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In Reply to Paradis and Whitehead

Eichbaum, Quentin, MD, PhD, MPH, MFA, MMHC

doi: 10.1097/ACM.0000000000002528
Letters to the Editor
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Professor of pathology, microbiology, and immunology; professor of medical education and administration; and director, Vanderbilt Pathology Education Research Group; director, Vanderbilt Pathology Program in Global Health; and clinical fellowship director, Vanderbilt University Medical Center, Nashville, Tennessee; Quentin.eichbaum@vanderbilt.edu.

Disclosures: None reported.

I thank the authors for their thoughtful comments, which I address here in the order raised.

The authors question the value of psychological safety (PS) for individuals who wish to “collaborate safely” on temporary teams “where trainees and academic faculty regularly move on and off clinical services.” In my article, I discuss such temporary, task-oriented teams that sociologist Engeström1 has termed knotworking or meshworking. It was beyond the scope of my article to discuss more detailed conceptualizations of teams such as Hollenbeck’s (as the authors suggest). I believe, however, that PS could feasibly be cultivated even on unstable, temporary teams in an organization that encourages and proactively nurtures a culture of PS: allowing open expression of opinions, being less hierarchical, nonjudgmental, and transparent (as occurred on some teams at Google, Inc.). The health professions are often oblivious of PS and instead tend to be constrained by professionalism and hierarchies of power resistant to democratic participation.

I raise Steve Jobs as an example of collaborative intelligence (CI) because he represents a high-profile example of someone we tend to remember more for his “destructive rudeness” than for his CI. But he clearly also had high CI (as evinced in Apple’s immense success), and his case supports my citation of Leavitt and McKeown2 that “irascible, dogmatic and sarcastic people (can have) high levels of CI.” Paradis and Whitehead’s question—“Where does potentially creative conflict stop and destructive rudeness begin?”—remains nonetheless pertinent, and may carry higher valence in the health professions, where patient care (rather than business profit) is at stake. The health professions have, however, shied away from exploring such difficult questions.

Regarding how “we might change these systems to encourage productive conflict and innovation,” I am not suggesting that we actively “encourage conflict” but rather that we learn to better harness its positive innovative potential whenever it occurs. Activity theory1 promotes the notion of “expansive learning”—curiosity and exploration that can arise from conflict (or “contradiction”) as a source of innovation and learning.

Raising awareness is a critical role of the humanities, especially in settings of uncertainty and ambiguity.3 I agree with the authors that “educational interventions alone” will not suffice to “flatten hierarchies.” The humanities have, however, played a critical role in raising awareness about many vexing social issues such as racism, sexism, LGBT issues, as well as multiple issues of power abuse. Such raised awareness subsequently prompted educational and legal interventions. The first step is therefore to raise awareness among supporters who then move issues towards effective interventions. This is one reason I believe the humanities should have a more central role in medical curricula.

Quentin Eichbaum, MD, PhD, MPH, MFA, MMHC

Professor of pathology, microbiology, and immunology; professor of medical education and administration; and director, Vanderbilt Pathology Education Research Group; director, Vanderbilt Pathology Program in Global Health; and clinical fellowship director, Vanderbilt University Medical Center, Nashville, Tennessee; Quentin.eichbaum@vanderbilt.edu.

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References

1. Engeström Y. From Teams to Knots: Activity-Theoretical Studies of Collaboration and Learning at Work. 2008.New York, NY: Cambridge University Press.
2. Leavitt M, McKeown R. Finding Allies, Building Alliances: 8 Elements That Bring—and Keep—People Together. 2013.San Francisco, CA: John Wiley & Sons.
3. Bleakley A. Medical Humanities and Medical Education: How the Medical Humanities Can Shape Better Doctors. 2015.New York, NY: Routledge.
© 2019 by the Association of American Medical Colleges