#futureofmeded: the future of professional identity

By Kaz Nelson (@kazjnelson) and Felix Ankel (@felixankel)

You have been a successful residency director committed to training the next generation of clinicians.  After many years of trying to know all things in medical education you find yourself in a professional existential crises.  You realize that you are in a hierarchical environment, using linear tools to try to succeed in an exponential #meded world. Your experience in leading a successful program with a robust curriculum, refined assessment tools, and clear policies seems less meaningful.  You start focusing on challenges with inclusion, professional well-being, and patient centeredness.  You wonder about the future and start developing foresight competencies. You realize that the future of knowledge, identity, and structure is changing.

How do you reinvigorate your professional identity? How do you role model inclusion, professional well-being, and patient centeredness for a future generation of #meded learners and Clinician Educators? In 2017, Dr. Kaz Nelson started “The Mind Deconstructed: Mental Health and Wellness with Dr. Kaz and George” podcast, with her brother.  Read on to see how her first-person account is an excellent case study on how a Clinician Educators can transition into a public intellectual.

The clinician educator as a public intellectual  

We grew up together as brother and sister, but for the first time George and I sat down together at a restaurant just the two of us. Our respective spouses and children were out-of-town on a shared family Minnesota lake vacation, but work responsibilities brought the both of us back to town early.

“We should have dinner just the two of us! Wouldn’t that be funny?”

We had made our way through the appetizers and acknowledged the rarity of this moment. It was then that George’s good friend arrived and sat down with us in the booth.

“George, I know we’re meeting later for a movie but is it okay if I join you early for dinner?”

Our strange table-of-two had become and even stranger table-of-three. Brett asked us how we were doing. I told him a little about my work and my goals to change the way the public views psychiatric conditions and those living with mental illness. George chimed in with his usual witty comments and insight. We laughed together and enjoyed our banter.

“You two should start a podcast!”

I immediately brushed off the suggestion. I’m busy. I don’t know how to start a podcast. Wouldn’t that be expensive? What if I said something medically incorrect? Are there limits to what I could say legally? And the universal… I don’t like the sound of my own voice, why would anyone want to listen to me?

George, an attorney and former marine, has always been a fast learner and never one to turn down a challenge. He suggested that starting a podcast would likely be quite simple and affordable. He’d be willing to assist with the technology and other logistical aspects, including editing. It was that it was at that moment that this “non-dream” became a reality. George, set off to watching several YouTube videos on “how to launch a podcast” and gave me an online shopping list of equipment to purchase. We came up with a list of possible names for our podcast and tried them out on family and friends. We arrived at “The Mind Deconstructed: Mental Health and Wellness with Dr. Kaz and George”.

From the beginning, the intent was to share high-yield, accurate, accessible, basic information on mental health and mental illness directly with the community and early #meded learners. This aim arose from my personal experience fielding questions from friends, family, colleagues, and community members (usually confidentially and privately) who were desperately trying to make sense of how to understand and get help for themselves or a loved one. I had honed this guidance and these teaching points over many years through the education of medical students and psychiatry residents. It was time for me to make this information available to the general public.

Since the launch of our podcast in September of 2017, my professional identity has shifted dramatically. Promoting this podcast compelled me to engage in the realm of social media, a space which I admittedly had actively avoided up to this point. I had been a busy medical student and resident and dreaded seeing the kinds of activities and life events I was missing as I buried my head in books and learning the art and science of psychiatry. I was unaware that social media spaces such as Facebook and Twitter were not just for casual friendships; these networks held the potential to promote and advance my professional goals in a manner which completely outpaced all of my activities up to this point.

The goal of academics is to cultivate and disseminate new knowledge. I had relied on presentations at national conferences and publication in peer-reviewed journals as my primary method of dissemination. As a Clinician Educator, this is indeed an important, but often slow and painstaking route to accomplish this goal. Through my podcast and social media engagement, I was able to directly access people seeking to learn more about mental health and mental illness. I developed my reputation as someone who cares and will work tirelessly to translate often opaque and complex information into accessible and digestible content for those faced with the common and painful reality of needing to manage psychiatric illness.

For the first time in my career, I started to receive substantial recognition, including awards. Up until this point, despite my hard work, recognition and awards were rare. I had accepted my fate that teaching is an unsung and thankless job. My cultural background, being a staunchly humble Minnesotan, had usually served as a somewhat pathological trait in academics where self-promotion is a requirement. In the new space, I marveled at the impact of self-promotion and, indeed, “putting myself out there”. In 2018, I was named the Minnesota Psychiatric Society “Psychiatrist of the Year” and a National Alliance on Mental Illness Minnesota “Exemplary Psychiatrist”.

I was also being contacted by local and national news outlets for my perspective on commonly experienced psychiatric phenomena. I realized that my sense of imposter syndrome and self-narrative that I was not “expert” enough to serve as a representative of psychiatry was a myth. If I was qualified to teach psychiatry to medical students, then I must be qualified to teach psychiatry to the general public.

Despite the expense, time investment, and potential risk of saying something I would later regret, entering the realm as a public intellectual has allowed me a broad and engaged audience to advance my personal and professional mission. This is particularly important in the field of psychiatry, where we are often encouraged to bring as little of ourselves into the public sphere, so as preserve the nature of the patient/physician relationship. However, I have observed that as podcast listeners learn more about my philosophy of non-judgmentalism and my desire to share practical and medically sound conceptualization of perplexing medical conditions, they are more likely to confide in me. Ultimately, the podcast has served as a bridge, rather than a barrier, to psychiatric care access.

My goal is to engender trust in the health system and in psychiatry. This podcast is not financially sponsored by an outside entity, nor do I receive financial compensation from a pharmaceutical or medical-device industry. The public is rightfully and understandably suspicious of sponsorship impacting the quality of information, particularly when it comes to psychiatric medication. With this global platform, and through working to earn the public trust in me, I hope to use this privilege to advance aspects of medical education and the field of psychiatry.

The area which I am most motivated to improve is in increasing compassion and empathy in the care people living with borderline personality disorder. My wish is to use this platform to join with patient advocacy organizations in order to change the name of this diagnosis to a less pejorative term and to reclassify the disorder from the realm of personality and into a different category in the Diagnostic and Statistical Manual. Three years ago, I would have felt powerless and somewhat foolish to presume that I could lead a national movement on this issue. Today I am certain that with proper strategy and investment this mission is well within reach.

I am grateful for that strange dinner meeting, the support from George and my family, and the overwhelmingly positive reception from my professional community and the public. I am grateful for the privilege of the global platform I am afforded in my work. I hope people listen and obtain frameworks and tools  necessary to smooth the road to psychiatric recovery. I hope to inspire and encourage others to engage in this public space so we may together tackle the global challenges facing our shared work.