There are a number of personal attributes characterizing the professional identity of “physician.” We are dedicated to patients, committed to lifelong learning, and responsible for a variety of other professional obligations. Each requires physicians to be highly accountable – obligated or willing to accept responsibility for one’s actions. In this post we present examples of how we’ve adopted peer accountability as a strategy to help us with the myriad responsibilities and obligations at the heart of our profession. Just in time for the New Year – we challenge each of our readers to consider finding an “accountability partner” in 2020!

The Concept

Accountability is an obligation or willingness to accept responsibility for one’s actions and resulting outcomes. Society expects us to be accountable for evolving medical knowledge and ultimately patient outcomes. We must also remain accountable to ourselves and our scholarship.

Our health, relationships, and an overall sense of wellness are often taxed by years of training and ambition. For those of us in academic medicine, clinical responsibilities and relationships outside of the hospital may limit our scholarship and productivity. Research and writing represent the homework that never goes away, the constant pressure to complete a to-do list that may never end. When it comes to ourselves, it’s easy to push to next week those tasks that could be finished today.

Although guilt can be a powerful driver of human behavior, productivity guilt and its associated self-blame can lead to underperformance. Accountability, on the other hand, offers us a mechanism to positively leverage our social networks to actually enhance our productivity. As Brene Brown suggests, accountability is an action of the courageous who choose to avoid blame, shame, and their own comfort in pursuit of something better.

This is where peer accountability comes in – a specific strategy for how to leverage social networks to help you achieve desired outcomes. Peer accountability is a well-known phenomenon in team sports, business, and organizations promoting self-improvement. Accordingly, accountability partners are individuals that hold you responsible for whatever you state that you want to accomplish. This strategy works because people are more likely to follow through with a task if they have shared an intention to complete it with another person.

Three  pairs of emergency physicians describe their experience with peer accountability as a strategy for navigating their career and improving productivity. Although the pairs vary in set up and expectations, each has found the experience to be rewarding and valuable.

Team 1: Jeannette Wolfe (UMMS-Baystate) and Mike Gisondi (Stanford University)

Jeannette and Mike have been exchanging emails on Monday mornings for over two years. Starting with the subject line: “This Week,” their emails are simple and often have no salutation or social message. The format consists of spotlighting 1 or 2 things that happened in the past week for which they are grateful and then listing the desired tasks to be completed over the upcoming week. The exchange intentionally helps them break down larger projects into more discrete actions, helping them stay on track in complex projects with soft deadlines.

There is no discussion of how to accomplish any of the stated goals, nor are there follow-up emails to monitor completion. Occasionally, the pair will send emails back and forth surrounding a particular issue but most weeks there is usually no anticipation or expectation of the other person’s response. In their model, accountability simply comes from the intentional act of organizing and sharing desired weekly goals.

This pair works well together for a number of reasons. Most importantly, Jeannette and Mike are at different institutions and their exchange has created a valued confidential space in which they can openly discuss professional and personal challenges, seek alternative perspectives, and celebrate accomplishments. There is no sense of competition and no bad feelings during less productive weeks. Sharing their different academic circles has also provided both of them with new professional opportunities including speaking engagements and podcasting.

Team 2: Arlene Chung (Maimonides Medical Center) and Nicole Battaglioli (Emory University)

Nicole reached out to Arlene earlier this year to become an accountability partner. The only other context in which they had previously heard of this concept was the gym — the professional accountability partner was a new, but not entirely unfamiliar concept. Their mutual respect for one another was enough to trial this strategy and test its effect on productivity.

They determined a few guidelines for their weekly Slack communication. Each Monday they share something for which they are grateful and list goals for the week. They also hold each other accountable for the stated goals from the prior week.

They consider their accountability system a success, although an imperfect one at times. The best outcome of their arrangement has simply been a weekly reason to stay in touch with one another. They are self-described members of one another’s ‘personal Board of Directors’ and their accountability relationship provides regular opportunities to connect. Their opinions are valued and sought out each week. Both Arlene and Nicole experienced challenging professional situations for which the accountability system allowed space to reflect with one another while continuing progress on stated projects.

Team 3: Fareen Zaver (University of Calgary) and Derek Monette (Massachusetts General Hospital)

Fareen and Derek were each venting about the challenge of saying “no” to projects as junior faculty and attendings despite full plates of work and interests. They decided to become accountability partners to help each other suss out which new projects and requests for their time were truly important — and which ones should be recommended to someone else who may be a better fit. Although the concept of accountability partners could be used for scholarship and productivity, Fareen and Derek identified a need to use this strategy to meet their goals to have a more balanced life outside of the hospital.

They initially agreed to check in at least monthly to ensure they were balancing their demanding schedules with personal priorities – family, travel, physical health and fitness. Sharing early wins (e.g. strategies for saying no to a project; prioritizing family despite competing clinical or academic demands) galvanized the team and over time it became clear that they each could achieve these goals with less support. They have nudged each other to ensure that their activities align with long-term goals and guiding principles, and in the process, developed communication routines for the variety of ways to respond to invitations to collaborate or join another project or team.

Suggestions for Working with a New Accountability Partner:

Although each pair has used peer accountability for a different shared goal (scholarship, productivity, wellness) there are several points that have helped each of these teams find success with the strategy. These tips for new pairs include:

    • Define the purpose (specific goals and outcomes) of using an accountability partner at the beginning of the relationship.
    • Discuss with your partner whether you share similar challenges and expectations.
    • Agree on a realistic routine for communication – both frequency and medium (e.g. email or Slack).
    • Determine your expectations for the person who receives the communication. Is one expected to reply? If yes, on which elements of the communication should he/she focus (i.e. big picture or dive into the details)?
    • Stay engaged. Be open to changing your goals of the partnership as your needs evolve.
    • Some partnerships may not click as much as expected. Be open to ending the agreement and always maintain confidentiality and respect for each other.
    • Celebrate accomplishments! The 1% improvements will eventually add-up to new patterns and routines.
Derek Monette, MD

Derek Monette, MD

ALiEM Deputy Editor-in-Chief
Medical Education Research Fellow
Department of Emergency Medicine
Massachusetts General Hospital
Derek Monette, MD

@DerekMonetteMD

Emergency Physician & Assoc Med Dir APPs @ MGH | Sim/debriefing to improve healthcare teams 🤝 | #IPE, #collaboration, #teaming
Fareen Zaver, MD

Fareen Zaver, MD

Chief Operating Officer, Chief Resident Incubator 2017-18
Lead Editor/Co-Founder of ALiEM Approved Instructional Resources - Professional (AIR-Pro)
Champion, 2016-17 ALiEM Chief Resident Incubator
Board Member, 2016-17 ALiEM Wellness Think Tank
Clinical Lecturer, Emergency Physician
University of Calgary Emergency Department
Fareen Zaver, MD

@fzaver

@UCalgaryEM Clinical Educator, interests in transition to practice, gender equity, #FOAMed @ALiEMteam & @WeAreCanadiEM #Meded #genderequity
Arlene Chung, MD

Arlene Chung, MD

Chief Strategy Officer,
2016-17 ALiEM Wellness Think Tank
Assistant Professor of Emergency Medicine
Assistant Program Director
Mount Sinai Emergency Medicine Residency
Editor, AKOSMED (EM wellness blog)
Arlene Chung, MD

@ArleneSujin

Residency Director @Maimonides_EM | @NYACEP Board Member | Chair, ACEP Well-Being | EMRA #45under45 | She/her | Intrepid searcher for harmony l Opinions my own
Michael Gisondi, MD

Michael Gisondi, MD

Associate Professor and Vice Chair of Education
Department of Emergency Medicine
Stanford University
Editor, ALiEM EM Match Advice series
Michael Gisondi, MD

@mikegisondi

Vice Chair of Education, Department of Emergency Medicine, Stanford University 🌲🏳️‍🌈
Nicole Battaglioli, MD

Nicole Battaglioli, MD

Champion, 2016-17 ALiEM Chief Resident Incubator Chief Operating Officer, 2016-19 ALiEM Wellness Think Tank Assistant Professor of EM University of Kentucky
Nicole Battaglioli, MD

@batt_doc

EM Doc- Wellness Think Tank- Wilderness Medicine Lover- Cupcake Connoisseur. Views and opinions are my own. #WellnessTT
Jeannette Wolfe, MD

Jeannette Wolfe, MD

Associate Professor of Emergency Medicine
University of Massachusetts Medical School/Baystate Campus
Jeannette Wolfe, MD

@wolfejeannette

Interested in how biological sex and gender can affect our health and behavior. Sex and Why podcaster Associate Prof of Emergency Medicine, opinions are my own