By: Olle ten Cate (@olletencate)
Berent Prakken, MD, PhD at UMC Utrecht’s Vice Dean for Education, to whom I report, has remained clinically active as a pediatric immunologist for one specialized clinic every two weeks, besides managing a huge organization with thousands of students and faculty. Since COVID, our meetings happen over videocalls and dinners, and we share our visions about the practice and purpose of education and health care. Unsurprisingly, we recently discussed trust of patients in doctors and of supervisors in trainees. Being a highly respected clinician, he revealed to me how he discusses occasional insecurities about courses of action with his patients. He developed the habit to suggest to the patient “We have some options and I’m not sure what to advise. Do you mind if I consult junior colleagues what to do?” and patients always agree. So he does, and senior residents and younger staff share their thoughts with him. That provides valuable information, for his own clinical knowledge and for patient management options, but also information about junior colleagues and residents. Some of them come with clever, thoughtful responses, others may less so. But they do not feel tested; they feel consulted. The situation is a mixture of peer teaching and collaboration, for the sake of health care, education and assessment.
This case illustrates the different purposes questioning can have in education and health care. Teachers and senior clinicians asking questions to juniors or trainees often do this to test them; not so much because the senior needs answers to supplement their own knowledge. Juniors and trainees asking questions to seniors might serve their need for content knowledge, but may also implicitly serve the purpose to reveal knowledge or at least to impress as being clever (‘boy, is that a clever question!’), especially within a group (a classroom, a conference session). But roles and purposes may be reversed! Seniors can also humbly ask questions.
When patients ask their doctor a question, the answer may sometimes be ‘I don’t know’, to reflect a personal lack of knowledge (the more junior, the more is there a need to learn), or it may be ‘We don’t know’, reflecting the limits of science1. In some cases, you may not be able to distinguish! Here is where peer consultation is useful.
In the example, a senior, being unsure what to advise a patient, seeks consultation among junior colleagues. In our conversation, I checked how patients usually react when he suggests consulting juniors. Would they worry about their doctors capabilities? No. They always seem to appreciate this strategy of consultation; it seems, in contrast, rather to add to their trust in the doctor.
I would call this functional humility, born from a willingness to ask for help, ignoring hierarchies, not coinciding with any embarrassment to reveal ignorance, nor to an attitude of showing-off cleverness. Humility includes the willingness to ask for help, openness to feedback2, from any credible source, be this supervisors, peers, inter-professional colleagues, and some cases, juniors and trainees.
About the author: Olle ten cate, PhD, is an Emeritus Profesor (AS Of October 2023) of Medical Education at University Medical Center Utrecht, the Netherlands
- Gruppen LD. Humility and respect: Core values in medical education. Med Educ. 2014;48(1):53–8.
- ten Cate O, Chen HC. The ingredients of a rich entrustment decision. Med Teach. 2020;42(12):1413–20.
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