marie Angele Theard: Sure. Our society is experiencing a renewed intentionality around understanding the ramifications of systemic racism. Unfortunately, this is thanks to the murder of George Floyd, and the stark disparities that we see in disease due to the COVID pandemic, which has led to a higher instance of death in communities of color as well has helped to fuel a lot of anti-Asian sentiments. So when you sit back a little bit and try to understand the impact of systemic racism, which is really a fixed way of thinking: you look historically, how certain groups were perceived compared to other groups, how the institution of enslavement of humans led to many people trying to find a way to justify this type of abusive institution. They did that by creating this category of "other" where African-American, Native Americans, Latinx, Pacific Islanders, Asians, and many other groups are fixed at "less than". So they're fixed at "less than" the "superior group": white people, who are fixed at better, smarter, more accomplished. That becomes the foundation of our society, and it continues to pervade every single one of our spaces. It transcends into medicine. When you look at the abuses during the Tuskegee Syphilis Experience or Dr. James Marion Sims, who was the father of gynecology, who experimented on one African American enslaved woman: did 30 operations to perfect treatment of urovesical fistulas. His whole argument was: people of color, Africans that are enslaved, they don't feel pain. You have patients who are aware of all of these atrocities, and that ends up creating this atmosphere, from the patient of color, of fear and mistrust. A survey conducted with the National Public Radio, Robert Wood Johnson Foundation, the Harvard Chan School of Public Health in 2017: they surveyed a number of people of color and revealed that a majority of African Americans reported having personally experienced discrimination, and 22% of those surveyed, even though they had a medical condition and needed treatment, they refrain from seeking medical treatment, only because of fear and mistrust of the medical establishment. So here you have even people who had the means and access to care, they still reported, because of their fear of discrimination and how they're going to be treated, in their mistrust, they tended to delay going to seek medical care. So that's on the patient side. When you go on to the health worker side, there are a number of studies of a variety of different healthcare workers and found significant bias, this preference of people that are white over people of color, and it did impact the care that they provided in the areas of pain, in the areas of empathy, in the areas of clinical decision making for pretty serious illnesses. So you've got this system of a fixed way of thinking of people that ends up having a negative impact on patients seeking care, as well as a negative impact on how physicians and other healthcare workers perceive certain groups of people.
[00:10:05] Christine J. Ko: Wow, Angele, that's amazing. I read Carol Dweck's book more than once, and I read your article more than once, and I have not made that connection in my mind. That makes perfect sense, that all of these "isms" - racism, sexism, ableism, et cetera, are really an example of the fixed mindset. I'll have to keep thinking about that. Given this systemic racism and this mistrust and bias in the system, what can we do to have a growth mindset?
[00:10:40] Marie Angele Theard: There are a number of things that we can do. One, read that article, read Carol Dweck's book. Think about your practice and look at medical education. One of the reasons that we wrote this article, with Dr. Rebecca Harrison, and MD PhD student, Dr. Mollie Marr, we take Dr. Carol's work, and we think about the environment that the learners are in. A lot of Dr. Carol Dweck's work is looking at the learner, and how they learn, and what is effective in that space. She touches a little bit on this idea of the environment, and we really expanded our thinking about what do we do to support the learner in that environment, and how do we support a growth mindset environment?
[00:11:23] As a faculty that is teaching residents, you have to believe that residents are capable of learning. The fixed mindset educator, sadly, is the educator that's going to look at, maybe, a resident who is a foreign medical graduate, who may have an accent it may be difficult to understand, or another member of underrepresented in medicine, an African American who they've decided are fixed at "less than" and that their inabilities or their mistakes are just a part of who they are, and it's not going to get better. And what ends up happening is you decide, before even making an effort to teach them, that they can't learn. So they become isolated. They become dissatisfied with their experience, and it actually ends up affecting their academic performance. So by creating a growth mindset environment, it's about becoming aware of your bias, becoming aware of how you're perceiving someone, and pausing for a minute, and really thinking about how you can be effective as an educator and thinking about being very specific about the problems that you see in the learner; so you can actually provide a program to support them so that they can become proficient. That's our goal in medicine: to make these medical students that are coming into our space proficient physicians.
[00:12:45] When you're sitting here thinking they can't learn, break it down. Come up with your rubric so that you can be very objective about what it is that you're trying to work on. Debrief with them. Talk with them at the end of the day, their weaknesses, their strengths. When you see their weaknesses, come up with a way to trying to help them with that. That supports the learner. They start to feel they're no longer isolated, but they start to feel like they're part of this team. They're more readily able to understand and accept criticism and there's a pathway to their success.
[00:13:16] Christine J. Ko: I agree with you. I think it's hard for learners when teachers themselves don't have a growth mindset and do see different learners as fixed at a certain level, especially if the teacher is implying either explicitly or implicitly, somehow, that one learner is better than another for whatever biased reason.
[00:13:36] Marie Angele Theard: A really interesting study that was in one of Carol Dweck's books, a study of 150 STEM professors and over 15,000 students. They found that the racial achievement gap in courses that were taught by fixed mindset oriented faculty were twice as large as those taught by growth mindset oriented faculty, and that student evaluations and classes taught by fixed mindset faculty indicated a very negative educational climate. You can actually even flip it when you look at how faculty approach white students or students from the majority race with the fixed mindset, where they start to believe that they can do no wrong, and that they're great, and they're talented, and they're phenomenal, and they start to overlook their mistakes. What happens is they get to the end of their training, and they haven't really accomplished everything that they could. They're actually doing a disservice for that group of students as well. It really becomes something that's important for every single student, that faculty educators do as much as they can to lean towards the growth mindset.
[00:14:39] Christine J. Ko: Absolutely. Yes. We are going to continue talking about the growth mindset in another episode, because this is just such an important topic. For this one, do you have any final thoughts?
[00:14:51] Marie Angele Theard: Don't be afraid to change, to be aware of your mindset, to take the time to pause. To be a really good educator is really critical to the success of our trainees. Successfully proficient trainees make great physicians, which is extremely important.
[00:15:10] Christine J. Ko: So inspiring. Thank you, Angele, for spending the time.
[00:15:12] Marie Angele Theard: Thank you, Christine.
