Volume 8, No. 3: Section 5, Autumn 2006


Starting Anew, Looking Back

My professional career, as well as my life, has been shaped by my grandfather’s oft-repeated injunction: “Whatever you are doing, do it as well as possible. If you can’t bring yourself to do that, then change what you are doing.” He believed that, if one followed this maxim, work would be rewarding. And it always has been for me. On July 1, 2006, I was privileged to assume responsibilities as Senior Vice President for Medical Education at the Association of American Medical Colleges (AAMC). This seems a capstone position to me, beyond anything I envisioned. Yet, as one colleague remarked, my previous experiences provided better preparation for this role than I could ever have planned. Curriculum design and management, development of assessments, program evaluation, faculty and leadership development, planning, experience with organized medicine, high stakes testing and accreditation (LCME, ACCME, and ACGME)* – I now have the opportunity to apply them all and work with amazing, talented and dedicated people. As an ENTP** who loves learning, synthesis and developing big ideas with others, this is a dream come true.

This wonderful opportunity comes at that fruitful time in life when there is no need to look ahead to career ladders or pathways, just the joy of daily work and the steadiness that comes with lessons learned along the way. For those who have not yet reached this point in life, here are some of the lessons I’ve learned and hope to apply in my current position.

Things I know now that I didn’t know when I started my first big job:

It takes time – for everyone – to learn the new job. If one already knows everything about the new position, then it’s not advancement. I’ve learned that it usually takes 12-18 months to gain a sense of mastery of the details, appropriate to the new position. There are at least two major learning tasks: creating a mental “big picture” in which to order the details, and determining which details are relevant to new roles. I now know the answer to the question that keeps recurring with each new job – “Will I ever learn enough to be good at this?” – and I enjoy the excitement of being on the steep side of the learning curve.

Pacing is important and it’s not weakness. During seven years as a full-time consultant, the opportunity to structure my own time taught me much about my biological rhythms. I’m a morning person so it’s optimal to use that time for researching issues and writing, and to use the afternoon for meetings. (I still need to learn to postpone opening email until at least mid-morning.) I also program in brief breaks every 90 minutes or so: a walk around the block, some balance exercises or one chapter of a novel. This is not weakness; research cited in The Power of Full Engagement by Jim Loehr and Tony Schwartz documents the benefits of periodic breaks on mental functioning.

Understanding one’s preferences is a great boost to self-management. As my understanding of the Myers-Briggs Type Indicator®** (a tool to assess personality preferences) deepens, my ability to manage my energy, my learning and my emotions grow. With my ENTP preferences for extroversion, intuitive perceiving function, thinking deciding function, and perceiving, I need to: engage face-to-face with people, not just on email; talk in order to explore ideas and remind others that I’m just exploring, not ordering; use personal reminders to attend to the feelings of others; and set limits on how much information I’ll gather before making a decision. Knowing that working outside my preferences always demands more energy, I program extra breaks on those days that are dense with detail and ask staff to bring visuals (print or image) when we discuss the details of projects. Understanding my preferences also aids me to honor my preferred learning style: reading is my dominant mode of learning, followed by tactics to process experience (reflection, journaling; recognizing patterns). I’ve learned to put more trust in my own intuition and regularly attend seminars and conferences, more to stimulate my thinking than to acquire information.

Each day must include some time for reflection. In one of his wonderful books, Max DuPree noted, “Reflection is not a luxury for leaders, it’s a necessity.” Some days the time for quiet solitude and reflection may be only the 15-20 minutes it takes to walk to work or lift weights. On good days, it’s 20 minutes of meditation and time outside or listening (just listening) to music. Without time for reflection, it’s impossible to extract the lessons about self and others from daily experience.

Self-nourishment is a personal responsibility. A brief but nasty illness 30 years ago taught me that I must be the keeper of my own wellness. In addition to the ongoing challenge of pursuing regular exercise and a healthy diet, I invest regular time in nourishing my spirit. Albert Camus wisely noted that to be happy, a person requires “time in the open air, love for another creature, freedom from ambition and opportunity for creativity.” Being patient with others, showing respect, focusing on the task at hand, developing people – all are easier when one’s spirit is well nourished. There are many ways to do this. For me it’s time outside, music, reading a good novel and a daily spiritual practice.

Detachment helps. One of the features of process consulting is that the consultant invests creative energy helping the client to develop a process, procedure or program and then must walk away, leaving the implementation, nurturing and tweaking to the client. It’s a great exercise in detachment – giving one’s labor and creativity to the work, and then giving the work over to life. One of the meanings of detachment is separation, in this case, freeing oneself from what is beyond personal control. As one sage observed, “We are responsible for the ingredients, not the results.”

Beginning anew, I’m not certain how this work will develop. In fact, I’ve never been certain what my real work is but I do have a very clear sense of whether or not I’m doing it. Time and experience have taught me that context may vary, but it’s persistence in the process of the real work, even if you can’t name it, that leads to impact. And I hope to make an impact, to help the dreams of others come true.

Carol A. Aschenbrener, MD
Senior Vice-President
AAMC Division of Medical Education

Brief Bio: The AAMC appointed Carol A. Aschenbrener, MD, as Senior Vice President of the Division of Medical Education on July 1, 2006. During the prior two years, she was the AAMC secretariat to the Liaison Committee on Medical Education (LCME). She was twice elected to the AMA’s Council on Medical Education and served for 15 years on the National Board of Medical Examiners, including chairing the entire board and chairing the Composite Committee (which oversees the United States Medical Licensing Examination).
Dr. Aschenbrener‘s medical degree comes from the University of North Carolina at Chapel Hill School of Medicine. After her residency in pathology at the University of Iowa Hospitals and Clinics, she joined the College of Medicine faculty for almost two decades, moving from professor to associate dean for student affairs and curriculum, and then to executive associate dean of medicine. From 1992-96, Dr. Aschenbrener served as the chancellor of the University of Nebraska Medical Center. (Brief Bio taken from a recent AAMC press release. Contact: Nicole Buckley @ 202-828-004; [email protected])
Additional Information
*LCME: The Liaison Committee on Medical Education is the nationally recognized accrediting authority for medical education programs leading to the MD degree in US and Canadian medical schools. The LCME is sponsored by the AAMC and the American Medical Association. (Taken from the web site: www.lcme.org) (Accessed 8/31/06)
ACCME: The Accreditation Council for Continuing Medical Education identifies, develops and promotes standards for the quality continuing medical education (CME) of physicians for the maintenance of competence and acquiring new knowledge to improve their medical care practice. (Taken from the web site: www.accme.org) (Accessed 8/31/06)
ACGME: The Accreditation Council for Graduate Medical Education provides the accreditation of post-MD medical training programs within the US through a peer review process and established standards and guidelines. (Taken from the web site: www.acgme.org) (Accessed 8/31/06)

**ENTP – the Myers-Briggs Type Indicator (assessment tool) type showing personality preferences for 1) Extroversion, 2) Intuitive-perceiving function, 3) Thinking-deciding function, and 4) Perceiving. (Web sites for further information: www.knowyourtype; www.teamtechnology.co.uk/tt/t-articl/mb-simpl.htm (Accessed 8/31/06)

1. http://www.teamtechnology.co.uk/tt/t-articl/mb-simpl.htm
2. Loehr J & Schwartz T. (2003). The Power of Full Engagement. NY: The Free Press (of Simon & Schuster, Inc.)

Hard Work and Talent Aren't Enough: Developing Political Savvy

Do you let resentment or intimidation drain your energy? Do you cringe at incivility in meetings? Do you often “personalize” events? Do you tend to imagine that the importance of your goals is self-evident and that your goals are shared? When someone disagrees with you, do you tend to become defensive? Do you have trouble building alliances? Are you pretty predictable? Do you take things at face value? If most of your answers are “yes,” then you probably struggle with organizational politics and likely are not fully utilizing your power to achieve your goals.

The only way to avoid organizational politics is to work completely alone. Politics is a natural way for competitive people to behave (“politics” and “people” come from the same root, “polis”). The task of politics is to find solutions to complicated issues. The more complex your organization (and Academic Health Centers are perhaps the most complex in the world) and the scarcer the resources, the more legitimate, competing goals there are likely to be.

Thus, no matter how excellent their clinical and scientific skills, physicians and scientists who lack political skills will not reach their potential. This may be dispiriting to purists and to those who equate politics with con men or bullies. But it’s a mistake to dismiss organizational politics as “show business for ugly people.” Politics can be constructive if your objectives are in the institution’s interests as well as your own and if the efforts used to achieve those objectives have integrity.

The Challenge
Preferring the lab or the OR where they are “in charge”, many physicians and scientists tend to over-rely on their most trusted behaviors, e.g., hard-driving perfectionism, self-reliance, and analysis. Many are more comfortable achieving “competence” than “connectedness” and pride themselves more on individual than group accomplishment. Requiring a relationship-building perspective and excellence in listening and communicating, political skills thus often represent a stretch.

Political skills can be especially challenging for women to acquire. Compared to men, women are less likely to garner effective mentoring, to have VIPs in their networks and or to be included in informal gatherings, e.g., the golf course. Women also enjoy a narrower band of assertive behaviors in most cultures, and strong women make some men (and women) uncomfortable. Compared to men, how women dress and look carries more weight, and self-promotion feels less natural. So developing a style that works is both extra important and requires extra finesse. An internal challenge many women must work to overcome is the desire to please and to be liked. Remaining on the sidelines only compounds these disadvantages.

Political intuition starts with interest in people. Developing a political compass involves deep attentiveness to what others say and how they act. Since such openness accompanied by a penchant for observation is the hallmark of great clinicians and scientists, remember that you’re building on a foundation you already have.

Becoming a Student of People
So what does becoming a student of people entail? Political intelligence is a sensitivity to the social contexts that define an organization’s culture. Just as you keep up in your discipline, you need also to study the systems you work in and how influential people operate—what their strengths, weaknesses, and motivations are. Be inquisitive. Use every opportunity to learn more.

Given your priorities (you know what are your goals are, right?), with whom do you need to build alliances or links? What key stakeholders and players do you need to influence? To build interest in and support for shared goals, seek to understand the other’s needs and pressures. Few will tell you their agenda directly, so you must snorkel beneath the surface: What appear to be their goals? How do they approach implementing them? Do they offer nonverbal cues? In addition to body language, pay attention to what is not said.

Try to individualize your approach to and your communications with others. For instance, for this person, what constitutes the most persuasive data (research, expert opinion, personal examples)? Are they most likely to be influenced by appeal to what others think, by what is in line with their self-image, or by what will achieve the fastest results? Adapt your message and style.

Even great ideas don’t sell themselves, so become savvy about positioning them. Similarly, learn to “frame” issues to favor your goals. How you frame or define a situation can reorganize perceptions—for instance, you can refer to an “argument” or a “debate,” a “difficult negotiation” or an ”opportunity to find common ground.” In any case, take care not to become defensive, which is a recipe for anti-learning.

Overcoming Blind Spots and Myopia
“Facts” are really social interpretations based on what you expect and want the world to be like. Where you “sit” determines what you see and the events you see that you immediately assign a meaning to. It’s easy to forget that there might be many other possible interpretations of the same occurrence. Also everyone tends to over-rely on their area of expertise and their preferred learning style, thereby missing important perspectives. For example, individuals who prefer quantitative assessments often miss crucial information about peoples’ feelings, while those who attend best to observable data may miss the “big picture.” So it’s important to compensate for these blind spots and discipline-induced myopia by teaming and consulting with individuals who bring other strengths and offer other perspectives.

Political skills consolidate with practice, especially if you actively reflect about what results you’re achieving and what you’re learning. Bounce your observations and questions off trusted colleagues. Ask them and yourself:

Take Home Messages
While this overview only skims the surface of these complex subjects, incorporating a few key practices can make a big difference:

If you could use personalized assistance in having more impact with integrity, consider hiring a coach. The ELAM Consultation Alliance is a compilation of vetted coaches [see: http://www.drexel.edu/elam/alliance/consultation2.html].

Janet Bickel, MA
Career Development and Executive Coach, Faculty Career and Diversity Consultant
[email protected]

Additional Reading:
1. Bolman LG, Deal T. Reframing organizations: artistry, choice and leadership. Jossey-Bass, 1997.
2. Egan G. Working the shadow side: a guide to positive behind-the-scenes management. Jossey-Bass, 1994.
3. Reardon K: It's All Politics: Winning in a World Where Hard Work and Talent Aren't Enough. Doubleday, 2005.

Fresh Approaches to Teaching Can Yield New Associations:

Teaching today’s medical students is oftentimes a challenge. Of course, being a medical student is probably a challenge of equal or greater proportions, but faculty members rarely view this perspective with the same gravity held by students. The complexity of effective teaching and learning requires balancing information output from the faculty member with information uptake and retention by the student. Students are quick to identify information output presented in formats unsuitable for uptake, such as the poorly prepared or obtuse lectures, or information nearly impossible to retain, such as the truly obtuse topics or topics with little apparent applicability for a future practicing physician. Therefore, effective teaching remains a constant challenge of reviewing new material, preparing new ways to present material, and seeking new connections between different disciplines to underscore the impact of the information.

This is an account of such a challenge that resulted in several unexpected associations between the genetics of gender development and the importance of childcare decisions. A review of hermaphroditism provided several insights into childcare and the impact of family symbolism to raising children that I failed previously to notice in presenting this material to students. The learning objectives for students were gender differentiation and development that provided fundamentals for subsequent objectives on steroidogenic disorders affecting gender.

Searching the Internet
The Internet is a wonderful resource for preparing lectures and providing resource material for students. Anything and everything can be found on the Internet and is often available for teaching without additional permission; however, during the past year I have never been refused permissions requested to use material found on the Internet for publication and/or dissemination to the public. Examples of materials I have used include text, figures, diagrams, algorithms, and photos. Many authors volunteer to send original material for better resolution.

To begin updating material on hermaphrodites, I began at my web browser. At this point, I strongly suggest no one search under the words “hermaphrodite” or “hermaphroditism.” DO NOT open anything that comes up for these words – believe me on this. You may find that, in doing so inadvertently, getting rid of emails that begin filling your inbox is difficult for a long time afterwards. You may even have to change your email address to get rid of unwanted emails.

Using Background to Enhance Teaching
I decided to give students some background on hermaphrodites with the hope that this would enhance their learning experience and reduce the snickering sidebars that accompany this topic. So I went to Greek mythology. My story begins here, but it is really two stories: one about Hermes, the father of Hermaphroditus, and the other about Hermaphroditus, the son. Both stories are important to understanding the culture of Hermaphroditus’ family and the Greeks who ultimately influenced the association of Hermaphroditus’ name with a genetic anomaly of gonadal development.

Either a male and female gonad in one individual, or the presence of male and female gonad tissue in a single gonad (a presentation known as an ovotestis) characterizes the genetic anomaly. Hermaphrodites are referred to as individuals with intersex. Hermaphroditism is not a psychosocial disorder, though psychosocial events will definitely influence the child’s development. It is an error in development that may occur on one or both sides of the body. Both male and female genotypes occur in the same individual.

Hermes (The Father)
The story begins with Hermes, most commonly recognized as the Messenger of the Gods. Hermes had many, many assignments. As Protector of the Roads, he did a lot of ferrying of messages and cargo for the Gods. As the God of Speed, Hermes delivered messages for the Gods, who wanted their messages delivered in a timely manner. Obviously, Hermes could also be considered the forefather of FedEx, an association overlooked by the FedEx corporate directors. Hermes was the son of Zeus and Maia, daughter of Atlas and one of the Pleiades. Not only was Hermes the offspring of an illegitimate affair, he was one of several gods who had one-night stands with Aphrodite, the Goddess of Love, and with other minor goddesses. Such one-night affairs may have been an occupational hazard, but my review of the literature revealed that fidelity was not a high priority among many mortals and gods, as well as Hermes and his father.

The name Hermes is associated with the Greek term herma – a rectangular stone pillar used to mark roads for safe passage. These pillars also became popular markers at the entrance of homes to ward off evil spirits. Unlike today’s rectangular pillars that often support large flower urns, hermai (plural for herma) in early Greece were topped by a sculpture of Hermes’ head. Located at, or near, the base of the pillar were sculptures of Hermes’ genitals. During an unpopular period of the Peloponnesian War, in about 415 BC, citizens of Athens did not favor sending their young men off on ships to wage war in Syracuse (the older one). Rather than picketing against this unfavorable war, hermai were defaced; thus, only their description remains. However, the description seems to elicit appropriate imagery. Several thoughts come to mind when considering these hermai. First, outdoor landscaping was apparently a man’s responsibility. What woman would mark the entrance of her home with stone genitals? I wonder if the location of the genitals, which when in a higher position may have been broken, was a compromise by sculptors to appease women complaining of bruised hips and thighs. Second, when did pet dogs enter Grecian life? [Think male pets!] Third, I suspect that hermai were defaced at the top and bottom, since pillars and other types of hermai have been found at many archeological sites. Finally, I also suspect that women, not the men going to war, defaced hermai.

Hermaphroditus (The Illegitimate Son)
Hermes and Aphrodite had a son named Hermaphroditus who was raised by a group of nymphs1. In my opinion, nymphs may not have been the best choice for childcare since they were constantly the target of satyrs’ lust. These nymphs resided in a place called Phrygia2 (frij'e-?), which seems a bit oxymoronic. Other half-siblings of Hermaphroditus were Priapus and Eros. Hermaphroditus was a very handsome young man. As a teenager he decided to leave home because his parents were constantly having affairs with the neighboring gods and goddesses, his father’s head and genitals were displayed at every door, and his nannies and tutors were nymphs.

Hermaphroditus was traveling the country when he encountered a reflecting pond that beautifully mirrored the nearby forests and meadows. In this particularly beautiful pond was a nymph named Salmacis – probably a water nymph. She was at once attracted to this handsome young god and invited him into the pool. However, Hermaphroditus was in deep thought about his life and the nature around him and ignored the nymph. After all, he had been around nymphs his whole life. As he walked along the pool, the nymph continued her solicitations. Hermaphroditus paid no attention to the nymph, but he was very much attracted to the pool. He decided to disrobe and enter the pool for relief from the searing, late afternoon sun. The nymph, as was true of most nymphs, did not appreciate a blatant rebuff. She sought a more direct approach. She swam to Hermaphroditus, embraced him tightly and began to wildly kiss and fondle him. Hermaphroditus fought vigorously to free himself from this unexpected attack but was unable to release her hold. Salmacis continued her sensuous pleasures and cried out to the gods that their bodies never be separated, even as Hermaphroditus was fighting to release her hold. The gods, who may not have been paying close attention to the events in this small remote pool (perhaps they were enjoying their own godly delights), granted Salmacis’ wish. The bodies of Salmacis and Hermaphroditus became one – half male and half female. In his horror of what happened, Hermaphroditus cried out to the gods with all the air his lungs could expel and begged them to punish any man who entered this pond by taking his virility. The birds and animals were quiet as the winds began to move from every direction. The gods heard Hermaphroditus’ cry and considered the terrible thing they had done. Then they granted his wish.

Unexpected Lessons
As I contemplated this story for medical students, several aspects seemed clearer than previously. First, the story might be better suited for behavioral science discussions, but interdisciplinary approaches for teaching often enhance learning. Hermaphroditus was a tragic figure, whose destiny was shaped not by genetics, but by his parents’ behavior and his own random wanderings that took him by the pond where Salmacis was bathing. Family counseling and individual counseling were indicated for both Hermes and Aphrodite before their affair, as well as during Hermaphroditus’ childhood. Second, even the names Aphrodite chose for her children did not consider the difficulties these gods would have to live with as they matured. Third, Hermes and Aphrodite were not involved in their child’s life. They should have paid closer attention to the childcare workers’ résumés. Just as no one today wants a landscaper from Leavenworth, nymphs from Phrygia should have been given a little more scrutiny. Fourth, Hermaphroditus’ curriculum would have benefited from a more adequate physical fitness program. Finally, teenagers shouldn’t roam the country in search of an inner self and meaning of life without a traveling companion. This tragedy points out only too clearly that mothers of handsome sons must teach them to beware of nymphs in ponds.

The students wildly received this information with great enthusiasm. They demonstrated great retention of this and related material about hermaphrodites on the evaluation – which was my goal. On a final note, I considered briefly the idea of requesting volunteers for dramatization of this material as it was being presented; however, after further consideration, I refrained from the temptation.

Linda Adkison, PhD
Mercer University School of Medicine
ELAM 1999-2000

Reference: Publius Ovidius Naso, Ovid IV, 288

1)A minor nature goddess usually depicted as a beautiful maiden among the ancient Greeks believed to inhabit forests and bodies of water. Today’s connotation of the word nymph may be closer to insect-like than maiden-like, or an issue of regional dialect.
2)An ancient country in western and central Asia Minor that is modern day central Turkey.

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