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Unlocking Secrets to Improve the Learning Environment

Joyce Fried

by Joyce Fried, Assistant Dean and Co-Director, Office of Continuing Medical Education, University of California, Los Angeles David Geffen School of Medicine

This session, moderated by Ann Bonham, included Frank Warren, Scott Wright, and Will Bynum as panelists. Dr. Bonham began by identifying the learning environment as an important topic if we are to live up to our mission of delivering patient- and population-centered care and health.

The first speaker was Mr. Warren, who began a project ten years ago called the PostSecret project in which he solicited people to send him a postcard with a secret they had been keeping such as a regret, fear, betrayal, desire, confession or childhood humiliation. He posted these anonymous secrets on a website he created and the project expanded exponentially in that he has received literally a ton of postcards which he has donated to the Smithsonian and from which he has compiled six books and written one play. Seven hundred million people have tapped into his website. His take-home message is that secrets are communal, that you need to find the courage to share them right away, and that they are the currency of intimacy.

Scott Wright recognizes the importance of improving the learning environment and relationships with peers, while allowing personal space.  He started by sharing his secret: that because of his disability, his patients often assume he is drunk.  He conducted a study in which he asked students about a powerful formative experience in their lives.  Of the 34 responses, seven students reported positive experiences while 19 reported negative experiences including mistreatment.  Twelve years ago he founded the Hopkins Learning Community, a program in which each medical student has an advisor from day one throughout medical school.  The advisor’s role is to support personal growth.  He described personal growth as understanding yourself and identified barriers to personal growth including fatigue and lack of time.  His take-home message is that trust in your relationships allows for more open relationships both in one’s professional life as well as in one’s personal life.

Will Bynum shared his secret; he has imposter’s syndrome since he began his faculty role two years ago. While he is sometimes distressed that he is not perfect, does not know answers to questions, and makes mistakes, he recognizes the value of being authentic, accepting his limitations, and sharing them with others.  He believes that in medicine we too often turn imperfections into secrets and experience shame, which causes us to hide, withdraw and disengage. Rather than become shame-resilient (which he defines as the ability to recognize shame when it occurs and transition to a more productive response), we have become shame-averse.  He also believes that shame-inducing influences from the learning environment, such as mistreatment, burnout, and high rates of depression, engender more secret-keeping as we convince ourselves we are deserving of mistreatment, that burnout is normal, and that being depressed is a sign of weakness.  Worse still, we believe no one else is experiencing what we are experiencing.

How do we foster a learning environment that engenders connections? Dr. Bynum suggested authentic conversations about our secrets, zero tolerance for behavior that intentionally shames, greater recognition of damaging emotions such as shame, and specific policies that give us the safety to speak out.  Individuals who keep a secret feel a burden 24/7.  What can faculty, mentors, and leaders do?  Tell their secret first thereby modeling this behavior. Show vulnerability, opening the door to sharing secrets and self-doubt. Reaction to another’s secret must be non-judgmental.  And perhaps anonymity such as in the PostSecret project can help make a safer space.  Finding mentors outside one’s specialty might be a solution to fear of showing vulnerability to one’s supervisor.  Dr. Bynum recommended that there be mandatory training for all clinical faculty on how to give effective, non-shaming feedback.

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