Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 10 The Future Physician: Navigating Holistic Assessment in Medical School with Dr. Raphäel Bonvin

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Flourishing in Medicine: From Surviving to Thriving Episode 10 The Future Physician: Navigating Holistic Assessment in Medical School with Dr. Raphäel Bonvin · Flourishing in Medicine: From Surviving to Thriving

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  And historically you can go back to the Greeks, you find already those aspects more than 2000
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  years ago, this commitment to self. Be well yourself before you treat the others. If you're
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  unwell, you won't be able to treat the others. So for us it's part of this core aspect of
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  professionalism and we expect them in the learning report at the end of the year that they will
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  reflect on their well-being. Welcome to flourishing in medicine from surviving to thriving. I'm your
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  host, Dr. Mick Krasner. This podcast produced by EmPRO, a medical professional liability insurance
• 0:46
  carrier headquartered in New York State, is offered to you because of EmPRO's deep commitment
• 0:51
  and track record of programs that support physicians they protect. This commitment includes many
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  wonderful learning opportunities that they've developed and I hope you enjoy this podcast and
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  explore other of their offerings. Today I'm really excited to share with you my conversation with
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  Dr. Raphael Bonvin, who is vice president and professor of medical education at the University
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  of Freiburg, Switzerland. He has committed his career to aligning medical education more closely
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  with the skills and competencies required to be a physician. Recognizing the formative possibilities
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  in designing educational assessments for learning purposes rather than just for grading and central
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  to his innovative and groundbreaking work in radically shifting medical education is the
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  importance of self-awareness and self-care as competencies that medical education must
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  address in order for the future professionals to provide excellent care and to flourish in
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  medicine. And now our conversation with Raphael Bonvin. Welcome to flourishing in medicine and
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  what's interesting having you on now is that we're publishing several podcasts around this time that
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  yours will be broadcast that have to do with medical education and its effects on flourishing
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  with medical professionals so we're really happy to have a professional intentional international
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  renowned educator like you as a guest so we'll begin and I begin all these conversations with
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  exploring what brought you into medicine you know in the experiences I've had with students with
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  clinicians teachers academics I've been really impressed by the unique narratives sometimes
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  there's some common threads in those narratives about why they chose to go into the health
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  profession sometimes it's early profound experiences sometimes it's something about serving humanity
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  sometimes it's something that occurred during their educational journey or earlier on so we'd
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  really love to hear about your path how you got to this where you are now and especially how you
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  chose medicine of all the talents you have and all the things that you could choose and please
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  take your time we were really interested in hearing about this okay thanks Mick it's a pleasure to be
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  on the postcard podcast well how did I enter medicine actually I was undecided between going
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  for physics biochemistry or medicine so I was usually interested in all three and finally I
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  decided to go into medicine because of the humanistic dimension I envisioned to find in
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  there that was the moment I decided to enter medicine and leave physics and biochemistry by
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  the side and funny enough we have in in Switzerland the six-year curriculum on the first two years are
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  heavy on basic science and I at one point got a little bit upset because there was just physics
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  chemistry biochemistry and first of all it was boring for me because I was well established in
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  those disciplines and that's not why I was entering medicine in parallel to starting medicine I
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  entered a traditional Chinese medicine school and actually that's the reason why I stayed in
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  medicine because I got what I was looking for medicine in this training of the traditional
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  Chinese medicine so this was a parallel track all over my studies with the traditional Chinese
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  medicine and for the first three years and the last three years there was some training in
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  homeopathic medicine so for me that was the reason why I stayed in medicine so I choose for the
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  humanistic was disappointed and stayed in because I had something that showed me there is something
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  at the end of the path but maybe you can unpack that a little more what was it about that experience
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  in training in Chinese traditional Chinese medicine that kept that humanistic drive alive in a way
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  that the basic sciences in the in the undergraduate medical education experience did not be curious
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  what it what did you see what did you feel what was the experiences that kind of told you oh yeah
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  this is about taking care of people and I'm in it and I know we'll get there in my traditional
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  studies so I was already quite at ease in those basic science I love those basic science so it
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  was not that I was not fulfilled with this but it was too easy if I may say for me and I really
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  chose not to go into that to discover something different and so in the beginning of my medical
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  studies I didn't find that because there was so much of basic science and what kept kept my my
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  enthusiasm in having chosen the path of taking care of some other people of caring people of
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  trying to cure them was this traditional Chinese medicine because we had already thoughts about
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  a therapeutic approach we had an approach of the patient that was holistic and not just some
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  disease so those are the things that nurtured my my enthusiasm in staying in medicine got it so
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  sounds like what what you're describing at least what I'm hearing is that there was a very clear
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  line connecting what you were doing in the traditional Chinese part of that medical education
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  to the patient whereas it was a little less clear learning the basic sciences naturally they were
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  more focused on mastering the basic sciences although I would imagine they tried to bring in
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  some connections with what it means for disease and health that it was just more obvious and clear
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  you know you've had many different paths including the traditional Chinese medicine but can you take
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  us from the medical school experience to your choices and how you decided to focus your mission
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  in life if you will on education on medical education you are a consummate well-known
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  medical educator who has had you know great impact on your own communities and others so tell us
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  about how you got there knowing that there was this drive to to be connected with the human
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  condition so basically it's it starts exactly in the experience I mentioned before while I chose
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  medicine so I went through the whole school I highly appreciated doing clinic so I did some
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  postgraduate training in clinic and I really felt at ease and that was my aim and that was really
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  full into it but looking back and also during my studies I was not happy with how medicine was
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  taught starting by the first year being so strange when you enter a clinical track that you don't
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  have clinic and so that was kind of the start of my critique of how I was taught and I was
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  pretty sure we could improve that so I had I was I was the chair of the student association
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  we looked at different aspects of our curriculum we tried to raise our concerns and try to put that
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  into into movement and there was a Weisdeen when he received our report that said I want you on my
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  committee we're going to do a study reform and that's actually one path that brought me into
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  medical education the other path is that I did my my doctorate t this on teaching teaching chest
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  teaching chest examination lung auscultation palpation percussion I loved those clinical exam
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  moments and I wanted to find a way to make it more accessible to my fellow student so I developed
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  at that time it was back in 1994 a CD-ROM a teaching CD-ROM that was quite new so I worked
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  actually two years on developing this teaching program within the neumatology department at our
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  hospital and that's where I got the direct experience about teaching and my involvement
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  and in parallel I worked on this study reform with the study reform committee so that was my
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  entering into medical education it's really fascinating how a recognition by a faculty
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  mentor or someone can completely solidify and in some ways change a career path by identifying in
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  you some aptitude and knowing that you were finding some meaning in that this person brought you onto
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  that reform committee and then you could say as the saying goes the rest the rest is history
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  of course you know the path that was to follow you know continues to be influenced by many many other
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  experiences but I think that's really great to round out your kind of educational interests and
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  clinical interests before we come back to education because I'm going to want to do that
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  is I'd like to hear a little bit about your curiosity and your training in some other
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  areas I know you're trained in hypnosis and also in acupuncture I guess that could be related to the
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  traditional Chinese medicine but tell us a little bit about how that developed as well.
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  So hypnosis was something I did as an adolescent and that was this magical approach of hypnosis
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  and vision of hypnosis and we tried some crazy stuff at that time as you do when you're an
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  adolescent with some friends so we we tried to anesthetize our our skin and put some needles in
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  and that kind of stuff so that was the crazy moment of my hypnosis I probably kept from that
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  kind of I befriended the idea that our mind is something more than some automatic approach and
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  from there on when I started medicine I that was history as you said before I kind of forget it but
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  then it came back again a brother of mine is a psychiatrist and I didn't know at that time but
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  he invested in clinical hypnosis and was restructuring a clinical hypnosis school.
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  He asked me to give him a hand from the education perspective and the deal was give me a hand and
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  you're allowed to have the training for free and that's how I came back to now with with I was
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  already a physician I was clinically active at that time I entered this world of hypnosis from
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  another angle and that's how I entered there and that was the moment where I stopped being
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  clinically active and I was asked to teach some of those aspects but I kept out of the clinical
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  teaching of hypnosis because I didn't have any ongoing clinical experience so I focused on
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  self-hypnosis and this is a teaching I I did for more than 20 years now on the one or two day
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  workshop for everyone so from the gardener person to the oncologist all people sit together in those
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  trainings and we explore together what they can change in the perception on how they live their
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  life. And the acupuncture part of your training is that part of the traditional Chinese experience?
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  Yes so the acupuncture part was this traditional Chinese medicine training.
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  I never practiced this after my training. It was for me more than a practical training,
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  a training in considering different perspectives of what I call reality. For me reality depends on
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  how you look at it. So for me it was this experience of saying okay there are different
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  realities when you look at the patient if you put the grid of our scientific medicine you have all
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  the physiology, physiopathology and the treatment that go with it. But if you put another look at
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  the patient and you apply the traditional Chinese medicine perspective then you have a whole other
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  understanding of this physiology, this physiopathology and the treatment that goes with it.
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  So I learned starting with my medicine to have different perspectives and pretty much convinced
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  from the beginning that depending on what's going on one perspective is better than the other but
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  that's not an absolute perspective. It's not that one technique is good and the other is bad. It
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  depends on the condition and the situation. It sounds like these experiences whether you're
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  clinically active with them or not have had a big influence on your main activity which has been
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  education and your understanding of perspective taking, empathy, all those other aspects of what
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  we want to train in our trainees and our students and physicians. And because this show is called
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  flourishing in medicine I'd like to come back to that focus on education and ask you to talk to our
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  listeners about the connection as you see it between the learning environment and well-being
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  and I'll give you some other prompts that maybe can help you. Maybe touching on the dynamics of
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  assessment. I know that you've studied that and written about that. Curriculum design,
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  maybe if there's any evidence related to those aspects and how physicians choose their,
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  make their career choices, the career path and even burnout, the relationship between the learning
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  environment and burnout. And then eventually if we get to it I'll prompt you if we go off on tangents
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  which is totally fine but I'd really like you to talk a little bit about what you've brought to
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  Freiburg, Switzerland, this new curriculum that I think really does have the opportunity to help
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  students and future physicians flourish and we'll come back to some parts of that that I'd like to
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  hear more about. So yeah the connection again between the learning environment and well-being.
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  Yeah I think it's a very important link for me and this perspective developed over time
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  based on my own experience. I went through three burnouts so each time I had the opportunity to
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  reflect a little bit more why I ended up there and what can I do as an educator in the system.
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  Now looking back or looking just at what is our job in the undergraduate curriculum is to prepare
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  our fellow students to become physicians and we based on the last hundred years we put emphasis
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  on knowledge. So actually all over the world at one point we considered that you reach the certain
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  level of knowledge and the society grants you the permission to treat patients. And this decision
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  is left to the physician where and when what's the threshold but we forgot that being physician is
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  more than knowledge. We have today a tremendous chance to rethink all that in the context of
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  artificial intelligence because knowledge we are not the master of knowledge anymore.
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  We can argue now for one or two or three years or in maybe five years. We are just in this
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  transition phase where technology for certain aspect is going to be better than many things we
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  can do as human. If we consider the situation where one artificial intelligence is able to pass
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  a national exam USMLE in the United States or we have our national exam too. Does it mean that
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  this artificial intelligence is a physician? Probably not because there are many more things
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  that are coming with the training and this decision to let you treat patient and those things were
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  just granted for. So I think education needs to now take care of those aspects that we just said
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  hey that's fine that comes with it. So that's one aspect the environment clinical environment
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  the world changes and our profession needs to rethink how we decide if someone becomes a
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  physician or not. It's not knowing by heart all this immense baggage of knowledge it's more to
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  know how to deal with it and the other aspect is how to be a physician not how to act as a physician
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  but how to be a physician. I think this is something that is difficult to introduce in the
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  training because we are so much knowledge focused and the way we address knowledge is with assessment
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  that are reliable and we have all the qualities education and edu-metrical qualities that are
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  attached to those assessment and for good reason I think it's very important. The problem I see is
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  that we just focused on that so we have to open up we have to look at the other competencies that
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  make a physician be a physician and try to help our students to develop those qualities in a reflected
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  manner. So this is something that needs a change because how would you say to a student based on
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  lack of reflexivity you're not allowed to continue your studies you will have a hard fight in if you
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  compare that to the knowledge if someone has all perfect mcqs and no reflectivity in many
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  situations in many schools you don't have the tools to tell the student you're not allowed to continue.
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  We know what it means to have a physician without reflection it's not possible so how we can introduce
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  that in the training of our student is this new movement that came with the understanding what
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  assessment does to the learning and how assessment can contribute to learning and not only measure
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  learning so assessment came out of this role of okay that's just a measuring tool and we now
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  consider that when you put an assessment there's a pre-assessment effect so that will steer the way
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  there's a pre-assessment effect so that will steer the way students learn there is a pure
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  assessment effect going through an assessment is a learning moment and there's a post-assessment
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  effect you may use what the result of your assessment to change or improve your learning
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  afterwards so it's more than just having a grade and that's how assessment for me joins this
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  reflection of developing other competencies that just knowledge and skills because if we find a way
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  in assessment to consider those sometimes contradictory statement of a student he is
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  good in knowledge but bad in professionalism or so on if you have on one side the grades
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  you need the grades on the other side to kind of balance that or and that's this approach it's to
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  look at the assessment not as a grading machine but as a teaching machine so the phrase goes is
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  assessment for learning instead of assessment of learning so tell us how how you've done this that
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  in your program have removed grades at least the way we generally think about grades and putting
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  all our efforts toward getting the grade completing the exam doing well on the exam for the exam sake
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  and how to really how you flip that upside down in a sense and really was about how to make it a
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  reflective process so one can understand where one's strengths are and what one needs to begin
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  to work on and really be invested in doing that work not just for grades sake but for the idea
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  of becoming a clinician a physician who can actually function well and be well as well
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  so the basic concepts can be really and it's really based actually on how you can look at
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  a patient that means in the clinic when you have a patient you have some solid data from the lab
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  this is calibrated you have your quality controls and so on then you have some interpretation data
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  or the history physical exam at a certain point also imagery and then you have your own feeling
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  when you are with your patient and this is very soft and sometimes the lab tells it all you don't
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  need to go further it's just so obvious but that's not always the case sometimes the interpretation
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  data gives you enough of information and the lab is just to confirm but you already know
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  sometimes the lab imagery are kind of more or less you are in the gray zone and there kicks in your
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  experience why you said this patient i keep this patient overnight here i don't let him go home
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  and so you have those different levels of of information that you have to manage to take a
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  decision so the idea in this what we call the technical term is programmatic assessment
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  is to not consider assessment in isolation you look at it as a program programmatic assessment
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  in a way that each measuring point is a point of information and then when you have enough information
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  you go to the decision so that's how basically we were able now here at my university in Fribourg
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  to go without grades at some university they do the same approach but they for regularity reason
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  had to keep the grades but the principle is the main it is the same is that every measuring point
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  every data of information may have different qualities like the labs standardized quality
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  control like the gut feeling you may have very subjective very but rich in information too
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  and to combine all that you take that as a whole picture of your student and you decide on this
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  picture if your student should continue study or should graduate so for some students if they're
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  just so bad in the mcqs that means they don't have the ground knowledge you can't figure out
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  how they could be physician or continue to the next year for some students is about the feedbacks
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  they get in the clinic because of certain behaviors they are certain way they interact with
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  this with the patient or with other clinician or nurse or physiotherapist or whatever so it's to
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  get those information at one point but not with the perspective to grade or not the student
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  the first perspective is to give the students the information where he should improve and that's
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  where we can open up and go broader than just knowledge and skills so knowledge and skills are
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  now in i would say in competition but that's not the right word i'm now on the same level of what
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  the students should get as a message what is important for me to learn to become a physician
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  and that's how we flip that around it's to go not to add to to to close the loop with the
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  analogy of the patient it would be nonsense in clinic to make kind of a mean score of
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  the different labs you have and you put the mean score for the radiology and then for the
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  and for the history and then for the and then if the mean score is above a certain number you say
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  pass or you say fail or your patient is okay or patient is not okay doesn't make sense so once you
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  enter this programmatic assessment understanding you get the same feeling when you have those way
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  of of grading and promoting student based on some mean score or even if you do some adjustments
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  it's free to get the picture for some students you have the problem in the knowledge some students
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  is about professionalism some students is about different aspects and sometimes it make the whole
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  difference yeah in some ways i think you're talking about really a culture of medicine change a culture
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  of medical education and so that the teaching experience on the wards for example would not
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  necessarily reify just knowledge as a way of assessing patients at the bed students at the
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  bedside but like you said like on an equal ground with those other personal professional qualities
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  and they're all important of course and so that so it's a it's really a cultural shift and i'd
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  imagine making that shift has been it's a growing it's a growth and there's growing pains i would
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  think in your own experience maybe you can share with us over the four or five years that you've
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  been implementing this what that's been like for your faculty also some outcomes how has it been
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  for the students how have they done on standardized measures of performance and also what do you know
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  about their well-being and even your faculty well-being in this new world that you're you're
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  striving or intending to create maybe i will start with the well-being and then transition to the
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  other points we include in the measuring points we ask from our students that they reflect on the
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  well-being it's part of professionalism we define that as commitment to self this is a quality that
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  every physician should have and historically you can go back to the greeks you find already those
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  aspects more than 2000 years ago and this commitment to self be well yourself before you
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  treat the others if you're unwell you won't be able to treat the others so for us it's it's part of
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  this core aspect of professionalism and we expect them in the learning report at the end of the year
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  that they reflect on their well-being and we differentiate that we make a difference between
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  self-awareness and self-care self-awareness is this professional competence
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  that we expect from our students self-care is a private competence how i will deal with that
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  and the school has nothing to say to that except it should be there if needed so that's the way
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  i found to kind of don't step in the trap to be prescriptive about what students to should do for
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  the well-being so it's really about being aware where they are in this work life this balance
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  they always call that this balance because the balance is so difficult to achieve that
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  when you don't achieve it people get the feeling they're missing something or they're not good at
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  it it's just life that always keeps you out of balance and the skill is to to handle the
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  this balance it's not to reach a balance that's how we talk with our students and they they come
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  out most of them some don't but that's where they get some feedback and we expect they do that they
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  reflect on okay that's where i am and that's my workload or that's i just have it i had one month
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  ago students came in and say i'm so sorry i'm i'm just exhausted there's i have such a strong
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  time we had just three deaths in our family i just can't anymore my scores are going down
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  so we don't have grades but we have scores in our exam so my scores are going down i'm so upset
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  about that and i told her listen that's not the important thing to learn for you now is you should
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  go home and take care about the most important things you can learn now for being a future
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  physician is what is that for you what does that mean for you so take the time you need
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  to care about that and then come back this is a high performing student so i don't have
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  as the vice dean i don't have any trouble imagining this person once she found back that she will
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  perform good well again should she be penalized at the end of the year because of that no because
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  she learned something that we don't measure but that's so important so that's the well-being the
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  way we can include that because we have this big picture with all those different pixel of information
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  and each pixel is not the pass or fail the big picture is and that is how we work with this
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  well-being so we have in our training next week i will have a half a day with our
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  fifth year student about physician burnout we address that we we have four hours with my colleague
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  in psychiatry where we address a subject like physician burnout because they are just before
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  the elective year and they will observe things so we want them to have some tools to think about
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  what they're observing so they're not just taking that in without being able to handle that in a way
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  or another when you say observe things you mean are you talking about observing the difficulties
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  of you know what it means to really work with patients and and how they can affect one's own
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  well-being and burnout or also what they see among their the faculty the clinicians or other
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  actually have been working for a while and the presence of burnout among them both actually i
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  mean it's just uh i mean they're entering this profession from being very peripheral in the
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  beginning they become more and more during the studies until their residents they become central
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  to this profession and so they are approaching one step after the other and they are getting
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  they are approaching one step after the other this clinic this professional identity of being a
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  physician what we know is that this professional identity can be this professional identity is
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  something that just happens builds up if you don't it's not something you you have to do it happens
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  but what we know is that professional identity can be reflected upon and probably you can
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  adjust things so to talk about those things to be explicit to explain my hope is that some students
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  or enough students have some tools to think about what they observe for example when they start
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  clinical rotation when they come back from the first rotation i asked them a question
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  what dreams were shattered by what you observed in the last six weeks this happens
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  if you talk about it but that's a way to kind of deal or use their experience to think about
• 37:13
  to reflect about and to see more than this conditioned response to either i put that
• 37:22
  i put that somewhere aside in deep down in my memory or it just explodes and i want to stop medicine
• 37:33
  yeah i think being transparent about it really allows people to deal with it or learn some skills
• 37:38
  to deal with it now early and those skills is really what we're trying to carry into our
• 37:44
  profession so because we're going to be facing as one goes out into the workforce as a practicing
• 37:51
  clinician physician things are going to come up things are going to be not exactly the way we want
• 37:57
  them to be right so how are we going to meet that and to learn some of those skills early rather
• 38:02
  than suppressing it or just saying i can't deal with this i'm out you know and that's that's a
• 38:07
  great approach i know there's been some outcomes reported on your program thus far and i i think
• 38:14
  our listeners would really love to hear about that maybe you can share a little bit about that
• 38:18
  and then one other thing which may be a little more subjective is what do you know about because
• 38:23
  it's so early what kinds of physicians these students that go through your program are becoming
• 38:29
  what are the choices they're making both in how they comport themselves but also what they choose
• 38:35
  to do in medicine what do you know about that what's your sense about that because it may not
• 38:41
  be really hard data yet yeah so the first outcome we we have um is this kind of hard data measurement
• 38:53
  of our national licensing exam it's the equivalent of usmle step two in the states
• 39:00
  and we have the same format uh or we as the usmle used to be so we have a clinical knowledge on the
• 39:08
  clinical skills exam at the clinical knowledge our students so we have two courts up to now that
• 39:15
  that finished our school and that took their licensing exam they took position two in switzerland
• 39:22
  so high up there and for the clinical skills exam we are in the first position both years
• 39:30
  also so we have two courts that perform very high at those uh at those formal exam and um
• 39:41
  maybe i should also tell that we don't have a special selection in the intake so it's not
• 39:49
  they have to take an exam to enter medical school in whole switzerland and depending on the level
• 39:56
  uh of performance they have they have the first second or third or fourth choice of school and we
• 40:02
  have about 60 percent of our students that end up in fribourg because it's not a huge city and so on
• 40:11
  as being one of the last priority they put in and so the choice they had is i do medicine at this
• 40:20
  at this place or i don't do medicine so many of our students are not the highest performer
• 40:27
  in these entry tests but at the end of the training they're up there but for me it's not
• 40:35
  the main end point it has a huge impact in in kind of acceptance of the system we put in
• 40:44
  without grades many people that were fighting against just become became quiet because much
• 40:53
  of the opposition was driven by fear and when people are afraid they're not kind mostly because
• 41:04
  that's just the way human being is and i had enough experience in curriculum design and reform to
• 41:12
  well to know that and even though it's it's tough in the moment you know you have to bite through
• 41:18
  until it's established and that was a great great gift that those two courts offered us
• 41:25
  to have those performance but for me the main aspect was just past the exam because my end
• 41:32
  point as educator is how you live your first year as resident and this is something we didn't have
• 41:41
  time for the moment to dig into because of resources we still are stabilizing our our
• 41:50
  curriculum but from the talks the exchange i have with our former students they are i find
• 41:59
  pretty well into it they're well oriented in clinic they're very productive compared to
• 42:05
  some other students that's the feedback i get also from the clinicians but then again they know
• 42:12
  to whom they're talking to and that may be biased so it's maybe wishful thinking but
• 42:20
  and another side what i observed is that some students tell oh i'm so exhausted by the training
• 42:27
  i take one year off before i start and they do that without with the clear understanding why they
• 42:35
  do that it's not kind of out of despair so again anecdotes but some of the students i talked to
• 42:46
  with this decision that was very well reflected and this is something i was not used to
• 42:53
  prior students i had at my other university before because that was kind of out of exhaustion
• 43:01
  they just couldn't do anymore or they would just say i will survive and i go into that
• 43:09
  but this is something we will try to go after in the coming years to see how they perform
• 43:18
  in the sense of being physician that's my focus more than performing and practicing or
• 43:27
  performing as a resident in the sense of can they do this and that and that yeah i think it will be
• 43:34
  it will be very enlightening and i think it's worth trying to trying to capture that
• 43:39
  the methodologies to capture that are probably going to be challenging but it sounds like you're
• 43:44
  it sounds like you're up for that challenge as you're speaking and talking about this and also
• 43:49
  describing you kind of have to have a thick skin or at least not take things personally
• 43:54
  what is it about you what are what is it about your qualities that has allowed you to persevere
• 44:00
  in really what is kind of a sea change even though it may seem incremental it's not at all it's quite
• 44:07
  a quite a shift in how medical education prepares for this new world really of of truly being a
• 44:16
  physician knowing that knowledge is just one part of something and we're not necessarily going to be
• 44:22
  the masters of the access to that knowledge any longer what are we master of so yeah what what
• 44:28
  was it about you that just kind of drove you to persevere and stay with it and and also i i'm
• 44:36
  assuming and you could tell me whether this is true or not and to what extent it's true
• 44:41
  it brings you joy and meaning helps you flourish for me i think one of my quality um if i would
• 44:49
  compare me to a plant i would be kind of a pioneer plant you know those those plants that grow in
• 44:57
  environment where it's difficult i'm probably not the kind of of plant that flourishes in a ground
• 45:05
  where everything is already growing um so i'm that's my drive to to bring some innovation
• 45:13
  um at the points where i think it's needed and this is all my career i mean i i made three
• 45:20
  curriculum changes and this is the fourth one this is that that was not the change that was a new
• 45:26
  uh construction so yeah that was pretty much all over my my career to to bring innovation to try to
• 45:35
  to make things move forward so that's maybe one quality the other is i probably get it pretty much
• 45:45
  what is experiential too much and what is innovative and feasible and this is a difficult
• 45:56
  line to find and i'm very open to exchange and looking into experience and the the green light
• 46:05
  in my head in doing that was after having visited cleveland clinic school because they have a very
• 46:15
  similar curriculum but they have 20 years of experience and i went there they were kind enough
• 46:23
  to host me for two days i had many interviews when i came out of those two days i said it's feasible
• 46:30
  we don't have the environment of cleveland clinics we are a public school so funding is very
• 46:38
  different we have a very small clinic hospital so we don't have this huge number of physicians so
• 46:48
  but i came out of cleveland with the profound understanding it's feasible and i stick to that
• 46:57
  so that was maybe my quality to be able to exchange try to find what's pushing and what's
• 47:07
  over pushing and so i think that's important especially if if you are so early in the wave of
• 47:15
  a change and there are many changes that are nothing but i think this one is profound
• 47:24
  and it functions i would agree i think it is profound and from what i saw on my visit recently
• 47:31
  it is functioning and another thing that i saw quality that i noticed about you is that you're
• 47:37
  a joy to be around you like to have fun and you're open to new experiences you just shared about that
• 47:44
  so maybe as we close this conversation if you can just talk about what what is this what is it you
• 47:51
  like to do for fun that you intentionally say this is what i want to go have fun what do you do
• 47:58
  well i grew up in the mountains in the alps so for me where i really feel home is when i'm
• 48:06
  out in the mountains in the forest or above the forest in and just walking so this is where i'm
• 48:12
  where i'm home i can walk for days i'm just happy so this is for the summertime and in the winter
• 48:19
  time i'm going to hit the slopes i love to to do a snowboard technique called extreme carving
• 48:30
  i mean i do snowboard since 1985 and so i was a very early adopter again here also that was the
• 48:40
  time where they forbid us to go on the slopes because they were afraid we're going to destroy
• 48:46
  them the ski slopes but so at that time that was doing really off off-piste boarding but we don't
• 48:53
  have that quality of snow anymore so i changed and i do extreme carve on the slopes and this is my
• 49:00
  body doesn't isn't up to the high level i would like to but i enjoy it immensely to just do some
• 49:07
  lay down there and and go through that so this is where i really get my energy is somewhere out in
• 49:15
  the mountains and then if possible with the family also and to share the moment together and yeah
• 49:23
  lovely lovely i did want to bring out one point which i must say i have to differ with you
• 49:31
  you talk about the students and their choices and you know in north america we think of switzerland
• 49:36
  would think of the alps will think of geneva will think of zurich will think of louis an
• 49:42
  those places but having been to freeburg i think it it's an it's a secret destination it is a
• 49:48
  beautiful destination so for any of the listeners out there who want to see a beautiful quintessential
• 49:55
  part of switzerland and really feel welcomed and at home freeburg is just a beautiful place so
• 50:02
  thank you anything else ralphel that you'd like our listeners you know we hope the listenership
• 50:09
  will grow to include not just clinicians out there practicing but educators students as well
• 50:15
  so any any other messages you'd like to give um maybe two message ones is is about freebo
• 50:21
  our students come with the tear in the eye because but they leave with the tear in the eyes
• 50:27
  the experience of freebo is is really nice maybe my message is to think about being the person you
• 50:36
  are and and try to explore what it means if you think about yourself not in terms of doing things
• 50:45
  but being be gentle with you on that journey thank you thank you this has been wonderful
• 50:51
  thanks very much for listening we will include a summary of today's podcast and links about
• 50:57
  dr bonvin and other references that were discussed in the show notes i'd like to conclude by sharing
• 51:04
  another practical exercise to help you flourish during your workday and to add to others that
• 51:10
  i've already shared with you in prior episodes to a toolbox you could say of skills that you can draw
• 51:16
  upon to enhance purpose meaning and well-being dr von von today spoke about skills of reflection
• 51:25
  and even emphasizing how challenging actually impossible it would be to practice medicine
• 51:30
  without this skill another aspect of reflection includes looking at oneself in our contemplative
• 51:37
  practices we ask ourselves to bring awareness to aspects of our experience and to understand
• 51:43
  to bring awareness to aspects of our experience whether they're somatic like body sensation or
• 51:49
  affective like how we're feeling or cognitive thoughts we're having this brief practice requires
• 51:56
  a simple mirror or you can use your smartphone so standing in front of the mirror or holding
• 52:03
  the smartphone in front of your face and turning the camera on and setting it as if you're taking
• 52:09
  a selfie so you can be looking at yourself and spending about 30 seconds or so that's all this
• 52:15
  meditation exercise takes you can time it if you'd like spending about 30 seconds simply looking
• 52:23
  seeing noticing
• 52:28
  you may find this odd different difficult as judgments may arise emotions may show up or even
• 52:35
  certain sensations in the body may become prominent that's all okay and of course you're
• 52:44
  not actually seeing yourself what you're actually seeing is a reflection of yourself
• 52:51
  capturing some features but not all of you so see if you can do this finishing this exercise with
• 52:59
  a small smile or a big smile if you'd like if you can and just notice the effect it has on your
• 53:05
  experience effect it has on your body sensations your emotions even thoughts that you're having
• 53:16
  i hope you found this podcast and this simple exercise useful to you and look forward to
• 53:22
  having you join us for the next episode of flourishing in medicine from surviving to thriving
• 53:27
  this podcast has been brought to you by EmPRO its Technical Director is Stan Sainjour and its Producer
• 53:34
  and the Vice President of Education at EmPRO is Gerri Donohue if you'd like to learn more about
• 53:40
  EmPRO please visit www.myEmPRO.com if you'd like to know more about EmPRO's peer support programs
• 53:47
  please visit www.myEmPRO.com forward slash peer dash support if you're a physician or medical student
• 53:58
  and in need of urgent support please consider calling the physician support line at 1-888-409-0141
• 54:07
  or visit www.physiciansupportline.com the physician support line provides a safe space to discuss
• 54:16
  immediately immediate life stressors with volunteer psychiatrists colleagues who are uniquely trained
• 54:23
  in mental wellness and also have similar shared experience of being a health professional
• 54:31
  for more information about me and my work please visit www.MickKrasnermd.com or
• 54:37
  www.mindfulpracticeinmedicine.com hope to see you next time