The Concept of Wonderment

Jill Gilbert, MD

It is a time of new beginnings. Many of you are graduating and starting your first job as a hematologist oncologist. Many of you are just beginning your training in this field. Regardless of where you stand in the trajectory of it all, welcome to this exciting time in your professional development.

I want to focus on the concept of wonderment as a tool in new situations. A graduating resident or fellow may be quite confident in their ability to navigate a world they have just mastered. However, wonder can be used as a mechanism to humbly, and with some excitement, attain the competency that is required to gain mastery of your new environment.

Wonder can be used as a protective blanket to ask questions or even to challenge a status quo. How does this work? There is an inherent innocence to wonder—a pure desire to learn and contribute without posing a threat.

Let me give you a concrete example of how this may work. A fellow starts training at a new institution. The fellow observes that a particular educational conference lacks attendance. You have an idea of how to improve this experience for the fellows based on your prior training experiences. A common way that a novice might address this concern is by saying, “This conference needs to change. Attendance is not where it should be. The lectures are boring.”

Inherent in these comments is a sense of judgement, which may be perceived as arrogant or threatening to program leadership. Your message will get lost because of the way it is delivered.

By using wonder, you create a nonthreatening opening for a synergistic vision that, at its core, is not about you but about the program, a common good. A recommendation that uses wonder as a tool to achieve a similar aim is the following: “I’ve noticed that lectures are not well attended. I wonder whether by asking participants to turn on their cameras, we may foster interaction and a more robust learning experience that attracts attendees.”

In the latter sentence, you have a suggestion, not just a complaint. Moreover, you couch this within the common good: the desire to promote an effective learning experience for all.

This same technique applies to those who will be entering independent practice. Right now, the recently graduated trainee is at the height of knowledge in the field given the proximity to training, studying for boards, etc.

However, the fellow is also entering a new professional reality in which the guardrails of Accreditation Council for Graduate Medical Education do not exist. For some fellows, this may be a difficult or unsettling transition in which duty hours don’t protect your time and patient caps are a thing of the past. The recent graduate may feel unsupported or unconfident in new surroundings. This is common, and it is normal to have trepidation.

A pitfall arises when feeling overwhelmed or inferior translates to defensiveness or arrogance. It is common for a new graduate to be unfamiliar with concepts comprising billing compliance, insurance authorizations, and posted patient reviews. In most cases, the business of practicing medicine is not a significant component of training.

This is all part of being a physician in this modern health care reality. Take every opportunity to learn on the job, ask questions, and identify key individuals in the practice who will help teach you the ropes. Meet with them early to obtain feedback along the way. Your sense of wonder is your power at this point.

For example, it is common to score poorly on patient reviews when new to a practice. A normal response is anger, especially if the message comes from a leader within the practice. A common retort is, “The patients are wrong. They have a bias. They do not understand me.”

However, take a deep breath and think about this as a problem that can be approached with wonder rather than anger. Use this experience to demonstrate maturity and professionalism and create relationships and sponsorship from within your practice environment.

Instead of an emotional attack, try the following: “I wonder whether there are tips to help me improve my patient rapport. Can you provide me with the name of an individual who scores well on patient reviews so that I can learn from them?” Or you could say, “I noticed that you have 5 stars on patient reviews. I wonder whether you could give me some pointers.”

Through this interaction, you have shown a desire to learn and a willingness to be taught. When you lead with wonder and humility, you open yourself to opportunity.

Jill Gilbert, MD, is a professor and associate director for Research, Education, and Professional Development at Vanderbilt University Medical Center in Nashville, TN.