Life career workbook for medical students and physicians
Contents
The author, Dr. Atsushi Kaku, kindly sent me a copy of his book.
As the introduction states, “This book is Japan's first ‘Career Workbook for Medical Students and Physicians,’ jointly created by physicians and career consultants. Based on the Code of Ethics for Career Consultants, it places an emphasis on respecting individual freedom of choice and the right to self-determination.” True to these words, the book focuses heavily on respecting the freedom of choice and self-determination of the individuals involved. Below is a brief summary of the parts that left a particular impression on me.
“Confusion between professional role models and career role model education in medical education”
“We occasionally see education aimed at keeping physicians in practice or returning them to the clinical frontlines—which can induce burnout—as well as instances where professional role models are confused with career role model education.”
“In career education, a role model serves as an example of a way of life, used to help learners recognize their own values and interests anew. By contrast, a role model in professionalism education serves as a model of expected professional roles, used to present an ideal image of a physician to strive for, along with desirable values and roles.”
“In career education, learners take pieces of interests and values they relate to from multiple role models and combine those pieces to build a conceptual model of themselves. In other words, it is a method for establishing identity, and it can also be used to reconcile one's self-concept with the external environment.”
“Ethics for faculty providing career education”
“The risk that fostering a sense of obligation or responsibility—such as feeling that one ‘must strive’ for a presented image of a physician—can increase burnout is not widely known. Preventing this requires interventions aligned with observational learning in Albert Bandura's social learning theory.”
“People are intrinsically motivated when they feel they are deciding their own actions, and extrinsically motivated when they feel controlled by others. If we use appeals to social mission to restrict freedom of choice within education, learners feel their actions have been decided by others, losing the sense that they determined their own actions.”
“In Japan, ‘resilience’ has been drawing attention as a skill to resist burnout. However, the current consensus is that burnout is fundamentally an organizational problem, not an individual one.”
“Attributing burnout to a lack of resilience shifts an organizational problem onto the individual and holds them responsible, which should be avoided. While it is necessary to provide education that builds resilience, we must keep in mind that we must not demand high resilience from learners.”
“In medical professionalism education and career education, the point that requires particular caution above all is that to the person conducting the education (the faculty member or attending physician), the learners are clearly in a ‘vulnerable position.’ Educators must be acutely aware of this fact.”
“In career education, you should not demand that the students or residents you directly supervise adopt values on which there is no fully generalized consensus. To sum up ethics in a single phrase: ‘How much can we devise ways to spare the person receiving support from having to do things they find unpleasant?’”
“The relationship between addressing SDH and burnout”
The book notes that multiple reports show addressing SDH (social determinants of health) increases burnout among healthcare professionals, which I also found to be a vital theme.
“Addressing SDH is often complex and demanding, which is said to increase stress among healthcare professionals (https://doi.org/10.1353/hpu.0.0163 ).”
“On the other hand, some reports indicate that addressing SDH conversely reduces burnout among healthcare professionals. ... Primary care physicians who feel capable of meeting their patients' social needs are known to experience less burnout (https://doi.org/10.1016/S0140-6736(18)31891-9 ; https://doi.org/10.3122/jabfm.2019.01.180104 ). This perception is more likely to develop when the workplace includes a multidisciplinary team, such as medical social workers and pharmacists.”
“To prevent burnout, it is desirable to approach challenges by asking not what ‘I’ can do, but what ‘we’ (as a team) can do (https://pubmed.ncbi.nlm.nih.gov/29924700/ ).”
Other topics
The book also covers Krumboltz's social learning theory, work-life balance, and the eight life roles, packing in essential content for providing career education.
“According to Krumboltz's social learning theory, career development is the result of experiences (‘learning’) that bring about changes in one's behavior. Many career choices are influenced by chance events, but everyday ‘learning’ actions draw in favorable chance events and turn them into opportunities.”
“Krumboltz's argument is consistent: recognize the importance of unplanned events, act on your interests, stay alert to capitalize on opportunities, and dismantle assumptions that hinder action.”
“WLB (work-life balance) is often viewed as weighing the two sides of ‘work’ and ‘life (personal time)’ on a scale to achieve an even balance, but in reality, it has a few more dimensions. Donald E. Super stated that people hold eight roles in life, calling these ‘life roles.’”
My own career has been heavily influenced by Krumboltz's career theory. Personally, whenever I talked about Krumboltz in the past, I used to pair it with the concept of career anchors. However, since the preceding chapters of this book include exercises that sufficiently deepen insight into one's values and abilities, I plan to use those instead.
I highly recommend this book not only to medical students and physicians themselves, but also to anyone involved in career education and support for medical students and early-career physicians.
You can view information about the book here. A full set of worksheets can also be downloaded from the support page.