Game face ON.

"Enthusiasm creates opportunities for learning."  

~ Daniel Wang, MD

EUSOM '13,  Small Group Beta

_________________________________________

Small Group Delta (and all of the other medical students in their class) are starting their clinical clerkships this week. Isn't that exciting? I sure think so. Anyways. I met up with them yesterday evening after their orientation session--partly to just lay my eyes on them but also to get their minds right for this next step. I'm a big fan of the "game face."

Ha.

That reminds me. When I was in residency, I used to pretend as if I was literally strapping on a mask when taking call or starting some particularly challenging rotation. My classmates knew about that little practice and would always get a chuckle when they saw me fastening my imaginary buckles behind my head. "GAME FACE ON!" I'd yell out. "BRING IT, BABY!"

Yup.

What that really was was me being intentional about whatever it was I was going to do next. Like, here was this line I was drawing in the sand that said over here is what I was doing before and over there is what I'm about to do. And something about taking a moment to clarify that has always been good for me. I still do that, actually. At the start of wards when riding the elevator up to meet my team on the first day, I put on my metaphorical game face. Sure do.

(A selfie of me at Grady with my game face strapped on.)

I think it makes a difference.

So yeah. That's what I wanted for my small group advisees. I needed them to get their game faces strapped on tight. And so. We met up and had our pleasantries. Then I launched into what I thought were some clutch things for them to know and do before jumping into this part of medical training. And most of them weren't that much different than this, which is pretty much the advice I had a couple of years back when SG Gamma started the wards.

But.

This time tapped into a great resource. This group is the fourth of my small groups to date. Two groups have since graduated on and one more is in their final year. I asked them for a few words of advice for "how to bring your A game" on the wards and clinical clerkships. And by "bring your A game" that means what are the ways to get the most out of the rotation and just maybe get an A while doing so. Oh, and I also told them to "keep it around the length of a tweet."

Ha.

I reached out to the whole Team Manning SG Fam--Small Groups Alpha, Beta, and Gamma. I got quite a few responses. Even if you aren't a member of the Manning SG Family Tree, that's okay. This advice is good no matter who you are. As a matter of fact, it's good advice for me, too.

I bring you:


SHORT SWEET ADVICE FROM THOSE WHO'VE BEEN IN THE MEDICAL STUDENT TRENCHES (AS MEDICAL STUDENTS) FAR MORE RECENTLY THAN YOURS TRULY.

(Oh, and the photos are all members of my small groups through the years. My, how the time flies.)


Like to hear it? Here it go!


______________________________________________

Words of wisdom to put on your mental post it notes. . . . 

"It's a marathon not a sprint. You've gotten this far. Don't let anything get in your way--ANYTHING."

"Go hard. This is a critical time. Don't drop the ball. Run hard and strong on every single play."

"Enthusiasm creates opportunities for learning." 

"Focus on what matters on wards: the patients, the care, the science. Be likable, but don't waste energy thinking about how to be likable." 

"Know things (about both history and pathology) for your patients."

"Don't be late."

"Always do your best. Even if you feel tired."

"Stay engaged and look happy to be there. Sometimes this means that you get to be super involved but sometimes this just means listening attentively during rounds...you never know when a question will be thrown your way."

"Develop a good understanding that it's not about you (or your attending), it's about the patient. This will get you far on the wards, and get you through some of the tougher days."

"Keep the patient and their well-being as your focus and all else will fall into place. Even if it's a rotation you aren't interested in as a career, there's something you can gain from it, appreciate the opportunity."

"Show up on time and have a question to ask (after reading up on the question first.)

"Never stop thinking. And remember: Happy spouse, happy house. And remember that it's all about expectations."

"Work hard. Seriously just work hard for your patients and always ask questions! If you act interested and clearly will do whatever it takes to give good patient care, automatic good eval and a great experience."

"Be nice. And don't ever lie."

"Don't let your midriff show!"

"Appearance matters. No matter how scruffy or gross you are in real life, tighten it up. No cell phones in view of anyone you work with.  Always think of the next step beyond what is asked of you."

"Be useful! Anticipate needs and attempt to formulate plans, even if you're wrong. Ask questions and study for the shelf exam."

"Hear Dr. Manning's motto in your head at all times: 'Don't embarrass me.'"

"Leave it all on the field. Every single time."

"Remember the 'my mama rule' and the 'It's not about you rule.'"

"Never stop caring."


***

Is there any question why I love my job so much? I get to receive text messages that say things like that. From people like this. 

Oh, and before I forget--couldn't miss a chance to add these last couple of snaps with my newest colleague at Grady. . . .

With Dr. Alanna Stone of SG Alpha EUSOM '11

Yep. In a few months I'll say good bye to Small Group Gamma . . and welcome Small Group Epsilon. . . . at the same time that Alanna from Small Group Alpha returns to the nest. Yes. We will be shoulder to shoulder at Grady Hospital. . . but this time as fellow FACULTY.

How cool is THAT?

Game face. . .ON!

***
Happy Wednesday--and hey! Don't embarrass me.

Oh and in case it got missed, here is my first day quick advice that I gave these guys.

And since I'm feeling mushy. . .here are my videos of SG Alpha and SG Beta. Le sigh. Along with the Beatles songs that are playing now on my mental iPod. . . .yes, I am a mush ball.

SG Alpha. . . 

Small Group Alpha - EUSOM Class of 2011 from Kimberly Manning on Vimeo.

and SG Beta's graduation day (for Mark who couldn't come to commencement.)

Commencement 2013 from Kimberly Manning on Vimeo.


. . . and, okay,  this isn't the Beatles, but is also from Small Group Beta. . . "Beautiful Stranger" by Madonna.  Watched this, too and got choked up with the other ones. Yes, my advisees have the most sentimental advisor of them all. :)

Small Group Beta from Kimberly Manning on Vimeo.

Time over time.

Session with Small Group Gamma, 2011

One thing I can tell you is

you got to be free

Come together, right now

Over me.

~ The Beatles

There's this point where it all comes together for my small groups. Where the laughs become easier and the acceptance is so implicit that everyone has permission to speak freely and just . . .be freely.

I've never been able to put my finger on exactly when that happens in the small group dynamic. But I've been lucky enough to see it happen over and over again. When it has happened and you're in that sweet spot, you feel it, too. No one has to say anything. You just know.

I felt that last night.

Small Group Gamma, est. 2011

You know what? This is--hands down--my favorite part of the experience of being a medical student advisor. It is also arguably one of the main measures of any small group's success--that "come-together" point where everything just gels.

"So what's the key?" a colleague asked a few of us recently. That day, I wasn't really sure. I tried my best to describe this, the "come-together" point, but it kept coming out wrong. But yesterday evening while breaking bread and laughing out loud with my small group of fourth year student advisees, the light bulb came on. I remembered something I'd heard recently that underscores this perfectly.

Ah hah.

What does it take? It takes the same thing that any important, longitudinal relationship takes to be a success:

Time over time. Yes. That.

Putting in time and giving your time. . . . over time. Being present and checked in during that time. And building upon those moments over and over again until it morphs into something that can't be torn apart. That takes time. And consistency. And repetition. Over time. It does. Popping in for a drive-by moment when there isn't some demonstrable longterm commitment to the relationship or group doesn't work. Just like it isn't a so much of a tragedy to miss one session out of the many when you've been putting in good, rich time over the long haul.

And you know? I would say that this concept relates to how we treat ourselves, too. A person who is exercising regularly and making health-conscious choices on most days won't ruin anything by dropping their guard and having some fun on a vacation cruise. Conversely, the person who goes work out with a trainer for 45 minutes on Saturdays but eats with reckless abandon and doesn't move the rest of the days might as well hold their cash money up to a blowing fan and let it go. The ever present parent or spouse who is invested day after day will see those benefits. That time over time will mask the imperfections even when we feel terrified that they'll ruin everything. But really, isn't that what everything is about? Building lasting foundations for strong towers later? That's what I think.

Time over time.

Yeah. So if I answered that question today, I think I'd say that. Because this is what it takes. And everyone involved benefits when that happens. I know I have.

Time over time. 

That's it. That's all.

***
Happy Tuesday. Who is getting your time over time? Who isn't but should? Remember, that deserving person should include you.

Now playing on my mental iPod. . . .how 'bout some Beatles, y'all? You're welcome.

Alpha, Beta, Gamma, Delta . . . . and more.

Man.

I love my job. I truly do. It goes without saying that I love taking care of patients at Grady Hospital. I think it's also understood that I deeply enjoy doing so shoulder to shoulder with amazingly talented nurses, social workers, interpreters, residents, medical students and ancillary staff. Even on the days that I feel most exhausted, some part of me always looks forward to going into Grady.

Always.

But in 2007? Something took my job to another level. In 2007, I was appointed as one of sixteen faculty advisors to our incoming class of medical students. We would be the first to usher them into what we affectionately referred to as "the new curriculum." Each faculty member was assigned between seven and nine students that they would both teach and advise over their entire matriculation through medical school.

The agreement was four years (plus a possible additional year) for each group. From the first day of school until they graduated, they would be our responsibility right along with the medical school administration. We would be their advocates, their teachers, their tough love-deliverers, and, if we were lucky, their go-to person for good times and bad times.

If we held up our end of the bargain, we'd get another group two years later. And another two years after that. And so on and so on and so on.

And so. That's what happened. I held up my end of the bargain and got to remain in this absolutely amazing role. And let's be clear -- I do not exaggerate one bit when I use those words "absolutely amazing." Being given the opportunity to have such sustained contact with learners is a huge responsibility. But more than that, it's such an honor. Man. It's one I don't take lightly at all.

So in 2007, I welcomed in Small Group Alpha--all of whom are full-fledged residents supervising young interns and medical students of their own. 

Two years later, I was trusted to take on Small Group Beta in 2009. And it amazes me to see where they all are some four years later.

Next thing I knew, two more years had flown by. Small Group Alpha had nearly all flown out of the nest and it was time to bring in a new group to the family. This time it was Small Group Gamma -- who I affectionately refer to as "The Gammites."

I promise you -- it seems like I just took that picture above less than five minutes ago. But you know what? I didn't. I took it two full years ago. And these guys -- The Gammites -- have been joined by two additional students while one of our originals has gone off to pursue a PhD for a few years. He will rejoin the medical school after (but that doesn't mean he isn't still a part of our family.)

Yeah. So the Gammmites are now big time third years now. The Beta bunch are slugging it out as interns with a couple of academic research/master degree detour exceptions. But what's even crazier is that some of the group in SG Alpha could even be ATTENDING PHYSICIANS by this time next year. Which is super, duper bananas when I think about it.

So you know what that means, right? It means that I just got a new group. Yes, yes, y'all. Small Group DELTA has arrived.

Wow.

I look at them and think about how much my relationships with the others have evolved. I think about how special each of them are and how thrilled I am to know that I get to do it all over again. And can I just go on the record saying that every two years I marvel at how I somehow ALWAYS seem to get the very best small group? Can I? Because that's totally how I feel.

And you know? I feel this way already about The Deltoids. (How could I resist calling them that?)

 

You don't have to say it. Their mean mug needs work, I know. But don't worry. We have four years to fix that. We also have three generations of expert mean-muggers to teach them the proper way.

 

 

 

Ha.

Seriously, though -- this is such an awesome thing to get to do. For more than just the obvious reasons like building wonderful relationships with my small groups. It's more than that. There are some other really unexpected yet really great perks beyond those four assigned four year experiences.

First there's just the things that happen just from having a regular presence in the medical school. Other students see more than just their advisors. The dynamic leads them to feel more comfortable approaching people to mentor them, too. And that's pretty darn awesome.

Over time, I've developed some very close relationships with students outside of my own small groups. Some of those students have been on my ward teams. But you know? The vast majority aren't. They're simply students who've seen me around and with whom I've interacted just from being there so much.

I like to call them my "accessory" small group even though they are mostly made up of individual relationships.

So that? That's another perk.

And then there's this other really, really amazing thing that happens. See, these students were supposed to be mine until they graduated. But you know what? When you build relationships with people, they don't just disappear into thin air on graduation day. And so. This really great thing has happened where my former students have kept my number in their phones. They call me with their critical incidents from their residencies. They text me with funny pictures and exciting life moments. And I just love it. Every bit of it.

Dan in Philly

Vishes being vicious

Sparky and his PGY3 swag at Wash U

Gunan looking pseudoexcited about his current rotation

Hreem looking like a PGY3 Ophthalmology BOSS.

Zach at your service on his current clerkship

Doris and baby Savannah in Chicago where she is an ER intern

Hreem and Neel on their wedding day in May

Jin doing some acro-yoga in D.C. between Anesthesia cases

Dougie and wife Anne are in a NY state of mind for his residency in Anesthesia

Tony mean mugs his ENT on call pager

When she isn't a green tutu wearing ninja, Antoinette is an upper level Ob/Gyn resident

And I could go on and on and on and on. . . .

Yeah. So today I was just thinking. Thinking about how wonderful it is to have a career that feels so meaningful on so many levels. How fortunate I am to get to do something that nourishes my soul and encourages me to grow. All of it is just so. . . awesome.

I'm so, so grateful, man. And I know I've said it before but it bears repeating. Damn, I'm just so, so glad to be here.

Yeah.

***
Happy Saturday.

Oh yeah! Guess what y'all? An SG first!! I have a DELTA girl in my Small Group Delta!! Woo hooo!!!  How apropos in 2013!

My advisee and my SOROR!! :)