The Kung Fu Panda movies are so successful because of their inspiring message: you’ll succeed if you are true to yourself. My absolute favorite of the series is Kung Fu Panda 3. To summarize, the story starts with Po, the Jack Black panda, teaching the Furious Five Kung Fu. He fails miserably. Even Master Shifu admits it. But Master Shifu tells him "If you only do what you can, you will never be more than you are now." This becomes a key theme during the movie.
Po then goes to the panda village with his real panda dad to learn Chi so he can defeat the otherworldly ox, Kai. He learns Chi inadvertently while motivating a village of pandas to be kung fu masters in their own way. And by doing so, he defeats Kai. But the challenge to win this way is knowing what it means to be completely yourself and do things in your own way.
“I've been asking myself that question. Am I the son of a panda? The son of a goose? A student? A teacher? I'm all of those things. [Po's chi forms the shape of a dragon around him] I am the Dragon Warrior! Get it? You see the giant dragon?” – Po
Once you learn what it means to be yourself and embrace who you are, including your strengths and weaknesses, you become like Po: Complete as-is. And with that, you become unstoppable.
In many ways, by embracing who you are, including your strengths and weaknesses, as an individual or a company or an organization, you demonstrate compassion.
Compassion goes beyond love to embrace acceptance. Rather than judging and punishing character traits that are perceived to be a weakness, you see their beauty and how they can be leveraged as a strength. There are no real positives or negatives in a compassionate environment. You consider the qualities and unique skillsets of each team member and how they will best contribute to solve a problem. A compassionate work environment will also encourage employees to care for their colleagues and ensure that everyone trusts that they all have everyone’s best interest in mind. By developing curiosity and respect, a team will develop the care and trust that will shift the employee experience to create not just a team, but a community.
This doesn’t imply that compassion doesn’t include boundaries. It most definitely does – and it needs to! Accepting someone’s good and bad qualities doesn’t mean that you need to accept their bad behavior through actions and words. How can you separate good from bad behavior at work? Ask yourself:
- Does this person’s actions support community building or does it isolate or segregate others?
- Is there an intention present to bring unity to the group or to invite division?
If this person’s actions don’t support community building, it’s not compassionate behavior. If his or her actions bring people together, then they can be considered compassionate.
What can compassion at work look like?
A few years back, I worked at a healthcare marketing and advertising agency. My employer’s client developed an innovative and effective treatment for a rare kidney disease, helping patients live longer, higher-quality lives. The end-state for most kidney diseases starts with dialysis, and if that isn’t successful, transplants. And if the transplants aren’t effective, then death. That means that their specialists, nephrologists, manage patients who often have a deadly prognosis that ends in renal failure. We’re talking about 1 in 7 adults or about 37 million people who have such conditions. But this treatment would give a smaller population of that group, about 60,000, hope. Note that there typically isn’t a lot of breakthrough medical research in nephrology because of the kidney’s anatomical complexity, how few have kidney disease, not a lot of research happening, and other factors. Although 1 in 7 having a kidney disease is significant compared to heart disease causing 1 in 4 deaths, it seems less significant. Or is it?
For this project, I needed to create personas for the nephrologists who would be prescribing this treatment. I researched who they are, what motivates them, and why this treatment would matter to them. What I learned about their story stayed with me because they were like Po. Over time, nephrologists lost their way and their profession start to fade away with few entering it. To save their profession, rather than aspire to be someone they weren’t, they learned more about who they were, embraced that, and became more of themselves to attract more physicians into the field. In the end, they beat their Kai, which was watching the slow death of nephrology as a profession.
Nephrologists, like many other medical disciplines, were retiring at higher rates than physicians were becoming nephrologists. There were already fewer in the field, and these specialists were having difficulties serving their patients. Most days, a nephrologist is traveling between multiple dialysis centers, offices, and hospitals. To “help” the nephrologists, physicians from other disciplines would step in to treat their kidney patients. But often their diagnoses weren’t completely accurate, the treatments weren’t always done properly, and in the end, they weren’t supporting the patient. The quality of kidney care was declining. And needless to say, that was problematic.
Add to that how nephrology is a difficult specialization. The kidney is one of the most complex organs to understand so there is a lot to master in order to be a nephrologist, including the various aspects of patient care. It takes grit, commitment, and patience to succeed. There’s not a lot of fame in nephrology since there aren’t many new developments in kidney treatment to save lives and few opportunities for developing innovative, new procedures. (Remember, kidney patients often have a tragic end-state that often is death.) We remember the legacies and innovations of brain surgeons and cardiologists—rarely nephrologists. To sum it up, the field is filled with overachievers passionate about kidney care without the resources available to support their success.
With this declining population and seemingly hopeless situation, the nephrologists knew that they needed to do something to increase the number of students specializing in nephrology. They couldn’t stand by and continue silently watching the quality of patient care decline, never mind watching fewer entering the field to provide that care. The nephrologists of the American Society of Nephrologists (ASN) gathered and created a plan to save the profession. The first step was to conduct a study. They used a survey to discover the perspective of medical students to help them define the problem and then used that research to identify solutions that would attract and retain nephrologists. Essentially, they decided to study themselves as they would a patient: gather information and facts, determine the problem, and find a solution.
In the initial survey conducted in the summer of 2011 with 90% of the respondents from university-based programs, the American Society of Nephrology found:
- 31% of the respondents indicated that nephrology was the most difficult physiology course taught in medical school
- 26% had considered nephrology as a career choice
- 25% would have considered nephrology if the field had higher income or the subject were taught well during medical school and residency training.
And top reasons for medical students not choosing nephrology in the study:
- A belief that patients with end-stage renal disease were too complicated
- Lack of a mentor or role models
- Insufficient procedures in nephrology
- Perceived difficulty of the subject matter
In another study completed at the University of Colorado in 2020 with a sample set of 25 students, there were similar findings:
- Nephrology teaching in medical school was described as not clinically relevant and too complicated
- Several felt as though they were not smart enough to be a nephrologist
- Few had a role model to look up to
- Residents used the word “stigmatized” to describe the field
- Ultimately, the low prestige of the field decreased their interest in it
The diagram below was reproduced from the University of Colorado study. It summarizes the challenges and could also represent what was found during the 2011 study.
Participants in the University of Colorado study gave suggestions to increase interest in nephrology, such as:
- Greater outpatient nephrology exposure earlier in the education experience
- Increased interactions with nephrologists, and
- Research and advancements in the field.
Given that the 2011 and 2020 studies have similar findings, it may seem that there was little progress in their acceptance of who they were overall. However, let's compare a 2014 study with a similar 2019 study. In 2014, 72% of respondents said they would recommend the field to others; in a 2019 study, that number rose to 80%.
To take this one step further, in 2014, perceptions of inadequate job opportunities were high—35% for United States medical school graduates (USMG) and 56% for international medical graduates (IMG), while in 2019 “inadequate job opportunities” fell to 12% USMG and 20% IMG. Although slow, there was general progress.
How did the nephrologists achieve this? The 2011 research helped them identify four areas to address immediately:
- Increase nephrology faculty interaction with medical students
- Increase clinical exposure to nephrology and clinical relevance of renal pathophysiology materials
- Uses novel educational modalities
- Increase exposure to the breadth of nephrology practice
To address these areas quickly, they focused on modernizing nephrology medical education by including in the curriculum:
- Small group learning
- Moderated physiology lectures
- Flipped classrooms (where students absorb the material asynchronously before apply it practically in the classroom/lab)
- Clearer Application of pathophysiology to patient
- Activity-based learning with clinical case scenarios
- Online lectures
- Exposure to multiple aspects of the field, such as clinical care, research, education, and leadership and to nephrologists in general
- Highlight research and advancements
- Gamification to make nephrology more relevant and enjoyable (e.g., the Nephrology World Cup)
These educational innovations made sweeping changes. By 2021, the best rate of filled Match positions was achieved since 2014. Graduating fellows' perceptions of job opportunities improved, with them recommending the field to others. When it came to research and innovative developments, the past decade yielded molecular discoveries and new treatment breakthroughs in proteins, antibodies, and inhibitors. And the ASN Kidney Health Initiative and the Innovation Accelerator (KidneyX) public-private funding partnership charted paths to rapid change in the prevention, diagnosis, and treatment of kidney diseases. The Advancing American Kidney Health Executive Order focused attention on patients with kidney diseases.
As a next step to make the field more attractive, the ASN Workforce and Training Committee summit re-envisioned the workforce, addressing right-sizing fellowship positions, diversity, recruiting incompletely tapped pools (e.g., osteopaths), alternative work structures (e.g., job sharing), and the nephrology sub specialization as a whole.
“Medical specialists of the kidney clearly will be needed long into the future. The question is no longer, “Will there be a workforce?” There will be one. The question is, “How will the future nephrology workforce discover, innovate, and deliver high value care?””
One could assume that the ASN had this perspective only of themselves, but it went beyond that. In one blog post, a medical student listed reasons why she wanted to become a nephrologist, which listed reasons like how it was:
- Intellectually stimulating
- Had meaningful doctor-patient connection
- Had dedicated teachers and mentors
- Included business savvy nephrologists
- And it was a rewarding career
Talk about a change in the perception and brand!
By listening to each other and prospective nephrologists (medical students), ASN discovered that nephrology devolved into a profession that no one wanted to enter mainly because they weren’t being true to themselves. Nephrology became known only as the study of kidney health. And that’s pretty dry and complicated. They needed to include a key element in education that was missing: what it meant to be a nephrologist by helping patients and providing them better care. Physicians often enter their fields with the intention to improve patient lives and help them be happier and healthier. With the state of nephrology at that time, that was happening infrequently, if at all. They weren’t teaching medical students what it meant to be a nephrologist – the patient responsibilities, the responsibilities to colleagues, the contribution to research, the importance of proper kidney diagnoses and treatments. The physicians weren’t actively researching cures or discovering new treatments or developing partnerships to innovate and find new treatments. Without research to discover new cures, they weren’t helping patients improve their lives. The status quo treatments of dialysis and transplants were only helping them stay alive, not help them have a better life. That’s not exactly inspiring. They had to change and re-embrace their passion for patient care.
By listening to prospective nephrologists, the established nephrologists realized that they needed to share their passion with the students for not just nephrology, but for the patients, so they would get excited about improving their lives too. The re-introduction of medical research provided students hope that they, too, will have opportunities to help patients live better lives beyond facing dialysis, transplant, or renal failure. The field took its first step in its own evolution to be an exciting career by improving patient care!
The nephrologists learned to be authentic to their values and to embrace their passions. As we know, compassion starts with individuals accepting and being grateful for their strengths and weaknesses as well as the strengths and weaknesses of others, like colleagues and patients. With more active nephrologists trained to embrace their passions for patient care driving education, training, research, and innovation, the field is destined for improvements. It will be interesting to see the results in coming years. There should be not just be a consistent experience, but it is a compassionate experience building in nephrology.
As we learned in Kung-Fu Panda, being a dragon warrior doesn’t mean that you have a special skill or do something unique. Dragon warriors are a more authentic version of themselves, embracing their strengths and weaknesses. And it’s the same for an organization, especially the nephrologists and the ASN. By re-focusing their attention back to their unified passion and motivation, improving patient care and quality of life for kidney patients, they revitalized their profession to improve treatments and spark innovation. And that passion for their patients helped them attract more nephrologists and rebuild the profession. They transformed nephrology into a “dragon warrior” organization to defeat their Kai, the death of their profession, and found new life. Hopefully, we’ll hear about other kidney treatment innovations soon and know that having a kidney disease won’t result in dialysis, transplants, or renal failure, but something else that include a long, happy, healthy life.
Additional reference:
https://consultqd.clevelandclinic.org/why-arent-more-residents-choosing-nephrology/
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