[00:00:00] Christine J Ko: Welcome back to SEE HEAR FEEL. Today, I have the great pleasure of speaking with Dr. Marie Angele Theard, who is an anesthesiologist with many years experience in the field of neuroanesthesiology. I already did one episode with Dr. Theard about the growth mindset, where we really focused on that definition of it. This second episode is going to delve a little bit deeper. Dr. Theard was educated at the University of Illinois, where she also completed residency. She went on to fellowship at Washington University in St. Louis. She is certified by the American Board of Anesthesiology, and she's a member of several societies in anesthesia, including the Society of Education in Anesthesia, the American Society of Anesthesiologists, as well as the Society for Neuroscience in Anesthesiology and Critical Care. For that latter organization, she is on the Board of Directors. She's currently working as a neuroanesthesiologist in the Department of Anesthesiology at the University of Washington, and she's an Associate Director of the Education Training Core at Harborview Injury Prevention Center in Seattle, Washington. As you probably noted from the prior episode, if you had the chance to tune in, education is very important to Dr. Theard, and partly why she's so interested in the growth mindset and has an article written on it that I think would benefit really all physicians as well as trainees to read. That link will be in the show notes.
[00:01:27] In the first episode with Dr. Theard, we focused on the general definition of the growth mindset versus a fixed mindset, and how these different mindsets can really affect healthcare, medical education, learning, and daily practice. This episode will focus more on specifics of what the growth mindset really looks like in action.
[00:01:48] Welcome to Angele.
[00:01:49] Marie Angele Theard: Thank you, Christine. Nice to be here.
[00:01:52] Christine J Ko: I love how you have really used the growth mindset to help with education of the next generation of doctors. Can you speak a little bit about what emotions you think characterize the growth mindset versus the fixed mindset?
[00:02:06] Marie Angele Theard: When I think about the fixed mindset, I think of detachment. I think of fear. You're trying to keep that space between anybody new or different from you. And so you stay in your lane. The growth mindset is just full of warmth. It's about engagement. It's about getting in there and really getting involved. It's giving your all to take care of a patient. It's giving your all to teach a resident and really trying to understand them so that you can do the best job you can to teach them. So it's about work, the growth mindset, a feeling of engagement, of hope, of a glass half full, and understanding. The growth mindset is just very big. When I think small and simple, I think fixed mindset.
[00:02:55] Christine J Ko: Yes.
[00:02:56] Marie Angele Theard: That's how I feel when I think about the two.
[00:02:59] Christine J Ko: Perfect. I like hearing it in your own words because I realized that listening to people speak about an article they've written through this podcast has really helped me understand and digest on a deeper level what I've read. There's a wonderful table in your article, and again, the link is in the show notes, where the fixed mindset being contrasted with the growth mindset. You do have that written in, that the feelings that characterize a fixed mindset are fear, shame, avoidance, and dismissiveness and detachment; versus the growth mindset: the feelings are courage, self-compassion in discomfort, curiosity, supportiveness, and this feeling of being able to be a change agent. That speaks to that glass half full; we can each do something. Can I ask you what you think about emotional intelligence and how emotional intelligence might help move us from a fixed to a growth mindset?
[00:03:56] Marie Angele Theard: Emotional intelligence is actually very important and very helpful because espousing the growth mindset, you have to be able to understand and manage your emotions because things happen. I work in the operating room, a very fast paced, a very dynamic environment. As a faculty educator, I think we're leaders in that space and we have to respond, we have to respond. We have to be able to manage our emotions. We have to be able to communicate effectively. We have to be able to empathize and understand. We're all going through a lot in medicine that is hopefully going to allow us to all emerge different and better. Everyone's experiencing growth. You have to have some patience and some empathy to understand and make room for that. It does mean overcoming some of the challenges so that you can deal with the conflicts in the operating room, which are not minor, unfortunately.
[00:04:48] Christine J Ko: Absolutely. I recently spoke with Dr. Luna Dolezal who is Principal Investigator in the United Kingdom for the Shame and Medicine project. She focuses on shame in medicine and how it's at all levels, including in medical education. She's worked with Dr. Will Bynum, who's at Duke University, who also has been looking at shame in the learning setting. I think it's beautiful how the growth mindset can really counteract shame because in speaking with Luna, I realized that, yeah, I felt shame many times and the problem with shame, or at least, the problem for me with shame in the past is: I just want to run away. I don't want to face it. So then I don't want to face whatever caused me to feel shame. For example, if it was a mistake, or something that I don't know. Of course it's going to benefit me to learn from that mistake and learn how to not do it again. Or if it's something that I don't know that's important to the practice of medicine, the practice that I have, it would only benefit me, as well as the future patients that I see, to be able to face that. It all connects, these feelings of shame or disengagement versus courage and curiosity; being able to interrogate, well, why did that happen? Why do I feel this way? What can I do differently? Can you give a specific example, as you did in your table from the article on the growth mindset in action in healthcare, or maybe a fixed mindset in healthcare, and help listeners picture how that looks?
[00:06:24] Marie Angele Theard: When you're doing something like this, you start to really think about your space, and the space you occupy, and the people that you deal with. All examples of the fixed mindset are opportunities for change. There are a couple of examples in fixed mindset. Two residents that were actually phenomenal. One was their ancestry or their ethnicity was Chinese, and another one, their ethnicity was African, actually Nigerian. Some faculty educators saw the gentleman from China as just difficult to understand, the accent was hard. There were comments about, " I don't know what I'm going to do with this resident. I'm just going to try to just let them keep going through, because I have no idea how to really find a way to understand them. It's too much effort. I can't do it." So just pass them along. I remember being on call and hearing this difficulty, and it's the same for this Black resident where there was this idea that, "I just don't think that they're ever going to be really good".
[00:07:22] And so as a new faculty in those spaces years ago, I am left with, what do I do? How do I deal with them? It made me ask some questions. Can you just tell me, so I know what to watch for? It led to a series of really good conversations. I was really very pleased to be able to compel them to engage on a different level, and together really think about how do you approach these learners and how do you find a way, through understanding. It was interesting, days later, the same trainee, the first language was Mandarin; days later, we engaged a patient and spoke to that patient in Mandarin. Being able to 1) acknowledge some of their challenges, but now you're actually empowering the resident by saying, Oh wow, it's great. It's wonderful. Here you are. You're able to engage. Taking that time to understand and see what this resident can contribute, you went from this space of just passing them through, just not really wanting to engage. What I saw happen, which I really enjoyed watching was being able to see the strengths that this resident had, and you see them also evolve and become more confident.
[00:08:32] There's a lot of work in the middle where you have to really take the time to understand and have a plan for affecting things. Another instance which touches a little bit on the importance of emotional intelligence is there's a constant kind of bit of a tug of war between surgeons and anesthesiologists in the operating room. You've got this drape that separates us, and, we oftentimes don't have a name. We don't have an identity. We're just this "anesthesia". And I remember a member of the surgical team asking for the table to go up or down and saying, "Anesthesia, up or down, if we could get moving, we could get this case done." Then they made this comment. "If your boy could just get the bed up, we'd be..." And I remember pausing. He was talking about one of the anesthesia trainees who was a man of color. And this thing, this statement came out, "your boy". For members of underrepresented groups, particularly African Americans and some members of Latinx population, "boy" becomes a very derogatory term from a time of pretty intense patriarchy. I could see in his face, this member of the surgical team, in two seconds he saw what he had done. There was definitely like, Oh, my God. I'm not going to ignore it. I'm going to address it, and actually start the work right here. "Okay, there's no boy here. There's no "boy" that gets admitted to medical school, becomes a resident, and gets to become an attending. These are men." I just gave the definitions of where we're at, and he was so quick to, "I'm so sorry. That should never have come out of my mouth, that it'll never happen again." It was very quick, and it was very professional. And then you're not done, because now you have to engage the trainee. You have to be able to give them an opportunity to unload, to be able to free themselves of this feeling that they have. So you need to give them a space to talk about it.
[00:10:15] There's so much work. There's quite a bit of emotional intelligence, but there's a lot of self-reflection and really thinking.
[00:10:20] Christine J Ko: Yes. The table is amazing. The great thing about is it looks so simple on the surface, and then when you really look into it, it's very deep and complex and covers how to move from a fixed mindset, which I think really does characterize a lot of the medical culture that I've been in, moving towards a growth mindset. It shows that each of us can make a difference. There're system problems, of course, and institutionalized issues as well, but we can really each make a difference. I find that really exciting and important.
[00:10:53] Do you have any final thoughts?
[00:10:55] Marie Angele Theard: One more thing about the table that I really like is it gives you a little bit of a play by play at a lot of different levels that we're in. As faculty, we have many different roles. The table's really applicable to the different spaces that we occupy within medicine.
[00:11:10] I've had the opportunities to learn at University of Illinois in Champagne, in Peoria, in Chicago; in Washington University in St. Louis. I've had the opportunity to work with some great educators in my career, and for that I'm extremely grateful. I think the growth mindset has really helped me to characterize my experiences to understand what I bring, to understand what we can all bring, and to understand where I can do better.
[00:11:34] There's another book called The Growth Mindset Playbook, and these two women educators, they, and Carol Dweck does this too, she talks about coaching. My husband is really into sports and I always think, when your kids, are playing soccer around the field, and the parents are standing at the side, what you hear is, they're cheering.
[00:11:51] "Oh, you can do it. You can do it. Kick the ball, get it over. Oh, you missed it, but you'll try again." You never hear them say things like, "It's not in you, you can't do it. Don't even try. You're not made for this." We don't say that. And sometimes we may think it, but we don't say it. We just cheer. I think about bringing that type of attitude to the operating room or to internal medicine or dermatology, bringing, "You can do it. Oh, you missed it. Let's try it again." And then afterwards, when you're pulling your son or your daughter, or a young child aside saying, "Hey, maybe some more sit ups or maybe some more running and you'll be better next time." When you think about that atmosphere and I think of myself as a coach, then you start to function more like that cheerleader that's going to do everything you can to really help promote proficiency in this trainee, successfully, and in a very positive environment. The growth mindset, the stimulation it creates, it allows you to create this back and forth that makes you very excited to teach just as the learner's excited to learn.
[00:12:56] Christine J Ko: Oh, I love it. I love the analogy. I love the excitement; your work is inspiring. Thank you for spending the time to talk with me.
[00:13:05] Marie Angele Theard: You're very welcome, Christine. It was a pleasure. Thank you.