Thriving Through Rotations:
Finding Wellbeing While You Learn

Transforming Healthcare Coaching Podcast — Episode 80: Thriving Through Rotations: Finding Wellbeing While You Learn. Co-hosts: Lillian Liang Emlet, MD MS CHSE CPC ELI-MP, and Klaus Grim, PA-C CPC ELI-MP.

80 - Wellbeing for Students & Trainees in Healthcare Profession

Lillian Liang Emlet: Hi everyone. Welcome to the Transforming Healthcare Coaching Podcast, and this week we are taking a viewer, a listeners question and bring it to you live with Klaus. And so one of our audience members posted the question, how in the world do you maintain wellbeing? When you are the student, when you are the learner, when you are the one going through the rotations, when you're changing hospitals every month, how in the world can you maintain wellbeing and learning?

When you're changing every 30 days because it's really stressful. I just acknowledge that change is hard and obviously as coaches, we help people through change quite a bit. And so Klaus are gonna chat about that today. So Klaus, I guess I'm curious , you, you do precept quite a bit and. A lot of times people will tell you, , in the downtimes, , in the department about some of the unspoken challenges that they face as students.

It's, it's these little quieter moments we have that we really love as educators. What are some of the unspoken challenges that your students and your residents face during the training years?

Klaus Grim: I love how you commented first off about those quiet moments. Those really are the. Best moments that we can have that are, I think, unu underutilized, that I think a lot of preceptors fail to use is those moments where we have a second to breathe. We don't have to chart where we can utilize that time to offer insights and advice. To our students on the real world application of our roles and how to be well in this process and get to know them too, as we are human beings. , We love connection. We love to hear other people's stories, but I think the biggest challenges are first talk generational. Things have shifted right from when we were students to how they are students and the challenges that they have.

A lot of them I'm not as familiar with. And so it actually comes down to me asking like, what are your challenges? Like, what are you going through? And a lot of the things that I hear is. Time, obviously, how many of us that I don't think has shifted yet in medical education, we are servants of our rotations.

We're servants of our schools. So whatever they tell us to do, we do. We wake up really early, we stay late, all to do the same thing every day. And so I think that's still the biggest challenge is. Time for themselves in the process of medical education is a big barrier for them to feel like they can actually find time for themselves in that process.

Lillian Liang Emlet: That's a great point. I, I hear the same thing from my trainees as well. When we do a time audit exercise, they just color and color and color and they realize that just a huge block of time, 12 hours, is allocated to being on service and sometimes can fail to see that even within the hours of the service of being.

Present. There are quiet times, there's moments to relax, there's moments to laugh, there's moments to go to the bathroom, hopefully to eat your dinner, to be a little mindful, to catch up on something silly. And that we often squander those 12 hours, , on the clinical service time. And how do we craft, how do you craft that?

Klaus Grim: Repeat the question one more time.

Lillian Liang Emlet: So how do you craft time even on a busy clinical shift?

Klaus Grim: Like, time for myself? Is that what you mean? So that's a, that's a great question because, it is very difficult coming from a, , fast-paced environment where we don't oftentimes have built-in breaks. And, and I think it goes back to what you talked about earlier. Those moments of, of quiet that you can utilize or find those times of quiet never means rushing patient encounters or rushing any part of your day. But there's always, sometimes a part of the day that you can find time that, that could be in the essence of when you're going to warm up your lunch, going for a walk, doing a quick walk, make a quick phone call while you're in that process, kind of stacking something else in that, in warming up your food with something else that could maybe bring you joy. One thing I'm in the process right now is actually how to build in exercise during work, like. Not saying like I'm doing like a Pilates workout or TRX, but how can I do something that incorporates movement? Granted, we move a lot in healthcare, we're up on our feeds, we're seeing patients. We're going back and we're charting, but we're up and down, but. How can we be a little bit more intentional about moving other parts of our body that we don't typically move during work? So I'm always finding ways to be creative and anybody who's listening, please send us what you think could be helpful because I could always utilize other people's strategies. How do you do it, Lily?

Lillian Liang Emlet: Yeah. , So I do think having some. Private time is really important for a lot of people. It's really overstimulating in the clinical environment you always feel like you have to be on. So I also think there's some definite role for the social group work room, like we're often socializing. So having that time in hanging out and, and deciding with your team.

We're gonna just after rounds, we are not going to. We're just going to chitchat and just relax or we're gonna set aside a different time or go get coffee in the afternoon. So social connection, connectivity, social connection is really important. And then also, I really think that alone time is really important.

I know for, , if half the world is extroverts and the other half are introverts or ambiverts, we actually need some alone time. So really being intentional and finding some time to go take a walk, go up and down the staircases. Our one hospital put in safeguards and like step counters and like little things on our stairwells because so many people were using it for exercise.

That was one of the suggestions they offered for wellbeing. 'cause then you sort of need to see that if you do all nine flights of the hospital, hospital building, you actually get a lot of steps in. And I know like for some people too, they're the, I actually was, was brainstorming. I wonder what it'd be like to wear like those little ankle weights.

Underneath your scrub pants because you then can get a little bit weights in as well. When you're running around and you can take 'em off. That's a good thing. You can take it off after half a day if it's really annoying. So those are some of the things I think for just being intentional, like go find time by yourself.

It is okay. You don't have to be on all day long with your work group.

Klaus Grim: Yeah. And it's a challenge among, I think, ER and urgent care at at least from what I've experienced, is 'cause oftentimes, , you're dealing with very critically ill people. So how do you take a step away for yourself, in those moments, maybe talking to a colleague and saying, Hey, can you follow the, my patients for. Five, 10 minutes while I just take a, a breather. And I think of people are afraid to speak up, to say, I could use a breather or I could use that, that, individual time, and I think we have to be more okay with that and and realizing that we may need that for ourselves and to find that time for ourselves as well.

So that's really helpful. And I, and I really like the the ankle exercise. That might be something. I give it a try.

Lillian Liang Emlet: I see our nursing colleagues do it all the time. The reality is like, , I haven't even eaten, I haven't even done anything. I've been on three road trips, a CT scan. I just need a break. They'll like cover each other one because it's actually a workplace requirement that you do need to have your 30 minute of just on your own.

And I, and I think it's also really great in some hospitals they have wellbeing rooms or little corners like a massage chair, a conference room, a garden. There's a reason why some people have environmentally engineered the opportunity just to step away. I do think. We are always on so much that whatever works for you.

I mean, honestly, I tell people all the time, go hide in the bathroom. I hid in the call room. I mean, ever since I was a fellow, I still remember. What, everyone deserves a 10, 15 minutes and you can just text your colleague to say, I just need to step away for 10 minutes. 10 minutes is really now that long when you put the timer on, especially to a meditation app, it's not long enough that you're back out here, unfortunately.

Klaus Grim: No, that's, that, that is true. And I think we, we all think that 10 minutes could be used for. charting Right. It's, it's the same thing I actually hear from my students actually all the time. It's, and is that, , every time they do feel like they have some free time, they feel like it, they have to be used studying or doing something right.

But if, really think about it, that 10 minutes of studying, how much is that actually. Absorbing or, or doing for you, whereas if you took those 10 minutes to free up some of that stress and weight on your shoulders how much more that would unlock for you in, in your studying when you go back to it.

Right. There's so, there's so much benefits from freeing yourself from some bad energy, right. And doing something that's, that's good for you.

Lillian Liang Emlet: As that brings up a point about brain science. The reality is, , after about 90 minutes, your attention does fade. You need to change, and we also know that movement helps. With neuro processing, and so you do actually need to get up and move. And so it's pretty much, you probably, we all probably should have a 90 minute timer on all of our watches to get up, move and breathe, because that will help us become more efficient at the tasks that we have.

That's pretty much what we know from brain science, and yet most of us don't really adapt to that unfortunately.

Klaus Grim: Yeah, I like that.

Lillian Liang Emlet: And so speaking of learning and thinking how to optimize it, I guess, if, what do you wish you had known about advocating for your own personal learning needs during your clinical rotations? I.

Klaus Grim: That's a good question because it brings me a little bit of anxiety about myself during rotations. 'cause when I was in rotations, I, , you're already so nervous about, , constantly switching to new locations, meeting new people who are grading you, who are pass or fail, and you say something wrong.

Is it gonna lead to a distasteful, , rest of the four or five weeks that you're there? but I guess, , one thing that comes to mind is, is , just speaking up about maybe more what you need, like, , I've had students like, and I, I, I like to think that as a preceptor, I, I listen a lot to my students and, and create a very comfortable, warm, inviting en environment for them to learn, but also to, to also feel like they are. Owning their patients and being an active member of the team just as I would want a coworker who's stepping into this environment to feel and or even just my patients, right, just to feel like they're in a very warm, inviting space where they can talk without judgment and they can get better.

Right. And so I think one thing I would, I would do is if you don't have a preceptor that is invested in that, thinking back to rotation. So I, I think I would've asked and said, , hey, I'd appreciate to have that 30 minutes of lunch, for instance, and being able to go for a walk.

Is that okay? Do I have to come back and eat my lunch? Right, right at the desk where we have to go right back to patient care. I think finding ways. To speak your needs in a very professional manner, I think would be really helpful. And, and say, this is what's gonna keep me well and keep me refreshed for the day and keep it so that I can get the best learning experience.

How does that work for you and your team? Right. I think, I, I think it's just advocating for yourself in a, in a way that reads the vibes of the room as well.

Lillian Liang Emlet: Yeah, that is really so important. I do think almost every single trainee does not feel like they have agency, and managing up is a skill that we often don't teach. But what you just sort of role model is the fact that. You are a member of this team, and also you have some opportunities to ask for, is this okay by you?

And to explain what is happening because, , just going off and doing your own thing is not helpful. You do have to, you are part of a team. And so being clear with what you need, what you're curious about, what you're working on so that people can help support you and actually offering them the opportunity.

Would you be able to support me or do you think there's another resource that I should be looking at? Because like, oh, I should go look In the shared drive, we actually have all of our protocols right there. Maybe there's just something you were unaware of, like allowing them and to participate and then, , they, they often feel really great that they can help you when you're learning journey.

People love everyone at healthcare, loves to help other people, but when you ask for it. Which I know again, in healthcare for some reason we find a hard way to ask. But when you ask correctly, you're managing up, you're managing laterally. You're offering them the opportunity to help me help you.

In some ways

Klaus Grim: And see things

Lillian Liang Emlet: differently

Klaus Grim: because, , a lot of our, , senior healthcare professionals don't just see it as, okay, you're a student. You gotta do what we say you gotta do. , And this is the way it is. I had to go through this. You have to go through this. But , that's the one thing I love about the newer generations is that they're speaking up and saying that, I need to be well and focus on my wellness in the same time. And something that, , we at here at Transforming Healthcare Coaching promote because, , in order to have a thriving healthcare environment, you need to be well in the first place. And so I. Just like you had mentioned speaking up, asking, and some, you may, it may, it may be a no, for instance, right, if you're in surgical rotation and they're like no.

You can't get a 30 minute break at 12 o'clock. Exactly. Because you may be scrub in a case, , but at least you asked and you fig and, and you didn't know what you didn't know, and you can still find ways. To find wellbeing for yourself amidst the chaos of that rotation. Just now need to explore other options. Like, is it okay after that case if I go take a quick walk right. Just to kind of myself, refresh on the case, and then come back with renewed energy or something like that, something with that, that would benefit you during that time.

Lillian Liang Emlet: That's so true. I think we often don't make our work visible. And so I think for me, the advice I often give , that I teach now for our, our fellows, is trying to set that learning goal at the beginning of each week into how can you find a micro habit that you're going to try to change or tweak upon.

You can't fix everything about yourself in one. Shift, or one week being on service or being part of a clinical team. And so what's the one little thing per day that you are wanna try to really narrow over? So for some people it's really the teaching part. For some people it's just gathering the data accurately.

For some people, it's making a decision and related to moving care forward day to day for a particular case, for example, and just making sure that you advocate for making time to debrief. A lot of times we just allow experience to sort of happen and we never really reflect on it. At the end of the day, I think one of my other colleagues, , he always points out, what did you learn today?

Because we all learned something that day. Every one of us who's on any particular shift, whether it be a communication a clarity a fact, a protocol, a drug dose, we learn something each day. Otherwise, I think it'd probably be, we all wouldn't be doing this anymore. 'cause I think most of us in healthcare really love to learn.

Klaus Grim: I love that. That's actually a pearl that I think I could be more intentional about is, is asking the students actually that I work with, . A little bit more follow through awareness, questions like that. 'cause you're right. , Unless we pause and think about it too. We may not be, we may be losing a learning opportunity for ourselves. 'Cause we're, we're doing so much all the time. It's like you're just experiencing, experiencing it and you're just trying to get to the point where you take your exam and you pass your boards and actually out there and practicing. But , it's. Gotta enjoy the process and, and see the little things that we're learning every day that are leading to that bigger picture of ourselves. what we're, I think we're speaking to is very challenging. Like, I mean, I've been practicing for, , al almost seven years now and, , implementing. Things for my wellbeing while at work is extremely difficult. Like, , because I'm also too, like, , if I have a minute, I wanna make sure my note is written and it's details,

so the next clinician, whoever stumbles upon it can read it and gets a good picture, then, , obviously spending time with my patients and, and teaching like all these things that I forget to take moments for myself. It is very difficult because as healthcare professionals, we we want to be hard workers.

We wanna give our all to our teams and the people we work with, or, , we, we follow through on some of our bad habits, scrolling social media or going on our phones, we're not actually doing things that are actually keeping us well. And we're like, okay, we'll do it when we get home.

And then sometimes a different bad habit may come about, we, we order food that may not be the healthiest and it becomes a trend or a habit or, , we may go, , go to the bar, whoever, what it may be for some people. If we don't really think about what keeps us well and finding small steps to do that every day it's challenging.

Lillian Liang Emlet: Which leads me to my next question. How can trainees proactively set themselves up for success before even walking into the new rotation?

Klaus Grim: So I think communication is big. As we talked about from the start here just being okay to. Talk, number one, like knowing that each rotation you go into, , you're gonna be, , working with patients. So knowing, knowing that that makes you a member of the team, so I think, and this is gonna go to serve you when you go to apply your jobs and advocating for your own, , benefits and needs. You'll have to be able to do that if you start right now with your rotations, that's gonna set you up for success for, for those conversations, those difficult conversations that happen when you get a job. But I think, knowing what keeps you well, if it's different for everybody, i've had students that like to go for a walk, like when, when they take their lunch, like they like to, they build in time to go for a quick walk. Or they will go get coffee, for instance. So knowing what it is that you can do for yourself to ke keep you well during rotations, I think is, is one thing very important.

And I think also being aware of. That might be very challenging and that how are you gonna build time for yourself outside of the rotation? And I think that's probably the biggest opportunity you have is , most of the time you have your schedule in advance. And so, , if you have a couple days off or whatnot what are you gonna do that's maybe outside of studying, right, that you can do for yourself, like going to the gym or connecting with a friend that you haven't connected with.

Or another classmate who maybe. Has same free time as you do, when you're on rotations, oftentimes you're separate from all your classmates that you just spent an entire year, couple years with, getting to know and going through some of the hardest things you probably have ever gone through. Your people, right, your team, and finding ways to just be well I think is is very important. So I think getting a big picture of, of where you're at and, and. Yeah. What will, what will fill your cup? ? That's not medicine always.

Lillian Liang Emlet: So I'm really hearing you say is that when you look at that month, make sure you have all those big rocks in first, which is you, your priorities, your relationships and making sure that's sort of somewhat planned or at least penciled in, your mind for these are gonna be downtime days, I'm gonna get to do certain things, have things to look forward to that are not related to , working your clinical shift.

, And for me, I think the things that will help set up for success is to some degree get mindfully into the zone. So we know that every rotation slightly different because we go through different disciplines, or different clinical practice areas. When we just show up with our best positive enthusiasm and desire to learn and be curious if you're grounded in that.

And so whatever it takes for you to get there, whether it's breathing, whether it's rereading, the, , sort of the anatomy or the chapters of what that content is when you sort of get into the zone, I call it cognitive zone or just being. Curious and happy to be learning in the environment, whether it's peds or whether it's dull or whether it's emergency skin is the zone and you just show up and be like, eager Beaver happy.

Because , people will remember you and write really great glowing re letters of recommendation and be like, I mean, she didn't know a whole bunch, but the reality is she learned a lot and, and. She showed up positive every day with good energy, good attitude, because I think all of us would agree.

Having someone on our team who's willing to, we all do the hard work, everyone, all of us do the hard work. But what sets you apart is gonna be that attitude and curiosity to be able to go the extra mile. And that really takes groundedness in yourself first. Because if you're not grounded, if you're just nervous, that's what's actually talking.

So if you're just good with where you are, you're doing the best you can be curious about what you're learning, I think the rest will follow.

Klaus Grim: I couldn't speak more to that. I mean, that is so true. And, it's, it's obvious when a student wants to be there. And granted, , it may not be the specialty of your choice too, but you can still learn a lot for maybe where your specialty is, so. From somebody who works in a very generalized setting, , you'll find a little bit of everything. And so and, and a lot of these little bit of everything show up in every specialty, so it's, it's very good knowledge to have. But I always value when a student is, , not just hardworking. 'cause you're right, you're in school, you made it this far, you're in the rotation, you're obviously hardworking.

It's just. eager, the eager wa the students who are eager to be there smiling, , staying their time where they're not like checking their watch constantly. Right. Or on their phone, , that speaks volume. It says, I wanna be here, I wanna learn and I am learning and I'm growing and I'm, and the ones that are also communicating too, asking questions, not just going throughout the day and, , case after case. And let it dismiss from there and, and really reflecting, as you mentioned earlier, as I think a colleague had asked the students is, what did you learn today? And and, and saying that out loud and, and, and showing joy in it,

Lillian Liang Emlet: , As we come to a close, what's one thing that every student listening your trainee student listening could do tomorrow to take ownership of your learning experience?

Klaus Grim: . It is, I think, reflecting after every day of your rotation. Number one, what did you learn today? But also to add on to the wellbeing piece here is what's one small thing I can do during that shift rotation. that can help me ground, refresh, reflect, and, and move and, and, and, and to keep me happy and, and, and joyful and, and healthy through, through that rotation.

Because, know, work shouldn't just be an excuse to, , not, , not do something for your health. So it could be as simple as. A short walk going up the stairs, , taking a break by going up the stairs and putting some ankle weights on, , or stepping outside and make a quick phone call to a family member if, , I think finding what it is that way it is for you that maybe you can build into your, your time and see how it makes you feel, and then reflect on that.

Lillian Liang Emlet: Like that. And so I'll take the opposite side where I, to me I think it's what intention for one small action. So for me, thinking through like, what's the intention as you, , drive. I, I, I can still imagine, I drive into work. My intention is to. Do one little teaching on the ventilator, or, my intention is just to make sure we get done on time for rounds so that everybody gets like a break before lunch.

Can you imagine that? Break before lunch even? So I, my head, like my, I even as in practice now have goals for how to take ownership of making the learning environment good and healthy for everybody. And so. Those are just some of my tips for how we can all be better learners in our interprofessional groups and make the environment healthy and happy for everybody.

Klaus Grim: I love that. Thank you for, for sharing that parole.

Lillian Liang Emlet: So we obviously listen to our listeners, so if you are a listener, this is your chance. Please email us at podcast@transforminghealthcarecoaching.com. We'll do an episode on whatever you want us to do an episode on, and hopefully I'll have some fun along the way. So reach out, connect like, subscribe, and please forward these episodes on to other colleagues.

We'd love to hear different perspectives and whether this is resonating for you. Klaus, any concluding, concluding thoughts?

Klaus Grim: No, I, and, and if you don't wanna send an email, send a comment on wherever you're listening from. We listen to and respond to every feedback that we see if we can. So thank you. And we look forward to sharing any of our coaching wisdom to anybody who has something that they're interested in. So thank you.