About Felix Ankel, MD

Department of Emergency Medicine
University of Minnesota Medical School
Regions Hospital

How We Have Kept and Will Continue to Keep Going | Summary of The Leader’s Library Discussion

keep going book

Last month, 30 people from 4 different countries and 15 different states + Puerto Rico, ranging from their early twenties to mid sixties, bravely jumped into a two-and-a-half day conversation on Slack about creativity, resilience, and their careers– the fifth version of The Leader’s Library. We discussed the book Keep Going: Ten Ways to Stay Creative in Good Times and Bad by Austin Kleon, and reflected together on the evolution of our creativity from childhood through middle age, and how a career in emergency medicine requires creativity in every possible form. Please see our earlier post for a more detailed summary of the book; below, we share the highlights of the group’s discussion.

Day 1

The first day started out with a personalized welcome video from Austin Kleon himself and introductions of participants. People shared what drew them to The Leader’s Library (connection, reflection, building community) and where they would like to incorporate more creativity (heal personal and societal wounds, bring innovative approaches to “wicked problems”, appreciate the beauty and joy in connections between things.) We then discussed the influence of specific individuals on personal creativity and how some have created a personal creative network (PCN) similar to personal learning networks (PLN). This was followed by a discussion about the spaces where people felt most creative, with many describing the benefit of being outside and disconnected from the activities of daily electronic living, while others felt most creative when connected with others through electronic means. Participants then volunteered their preferred medium for expressing creativity with lots of sharing of paintings, photography, poetry, and welding projects.

Day 2

On the second day, we covered the first 8 tenets of the book. 

1. Every day is groundhog day.

This is really about having a daily discipline: take one day at a time, establish a daily routine, and have reflective practice. Participants discussed morning and evening routines, journaling as an anchor, and the importance of routine in setting boundaries between “doing” and “being”. Some discussed an unease with routines, as our chosen lives as emergency physicians are by nature unpredictable. However, this discomfort belied participants’ flexibility and resiliency– even in pure chaos when nothing is going as planned, we’ll get through, the day/shift/week will inevitably end, and we’ll start again tomorrow.

2. Build a bliss station.

This is a “space” or “time” to disconnect from the outside world to connect with yourself. The concept of being on “airplane mode” even when not on an airplane resonated with many. Participants shared examples of their physical (outdoors, home office, kitchen island) and temporal bliss stations; for some, their bliss station was simply an extra in-tune state of mind. The conversation also revolved around the art of “saying no” and of intentionality when creating one’s career journey. Some highlights: recognize that one’s capacity is finite, and in order to say “yes” to one opportunity, one must say “no” to another; when invited to do something, ask, “What is this person really trying to achieve? Can I help them in a different way to achieve this goal?”; and journal in the days following activities and review how you felt afterward– did this project invigorate you, or were you entirely drained? Use this insight to inform future decisions.

3. Forget the noun, do the verb.

We often define our identity with who we are rather than what we do. Kleon suggests that “creative” is not a noun and that real work is play. We had a robust discussion on what “verb”-ing looks like for each of us. In looking at our careers, many of us recognized our professional “nouns” in one bucket (emails, meetings, academic rat race), and our liberating, expansive doctor “verbs” in another bucket (to help, think, read, teach). We discussed ways to contract bucket 1 (wait 24 hours to answer an email, skip meetings that aren’t action-oriented) and expand bucket 2 (step out of academia, work only on passion projects [that whole “saying no” thing again!]). 

4. Make gifts.

This was about the importance and joy of gifts. This was also about the trappings of “suckcess” and the tyranny of metrics. Kleon suggests that we should leave money on the table, we should forget to take things to the next level, and let low hanging fruit fall off and rot. Instead of the quantitative, focus on the qualitative. Be kind, be generous, be unique.

5. The ordinary + extra attention = the extraordinary.

This tenet resonated with many. Participants discussed ways they’ve cultivated over the past year to slow down and pay attention to the world around them with mindfulness techniques. With slowing down, we can finally focus attention on what we’re paying attention to, then with intentionality nurture this by giving extra attention and create something extraordinary. An interesting angle discussed how Peleton pandemic buys helped people get into the mode to conserve cognitive load and emotional labor, to slow the mind through exercise.

6. Slay the art monsters.

Kleon’s “art monsters” are those ubiquitous beings who somehow create beautiful work while behaving badly and contributing net negativity to the world. We reflected that we don’t want to become “monsters” in the same way, prioritizing output and the final project over the craft of medicine. Kleon argues here that “art is for life, not the other way around,” and this was a good reminder that we chose our careers because we wanted to make our, and others’, lives better, not to drag ourselves or others down. Many discussed this juxtaposition of simultaneously loving their practice (caring for patients, educating others) with living periods of time where pursuing their craft made themselves and others miserable. We all can have monsters coming to visit; the key is keep them around for the shortest time possible.

7. You are allowed to change your mind.

This tenet challenges the obsession with being right (hello, medicine!). Our discussion revolved around history-as-educator (“history may not repeat, but it sure does rhyme”) and philosophy-as-educator [Daily Stoic]. Some participants regularly revisit their own history through re-reading old journals; others learn through reading others’ histories in books, applying lessons from our ancestors’ missteps to our own current leadership challenges. There was also discussion of the (inverse) relationship between confidence in a position and being right. See the Dunning-Kruger prayer. In Kleon’s words, “to change is to be alive.”

8. When in doubt, tidy up.

We closed the day with a discussion of tidying our workspaces, both mental and physical. Sleep tidies up your brain. Tidying up your workspace is an exploration and a great way to focus energy when stuck or overwhelmed. Participants discussed their approach to tidying up offices, kitchens and gardens and the positive creative effects it had on their creativity. 

9. Demons hate fresh air.

On the third and final day of discussion, we covered Kleon’s final 2 tenets. This is one of the more intuitive tenets– that getting one’s bootie off one’s chair and going outside can stimulate creativity and launch us past writer’s block. However, Kleon takes this beyond endorphins and argues that, by going outside, we better integrate ourselves into our communities and reality: “If we do not get outside, if we do not take a walk out in the fresh air, we do not see our everyday world for what it really is, and we have no vision of our own with which to combat disinformation.” Participants had varied strategies for getting themselves OUT, though most agreed that getting outside had been critical to their physical and mental wellbeing over the past year. Several people cultivated a habit of photographing their surroundings while out walking, a practice which helped them stay present. One participant shared that for them, this tenet took on a metaphorical meaning– by letting their internalized shame out to “fresh air” through writing or speaking, its power over them lessened. 

10. Plant your garden.

Kleon, and our participants, focused on seasonality here. We don’t expect plants to flower in the winter, nor do we furiously cling to an oak tree’s leaves when they tumble off in the autumn; why, then, in academic emergency medicine, in medical education, in medicine in general, do we completely disregard this natural rhythm and instead attempt to overpower it with a decades-long continuous stream of hard work? Why are we surprised that our creativity stalls periodically, when we know innately that everything in our world is cyclical? Participants brainstormed ways to integrate periods of recuperation and recharge (what Kleon calls “dormancy” in this essay) into their professional lives, not just for rest, but also to enhance creative output. One participant reflected, “I’ve personally struggled with having to ALWAYS be ‘on’ in terms of being creative, but now understand that creativity ebbs and flows and the key now is to capitalize when the time is right.” 

Synchronous Conversation

We closed out The Leader’s Library with a live video conversation, during which participants ranging from medical student to late-career professor mused about the connections they formed during The Leader’s Library, new ideas they’d be taking back to their institutions, and shocking realizations they’d had while learning from and with their co-participants. Independent of differences in prior life experiences and current situations, all participants affirmed a renewed appreciation for the role of creativity in their professional lives.


Whether in the US or India, academic or community emergency medicine, medical student or faculty, leading or trying to lay low, our facilitators and participants all need to keep going– and the past year plus has made this an incredible challenge. We’ve known a solution to this challenge since our preverbal years– taking a handful of crayons to a blank page helped us cope with doctor’s visits and tortuously slow restaurant service, art allowing our brains to take a break from the world around us and observe with a new lens. Participants left the fifth iteration of The Leader’s Library with plans to better support creativity in themselves and their colleagues, with a goal of improving not only the quality of their work, but also the quality of their existences

The facilitation leadership team were wholly inspired by the participants and their vulnerability and candid insight. Stay tuned for our next turn in the fall and until then, ta-ta for now!

By |2021-06-17T10:47:44-07:00Jun 29, 2021|Book Club, Leaders Library, Medical Education|

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 |2021-04-23T19:33:45-07:00Dec 23, 2020|Book Club, Leaders Library|

ALiEM Statement Against Racism

ALiEM Statement Against Racism

Illustration by Dr. Moises Gallegos

Academic Life in Emergency Medicine (ALiEM) stands in solidarity with emergency physicians and learners in denouncing the structural racism and acts of violence that disproportionately affect persons of color. ALiEM denounces the senseless death of George Floyd which adds to the ever-rising numbers of deaths among Black men and women. The dissemination of the now-viral video documenting Mr. Floyd’s last desperate moments has brought a renewed public awareness to a disease that has for far too long afflicted this nation. We see the injustice and disparities in healthcare that are made even more visible during the COVID-19 pandemic. ALiEM is committed to taking action against racism and discrimination and joins the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), and the American Academy of Emergency Medicine (AAEM) in urging frontline healthcare providers, educators, and leaders to promote a safe, equitable, and inclusive learning and patient care environment in emergency medicine. We support diversity in free and open access to medical education and uphold efforts to embrace our common humanity.

By |2020-06-01T16:43:29-07:00Jun 2, 2020|Public Health|

The Leader’s Library: Dare To Lead | Curated Summary of the Discussion

Dare to Lead summary | The Leader's Library - a professional development book clubIn April 2019, a group of intrepid readers embarked on an adventure together: the debut session of The Leader’s Library, ALiEM’s new career development book club. Learners and instructors from around the world read and discussed Dr. Brené Brown’s newest book, Dare to Lead, on a 5 day journey via Slack. Each day had its own theme (Rumbling with Vulnerability, Values, Empathy and Shame, Learning to Rise, and Toolkit), and the asynchronous discussion was robust. A day-by-day breakdown of our conversation, along with tangible takeaways and recommendations for further reading, is summarized below.


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