About Dina Wallin, MD

ALiEM Series Editor, The Leader's Library
Assistant Medical Director of Pediatric Emergency Medicine
Zuckerberg San Francisco General Hospital;
Assistant Clinical Professor of Emergency Medicine and Pediatrics
University of California San Francisco

Defying Forgettable Flatness: The Power of Moments | Summary of The Leader’s Library Discussion

The Power of Moment book for the Leader's Library

In September, ALiEM hosted its fourth iteration of The Leader’s Library, this time discussing The Power of Moments by Chip Heath and Dan Heath [Amazon link to book]. Driven by a purpose “to defy the forgettable flatness of everyday work and life by creating a few precious moments,” 30 participants and 6 facilitators embarked on a 3-day voyage through the book, exploring general themes of CREATE (how do we manipulate our surroundings to create powerful moments?), REFLECT (how have powerful moments influenced our personal and professional lives?), and CAPITALIZE (how can we utilize moments to effect change and progress?). The interprofessional group of participants hailed from 6 countries, representing all levels of training, with local, regional, state, national, and international leadership experience. Lots of lived moments to contemplate!

The authors explain that for a moment to jump out at us and really stick, influencing our outlook and changing our behavior (a “defining moment”), the moment must:

  • Elevate us: pull us up from the mundane into something special (ex. a colleague brings you a fancy latte on shift to celebrate your birthday), and/or
  • Deepen our insight: change our understanding of the world (ex. hearing a speaker who completely reframes the way we’d always viewed a topic), and/or
  • Instill pride: help us see ourselves and others at our best, and be proud of this (ex. public recognition at faculty meeting for a job well done), and/or
  • Create connection: link us with others (ex. current residents, faculty, and alumni celebrating together at residency graduation)

Once we understand these critical components of defining moments, we can then engineer our environments to create these moments intentionally. Whether a person is a community provider seeking to spice up their on-shift work, or a residency program director hunting for ways to boost morale in a tough year, or the director of a regional disaster response during a pandemic– all of us in emergency medicine could use some extra powerful moments in our lives.

Day 1: Create

The first day of The Leader’s Library started with participants describing particularly memorable moments in their lives. Inevitably, the conversation shifted to the concepts of time and timing, and a nuanced discussion ensued around our relationship with the two (how is a minute different from a moment?). In the Greek language there are two words for time: chronos and kairos. Most of our professional energy is spent focusing on time (chronos), while most meaningful moments are more significantly influenced by timing (kairos); participants discussed how we can shift our worlds more toward kairos to maximize great moments. (For example, selecting a kairos time to deliver important feedback might create a defining moment for the recipient, while a feedback session centered around chronos is just another meeting.) 

We then contemplated how mindset can affect moments, and whether people with a growth mindset inherently experience moments differently than ones with a fixed mindset (participants felt that they do– a growth mindset allows an individual to recognize a low point or “pit” as a valuable learning opportunity, a powerful moment, while a fixed mindset might only perceive an obstacle). 

We then discussed transition. Acknowledging that many memorable moments happen during times of transition (birthdays, graduations, weddings, funerals), how can we as leaders and educators choreograph inevitable transitions (such as the start of a new rotation, or the beginning of a new postgraduate year of training) to maximize and enhance the experience for our learners? Participants shared a wealth of great ideas, such as a resident receiving the “golden laryngoscope” trophy once they’ve signed off on intubations, bringing a cake to a trainee’s last shift of residency and sending a picture of them cutting it to their family, and welcoming a resident who’s been lost in off-service land with a cup of coffee and a granola bar on their first shift back in the ED. 

Lastly, we explored how we can maximize moments in non-transitions. The authors write that “breaking the script” can help elevate an everyday experience into a powerful moment, and ideas our readers had included holding small meetings outside, taking a walk with a mentee instead of sitting in an office, and giving kudos spontaneously when it’s earned, rather than storing it up for a semi-annual evaluation.

Day 2: Reflect

On day 2, we turned inward to reflect on defining moments, both positive and negative, that we’d experienced over the course of our lives and careers. One participant applied the chicken-egg paradox to moments, and wondered if moments are external stimuli that happen to us and shape the stories we tell ourselves to make sense of the universe around us, or if moments are only perceived and noticed after an internal reflection process– do moments shape our stories, or do our stories shape our moments? The consensus was a resounding YES (to both). 

We explored the authors’ proposed formula for leaders seeking to stretch their team members into growth– many participants work with learners of all stages, and easily applied these managerial concepts to medical education. The Heaths argue that (high standards + assurance) + (direction + support) = enhanced self insight, or personal growth. How might this look in medicine? A faculty member working on a manuscript with a trainee might say, “I wrote several revision suggestions. I expect high-quality writing out of you, and know you can achieve it. I pulled some examples of outstanding scientific writing for you. We’ll meet again next week, and I’m available by e-mail in the interim.” This sure has a different impact than simply sending the trainee a document full of markup and critiques! By applying this formula and thinking in moments, we shifted this encounter from discouraging to motivating, from banal to defining, all with an extra 1-2 minutes of effort.

Early career participants reflected that this might be easier in theory than in practice; one participant stated, “The knife’s edge balance of being shamed vs having high expectations placed on us, then living up to them, is crazy!” A mid-career participant sagely counseled, “As I’ve continued to have fascinating professional opportunities, I find that less surprises me and fewer things wound me. Cultivating equanimity… and caring about life, but with a certain indifference to the details, helps transform a wider array of experiences into growth opportunities rather than moments of hurt.” Yet again we returned to the premise of thinking in moments facilitating continual professional development and evolution.

We closed day two with a discussion of purpose vs passion. Although “passion” seems like an exotic way to fuel one’s career, the authors maintain that “purpose trumps passion:”

Passion is individualistic. It can energize us, but also isolate us, because my passion isn’t yours. By contrast, purpose is something people can share. It can knit groups together.

Successful leaders can cultivate a shared purpose in their organization, so everyone (passionately) fulfills their roles to the best of their ability toward this common purpose– from respiratory therapists to attending physicians to child life specialists, each team member is united in this purpose. And how do we unearth such purpose? By asking a series of “whys.” The authors use a great example from healthcare, querying a hospital custodian:

  • Why do you clean hospital rooms? “Because that’s what my boss tells me to do.”
  • Why? “Because it keeps the rooms from getting dirty.”
  • Why does that matter? “Because it makes the rooms more sanitary and more pleasant.”
  • Why does that matter? “Because it keeps the patients healthy and happy.”

Narrowing the scope from organizational to individual, one participant mused that this exercise could have incredible value as one contemplates one’s own career, or scaffolds a mentee as they generate a 5 year plan, although “it almost seems invasive, like if I did it in a residency interview it would be too much… but not too much for me alone with a piece of paper, and maybe not too much for a conversation with a learner struggling to find their purpose, if it felt safe for them to look that deep.”

Day 3: Capitalize

Discussion on day 3 focused on actions we can take to make the most of the moments, both big and small, that we experience and create throughout our careers. We discussed several ways of highlighting little moments we experience every day. Some participants plan to ask themselves and their learners after a shift about what they learned and who they learned from to highlight and celebrate that learning and teaching, and to cultivate a gratitude practice. Monthly didactics can be reframed from a residency requirement to an opportunity to create positive moments for learners– a chance to celebrate milestones and forge connection. Participants reflected that sharing one’s own journey and personal defining moments can spark new powerful moments for others. One person shared a cool practice: “I am pretty old school and prefer to read paper books. I have a habit when I finish reading a book, I write my major learning points inside the cover, and then I think of someone to give the book to, or sometimes mail to. Eventually this process is repeated, and that inside cover is chock-full of amazing ways the book has inspired people.” Mind blown.

The Power of Moments: Take home quotes from our discussion

Several discussants plan to do something similar; we’ll close this post with some major messages they would write inside the cover of this book. Thanks to our outstanding facilitators, engaged participants, and you, the ALiEM community, for constantly pushing your leaders to grow. Hope to grow with you at The Leader’s Library, V5 in the spring!

“I’d write the table of contents… It really sums up so many of the key points of the book and in very few words.” – Table of contents: Defining Moments. Thinking in Moments. Build Peaks. Break the Script. Trip Over the Truth. Stretch for Insight. Recognize Others. Multiply Milestones. Practice Courage. Create Shared Meaning. Deepen Ties. Making Moments Matter.

“Small moments can have great impact as defining moments. Commemorate milestones, no matter how small.”

“We remember our lives as a series of moments, good or bad, large or small. While many moments happen organically, some can be created, engineered, or encouraged. Remember your moments and learn from them. Encourage positive moments for those around you.”

“Pause. Soak up the present. You could be missing out on a moment that could impact you or someone around you. Try to make it a better moment.”

And, a final quote from she who started it all, Dr. Michelle Lin: “Moments matter. Pass it on.”

By |2020-12-15T09:24:17-08:00Dec 23, 2020|Book Club, Leaders Library|

The Leader’s Library: The Power of Moments | Sign Up for the Book Club

The Power of Moments in The Leader's Library

Thus far, 2020 has been a year of catastrophic events, some surprising and others disappointingly predictable, and many people are struggling to navigate the chaos, to grasp at some semblance of a routine in the face of an unpredictable near future. Time has become a blur, a coalescence of unremarkable (yet unprecedented) moments.

What if we have the possibility to intentionally create these moments, for ourselves and those around us? What if, by reframing the way we view memory, experience, and time, we could be the powerful author of our own moments?

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By |2020-08-30T20:03:46-07:00Aug 30, 2020|Academic, Book Club, Leaders Library|

PEM Pearls: Chest Radiographs for Shortness of Breath

chest radiograph

Figure 1: Photo by Tim Bish on Unsplash

Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone and color. Thick, copious secretions are coming from his nose. He is tachypneic with diffuse wheezes, crackles, retractions, and nasal flaring. His respiratory rate is 70 and his oxygen saturation is 88% on room air. Would you order a chest radiograph (CXR) for this child?

CXRs are routinely obtained in adults with respiratory symptoms. Children, however, are more sensitive to radiation and can have multiple respiratory infections every year. CXRs can increase cost, length of stay, and may not always be necessary.

This post presents some guidelines on when (and when not) to get a CXR in pediatric patients.

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By |2020-05-02T11:46:09-07:00May 27, 2020|PEM Pearls, Pulmonary, Radiology|

The Leader’s Library: The Coffee Bean – Open call for participants

The coffee bean the leader's library book clubLife recently has been, to say the least, a hair stressful. The global pandemic, with all the resultant lifestyle upheaval, has seized a commanding presence in every minute of every day, personal and professional, and many of us are feeling the heat. There’s never been a more appropriate time then to cultivate effective coping strategies as a community, and ALiEM is here to help, with the third installment of The Leader’s Library, covering The Coffee Bean: A Simple Lesson to Create Positive Change by Jon Gordon and Damon West.

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By |2020-05-06T16:12:42-07:00May 8, 2020|Book Club, Leaders Library|

I’m an Emergency Medicine Physician With COVID-19, Now What?

COVID-19 physicianA 35-year-old female emergency medicine physician presents for evaluation for severe myalgias, headache, fatigue, mild nasal congestion, profound anosmia, cough, and subjective fevers and chills. She has no measured temperature above 100.4°F, but has been taking anti-inflammatories around the clock. The day previously, she called occupational health and received testing for the novel coronavirus. The next day, her test returns positive. What happens next? We are here to share our personal experiences with COVID-19 and provide some resources to best support yourselves, your families, your learners, and your colleagues throughout this uncertain and ever-changing situation.

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By |2020-04-10T23:25:40-07:00Apr 10, 2020|COVID19, Life|

The Leader’s Library: Radical Candor | Curated Summary of the Discussion

radical candor

Welcome back to The Leader’s Library! In our second installment, throughout the week of October 14, 2019, a group of selected learners across the globe tackled Radical Candor by Kim Scott [ALiEM book summary], and generated another fascinating asynchronous dialogue on Slack. This go-round, we had 3 days of discussion with days for reflection in between. Below are the main points that emerged from our robust conversation.

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By |2019-11-10T23:10:07-08:00Nov 18, 2019|Book Club, Leaders Library|

Measles 2019 Updates: The Comeback Kid

Measles

The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years [1]. Globally, measles kills over a hundred thousand children [2]. In the U.S., one child dies for about every 1,000 cases [3]. Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. The CDC now has new vaccine recommendations, and it’s imperative that ED providers join forces with public health providers to prevent future measles cases and deaths (photo credit).

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By |2019-10-31T12:57:05-07:00Oct 28, 2019|Dermatology, Infectious Disease, Pediatrics|
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