- Margaret Mou
1. As a recent PHM fellowship graduate, tell us what your advice is for residents contemplating PHM and unsure about pursuing a fellowship.
For many just coming out of residency, 2 years more of training does not always seem to be a priority, especially if that residency was inpatient heavy. Especially as a former Chief Resident where I acted as an attending, it was strange going back into fellowship. However, PHM Fellowship was incredibly impactful for my career trajectory:
1. Many fellowships offer the opportunity to pursue another degree. My interest in academic medicine lent itself to a Master's in Education, which I was able to do concurrently with fellowship in 2 years.
2. Fellowship enhances comfort in the scholarly landscape. I was a novice in scholarly activity and research, and fellowship taught me how to navigate this environment, from critically reviewing articles to undertaking my own project to the publication process. Even if research is not a priority for a career, we are all life-long learners, and it is always beneficial knowing how to stay well-informed in our profession.
3. The community becomes much more intimate. Through fellowship, I was able to meet one of my mentors, who ended up recruiting me to work for the division I work at now. I was able to meet others who were passionate about certain subsets of PHM that I was also interested in. And, the fellowship provides more resources to pursue interests and goals to lay the foundation of a career.
4. Fellowship gives the space to be intentional about goals, both personal and professional. Fellowship was the first time I had significant control over my schedule, teaching me to be thoughtful about time management and professional pursuits. It also gave the flexibility to think about how to approach medical education and delve into hospital administration.
5. Board eligibility is a perk.
All this being said, I recognize that fellowship is not for everyone. Fellowship lays down a solid groundwork for a career that does not have to be all clinical, especially for those who want to be in academic medicine. My passions in medical education and physician wellness were nurtured in fellowship, which continues to play roles in my current position and will likely in the future.
2. You led a great 10-minute guided meditation before a webinar on Imposter Syndrome. How do you find time in your busy schedule to meditate? Any tips for those of us considering the practice?
Meditation makes me less tired and more productive. If I am unable to practice before or after work, I will make an effort to meditate while I have some down time at work. Too often, work bleeds into life. I enjoy life bleeding into work. It only takes a few minutes, usually something we all have, to find a quiet space to be grounded, to stay present, and to just check in with ourselves. I always finish with some loving-kindness meditation, which helps me to prevent compassion fatigue, finding more kindness for myself and for patients and their families. But, these efforts do not have to be formal. Just taking some moments in the day to be present and intentional about mundane activities also creates mindfulness, making it more a way of life than a formal practice.
3. Can you also tell us more about your work with Imposter Syndrome?
Lucky for me, I was able to work with the amazing Riva Kamat and Dana Foradori on the Imposter Syndrome workshop, both academic pediatric hospitalists that are also wellness warriors. Imposter Syndrome became a topic of discussion when noticing the transitions that we all had to go through the last couple of years with the pandemic and with shifting expectations, understanding that transitions can often lead to feeling inadequate and creating self-doubt[i]. Especially for women in medicine, Imposter Syndrome is commonly felt, though not always identified[ii]. Therefore, we created a workshop to encourage others have some self-reflection on their own thoughts and self-doubt and how to quiet those voices. This is a topic that provides opportunities for future research and exploration, as we are only scratching the surface.
[i] LaDonna KA, Ginsburg S, Watling C. "Rising to the Level of Your Incompetence": What Physicians' Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Acad Med. 2018 May;93(5):763-768. doi: 10.1097/ACM.0000000000002046. PMID: 29116983.
[ii] Salib S. On Gender Bias and the Imposter Syndrome. J Gen Intern Med. 2022 Jan 6. doi: 10.1007/s11606-021-07318-y. Epub ahead of print. PMID: 34993870.
4. As the current Vice-Chair of the AAP SOHM Subcommittee on Provider Wellness, how can we be intentional about preventing burnout? How has the COVID-19 pandemic impacted morale?
The more work I do in Provider Wellness, the more I recognize that preventing burnout looks different for every individual; it takes quite a bit of self-reflection (and sometimes professional intervention) to understand what drains us and what energizes us. What I have started, especially when working with trainees, is to have a wellness goal that can be done at work for the week that I am on. Some enjoy journaling for a few minutes prior to rounds, some do yoga, some will take their lunch outside when the sun is out, and some will do a mindfulness exercise. Usually, these activities take only a few minutes out of the work day; the intentionality of doing these activities puts people in the mindset of remembering to do something for themselves, which sometimes is enough. On a more institutional level, burnout can also look different. It requires some probing from leadership to understand the root for burnout of each division, department, and institution. Ways to help include ensuring enough staffing, encouraging public accolades for accomplishments, fostering respectful collaboration with other providers, being transparent about changes, harboring safe spaces for personal needs (mothers who are pumping, areas for quiet reflection or meditation, individual offices), and support available in times of grief (i.e. second victims' group). In this time, it is also important to emphasize diversity in leadership. These needs cannot and will not be met unless voices are represented equally.
The pandemic has impacted morale in so many ways. Many of my colleagues were forced to practice adult medicine, facing unprecedented levels of illness, death, and public ignorance, while bringing fear of contamination back to our loved ones. We all suffered the loss of not being able to see each other in person and facilitating group cohesion. We all hesitate now to lean in for a hug when sometimes that is what we need. We all are feeling the fatigue of Zoom and WebEx and (insert your favorite online platform). And we all still have to carry on in our personal lives, with our own personal responsibilities. Ways to help:
1. Find a community, and incorporate this into a routine, even if it is only virtual. Maybe it looks like having a game night with family every Monday evening, or having coworkers gather once a month outdoors. The SOHM Subcommittee on Provider Wellness would also be thrilled to be your community.
2. Check in with yourself: What made the job worth it today? What was challenging? Do I need to seek help? Who can I talk to?
3. Check in with each other. It is amazing what even a text message saying "are you okay" can do for colleagues, especially after a traumatic experience.
4. Understand our balancing point with information (especially on the internet / social media): what is good to know and what pushes us over the edge.
5. Find ways to let go of the negativities we bring: understanding our scope of control, meditation and mindfulness, journaling, therapy, etc.
6. Understanding what brings us value as a physician, both intrinsically and extrinsically, and how to promote that in the workplace. Especially for leaders, this can really make a difference.
5. You recently stepped down as the AAP Section on Pediatric Trainees (SOPT) Executive of Fellow Initiatives. Can you share with us some of your work with this group?
It was such an honor to work with this group of execs from AAP SOPT. My role was to facilitate communication amongst different subspecialty fellows within those subspecialties, coordinate support with AAP's wealth of resources, provide solutions for barriers within different chapters' trainees, and participate in SOPT Safe Spaces, which discusses challenging topics specific to pediatric trainees (not matching into residency, microaggressions in medicine, burnout, etc.). This helped me to gain insight on the power of AAP to advocate for children's health, what we can do as a single voice, and the degree of unassuming collaborative passion this community has.
6. In your hospital, you are the Co-Chair of the Physician Well-Being Committee. What are some ways to promote wellness in the workplace?
This work cannot be done alone. I am lucky to be a Co-Chairs with Helene Morgan, MSW. Her institutional knowledge and background in Social Work created a gathering of stakeholders from different areas in the hospitals that are wellness champions for their department or division. Again, each community has their own needs, and we are assessing needs, while finding creative ways to target those needs. Please refer to #4 for other ways to promote wellness in the workplace.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Wellness has been a hot topic of conversation the last couple of years. Two important things: 1. It's okay to not be okay (because this feeling of not being okay will also pass). What's more important is being self-aware and setting good boundaries, especially as leaders, and modeling that for others. 2. We don't always have control over other people's suffering, no matter how hard we try. In those times, compassion (especially for ourselves) can really help.
For many just coming out of residency, 2 years more of training does not always seem to be a priority, especially if that residency was inpatient heavy. Especially as a former Chief Resident where I acted as an attending, it was strange going back into fellowship. However, PHM Fellowship was incredibly impactful for my career trajectory:
1. Many fellowships offer the opportunity to pursue another degree. My interest in academic medicine lent itself to a Master's in Education, which I was able to do concurrently with fellowship in 2 years.
2. Fellowship enhances comfort in the scholarly landscape. I was a novice in scholarly activity and research, and fellowship taught me how to navigate this environment, from critically reviewing articles to undertaking my own project to the publication process. Even if research is not a priority for a career, we are all life-long learners, and it is always beneficial knowing how to stay well-informed in our profession.
3. The community becomes much more intimate. Through fellowship, I was able to meet one of my mentors, who ended up recruiting me to work for the division I work at now. I was able to meet others who were passionate about certain subsets of PHM that I was also interested in. And, the fellowship provides more resources to pursue interests and goals to lay the foundation of a career.
4. Fellowship gives the space to be intentional about goals, both personal and professional. Fellowship was the first time I had significant control over my schedule, teaching me to be thoughtful about time management and professional pursuits. It also gave the flexibility to think about how to approach medical education and delve into hospital administration.
5. Board eligibility is a perk.
All this being said, I recognize that fellowship is not for everyone. Fellowship lays down a solid groundwork for a career that does not have to be all clinical, especially for those who want to be in academic medicine. My passions in medical education and physician wellness were nurtured in fellowship, which continues to play roles in my current position and will likely in the future.
2. You led a great 10-minute guided meditation before a webinar on Imposter Syndrome. How do you find time in your busy schedule to meditate? Any tips for those of us considering the practice?
Meditation makes me less tired and more productive. If I am unable to practice before or after work, I will make an effort to meditate while I have some down time at work. Too often, work bleeds into life. I enjoy life bleeding into work. It only takes a few minutes, usually something we all have, to find a quiet space to be grounded, to stay present, and to just check in with ourselves. I always finish with some loving-kindness meditation, which helps me to prevent compassion fatigue, finding more kindness for myself and for patients and their families. But, these efforts do not have to be formal. Just taking some moments in the day to be present and intentional about mundane activities also creates mindfulness, making it more a way of life than a formal practice.
3. Can you also tell us more about your work with Imposter Syndrome?
Lucky for me, I was able to work with the amazing Riva Kamat and Dana Foradori on the Imposter Syndrome workshop, both academic pediatric hospitalists that are also wellness warriors. Imposter Syndrome became a topic of discussion when noticing the transitions that we all had to go through the last couple of years with the pandemic and with shifting expectations, understanding that transitions can often lead to feeling inadequate and creating self-doubt[i]. Especially for women in medicine, Imposter Syndrome is commonly felt, though not always identified[ii]. Therefore, we created a workshop to encourage others have some self-reflection on their own thoughts and self-doubt and how to quiet those voices. This is a topic that provides opportunities for future research and exploration, as we are only scratching the surface.
[i] LaDonna KA, Ginsburg S, Watling C. "Rising to the Level of Your Incompetence": What Physicians' Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Acad Med. 2018 May;93(5):763-768. doi: 10.1097/ACM.0000000000002046. PMID: 29116983.
[ii] Salib S. On Gender Bias and the Imposter Syndrome. J Gen Intern Med. 2022 Jan 6. doi: 10.1007/s11606-021-07318-y. Epub ahead of print. PMID: 34993870.
4. As the current Vice-Chair of the AAP SOHM Subcommittee on Provider Wellness, how can we be intentional about preventing burnout? How has the COVID-19 pandemic impacted morale?
The more work I do in Provider Wellness, the more I recognize that preventing burnout looks different for every individual; it takes quite a bit of self-reflection (and sometimes professional intervention) to understand what drains us and what energizes us. What I have started, especially when working with trainees, is to have a wellness goal that can be done at work for the week that I am on. Some enjoy journaling for a few minutes prior to rounds, some do yoga, some will take their lunch outside when the sun is out, and some will do a mindfulness exercise. Usually, these activities take only a few minutes out of the work day; the intentionality of doing these activities puts people in the mindset of remembering to do something for themselves, which sometimes is enough. On a more institutional level, burnout can also look different. It requires some probing from leadership to understand the root for burnout of each division, department, and institution. Ways to help include ensuring enough staffing, encouraging public accolades for accomplishments, fostering respectful collaboration with other providers, being transparent about changes, harboring safe spaces for personal needs (mothers who are pumping, areas for quiet reflection or meditation, individual offices), and support available in times of grief (i.e. second victims' group). In this time, it is also important to emphasize diversity in leadership. These needs cannot and will not be met unless voices are represented equally.
The pandemic has impacted morale in so many ways. Many of my colleagues were forced to practice adult medicine, facing unprecedented levels of illness, death, and public ignorance, while bringing fear of contamination back to our loved ones. We all suffered the loss of not being able to see each other in person and facilitating group cohesion. We all hesitate now to lean in for a hug when sometimes that is what we need. We all are feeling the fatigue of Zoom and WebEx and (insert your favorite online platform). And we all still have to carry on in our personal lives, with our own personal responsibilities. Ways to help:
1. Find a community, and incorporate this into a routine, even if it is only virtual. Maybe it looks like having a game night with family every Monday evening, or having coworkers gather once a month outdoors. The SOHM Subcommittee on Provider Wellness would also be thrilled to be your community.
2. Check in with yourself: What made the job worth it today? What was challenging? Do I need to seek help? Who can I talk to?
3. Check in with each other. It is amazing what even a text message saying "are you okay" can do for colleagues, especially after a traumatic experience.
4. Understand our balancing point with information (especially on the internet / social media): what is good to know and what pushes us over the edge.
5. Find ways to let go of the negativities we bring: understanding our scope of control, meditation and mindfulness, journaling, therapy, etc.
6. Understanding what brings us value as a physician, both intrinsically and extrinsically, and how to promote that in the workplace. Especially for leaders, this can really make a difference.
5. You recently stepped down as the AAP Section on Pediatric Trainees (SOPT) Executive of Fellow Initiatives. Can you share with us some of your work with this group?
It was such an honor to work with this group of execs from AAP SOPT. My role was to facilitate communication amongst different subspecialty fellows within those subspecialties, coordinate support with AAP's wealth of resources, provide solutions for barriers within different chapters' trainees, and participate in SOPT Safe Spaces, which discusses challenging topics specific to pediatric trainees (not matching into residency, microaggressions in medicine, burnout, etc.). This helped me to gain insight on the power of AAP to advocate for children's health, what we can do as a single voice, and the degree of unassuming collaborative passion this community has.
6. In your hospital, you are the Co-Chair of the Physician Well-Being Committee. What are some ways to promote wellness in the workplace?
This work cannot be done alone. I am lucky to be a Co-Chairs with Helene Morgan, MSW. Her institutional knowledge and background in Social Work created a gathering of stakeholders from different areas in the hospitals that are wellness champions for their department or division. Again, each community has their own needs, and we are assessing needs, while finding creative ways to target those needs. Please refer to #4 for other ways to promote wellness in the workplace.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Wellness has been a hot topic of conversation the last couple of years. Two important things: 1. It's okay to not be okay (because this feeling of not being okay will also pass). What's more important is being self-aware and setting good boundaries, especially as leaders, and modeling that for others. 2. We don't always have control over other people's suffering, no matter how hard we try. In those times, compassion (especially for ourselves) can really help.