Sept. 27, 2023

#102: Resilience by Design: Mentors, Modelling, And Why Context is King. With Assoc. Prof. Sarah Guess.

#102: Resilience by Design: Mentors, Modelling, And Why Context is King. With Assoc. Prof. Sarah Guess.
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Season 1

How do we make 'resilience' more than just another buzzword and resilience training not just a box to tick for the HR department?

Assoc. Prof. Sarah Guess is a specialist in Small Animal Internal Medicine and Associate Professor at Washington State University where she teaches internal medicine. Outside of her clinical work her interests and research are in educational psychology, resilience and wellbeing, and elements of clinical supervision and resident training. Sarah has presented her research on resilience at the national level and is known for her mixed-methods approach to research, and she was the recipient of the 2021 Zoetis Distinguished Teacher Award and the 2020 Wescott Award for clinical teaching.

In this episode she shares what she is learning and teaching around fostering resilience in a way that does not just rely on shifting the responsibility onto the individual to 'be more resilient', but rather focuses on the context that our resilience will challenged in. We talk collaborative relationships, workplace culture, model behaviour and we detour into the things that can improve personal resilience.

This one is essential listening in particular for anyone who is in a leadership, support, mentoring or teaching role.

 

Topic list:

12:08 Importance of non-punitive error culture.

16:25 Mistakes are expected and respected.

23:49 Resilience in education psychology.

26:33 Focus on faculty well-being first.

33:01 Importance of collaborative mentorship.

39:39 Resilience - it's trained, learned and necessary.

49:59 Embrace growth from negative experiences.

53:20 Exercise is an incredible tool.

56:10 Personal resources that foster resilience.

70:48 Keep showing up, even when it's hard.

 

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When I started my career, if a clinic had an ultrasound machine and a computerized record keeping system instead of paper cards in a middle filing cabinet, you'd be an employer of choice.I have to confess that some days I do wonder of letting go of that card system was worth the effort, but I'm sure we'll get there one day.
Over time though, the focus shifted to balance time of work and also money.Basically, pay me more and give me half a day off each week and I'm yours.But the evolution of veterinary science continues and employers jostle to find out what it is that their teams want from them.
So in 2023, what is it that we, the humans in the vet profession, want when we are looking for jobs or deciding whether to stay in our current role?I had the opportunity recently of discussing this question with some very smart people, and recent research findings apparently indicate that what we value most is support, both clinical and nonclinical.
But what does that support look like and what is the ultimate goal of that support?After the conversation in this episode with Dr. Sarah, Guess, I think that perhaps the answer to that question is resilience.Our goal is resilient individuals and resilient teams.
But how do we make resilience More than just another buzzword or something else to add to the syllabus of our vet students or a box?To tick by the HR department, Doctor Sarah Guess is a specialist in small animal internal medicine and an Associate Professor at Washington State University where she teaches internal medicine to 3rd and 4th year vet students.
Outside of her clinical work, she was part of a PhD project on education psychology and her ongoing research is on resilience and well-being and elements of clinical supervision and resident training.Basically, how to help the mentors in residency programs teach and model resilience to their residents.
In this episode, she talks us through what she's learning and teaching.You learn about what the research says about the key building blocks of good mentoring and support that fosters resilience.What I love about what Sarah teaches is that it's not just about shifting the responsibility to the individual and saying here are ways for you to be better at dealing with crappy situations.
A lot of it is about improving the context that individuals and teams experience their challenges in.It's also not about trying to remove all of the challenges, but rather creating an environment where we are supported through those challenges in a way that allows us to bounce back.This one is essential listening in particular for anyone who is in a leadership or support or mentoring or teaching role.
So if that's you, thank you for the important work that you do and enjoy this conversation with Dr. Sarah Guess.But before I let you go, just a quick bit of background about How I Met Sarah.I'd heard of people removing pituitary glands from pituitary dependent cushion or dogs, and I wanted to do an episode on this topic on the clinical podcast.
So I asked around to find out who the best people would be to discuss this with, and all roads led to the pituitary team at Washington State University.So I had the privilege of recording an episode with Sarah, the medicine component of the team, as well as a neurologist, a surgeon, and a criticalist all in one session.
And yes, I was quite intimidated to create a super informative and up to date resource on the topic that will allow GP vets to have intelligent discussions with the owners of the cushion with patients and to help make informed decisions armed with the most up to date options out there.
Now if you haven't come across our clinical podcast yet, that's essentially what we do.We find the best minds on topics in small animal surgery, emergency critical care, and medicine and ask all of the dumb questions to get all of the smart answers to create, easy to consume, and dare I say, fun updates that will leave you informed, up to date, and more confident.
As a clinician it counts for CE points, but I honestly don't feel that that's the point.It's about ongoing personal growth and improvement and the kick that you get from knowing your stuff and about feeling more fulfilled at work.To listen to Sarah and her team and to the other 400 plus episodes, go and give it a try at vvnsupercast.com Okay Dr. Sarah Guess.
Welcome to the event file.Thank you so much for joining us.Thank you.I'm so happy to be here.I have been listening to the podcast since last time and I there are so many amazing people that you've interviewed and spent time with and I just feel like, wow, Are you sure you want me to be here with all these cool people you're?
Kidding.I love that.I love the modesty that I get from guests.The previous one for anybody who's not a listener, to our clinical podcast.The previous time I chatted to you was part of the team.Who?Cuts pituitary glands out of dogs and cats with the most incredible mind blowing stuff that you do.
So I love that modesty.We're still gonna talk about the brain this time, but not so much about cutting little bits of brain out, right?The different aspect of the brain, Yeah, the non physical part of the brain.But that it's relevant to us and how we navigate our careers.Sarah I usually start these with a thing.
I saw a graffiti that I saw on the side of a building that said bad decisions lead to good stories, and I think that leads to good stories.If nothing else, does that resonate at all?Do you agree or disagree?And if you think there's some truth to it, do you have any stories that would fit with that?
Oh.So my, like, very first gut reaction is like, oh, I totally disagree with that, because as an internist.The core of my being is that you make the best decisions you can with the information you have at the time and that no one should be encouraged to make a bad decision to get a good story out of it.
And then, you know, and I think about it more and I kind of peel back that initial reaction.I'm like, you know, a lot of my best stories come from some of my worst decisions.And so I guess I'm a little bit on the fence about that.
I can give you an example if you want.I'd love one.I'm a runner, a distance runner, and I was running a half marathon in Portland, OR, OR in the area, and I went into it with a kind of nagging injury that had been bothering me in my entire buildup, and it was pretty bad on that day around like mile seven or eight.
I was just thinking about dropping out because it was really painful.It was in my leg, sort of on the side of my leg.And I decided, you know what?I'm going to keep going.OK, so there's the bad decision, right?Like, keep going even when something hurts.Not ideal.However, it turns out to be a great story because as I was running made, this bad decision goes to just like power through keep going.
And I wasn't paying enough attention to what I was doing and stepped in this pothole and I had this like popping sensation up my leg where the injury was.And then that turned into the pain completely going away.
Like all of the discomfort that I had in my buildup, it was like pop completely cured.And it was like in the Mario Brothers where you get like the turbo boost and you just like go really fast with little Mario.That's how I felt.It gave me like this turbo boost to finish out the race and I ran really well after that.
I did it in negative splits and had a great time so.Bad decision, Good story.I guess even though I'm an internist, I'm not like fully removed from this graffiti that you saw that it happens and I I don't know.So I guess I agree and disagree.
But I can think of times when it's definitely been true for me.I have to clarify my thoughts on the question.It's definitely not to encourage people to make bad decisions.Right outside first.Reaction.Definitely not saying go no, just purposefully make a better.
I like it.I like the stories that come out of it because you have so many where you go at the time.It's something really dumb or the wrong thing and then it works out well.Or, if nothing else, some good lessons I learned from some of these stories.It's like the reverse.
It's like the evil twin of the quote.Hindsight is 2020, but.You have a good story or you learned a good lesson.So I kind of love that, and it makes me feel better about some of the bad decisions I may have made in the past, because I've got good stories to learn from it.
You grow a little bit, you get better every day, that kind of thing.I'm going to segue from that into another section, but I do just want to ask you your your running story there.As a fellow runner, do you know what was wrong?What was the injury that miraculously got fixed by stepping in a bottle?
I don't know.I have chronic IT band syndrome that I've dealt with like in physical therapy over the years and it seemed to be coming from that.But I don't know if something was out of alignment that was like pulling on my IT band and then like popping it just loosened it enough so the IT band wasn't a problem.
But since then, since that pothole moment I have not I've that was.Five or six years ago and I have not had any problems or discomfort with my IT band, so I don't know.Something happened to fix it, and I'm just like counting my lucky stars, thinking my lucky stars that that was the case.
So you said something there about your we're talking about the bad decisions and then the lessons learned from it, which I wanna go straight to.Was it a research paper or part of your PhD or whatever you did?Somewhere I found something that you authored and or co-authored.
Something on medical errors and the attitudes of students around those.I feel like that could potentially tie in.Do you wanna tell us a little bit about that paper or what exactly it was?Yeah, for sure.I am so proud of that work.Before I even say anything about it, I have to give major credit to the other authors on the paper.
Denise Waiting is a technician who is part of the patient safety team, and she really helped with sort of bringing everything together.Beth Davidow is a criticalist here, and she is just a force of nature.And when she and I worked together at Washington State University, she got a summer research fellow to do a part of a research project someone named.
Cordelia Alexander leader and she's the lead author on the paper at the time she did this paper she was a second year vet student and she took this study from idea Genesis to publication in like less than eight months and she really she drove the bus on the study and Dr. Beth David out and I we were the backseat drivers like do this do that but she drove the.
Research and just did an outstanding job.And what I love about that study is that when we sat down to think about what we wanted to do for that project, the idea sort of came from the fact that we have a lot of knowledge about medical errors in human medicine, but it's less peer reviewed in veterinary medicine.
There's definitely stuff out there about medical errors in vet Med, but we wanted to capture not only what this looks like from the patient perspective, but more.So what it looks like from the student internal psychological perspective and that's what we set out to do, which is where I was able to bring some of my background with mixed methods research.
So we did a survey based study where we got metrics on you know, have you had an error, yes or no, those sort of binary questions.But then we also added a qualitative component to allow the survey participants to describe their own.
Variances with medical errors and that I think was key to understanding the complete picture around medical errors.And these were specifically errors as students, so like during the practical part of your course, making blunders along the way.
Right, right.In the hospital here we have an active teaching hospital and So what we did for this study is we surveyed.Students at the end of their third year as they're coming into the hospital, and students at the end of their fourth year as they're leaving the hospital.
So we wanted to capture a naive population and an experienced population and see where they differed after having a year of clinics under their belt.And what we ended up finding in that study, which is probably my favorite thing about it, is that students had a lot of.
Anxiety about medical errors, which I think is not a surprise to anyone but out of the respondents that we had, 100% of them had committed a medical error at some point in time and. 7% of them did not report it, which is really interesting.
And when you couple that with the degree of anxiety and concerns about their professional reputations, their careers, things like that, it really made us take a step back and say wow, we have a lot of work to do.Still around medical error culture in the teaching hospital here, we really push a non punitive medical error culture, meaning that if you report a medical error, you report that you've done something, there will be no punishment.
There will be no.Negative repercussions to you, like we're not going to make you go through the paces on it or like do demerits or anything like that.We're here to help you support you and ultimately fix the problem.So what we learn is that we still have a lot of work to do with facilitating and fostering that culture of non blame and basically putting systems into place to prevent those errors without blaming the humans that create them, if that makes sense.
So that's one of the big things that came out of the paper.So to summarize, you feel like what you learned as an educator or as a a mentor is that you need to make very sure that the team understands.It's kind of expected because there's 100% strike rate like you're all going to do it and what we want is to learn from it and and not you're not in trouble.
It's an expectation, and here's how we're going to deal with it when it happens.Exactly.And how do we put systems in place to mitigate those errors so that when they do happen, we know they will happen when they happen.It's not catastrophic for the patients.Like we can put systems into place to protect us from our own human nature of making mistakes and see where can we go in and find out those checks and balances so that you made a mistake but someone caught it before it reached the patient.
And the key to that is reporting it and saying, like, I made this mistake.I drew up 10 units of insulin when I meant to give one.And luckily we have a buddy check system, so I didn't actually administer that to the patient.It was not catastrophic.Those sorts of things are really what we're aiming to do.
And I just took for granted as an educator that like, I just thought.It was assumed that like, of course I'm not gonna blame you.Like you're a vet student, you're still learning, I'm here to help you.And obviously, we still have a lot of work to do to communicate that message to our students.I had an experience the other day.
We occasionally have students come and spend time in our practice and one of the students made a mistake, injected, flushed the drip line with the drug.Actually it was a CRI that was set up, but she didn't realize and flushed the line and she went was there.Something in that, I think I just gave it and it was quite a lot of the drug and then you could, I could immediately see a face that oh shit, am I going to be in trouble?
Is the patient going to die?And from my personal experience, I almost feel like it's good when you start making, obviously don't try to make mistakes, but you have to make them.You have to make them.So my response to it was excellent.That's probably your first out of thousands of mistakes that you're going to make.
So what I want you to do is go figure out for me what are we going to do about this.What are the percussions for the patients?Sit, get me some doses for antidotes.What am I looking out for?And I think it was really good she she had that.She came and apologized again.Later I said no, you don't need to apologize.
It is an expectation that you will make mistakes.It is, it is nice.It was a nice experience for me to see that as well.That's so good to have someone there who's supportive of that and who sort of has the the right response, for lack of a better word, you know that we.
I always tell the students mistakes are expected, respected and corrected and that's what we're going to work on.Respected and corrected.I like that a lot.That's cool.And that's exactly what you did.So leading into that or leading from that part of your training at WSU is resilience training or let's say the non clinical training of the students or explain your role, what do you do at the faculty in the non clinical sense?
It will make a lot more sense if I sort of talk about my background and like the origin story of how I came here.That makes more sense.Oh yes, I like origin stories.Let's go.OK, great.I graduated from Washington State as a vet student over 10 years ago, and I knew that I wanted to be an internal medicine specialist, so I went straight into specialty training.
Got a really great residency and I had these 4 mentors in my medicine residency, which I did at Kansas State University that were like the Dream Team, like they were the Quad.They were such outstanding, incredible mentors and it made me appreciate how difficult mentorship can be and wasn't something that I like, thought about all the time.
In any case, I loved internal medicine.It's definitely what I would.Prefer to do is how I would prefer to spend my time in this life.I love it.And they were committed to sort of giving me every opportunity that they could.So towards the end of my residency, I expressed interest in staying at an academic institution and being on faculty, and they got me a meeting and an introduction with.
A really brilliant researcher called Susan Matthews, who is from Australia.She's from New Zealand and Australia and was coming through Kansas on her way to start a job at Washington State University, and I got this meeting with her.
We sat down and we sort of hatched a plan for a potential PhD project.And I was.Thrilled about that opportunity, and by a crazy turn of events was unable to take the job.
I needed to not be on a graduate student salary at that time in my life and with my family.It wasn't the ideal time, it was the right thing at the wrong time.So I unfortunately had to turn down the opportunity to pursue a PhD with her and went into private practice.
And after two years in private practice, I really had the chance to.Tone my skills as an internal medicine specialist and grow and improve from where I was at as a resident.And after two years, my contract came up and I started thinking, you know, what about how much I wanted to be in academia?
And what about the research desires that I have and pursuing A trajectory with students?And I thought, you know, maybe I'll give Susan a call and see what's going on over at Washington State.And so I I called her up kind of out of the blue and just said, hey, I'm sure that you've already filled a spot for that PhD student, but I'm interested in coming back.
Could I collaborate with you on any research or can I do anything?And she said, well, actually I have not filled that spot and let's meet and talk about it.And she took a huge chance on me because I had turned down the position two years prior to that, but was really willing to, you know, bring me back in and work with me.
And so she got me back to WSU and then brought someone into the mix who was a Co mentor, Co chair on my pH.D Project.Brilliant researcher named Michelle MacArthur and she is in Australia at Adelaide.
She's a clinical psychologist and she works with veterinarians and vet students.And between the three of us we just sort of sat down and thought about what can we do to make a difference.They had done a lot of resilience research already, and they had a huge foundation of building the resilience theory and the framework and what that looks like, and it kind of all just came together.
So I started that research project and then of course COVID happened.I had a lot of things that came up to potentially obstruct the PhD in the research, but we were able to power through.And then after a couple of years, I joined the faculty here at Washington State.
And now I'm just still kind of finishing up tying the loose ends on the research projects that we worked on, which I'm happy to get into too.Yeah, So what is the PhD?What is it on?So the PhD is it was technically in education psychology.And I say was because I had to extend it out to the point where I eventually stopped the PhD.
So I'm a PhD drop out or you know, humongous failure, whatever we want to call it between joining the faculty.And most of my appointment now is clinical, so I'm in the clinics 60% of the year, which means on call and residents and students, and I love that work.
Doing internal medicine in the clinics is awesome and I just have this research sliver that I am working on.So when I was doing the PhD though, I got all the coursework done, and the PhD was in education psychology.And that was where I got to take all that great coursework and explore like what that is and what that means.
And it sort of set the stage and teamed me up for, you know, being able to collaborate on the research projects that I do now as a faculty member, both my own research and collaborative stuff with other researchers in the college, which is kind of cool.So I was able to use those skills even though I didn't end up getting the PhD.
So to find education psychology, is that how to teach better or what is that?That's a perfect way to say it.One of my mentors in the Ed Psych program, Robert Danielson, put it very eloquently.He said education psychology is learning how to help learners learn and help teachers teach.
And so they study everything from the contextual environment in which we learn to research methodology for studies, to examination performance, to epistemology and ways of knowing and how we think about what differentiates knowledge with a capital K from justified belief.
And we got to explore all of that in our coursework in the education psychology program, which was very cool and definitely sort of changed the way that I think about things and change the way I approach research previously, having been a very quantitative researcher.Like, I want the numbers, I want the data, I want the raw facts into.
Like understanding what a researcher's lens looks like and what it means to explore how you really know something or how you want to come to know something is really eye opening.It was a cool way to think about the topic of resilience and the topics that we work on now in our research team.
Feel like there's a I can see a crack and a door opening over a whole different rabbit hole about this stuff.That sounds fascinating, the teaching stuff.Maybe we won't go there just yet, but how does the the resilient stuff tie into that?Like in that education, psychology is a part of that, making sure that the the students or the learners or whoever are.
In a good head space to do this?Or or is this a completely different thing that you're just applying these principles to?It's a little bit of both.So with resilience theory, we think about contextual resources, personal resources, strategies and outcomes.
And all of those facets build into what we know as resilience or grit, or the ability to bounce back.That's how people conceptualize resilience.And so when we think about education psychology, resilience applies to that a lot in many ways.
And education psychology helped solidify and connect the dots between the various facets of resilience theory And thinking about Okay well, how can I design a study that helps clinicians be more resilient?
It doesn't really work very well for me to send out an e-mail that says, dear faculty, please be more resilient.Like that's not going to yield any kind of behavior change, right?But can I explore what does it look like to mentor your residence?
And could improvement in mentorship or training or coaching and mentorship for you?I don't want to say improvement, I guess because I think everyone here that's on faculty, we're here because we love what we do and everyone here is already a great mentor.But could coaching and support in clinical supervision, could that contribute to overall resilience?
If we have training on this facet, will that increase your resilience and sort of starting to probe those different avenues within the structure of resilience, that being a contextual resource, your workplace resource, how you mentor residents would be your context for being resilient.
And if we can maybe improve, or again, I don't, I hate using that word.But if we can maybe change or support your mentorship of your residence, will that ultimately lead to resilience outcomes?Knowing that, that's part of the groundwork for resilience.There's a lot to unpack there.
Yeah, there is.So.So the resilience training or the structure or the program that you build, is that for the educators?To both be more resilient and to teach resilient or foster resilience in these students?Or are you directly working with a student?
So when I first started the PhD and we were coming up with idea genesis for what this project would look like, I really wanted to focus on students because I thought they're captive population.They really need help.The faculty is here for them, like we're all on board with supporting the students and getting them everything they need and giving them every chance that they can to succeed and thrive and be resilient.
And so we should really focus this research on the students.But the feedback I get is that maybe we need to start with the people who are working with students in improving their well-being and resilience.
And then that potentially has the possibility of having a spillover effect or ripple effect for affecting students.And maybe we can create this chain reaction that will blow all the way out to our student population.And then when they graduate, maybe it will go even beyond that as they're disseminated into the world.
And so the focus really became clinical faculty.And I would love to pair clinical faculty with residents.There are logistical things about researching the resident population versus the faculty population that are different or that are challenging.
But we really decided to start with the faculty because up until that point in the literature, no one had robustly asked faculty, how do you feel about clinical supervision?How are you doing with resilience?well-being burnout and had that data widely peer reviewed.
Since then, the AAVMC has done a lot of work and has documented how clinical veterinary faculty are doing and that research has really started to blossom.And so our niche is really in clinical supervision and what that looks like in terms of resident training, resident mentorship in the context of a teaching hospital.
Makes a lot of sense.So the goal is teach the smaller group of people who are going to model.How to model resilience and sustainable practice versus then trying to shove it down the throat of a large group of people who are so worried about the clinical stuff they need to learn that they actually probably are not that open to listening.
I I sent you the quote as part of the e-mail in preparation for this.I spoke to somebody from another union in Australia, another university, who said speaking to the students and asking them what do they want to learn and what do they think about the well-being.And the quote was they say that they are sick of well-being stuff and they feel that they aren't hearing good things about being a vet and they just need to do a lot of add on Wellness stuff presented to them by a group of burnt out people.
That resonates with me so much.I'm so there with them on that quote.Whoever said that quote said it really well, better than I could.So the goal with this, the genesis of this, was to sort of work with that group of people to model that behavior.Cuz I think as we age in the profession and as we go through our careers, there is that potential to get cynical and to start displaying more of our burnout as you go through.
And so it's kind of pointless to tell the vet students when they walk into the clinic, okay, you need to be resilent, You need to bounce back.And I hate my job.I don't want to be here either, like it doesn't.That's a mess.Does it?That's an extreme example.I've never heard anyone here.
No, but you're right.But you spot on though it's it's muddled.I did totally get that.I I remember that I made many come as mentors who showed me the exact wrong message from pre vet days.You know talking to friends whose dads are vets and seeing that then going, oh, am I sure I want to do this because he does not look happy, right.
We go into it with I mean of all the professions being a veterinarian is the one that we hear people say, I wanted to be a vet when I was five years old and you have this like big dream going into it and it really makes you second guess when these things come up.And so I think it's it's been super important to start with the strategy of you know before I even I'm not even at a point where I'm I have created enduring educational materials for faculty.
I started with a three phase fact finding mission to try to gather as much data as possible on this group of people and understand their thoughts about it.And this is where again the mixed methods approach that I use came in.
We did some survey based quantitative data, which is super valuable.And then we also have this humongous qualitative analysis, which is what I'm working on.It's like my precious thing that I've been working on with Susan so closely.
Susan's a really great, terrific qualitative researcher, and we've gone through close to 3000 quotes from faculty members and coded them into a coding scheme to try to understand a picture of how faculty feel about clinical supervision and resilience and coming to work each day under these circumstances.
And I think that getting the opportunity for the faculty to tell their story before I try to create a seminar to tell them what to do is really important because the seminar is going to be built on what they are asking for, what they need.And by they I mean me too, right?
Like, I came into this faculty position having researched clinical supervision, resident training, and resilience, and I didn't really have much more of a leg up than anyone else.Like, I was like, no one teaches you how to do this right.Like, there's a lot to it.
And when you start to explore the concepts in other professions, there's a lot of meat to chew on.There's a lot there.It can be kind of overwhelming.And so my goal is to come up with something where I can get the faculty perspective and then help create some materials to support them in what they're already doing well and help provide structure for things that they can do better or differently to make that supervisory relationship better from their perspective and hopefully from the residents perspective as well.
So curious about the content of the program that you're building and we'll get into that, but I want to start with saying.What does the desired end result look like?What does a resilient clinician, mentor, or student look like?What are we aiming for?
It's so hard to define and this is really vague, but in my mind what I have always thought of is getting back to my origin story.I want it to look like what I experienced with these four mentors, like the experience that I had.
I want everyone to have that experience.I want it to look like my experience with Michelle and Susan mentoring me as a PhD student.That non hierarchical, collaborative relationship that I had with them certainly is going to be different for every dyad, for every pair of mentor, mentee people.
It's going to look different potentially.Not always mesh as well as I did with my mentors, but it's vague.But that's sort of the end goal in my mind, that I have to sort of work out how I'm going to bring that to life.How am I going to get from where we're at now with fact finding, to everyone having a mentorship experience that is positive for them, and that's for the mentor and the mentee, because mentoring someone is taxing.
It's exhausting and I think that if we can get something that is an outcome that's positive for both, that would be the dream.So creating the materials is the step before that, and gathering the information is the step before that, and that journey is going to be hopefully where it goes.
So to make it more relevant and more personal to your experience when you had that dream team of of mentors.Where they're defining characteristics about them, things about them that with what you know now you can look back and go.I looked at them and went, I want to be like that.
What about them were the things that you aspire to be like?I mean, they're all pretty awesome people.It's Kate Kukunich, Ken Harkin, Greg Rauer and Tom Shermer Horn.And they each had a niche area that they focused on as internists.
But they also were very respectful of me, treated me as if I was a collaborative partner in the relationship.And that's sort of 1 area that I try to focus on with my residents.Or one big take away I had from that experience is to form that alliance early on.
It's not a situation where I'm telling my residents, do this, do that, don't do this, don't do that.It's a situation where I'm saying how do you think you should do this?Do you have something that you've researched that's new for me that I can learn from you?
And building that non hierarchical collaborative relationship is what's really important to me.And in doing this research that kind of highlights one of the most problematic areas.It's a it's a double edged sword because in the best scenario, someone had a good mentor and they mentor their future mentees as they were mentored.
Like you just learn mentorship from the example that was set for you prior and that is good and bad.The good news is when someone has a good experience, they can pass that along.When they have a bad experience, they're either traumatized and don't mentor anyone else or potentially pass that along too, because it made them tougher, or they learn from it or whatever.
And I think that there's so much more to it than that in terms of finding out what the contexts are.What does the theory say?What does the research say to build those relationships and to actually come up with solid skills and strategies that take us further than I had this experience?
So I'm going to do this.Experiential learning is a very powerful tool, but it's not the only tool out there.And that's where our research is going to try to build a structure based on the literature, based on our information that we have gathered from the respondents to our study and our survey, based on what's going on in the profession currently and building some material that will be useful, helpful and enduring for people to have those skills to mentor.
Because I think that was the biggest frustration is no one ever taught me how to do this.Like, I don't know how to do this.I had a good experience and so I'm passing that along.But there's more to it than that, and maybe there's more that I can do to be better.So it's a case of saying that experience that you had that you loved.
Here's what the data says about why you liked it, or your experience that was so terrible.Here's why it was terrible.And here are the facts about how you can do it better for the person coming behind you.Yeah.Like, let's unpack that.
Let's talk about what those things look like, and maybe there are things that we can do that are universally applicable to help with those strategies.Because it sounds like we're talking in your scenario, it was a resident in the specialization journey, but the same would apply to somebody mentoring a vet student or the senior veteran practice mentoring the new grad who's starting at the clinic.
Or the same principles would apply across the board for all of this, right?That's exactly right.And in the profession as well, one of the cool things about veterinary medicine is that we have a great relationship with other practitioners.It makes me happy that a practitioner anywhere in the United States or beyond can call me up and say, hey, can I pick your brain on a case really quick?
We have a humongous list serve in the ACBIM for all the internists to say hey SOS I need help on this case and you can e-mail all the internists and get feedback in in the moment about what you have going on and that is a facet of clinical supervision as well.
It's us helping each other and I think again when you kind of remove yourself from the hierarchy aspects of supervising someone and turn it into a collaboration and something where helpful that that has the ability to affect all the different contexts in which we provide that supervision.
So that could be, like you said, at the level of the hospital, the team, our technicians, there's back and forth, my technicians do a ton of teaching and a ton of clinical supervision there, the eyes and the ears of our service and in many ways know the students and the patients as well or better than I do.
And if we can model that and train that at all of the different areas that contribute to the veterinary team, I think it's got huge potential especially to circling back, improve resilience and well-being.Yeah, so let's look at resilience.
You said earlier that the rough definition of resilience is the ability to bounce back, to recover.So if we look at the non human definition of resilience, it's when you when something gets bent out of shape, can it get back into its original shape again, right?So right, here's a personal question, because you said earlier that even though you're studying all this stuff, you're not the finished, fully resilient thing.
Do you consider yourself as resilient?My resilience scores are pretty good on the metrics that I've taken.Yes, of course.Take it.I have taken all of them as a researcher of resilience.My scores are pretty good.I think it's for me at least.
What I've noticed is it's very contextually specific.And so I think, like, for example, we were chatting before I have like flight anxiety and in the moment I have anxiety or I have nausea.When I'm on an airplane, I'm not going to bounce back until I'm off of that airplane.
Like, the contacts has to completely change for me to show my resilience.And then as we're walking through the airport, I'm like, oh, maybe I want to like grab a snack, OK, I'm starting to feel better.But in the clinical setting, I have strategies that I know work for me to be more resilient and strategies personally that work for me to be more resilient and all of that sort of plays in.
But the context is is really important and that's what we focus on in our research is creating a context where resilience can happen and grow for practitioners based on the mentorship relationship.So your high resilience scores?
Are those inherent or are they trained?It's trained.I am very confident about that.What I love about studying resilience and what all of the research would suggest is that there's no inherent ability for resilience.There are certainly things that come up throughout the human lifetime that may need to be unpacked, relating to past traumas and things that need to be addressed that could lead to a lower threshold for burnout, well-being and things like that.
But there's nothing inherent about resilience.It's completely learned.And it it's, I mean, it's work to unpack that and figure out what does it mean for me to be resilient?What strategies can I draw from?What contexts are important to me?What personal resources do I have and what does that look like when I get those outcomes for resilience to build back into being more resilient?
So the thing, the great thing about resilience is that I, as a researcher, I'm not interested in studying anything that's really inherent.If that was the case, I can't do anything about it.If you're either born with it or you're not born with it, I can't help you.But resilience is the opposite of that.
It's very much something that can be learned, trained and can grow.And I think over the past few years there is a negative outlook like people are like, oh, I'm so sick of hearing about being more resilient because it puts the especially through the pandemic, right.
That's a big example that people come up with.It puts the onus of responsibility on the individual and that is not the case.I want to really counteract that message that you need to be resilient as an individual.The definition of resilience. 1/4 of that definition is based on contextual resources.
So there is a huge component to changing workplace culture and changing the things around you and helping improve the things around you to improve your own resilience.And the onus of responsibility should never be placed on the individual to be more resilient.
It's a group effort with the context that you're in.I need the turbulence to stop if I'm going to be able to be resilient on an airplane, to go back to that metaphor, right.And so that would be an example of if you have turbulence in your workplace, it's going to be hard or impossible for you to be resilient in that context.
For some people, for others, their tolerance is lower, lower or higher, and they can bounce back.But it doesn't work for everybody.And so I think that we have to press pause on the idea that resilience means you're on your own to figure it out and bounce back, because that's not the case.
That's not what resilience research is all about.And that's one thing that I really love about it.So did you say the contextual thing is about 1/4 that?I hear that correctly of the of the picture, Yes.Yeah.The four components of resilience are personal resources, and those are things like family, religion, etc.
Contextual resources, which is like workplace.Maybe that's administration, leadership, the people you work with, your building, you know, if your building is falling apart and you have rain coming in on your head every day at work while you're trying to sit at your desk, it's going to be tough to be a resilient right.You need to change the context.
The third thing is strategies.And for me, that is running.I'm a distance runner and that's a strategy for resilience that fills my tank every day, so to speak, For other people's strategies, maybe like sleep and good nutrition, that's important to me as well.
Those kinds of things that you do to be more resilient.Maybe it's yoga, maybe it's, you know, whatever you physically do to fill your bucket.And then the 4th part of resilience is outcomes.And those are the things that come out of being more resilient, like having greater wellbeing, noticing growth in your personal relationships, growth in your career, all those outcomes that come from improved resilience.
Those are the four facets.And the one that we focus on is with the context.I would love to do a study where I make half of the faculty go for a three mile run every day and the other half of faculty not do any exercise for a day and continue that study for a few months, see what happens to their resilience.
But I don't think the IRB will let me do that or it's going to be tough.It's going to be tough to get that past the IRB.So the context is what what we focus on with the mentoring relationship and the workplace resources.I just want to clarify, your desire to make everybody go for a three mile run, is that contextual?
Is that contextual or do you feel that as a strategy that'll be beneficial?That would be a strategy, yeah.If I wanted to research resilience strategies, that would be one way to do it.Or I could make everyone eats no candy, you know, very, very healthy food for 30 days and see what happens to their resilience.
And then another group eat very unhealthy foods for 30 days and see what happens to their resilience.But again, IRB is not going to not going to approve that.So the context is the easiest place to focus on to study.The strategies are things that we can suggest.
We can say this is what there actually are research papers about exercise, non exercise, nutrition, nonnutrition.They're difficult studies to conduct and very, very difficult for someone like me who's on clinics all the time and can't keep tabs on everyone, make sure everyone's going for their run or eating their healthy lunch or whatever the case may be.
So the personal resources, the strategies and the outcomes are really difficult to pin down in the veterinary context, but the contextual resources is where we focus and that's easier to, easier to get our head around and easier to effect change.I just wanna clarify something with the outcomes that is still part of creating more resilience.
Do the contextual, personal and strategy thing and then I've experienced something good and that in itself builds more resilience.Is that I understand okay, Cool okay.And are those four pieces, are they fairly evenly weighted?
Such a good question, we don't know for sure.There is a study about mindfulness as a potential either even consider it either a personal research or potentially a strategy.And Michelle MacArthur is the expert on this mindfulness and how it impacts resilience.
And people who score higher and mindfulness score much higher in resilience.But we haven't explored all of the other facets like people who eat really healthy, more resilient or are people who are religious more resilient or less resilient or we haven't explored all of them to understand if they're weighted evenly resilience research.
So that definition with the four facets of resilience as a theory, I think was published in 2016.I mean definitely in the past ten years that's come out.And so really the research is in its infancy and is very much under exploration currently, which is, which is cool and one of the reasons that I enjoy being part of it.
There's some really cool stuff about it.I'm fascinated about the whole resilience thing as well that's why I'm so excited to have this conversation.I'm interested that you focus on the contextual and and curious about why because and I'll I'll explain and I definitely agree on that.
I I've said it before on the podcast and it's really over dramatized probably for the veterinary context but when we talk about resilience but and then you look at the way that many veterinary workplaces are set up, I I get this picture of.The First World War trenches where they did that strategy of everybody run at the same time and run into machine gunfire and you're going to get mowed down.
And I feel like talking about just the personal and strategy part of resilience is a bit like saying, well, let's train those soldiers to be better fit or stronger and then we still send them into machine gunfire and it's going to make no difference.So I like that that's a big focus.But then on the flip side, there is also.
And maybe this is different because you guys are focusing on on an educational institute and not necessarily a clinical veteran workplace.But there are aspects of the career of the job that are going to be hard, right?We can't take sick animals out of the equation, We can't take emotional owners out of the equation, and unfortunately we can't take money and all the things that add stress to the profession, you can't remove that.
So working on the personal and strategy part I feel still has a place.Do you agree with that 100%?The deal with resilience is that by definition, there has to be something that knocks you down, right?But you have to have the opportunity to bounce back.
And that's another reason that I love researching it, because we know that those things are there, they're inherent in our profession.That's what we signed up for when we went into this career, and that's what we sign up for when we go to work every day.And So what I love about the research and resilience is that in terms of contextual resources, we can't take away every context that's potentially going to knock you down.
But can we create a community of practice or community of learners or a support system within your context that helps you bounce back from that more quickly?And maybe the solution to that is appropriate and excellent mentorship to create a collaborative environment where we're in this together and we can bounce back from those things that take us down because they are going to happen.
And I think without the opportunity to bounce back, there's no chance to grow or thrive.Thriving is a different construct, you know, even above resilience, where resilience would be bouncing back to baseline and thriving would be the example that we sometimes talk about is like being immunized, like it hurts.
You get the immunization in your arm, but then you bounce back and now you're stronger than you were before, right?You surpass your resilience and go into thriving where now you're immune to the disease and if you get the disease, you're going to be stronger.And so thinking about resilience being a stepping stone to thriving and growth and those what some people see as setbacks or difficult challenges or troublesome times, we want to reframe, to look at as opportunities for resilience.
And then thriving growth and bouncing back and not go into the darker half, which is maladaptive strategies where you get hit with all these problems and hit with all these things and you succumb to that and either leave the profession, which maybe for some people actually is the best thing.
And I'm totally supportive when people choose to go that way with their journey or, you know, you go into some maladaptive strategies that are unhealthy for coping with that kind of daily weight that is put on you.And again, I'm not a psychologist, so it's hard sometimes for me to describe these concepts based on our research.
The faculty respondents from our surveys were greater than 85%, were overwhelmingly positive for the workplace and training residents, and a few of them were really negative.And so I think if we take those negative responses and find out how could there be growth opportunities there, then that could be really powerful tool.
And the other thing that I should say that's really important is that those negative things that come up sometimes are just that and making space for the bad days, making space for the negative things.I think it is important and saying, you know what, this is a bad thing.I'm going to pack it away and leave it there or I'm going to address it and try to move forward from it.
I think both of those are fair and valid ways to handle all of this junk that gets sent out us throughout the day.Did you say the personal and strategy component of this?You guys don't really teach at this point, or is there some part of the syllabus that covers that as well?
I do try to cover that, but it's not something that I'm actively pursuing research in those avenues.So I have a list of, you know, different things and most of it comes through our Wellness team here at Washington State.
They work with the students more, much more than I do on personal resources like checking in with them about family and their home life situation, things like that.That's beyond my purview and checking in with them about strategies and how they can optimize their performance, optimize their resilience, things like that.
What we focus on in our research is those contextual resources.But I do encourage the students in orientation.Every two weeks we get a new batch of students and orientation.I tell them that on this rotation, you need to get adequate rest, you need to get adequate nutrition, you need to get adequate healthy movement, whatever that means for you.
And I don't go into it further than that, other than the students know that I'm pretty open and can share with them what I'm doing.Whether or not that's good for them is up for their own interpretation, but I'm happy to model that and at least share what I'm doing on a daily basis to try to be more resilient as these things come our way.
And I think being transparent about that is kind of refreshing for our students that they like to hear that someone is invested in their health beyond just clinical performance.And again, I think it's important that you're modeling it.So back to that quote we said earlier, where the students feel like it's.
Being shoved down their throats, it sounds like your approach is more well, this is how I do it and this is how it works for me.It's your business whether you take it up or not.And I don't wanna sound too Pollyanna, I totally agree with that.But I also have moments when I'm like really frustrated and I'm authentic about that.
And I think it's good for the students to see those moments too.Or moments when I'm really sad and I'm lucky to be part of a faculty at WSU that's supportive of that.And administration.That's very supportive of us being able to be our authentic selves on clinics and be professional at the same time and sort of show that humanity and some of our strategies for building resilience.
The faculty here do such an outstanding job with that.I'm learning a lot from them too.In those moments when you're frustrated or there's something going on in the clinic that's not ideal or you're just having a rough day, it's good to see what other people have done and good to see that there's camaraderie there and maybe even a little bit of commiseration.
It helps.To make it personal again.You want to come back to the contextual stuff and and what?Whether there's any key things we can take out of what you guys are learning that people can apply to their context or their practice or their business or, but first, personal, personal resources and strategies for you.
If you had to pick one or two key things, that makes the biggest difference for you.What would it be for me, the biggest one.I've talked about this already, but I'm a distance runner, and if I a lot of that is a strategy and a personal resource because my family is incredibly supportive.
I have a family that can tolerate me leaving at 5:00 AM for a run and coming back at six, and that's okay for them.Like they can manage without me for an hour during that time.And so both of those things are really, really, really important.And I I am open with that, with the students about that.
And I'm also open about the fact that the reason that running is such a good strategy for me is that I'm kind of terrible at it.Like I'm the most mediocre runner ever.I'm never going to win a race.I'm not fast.
It's something that I enjoy.And I think the reason I go back to it every day is because it knocks me down a peg on my confidence level when I'm, like, exhausted one day after running just one mile, Like, which for some people a mile is amazing.You know, for someone who runs every day, it's a little rough when you're 1 mile in and you're like, Oh my gosh, I'm dying.
But I try to share that and be open about that with students I try to use.The other personal resource I have is humor.I try to find something funny in situations and, you know, create a joke or create an inside joke with students.It's one of the things that I really enjoy about students is they are hilarious and a lot more funny than I am.
And if I'm kind of open to that reciprocal humor that comes with our profession, sometimes it's dark humor, but open to that, then I think it really builds a good community there.And those are the things I talk with them about.I heard somebody say about running.The reason they run first thing in the morning is that.
At least they've done one terrible thing in the day, and the worst part of the day is over.And the day can only get better.They can't get worse.Yes.Yeah, I've heard that too.Yeah, giving out of bed, especially right now.It's lovely.And it's beautiful. 58 degrees when I go for my run, or 64 degrees when I go for my run.
Fahrenheit.But it's harder in the winter when it's cold and snowy and dark and you're wearing headlamp and yak tracks and all that stuff.And yeah, I don't know.I think I like that resilience.I like running, but I'm definitely.I like it when it's nice.I don't know if I can do running in the snow.Well, if I'm being totally honest, I have a treadmill, there we go.
I've got like a TV show playing, so it's pretty push situation.OK, that sounds smart.That's a good strategy, contextual.Texture resilience?Yes.Change the context.It's interesting.Have you ever come across do you listen to podcast and we'll come to that towards the end.
But are you a podcast listener?I consume so much content between running and commuting.Yes, big time.Have you come across the Peter Tia Podcast?Dr. Peter Tia is a Human MD.Do you listen to the Drive podcast?
Yes, the drive.So my husband just brought this up.I literally, it's so funny you would bring that up because I just started listening to it yesterday.I am part of my commute and as I was doing chores around the house and it's really, really interesting.It's like going to a medical lecture.
Like they really lay it all out there and I have to sometimes slow it down or back it up to look something up.I mean, in the one I listened to, they mentioned like 100 different drugs or something while I was listening.It's just it's super interesting.The reason I bring it up, though?And it comes back to the exercise as a strategy.
I'd recently listened to a Q&A episode and he says one of the most common questions he gets is if you could do one thing to live healthier for longer, he says it's it's very hard, he says.For example, if you sleep 2 hours a night every night, then anything else I tell you is going to be null and void because that's a keystone, he says.
But putting, he says, if everything else in your life is at a 60%, so you're okay, you're not terrible, you're not a heavy drinker and you don't smoke 70 packs of cigarettes a day.All things being equal, the one change you can make was probably going to be regular exercise, regular movement for living healthier, happier for longer.
It is the magic.It seems to be the magic solution that no one, no one, wants to hear about.Or maybe not very many people want to hear about.But it is.I'm totally on board with that.But which is challenging that because I do.I do mentoring for some young events as well and it's something that I try and preach.
But then you you listen to their their day and sometimes it's just practically really hard.Yeah.If you're especially if you have kids and stuff like that as well.But if your day is really long and you're up at and and I say because I'm as my career has progressed I'm less and less tied to 12 hour clinical days and then occasionally I have a 12 hour clinical day and I go I have no time or energy for exercise.
I can't go and preach.You should exercise most days and then on the day that I've got my full day, I'm like stuff freaking way, I'm going to come home and eat pizza and watch TV.Totally.I think part of it too, is that exercise, because of social media, has become so polluted and what it looks like.
And I try to convey to students that exercise for you could be walking up to campus to grab lunch really quick and coming back like take 15 minutes and go for a walk.I know that Doctor Atia recommends a minimum of I think 30 minutes, five days a week or six days a week or something like that.
And one hour, 6 days a week is better and you know, whatever, but exercise.Doesn't have to be like this perfect outfit with a perfect ponytail, going to the perfect treadmill at this gorgeous gym and like taking time to do that.
I mean, it can look like a lot of different things that can look like doing a quick workout on your app in your office while you're having your lunch break or whatever, maybe do a 20 minute workout.There's so many apps for that now and you can do that in scrubs and maybe that's what it looks like.
So there's so many different.Ways that exercise can manifest and I think I'm really, really privileged to be able to go for a run every day and that's partly why I do it, is that it manifests that deep sense of gratitude for being able to do that.But it can look like a lot of different things, and I try to be supportive of the students when they need to do what they need to do and.
If they're on the verge or something, I usually request that they go for a walk across the street.We have a copy place that's a very short hike, but a hike nonetheless.And I, you know, want to encourage them to just get out and try to do something so it can look like a lot of different things.
But yeah, exercise, man, it's hard, but it's important.Well, we said before and despite it, before we started recording your yoga mat in your office.So sticking back to the contextual part of creating resilience, are there some takeaways that somebody listening to this who maybe runs a practice or something like that, they think OK, well here because it can feel so overwhelming when you start looking into the stuff and and I've owned a practice, I've run a practice and there's so many things that I know I should do to make it a better workplace.
But where do you begin?So if you had to say from what you guys have found in your research, step 1-2 and maybe 3, Where do you focus on to create a context that fosters resilience?The biggest thing that I can recommend is a recognizing opportunities for contextual resources for resilience.
So I think just putting a name to something is really helpful and is key for saying this is an opportunity for resilience.This isn't just a task or a thing that I have to check off of my list.And in doing that, I'm going to take and borrow research that we incorporated into our definition for clinical supervision, which we published in 2020.
And the definition that we came up with for clinical supervision incorporates work by Doctor Proctor.We think about proctoring as like monitoring someone while they're taking an exam, and it has nothing to do with that.It's just her name.That's it.So it's called the Proctor model and I borrow heavily from that in our definition of clinical supervision, which we published in 2020.
And there are three domains that I think a practitioner could take with them.And if they are just aware of these domains, that awareness really brings a heightened sense of ownership and communication and ability to understand that moments in time.
And those 3 domains are the normative domain, formative and restorative domains, and the normative and the formative domains are the two that are the most commonly conceptualized as like classic supervision of someone else.
So normative domain is things like what happens if you get legal action taken against you.What do you do if you need to prescribe a drug that is not readily available, like those sort of logistical, legal practice things.
The formative domain concerns the knowledge of practice.So these are things like this is the dose you should use for this antibiotic and this is how you should treat I MHA and this is how I prefer to do this surgical procedure and then the. 3rd domain is the one that I think it's neglected the most, and that's the restorative domain, and that is attending to your personal strategic and contextual resources for resilience and wellbeing.
So those are things like modeling empathy, or listening to a colleague, or making sure that your employees get their lunch breaks, making sure that they have access to healthy food while they're at work.Making sure that they have resources for problems that come up and ways to navigate through them.
The restorative domain I think is what gets ignored.And once practitioners think to themselves, okay, and this goes for practitioners, students, everyone that I work with, once they think to themselves okay, I'm responsible as a supervisor, as a mentor for making sure someone knows about practice.
Great.I'm also responsible for making sure they know how to navigate legal complaints, drug prescriptions, all of those normative aspects of our practice.And I'm responsible for making sure that they have the ability to restore themselves throughout the day.
That tends to be fairly transformational for practitioners, at least that I've worked with.And I think people who get that going into it, who understand that as a supervisor, as a mentor, as a boss.You are responsible for all three of those facets and to be very successful.
They have good relationships.They have a good workplace culture because of the recognition that it's more than just giving someone knowledge to practice or helping defend them when they get dude or whatever the case may be.There's more to it than that.
It's creating an appropriate context and culture for those individuals, especially when our leadership gets that.It's huge and it makes a humongous difference for the people working with them and for that modeling behavior that when you have that an employee that goes out into the world or a student that graduates, they take that skill with them, That's something that is not necessarily taught.
But that's very translational and is very.Ingrained in the person's practice as they move forward, once that has been incorporated, once they've seen what that looks like, it really does move forward with that individual.So again, it has the potential for that ripple effect if someone understands that those 3 domains are your responsibility as a practitioner, as a supervisor, and is there one that is weaker for you and can you grow that one?
Can I try and create a metaphor And I'm going to.Explain it.I love it.I love metaphors.Yes, I'm here for this.And then you can critique my metaphor and maybe expand on it.So let's compare this to I'm going to teach my kid.
Luckily I'm not there yet, but it's coming soon.Teach my kid to drive.So normative would be these are the road rules.You have to stop the red lights and drive on the left side in this country and you have to stick to these things.It's the bureaucracy of driving.
Formative is this is how you drive, this is how you change the gears.This is how we're going to pull away.But maybe restorative is this is how we think and this is how we are when we drive.So are you courteous towards other drivers?You drive aggressively.
Are you going to stop every hour and a half to take a break and not drive tired and not drive drunk?And does that kind of make sense?Is that a way to look at it?Yes, that is how I love that metaphor.I'm gonna steal that from you for future cuz it's so digestible.
The only thing that I would add is that maybe restorative would be like if you drive really well, maybe we'll go through the drive through and get an ice cream that you can eat safely when your hands aren't at the 10:00 and 2:00 position.When you get home or maybe while you're driving, I will make sure that there's.
Soothing music playing or no music playing and that the temperature is correct so you don't get too hot and stressed out.Tending to those things behind the scenes that really do make a difference.And definitely a drive through ice cream.In Australia we have drive through alcohol bottle shops.
You can't.You can.We're going to stop and we're going to model that We're going to get ice cream.Not yet.Yeah, exactly.There you go.That's another really good one.Also the normative domain.OK, cool.All right, I like that.Thank you for that.We should probably start wrapping up.
I'm going to ask you one before we do the official wrap up questions.I've something that I found on your bio.You always tell your students that if I found $1,000,000 on my way home in the evening, I would still be there the next day doing exactly what you're doing now.Really.
Still true.Still true.I tell them that all the time.I honestly, I'm so grateful and feel very privileged every day to be able to come to work and actually have this be the way I would prefer to spend my time that day.
I tell the students that exactly that I I do need the money.Like that's part of it.If I wasn't getting paid, I probably wouldn't be able to do this.But if I had unlimited resources.This is how I would prefer to spend my time, and I knew that being on faculty was going to be challenging and difficult.
But I went to vet school with the intention of being on faculty in internal medicine at Washington State University, and it's just as awesome as I knew that it would be.And I don't see that changing anytime soon.I really do get to have the dream of waking up every day and doing whatever I want to do, and usually whatever I want to do is.
Come to work beyond clinics, be with these outstanding students, residents, faculty members, technicians, support staff, and do this cool thing called internal medicine in a teaching hospital.I I love it that much.What a privilege, what a win.That's amazing.
I want to put a spin on that, though.So let's say it does happen.You don't just win $1,000,000.You win 30 million and you have endless money.How would you do what you do differently?Well, I would buy myself some really sweet equipment.
Medical hospital equipment, medical equipment.Yeah, our hospital is super generous, but I mean, nobody can afford a lot of what the cool toys are out there that they have, right?That I would love to.What would be your first toy that you buy?I would buy a huge like premium Olympus scope set.
The hospital did purchase my dream ultrasound machine, which is the vet GE.Sorry for everyone who likes the other models.I like them too.Samsung I love.I love Samsung as well.There are a lot of good models out there, but they bought my dream ultrasound and I look forward to driving it any chance that I get.
But yeah, it would be cool to like, buy some cool equipment.I mean, and this is after all the personal stuff.Like I pay off all my family's debt if any, and give big chunks of money away.Make sure Henley.My daughter has savings for life.You know all that stuff, you know that comes in and then after that get to come to work, play with some sweet equipment, fun, some awesome research studies.
I'd probably keep it here and you know, elsewhere.Meaning I would keep it in house and make it pay off in external external rewards, research and things like that.Would you work less, do you think?
I don't think so.I don't know.It's hard to say.If I was in that Synovia, you know, would I would I work less?I'm a morning person, so I like, I like coming to work.I don't mind the day kind of.I feel like if I was asked to work less, I would have trouble doing it right now.
And maybe that'll change in the phase of my life that I'm in different phases, but.Right now, 5:00 comes up really, really quick and I got a bolt out of here at 5 for family obligations and I love being able to do that and having that opportunity.But, you know, the day comes pretty quick, so I can't see myself like being able to leave at 3:00 or anything like that.
Wow, that's really cool.OK, Podcasts, you said you do listen to a lot of stuff.Talked about the drive.What else?Is there anyone that I'm missing out on or that I definitely should have on my playlist?Well, maybe you already have it, but the one that I've been listening to over the past few weeks is called Funny Because It's True with Elise Myers.
Elise Myers, I'm a humongous fan of hers and I have been since before she started this podcast.She is, I can't.It's hard to explain exactly what she does.She is a comedian slash musician slash awesome, brilliant human being.
And created this podcast where she interviews people about things in their life that are funny because they're true.And it's a lighthearted, uplifting podcast that also has me thinking on a deeper level every day.
When I listen to it and I love everything about it, it's very, very cool.Awesome.Thank you.Definitely adding that to the list.When I go from my run later, that's going to be my my listening.And I assumed you already listened to Hidden BRAIN.Yeah, I do.
Yeah, that's the, I mean I have all my like staples like HIDDEN BRAIN and now the drive is in that group or whatever.But the the one I picked up recently that not too many folks I've heard of is funny because it's true.All right.Thank you.The pass along question I ask guests to give me a question for the next guest, not knowing who that guest is going to be.
And I have to confess, I messed up.I asked the question of my previous guest and then I forgot to ask them for their question to pass along.So what I did, what I did.And I've done this once before and it's actually quite fun.I went to ChatGPT and I explained the scenario and I explained podcasting, what we do and the question and I said, can you give me a question for my next guest and chat?
GPT wanted to know that if you could spend an entire day immersed in a single activity without any distractions or obligations, what would it be?I really want to run an ultra marathon.Oh yeah.That would be the day I would need to know what day it is so that I could like, prepare and get in much better shape.
But I would spend the day like running up a mountain and back with a crew team giving me snacks and beverages like that would be the day immersed and running.I think when you run a distance, you learn everything you need to know about yourself and everything you need to know about the world around you.
And I love those two components.And like other than how much I enjoy coming to work and spending my time here, aside from that, I would just I would run all day.What sort of distances do you run?What's the longest you've done as an event?I've done a marathon and mostly half marathons.
I like because I can run the half marathon and then go for a run again a few days later.Like I don't have to have a huge recovery like with.Yeah, I'm not busted.I'll busted up.We have fantastic ultra in my neighborhood.
I live on the Sunshine coast of Australia.Google the black hole 100.You can choose 100K, which is huge, or you can do the 50 and the 50 is more reasonable and it's through forests and along creeks and it's very up and down.
So put that on your list and come and do it.Pick it.It's October every year.They said there's your goal.Pick the black hole, come and do it.You can come and stay with us.Can't wait I am so there in like.Two years when I've trained well, the 50K is more my speed, the ChatGPT said.
If you could spend a day doing anything, I think it would take me more than a day to run 100K.Like I would be doing that for like 48 or 72 hours.No, that's not that's not my bag either.That that to me just sounds like torture.I don't understand.Yeah, Yeah.Yeah.All right.And then we wrap up with this question.
You have an opportunity to speak to all of the veteran new grads of the world of 2020, and you've got a couple of minutes to give them just one little bit of advice.What is Sarah's advice?Keep showing up.And to put that into context, I read this book earlier this year.
It's the book that Des Linden wrote.She's an American female distance runner who was the first female American to win the Boston Marathon in over 30 years.And six weeks before her Boston win, she wrote this on Twitter and then wrote a book about it later, which was just published this year.
But this was her Twitter quote.Some days it just flows and I feel like I'm born to do this.Other days it feels like I'm trudging through hell.Every day I make the choice to show up and see what I've got and try to be better.My advice keeps showing up.
March 5th, 2018.That was again, just six weeks before her Boston win and.I love that advice because some days are hard and I think that you have to show up with your skills and your best self.And the other way that I describe keep showing up is do, yeah, show up to your work, show up for your patients, show up for your people, but also show up for yourself.
And if that means that showing up means you need.Some time off to take away from work, maybe show up for yourself and take care of what you need to take care of and then show up for work.Figure out what keeps showing up means for you.
But I think it's important because it's a very simple concept of 1 foot in front of the other really does get you very far and some days you are going through the worst of it and other days are great, but you keep showing up and see what you've got and try to be better.
Amazing now I almost did it again.I almost forgot to ask you for your question for my next guest.My question for your next guest, I can't wait to hear.The answer is what is something that you believe to be true that nearly everyone else disagrees with you on.
Ooh, that's a good one.That's gonna take a bit of thinking.Brilliant.I like that so much.Sarah, thank you so, so much for your generous time.Thank you for what you do.It's such important work.
And going back to that quote I got from the other person that ends with, with the students feeling like they just hear from a bunch of people who are that they should do better from a bunch of people who are burned out.I feel like you are the opposite of that.It's so nice to hear somebody say I would show up even if I had $1,000,000 in the bank, because it matters.
And what you do matters.So thank you for doing that.Thank you so much for having me.This has been a real pleasure and I hope that something is helpful for someone listening.And I've just, yeah, I really enjoyed being here, really enjoyed chatting with you and I appreciate what you do so much too.
I'm also enjoying listening to Vet Vault, so it's been great privilege.We talked a lot about running in this episode, and I know that many of you, like Sarah, are runners.
And runners need good shoes.And if you're not a runner, someone else who needs a good shoe are vets who spend all day on their feet.But what defines a good shoe for running or for vetting?Well, like a good mentor, a good shoe has to offer great support.
It needs to be tough and long lasting and comfortable, and there are lots of shoes like that out there.But there's another level of good How much do they impact the environment?And with the vast majority of other comfortable, supportive shoes out there, the answer is a lot.
From production to the millennia that they will spend in landfill once you are done with them.One of our official supporters at the Vet Vault is Tarkine shoes.I picked them as a supporter because I wear them running and I wear them to work and I love them.I love them for being more than just good for those jobs of longevity and support and comfort and all of that stuff.
But they're also very.Good when it comes to environmental issues.Tarkine are one of the world's most eco friendly running shoes with features like apples that are made from recycled plastic, the world's first compostable footbed and with their return to Tarkine program.Which means that once you're done with them, you can send them back to be recycled to be reborn as useful things like bags, fabric and yoga mats.
Plus 3% of every sale goes to conservation causes.As a bonus, the material that the apples are made from is super breathable.To avoid hot, sweaty feet at work and also seems to be almost entirely impervious to all manner of bodily fluids from our patients.
I can tell you that from personal experience, the team of Tarkine have given us a discount code for you to go and grab your next pair of work slash running shoes.If you buy shoes with this code, I will get a small percentage of the sale, so you will also be supporting the event vault.Go to tarkine.com.
That's TAR kine.com.And use Vetvault.That's one word, VETVAULT at checkout to get 10% off your purchase.Or follow the link in the show description wherever you are listening to this to Around the Future with tarkey.
I'm.

Prof. Sarah Guess